Sequential analysis of the effects of naltrexone on the environmental mediation of self-injurious behavior.

Symons, Frank J.; Tapp, John; Wulfsberg, Anna; Sutton, Kelly; Heeth, William L.

doi:10.1037/1064-1297.9.3.269

Cited by 34 publications

(36 citation statements)

References 31 publications

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“…In the first reported application of sequential analyses to examine whether contextual contingencies of SIB change with pharmacological treatment, Symons et al, (2001) employed an event-based lag approach to assess the sequential dependencies between SIB and antecedent staff instructional behavior during opiate-antagonist (Naltrexone) and placebo administration. Though their conclusions were limited by a low number of subjects (n=4), they did report reductions in the rate of SIB and an increase in the sequential dependencies between staff behavior and SIB during Naltrexone treatment.…”

Section: Introductionmentioning

confidence: 99%

Temporal patterns of self-injurious behavior correlate with stress hormone levels in the developmentally disabled

Kemp

Fillmore

Lenjavi

et al. 2008

Psychiatry Research

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While the origins and developmental course of self-injurious behavior (SIB) remain relatively unknown, recent studies suggest a biological imbalance may potentiate or provoke the contagious recurrence of SIB patterns in individuals with severe developmental disabilities (DD). Evidence from several laboratories indicates that functioning, relations, and processing of a stress-related molecule, proopiomelanocortin, (POMC), may be perturbed among certain subgroups of individuals exhibiting SIB. The current investigation employed a unique time-pattern analysis program (THEME) to examine whether recurrent temporal patterns (T-patterns) of SIB were related to morning levels of two POMC-derived hormones: β-endorphin (βE) and adrenocorticotropic hormone (ACTH). THEME was used to quantify highly significant (nonrandom) T-patterns that included SIB within a dataset of in-situ observational recordings spanning 8 days (~40 hours) in 25 subjects with DD. Pearson's product-moment analyses revealed highly significant correlations between the percentage of T-patterns containing SIB and basal levels of both βE and ACTH, which were not found with any other "control" T-patterns. These findings support the hypothesis that the recurrent temporal patterning of SIB represents a unique behavioral phenotype directly related to perturbed levels of POMC-derived stress hormones in certain individuals with severe DD.

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Section: Introductionmentioning

confidence: 99%

Temporal patterns of self-injurious behavior correlate with stress hormone levels in the developmentally disabled

Kemp

Fillmore

Lenjavi

et al. 2008

Psychiatry Research

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“…The third study of 26 participants found that neither single-dose (100 mg) nor long-term (50 and 150 mg) naltrexone treatment had any therapeutic effect on SIB [33]. Finally, naltrexone had clinically significant effects (≥33 % reduction) on the daily rates of three of the four participants' most severe forms of SIB, but results did not reach statistical significance in the most recent study included in the review [34]. There were very few noteworthy adverse events in any of the four trials that were reviewed.…”

Section: Opioid Systems Modulating Agentsmentioning

confidence: 99%

Treating Nonsuicidal Self-Injury

Guerdjikova

Gwizdowski

McElroy

et al. 2014

Curr Treat Options Psych

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Cognitive behavioral therapy Opinion statementNonsuicidal self-injury (NSSI) evaluation and treatment are critical for comprehensive patient care. A thorough assessment of nonsuicidal self-injury(NSSI) following DSM-5-proposed criteria is critical in understanding and treating NSSI and should be informed based upon past and current self-harm behaviors, including self-injury methods, frequency, severity, and intent, along with a comprehensive suicide risk assessment. After NSSI is diagnosed, patients should be offered proper management of co-occurring psychiatric illnesses, if applicable, enhanced by an 8 -12 week trial of cognitive behavior therapy (CBT) focusing on NSSI. Cognitive strategies to be used include Socratic questioning, keeping thought records, and addressing self-derogatory and distorted beliefs about NSSI. Behavioral strategies include contingency management, behavioral activation, and addressing environmental factors maintaining NSSI. In adolescents, individual CBT work might be supplemented with family-based therapy. Dialectical strategies (acceptance and distress tolerance) and skills training (focus on improving emotion regulation, problemsolving, interpersonal, and communication skills) can be used to enhance CBT, but in some cases DBT can be cost prohibitive. If adequate psychotherapy trials are ineffective, a pharmacotherapy trial of emerging drug therapies for NSSI, e.g. naltrexone, Nacetylcysteine, or topiramate to enhance supportive psychotherapy would be recommended. We would encourage patients to continue effective treatment for at least 6 months and would continuously assess for self-harm urges and behaviors. Psychoeducation and adequate treatment of comorbid conditions should be provided on an ongoing basis along with attention to physical self-care and regular exercise.

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“…In the single study that has evaluated the effects of naltrexone using time-series analysis, Symons et al [58] made very interesting observations. First, they reported that three of the four patients evaluated had at least a 33% reduction in their SIB.…”

Section: Efficacy Of Opiate Blockers In the Treatment Of Sibmentioning

confidence: 99%

Opioid Antagonists May Reverse Endogenous Opiate “Dependence” in the Treatment of Self-Injurious Behavior

Sandman

Kemp

2011

Pharmaceuticals

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Self-injurious behavior (SIB) is a primary reason that individuals with neurodevelopmental disabilities (NDD) are either retained in restrictive environments or are administered psychotropic medication. There are no known causes and no universally accepted treatments for this complex behavior among individuals with NDD. There is developing evidence, however, that individuals exhibiting SIB have a disturbance of the opiate-mediated pain and pleasure system. One hypothesis is that SIB reflects insensitivity to pain and general sensory depression (hypoalgesia), perhaps related to chronic elevation of endogenous opiates. For instance, many self-injurious individuals do not exhibit the usual signs of pain after their “injurious” behavior. Moreover, for some individuals the addictive properties of elevated endogenous opiates (euphoria) may be responsible for maintaining their SIB. In this perspective, SIB may be viewed as an addiction because it supplies the “fix” for tolerant, down-regulated opiate receptors. Reports that levels of endogenous opiates at rest and after SIB episodes predict positive responses to opiate blockers (e.g., naltrexone) provide further support for opiate-mediated SIB and form the basis for a rational treatment strategy. Although the long term effects of opiate blockers on SIB are unknown, reduction in SIB following acute treatment provides support that a specific biological system may be dysregulated in a subgroup of patients. It is concluded that naltrexone produces a clinically significant reduction in the serious and life-threatening behavior of self injury for individuals who have not been responsive to any other type of treatment. Several suggestions and cautions are provided for regimens of naltrexone treatment of SIB.

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Sequential analysis of the effects of naltrexone on the environmental mediation of self-injurious behavior.

Cited by 34 publications

References 31 publications

Temporal patterns of self-injurious behavior correlate with stress hormone levels in the developmentally disabled

Temporal patterns of self-injurious behavior correlate with stress hormone levels in the developmentally disabled

Treating Nonsuicidal Self-Injury

Opioid Antagonists May Reverse Endogenous Opiate “Dependence” in the Treatment of Self-Injurious Behavior

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