Behandlung dissoziativer Symptome mit Nalmefen bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer posttraumatischer Belastungsstörung

Enning, Frank; Schmahl, Christian

doi:10.1007/s00115-021-01239-1

Cited by 5 publications

(5 citation statements)

References 13 publications

(10 reference statements)

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“…In addition, data could not be obtained from some articles that could have been included, partly because these publications were so old. In this sense, this meta-analysis highlighted the absence of current research on the subject, with exceptions such as Gainer et al ( 2021 ) and Enning and Schmahl ( 2022 ). This paucity of data and sample also entails the lack of statistical power for analysis of race and sex-related differences in effects.…”

Section: Discussionmentioning

confidence: 88%

“…First, Martín-Blanco et al ( 2017 ) found significant results indicating that nalmefene can reduce the symptoms of patients with BPD, although they did not specifically measure dissociative symptoms. Second, Enning and Schmahl ( 2022 ) conducted a study in which nalmefene showed promising results as a possible alternative to naltrexone, particularly in the case of intolerance or insufficient naltrexone efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies support the efficacy of dissociation treatment with naltrexone (Bohus et al, 1999 ; Lubin et al, 2002 ; Simeon & Knutelska, 2005 ). In the same line, there are promising results with nalmefene (Enning & Schmahl, 2022 ; Glover, 1993 ). Although less research has been performed with this drug, there is some suggestion that nalmefene may be more easily tolerated than naltrexone at higher doses (Enning & Schmahl, 2022 ; Glover, 1993 ).…”

Section: Introductionmentioning

confidence: 96%

“…In the same line, there are promising results with nalmefene (Enning & Schmahl, 2022 ; Glover, 1993 ). Although less research has been performed with this drug, there is some suggestion that nalmefene may be more easily tolerated than naltrexone at higher doses (Enning & Schmahl, 2022 ; Glover, 1993 ).…”

Section: Introductionmentioning

confidence: 96%

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Treatment of dissociative symptoms with opioid antagonists: a systematic review

Escamilla,

Juan,

Peñalva

et al. 2023

European Journal of Psychotraumatology

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Background: The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. Objective: To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. Method: The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. Results: 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62–2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 ( p < .001)] and there may have been publication bias. Conclusions: Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate – large effect size in reducing these symptoms.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Treatment of dissociative symptoms with opioid antagonists: a systematic review

Escamilla,

Juan,

Peñalva

et al. 2023

European Journal of Psychotraumatology

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“…Another trial, comparing Suboxone (buprenorphine and naloxone) to long-acting injectable naltrexone, an opioid antagonist, for comorbid alcohol use disorder and PTSD is also in recruitment phase (NCT03852628) [ 560 ]. Finally, nalmefene, an opioid antagonist, has been investigated for dissociative symptoms in patients with comorbid BPD and CPTSD [ 561 ], which follows emerging reports of opioid antagonists being used for BPD and dissociative disorders comorbid with PTSD [ 562 ]. Theoretical support from animal and preclinical data suggests a role for the opioid system in dissociation [ 222 ], again recognizing the need to assess and study PTSD subtypes and symptom profiles.…”

Section: Emerging and Novel Approaches To The Treatment Of Ptsdmentioning

confidence: 99%

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Burback

Brémault‐Phillips

Nijdam

et al. 2024

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This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of treatment yields a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

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Persönlichkeitsstörungen

Schmeck,

Romanos

2023

Neuro-/Psychopharmaka Im Kindes- Und Jugendalter

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Behandlung dissoziativer Symptome mit Nalmefen bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer posttraumatischer Belastungsstörung

Cited by 5 publications

References 13 publications

Treatment of dissociative symptoms with opioid antagonists: a systematic review

Treatment of dissociative symptoms with opioid antagonists: a systematic review

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

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