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Clinical Pharmacology Services Coordinator and Clinical Assistant Professor Department of Pharmacy: Clinical and Administrative Sciences University of Oklahoma College of Pharmacy 1110 North Stonewall Oklahoma City, Oklahoma 73117-1223 fax 405/271-2988 nancy-brahm{at}ouhsc.edu
Consultant Psychiatrist Enid, Oklahoma
Student College of Veterinary Medicine Stillwater, Oklahoma
State Medical Director Department of Developmental Disabilities Services Adjunct Clinical Associate Professor Department of Pharmacy: Clinical and Administrative Sciences College of Pharmacy University of Oklahoma
Published Online, June 29, 2004. www.theannals.com, DOI 10.1345/aph.1D591
Case Report. A 53-year-old man diagnosed with congenital blindness, profound mental retardation, and aggressive behavior was admitted to one of the state-run intermediate care facilities for the developmentally disabled secondary to closure of a nursing home. The most recent history and physical and laboratory work were not provided. Behavioral information from the nursing home was limited, but did report aggression and fecal smearing; it did not include behavioral antecedents. Staff who transitioned from the nursing home to the new facility reported they had been unable to predict when smearing would occur, although it was a frequent event. Admission medications included olanzapine 10 mg/day and carbamazepine 500 mg/day for aggression.
Routine laboratory admission procedures for our facility included ova and parasite (O&P) testing. The results were positive for Blastocystis hominis and Entamoeba histolytica cysts, and treatment was initiated with metronidazole 750 mg 3 times daily for 2 weeks.1 The infection resolved and a follow-up O&P was negative. The patient was less aggressive, fecal smearing had decreased, and he was more redirectable following resolution of the infection. Behavior improved to the point where olanzapine was eventually discontinued.
Discussion. If the etiology of rectal digging and fecal smearing is not properly identified, these behaviors often result in the administration of psychotropic agents in an attempt to control behavior. In order to avoid the inappropriate use of psychotropic medications for aggression associated with rectal digging and fecal smearing in this population, screening for parasitic infections must be part of the differential diagnosis of the etiology of these behaviors.
Footnotes
Nancy Brahm participated in 2 asthma health fairs underwritten by GlaxoSmithKline, and Rebecca Brahm served as the student liaison for Pfizer. No conflicts existed in the preparation of this letter to the editor. No outside funding was obtained.
References
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