Naltrexone in the Treatment of Dissociative Symptoms in Patients With Borderline Personality Disorder

Bohus, Martin; Landwehrmeyer, G. Bernhard; Stiglmayr, Christian; Limberger, Matthias F.; Böhme, Renate; Schmahl, Christian

doi:10.4088/jcp.v60n0906

Cited by 140 publications

(66 citation statements)

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“…Dissociation symptoms improved. It was concluded that the results of the study supported the hypothesis that an increased activity of the opioid system contributed to the dissociative symptoms [38]. Thus, PWCP who have a predisposition to dissociation may learn to spontaneously dissociate or put themselves into a trance state to elevate their endorphin levels and thus decrease pain.…”

Section: Discussionsupporting

confidence: 62%

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Pain-determined Dissociation Episodes

et al. 2001

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Objectives. Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or perception. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue ( DF) and dissociative identity disorder ( DID), in patients with chronic pain ( PWCP). Design/Patients/Interventions/Outcome Measures. From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP evaluated and/or treated at the University of Miami Comprehensive Pain and Rehabilitation Center. The salient features of these six dissociation PWCP are presented. All four DF PWCP completed a dissociation experience scale first at the time of identification of the dissociation disorder (with chronic pain) and one alleging their experiences with dissociation predevelopment of chronic pain. Results. Frequency percentage for dissociation for this population was 0.235%. For all four of the DF PWCP, dissociation episodes began after the onset of chronic pain. All six (100%) PWCP described or associated their episodes of dissociation to times when their pain would increase. Mean dissociation scale scores for the four DF PWCP were 1.4 ± 1.11 pre‐chronic pain and 20.53 ± 16.82 at time of identification of the dissociative disorder (with chronic pain). Conclusions. The frequency percentage for dissociation within PWCP is small compared with psychiatric populations. There may be an etiological association between the development of dissociation episodes and the development of chronic pain and/or increases in chronic pain.

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Section: Discussionsupporting

confidence: 62%

“…Here, in a recent treatment study dissociative symptoms were treated for a period of 2 weeks with an opioid receptor antagonist, Naltrexone, in an open label trial [38]. Dissociation symptoms improved.…”

Section: Discussionmentioning

confidence: 99%

Pain-determined Dissociation Episodes

et al. 2001

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“…[88,89] Opioid dependence Yes (Adult) Available data suggest that naltrexone is an effective and safe narcotic antagonist for the treatment of narcotic addiction. Pruritus of skin No Efficacy in uremia-associated pruritus controversial Effective for pruritus caused by other etiologies such as dermatological diseases, liver cirrhosis, or diabetes [124][125][126][127][128] Self-injurious behavior No Effective in treating self-injurious behaviors in autistic and mentally retarded patients Reduces dissociation symptoms and flashbacks in borderline personality disorder [129][130][131][132][133] www.chemmedchem.org lation of naltrexone, Vivitrol. [38] Administered intramuscularly, this once-a-month treatment was recently approved by the FDA for the treatment of alcohol addiction.…”

Section: Nomentioning

confidence: 99%

Mu Opioid Receptor Antagonists: Recent Developments

2007

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For thousands of years mu opioid agonists such as morphine have been utilized for their analgesic properties. Today, morphine and related compounds are still used as a first line therapy in the treatment of moderate to severe pain. However, despite the clear benefits of mu agonists in pain management, severe side effects such as dependence and respiratory depression are associated with use of these drugs. To date, there are only two approved mu opioid antagonists for use in the treatment of these adverse effects, that is, naloxone and naltrexone. However, many other clinical and therapeutic areas have been linked to mu opioid receptor antagonism. These include treatment of opioid induced pruritis of the skin, obesity, and Parkinson‐induced tardive dyskinesia. Currently there are two compounds, N‐methylnaltrexone and alvimopan, under FDA review as possible treatments for opioid induced bowel dysfunction and postoperative ileus. These compounds are of special interest as they are peripherally restricted. This attribute enables treatment of peripheral side effects induced by opioid agonists without reversal of the centrally mediated analgesia of the agonist. In this article we discuss the structural classes of mu opioid antagonists, their potential clinical applications, and review the relevant patents of the last ten years.

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“…Bohus et al 52 estudou os efeitos da naltrexona em pacientes limítrofes. Foi observada importante redução em sintomas dissociativos nesse EA.…”

Section: Naltrexonaunclassified

Tratamento farmacológico do transtorno de personalidade limítrofe: revisão crítica da literatura e desenvolvimento de algoritmos

Carvalho

Stracke²,

Souza

2004

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃOO transtorno de personalidade limítrofe (TPL) é um diagnóstico clínico que engloba uma vasta gama de apresentações. As manifestações da síndrome podem ser agrupadas em três núcleos sintomáticos, a saber: 1) sintomas afetivos, que incluem estados afetivos flutuantes, como depressão, raiva e hostilidade; 2) distorções perceptuais e cognitivas, como delírios de referência, ideação paranóide, ilusões e fenômenos dissociativos; e 3) comportamentos agressivos e impulsivos, como automutilação, agressão física e verbal a terceiros, comportamento suicida, uso abusivo de drogas e promiscuidade 1 .O TPL tem uma prevalência relativamente alta (representa até 25% das admissões a algumas unidades psiquiátricas) 1 e impõe séria morbidade e letalidade a pacientes limítrofes. As relações interpessoais desse grupo de pacientes são usualmente intensas e caóticas 2 .Como esse transtorno tem uma ampla gama de apresentações clínicas, é comumente difícil encontrar um grupo específico de fármacos para tratar pacientes com TPL. Talvez por essa razão praticamente todas as classes de psicofármacos foram testadas nesses pacientes. Muitos clínicos tratam pacientes limítrofes empiricamente. Diretrizes baseadas em evidências são difíceis de serem encontradas. ObjetivoO presente estudo tem como objetivo revisar a literatura e livros-texto de referência em busca de evidências que norteiem o tratamento farmacológico de pacientes limítrofes. Os trabalhos obtidos serão analisados pelos autores em busca de potenciais vieses, validade externa e erros de delineamento. Assim, procura-se revisar criticamente a literatura existente. Finalmente, modelos de algoritmos são propostos para cada grupamento de sintomas.Tratamento farmacológico do transtorno de personalidade limítrofe: revisão crítica da literatura e desenvolvimento de algoritmos

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Naltrexone in the Treatment of Dissociative Symptoms in Patients With Borderline Personality Disorder

Cited by 140 publications

References 0 publications

Pain-determined Dissociation Episodes

Pain-determined Dissociation Episodes

Mu Opioid Receptor Antagonists: Recent Developments

Tratamento farmacológico do transtorno de personalidade limítrofe: revisão crítica da literatura e desenvolvimento de algoritmos

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