Naloxone attenuates self-abusive behavior in developmentally disabled clients

Abstract

The opiate antagonist naloxone was effective in reducing self-abusive behavior in two mentally retarded clients with an extensive history of such behavior. Three doses of naloxone (0.1, 0.2, 0.4 mg) were compared with a vehicle solution in a double-blind, crossover design. Naloxone greatly attenuated self-abusive episodes in one client and eliminated them entirely in the second client. In addition, use of self-restraining behavior by one client was reduced. The findings suggested that some clients with self-injurious behavior may have disturbances of the endogenous opiate system. Maintenance of self-abuse by tonically elevated pain threshold and/or by the putative addictive characteristics of such behavior was discussed.

Proopiomelanocortin (POMC) disregulation and response to opiate blockers

“…Two POMC or opiate hypotheses of SIB-increased pain tolerance and addiction to endogenous opioids-have been reviewed extensively [Sandman and Hetrick, 1995;Sandman et al, 1998;Sandman, 19901988;Cataldo and Harris, 1982;Deutsch, 1986;Farber, 1987]. Apparent insensitivity to pain generated the hypothesis that SIB was a symptom of general sensory depression, including hypoalgesia [Cataldo and Harris, 1982;Davidson et al, 1983;Farber, 1987;Sandman et al, 1983;Sandman, 1988]. In this case, opiate blockers might attenuate SIB by increasing pain (hyperalgesia) during the abusive act.…”

Self-biting with multiple finger amputations following spinal cord injury

“…In rats, stress-induced acceleration of DA metabolism in the medial frontal cortex can be reversed by naloxone, implying endogenous opioid facilitation of the DA stress response (Miller, 1984). DA antagonism could have been responsible for the reduction by naloxone of self-abusive behaviour reported by Sandman et al (Sandman, 1983).…”

“…SIB may be related to blunted nociception maintained by endogenous beta endorphins (Sandman, 1983). SIB could be a type of reinforced addictive response to the release of endorphins by pain-inducing behaviour (Richardson, 1983).…”

Role for Opioid Peptides in Self-Injurious Behavior: Dissociation from Autonomic Nervous System Functioning

“…Using an opioid radioreceptor assay, Gillberg et al [10] re cently reported that SIB children had higher 'fraction IT opioid concentrations in their CSF than normals. Second, naloxone, a short-acting opioid receptor antagonist, has been shown to reduce SIB frequency in adults [11,12], although reports with mixed results [13,14] and no effect [15] have been published. Unfortunately, naloxone has little therapeutic usefulness since it has to be ad ministered parenterally instead of orally to retain its potency [16], On the other hand, naltrexone is a potent opioid antagonist which retains much of its efficacy when ad ministered by the oral route.…”