Abstract
Two hypotheses have been proposed linking dysfunctions of the endogenous endorphin system with the origin and maintenance of self-injury in some individuals. This has spurred interest in the use of opioid antagonists, most commonly naloxone and naltrexone, to treat self-injury. Although many of the studies have reported positive findings, these data must be interpreted wit caution because the majority of the studies were typically anecdotal case reports or were methodologically flawed. We present a clinical and methodological review of the research on the efficacy of both naloxone and naltrexone in the treatment of self-injury in individuals with developmental disabilities. Taken in their best light, seven of nine studies using naloxone showed a positive effect on self-injury and 16 of 18 studies using naltrexone showed a positive effect. The implications of these data are discussed in terms of future research.
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Aman, M. G. (1991) Pharmacotherapy in the developmental disabilities: New developments.Aust. New Zeal. J. Devel. Dis. 17: 183–199.
Aman, M. G., and Singh, N. N. (1988). Patterns of drug use, methodological considerations, measurement techniques, and future trends. In Aman, M. G., and Singh, N. N., (eds.),Psychopharmacology of the Developmental Disabilities, Springer-Verlag, New York, pp. 1–28.
Aman, M. G., and Singh, N. N. (1991). Pharmacological intervention. In Matson, J. L., and Mulick, J. A. (eds.),Handbook of Mental Retardation (2nd ed), Pergamon Press, New York, pp. 347–372.
Barrett, R. P., Feinstein, C., and Hole, W. T. (1989). Effects of naloxone and naltrexone on self-injury: A double-blind placebo-controlled analysis.Am. J. Ment. Retard. 93: 644–651.
Basbaum, A. I., and Fields, H. L. (1984). Endogenous pain control systems: Brainstem spinal pathways and endorphin circuitry.Annu. Rev. Neurosc. 7: 1143–1152.
Beckwith, B. E., Couk, D. I., and Schumacher, K. (1986). Failure of naloxone to reduce self-injurious behavior in two developmentally disabled females.Appl. Res. Ment. Retard. 7: 183–188.
Bernstein, G. A., Hughes, J. R., Mitchell, J. E., and Thompson, T. (1987). Effects of narcotic antagonists on self-injurious behavior: A single case study.J. Am. Acad. Child Adol. Psychiatry 26: 886–889.
Blumberg, H., and Dayton, H. B. (1973). Naloxone and related compounds. In Kosterlitz, H. W., Collier, H. O. J., and Villarreal, J. E. (eds.),Agonist and Antagonist Actions of Narcotic Analgesic Drugs, University Park Press, Baltimore, pp. 100–119.
Campbell, M., Adams, P., Small, A. M., Tesch, L. M., and Currens, E. L. (1988). Naltrexone in infantile autism.Psychopharmacol. Bull. 24: 135–139.
Campbell, M., Overall, J. E., Small, A. M., Sokol, M. S., Spencer, E. K., Adams, P., Foltz, R. L., Monti, K. M., Perry, R., Nobler, M., and Roberts, E. (1989). Naltrexone in autistic children: An acute open dose range tolerance trial.J. Am. Acad. Child Adol. Psychiatry 28: 200–206.
Consensus Development Panel (1989).Report of the Consensus Development Panel on Treatment of Destructive Behaviors in Persons with Developmental Disabilities, NIH, Bethesda MD.
Davidson, P. W., Kleene, B. M., Carroll, M., and Rockowitz, R. J. (1983). Effects of naloxone on self-injurious behavior: A case study.App. Res. Ment. Retard. 4: 1–4.
Gillman, M. A., and Sandyk, R. (1985). Opiatergic and dopaminergic function and Lesch-Nyhan syndrome.Am. J. Psychiatry 142: 1226.
Herman, B. H., Hammock, M. K., Arthur-Smith, A., Egan, J., Chatoor, I., Werner, A., and Zelnik, N. (1987). Naltraxone decreases self-injurious behavior.Ann. Neurol. 22: 550–552.
Kars, H., Broekema, W., Glaudemans-van Gelderen, I., Verhoeven, W. M. A., and van Ree, J. M. (1990). Naltrexone attenuates self-injurious behavior in mentally retarded subjects.Biol. Psychiatry 27: 741–746.
Knabe, R., Schulz, P., and Richard, J. (1990). Initial aggravation of self-injurious behavior in autistic patients receiving naltrexone treatment.J. Aut. Devel. Dis. 20: 591–592.
Leboyer, M., Bouvard, M. P., and Dugas, M. (1988). Effects of naltrexone on infantile autism.Lancet 1: 715.
Lienemann, J., and Walker, F. D. (1989a). Reversal of self-abusive behavior with naltrexone.J. Clin. Psychopharmacol. 9: 448–449.
Lienemann, J., and Walker, F. D. (1989b). Naltrexone for treatment of self-injury.Am. J. Psychiatry 146: 1639–1640.
Luiselli, J. K., Beltis, J. A., and Bass, J. (1989). Clinical analysis of naltrexone in the treatment of self-injurious behavior.J. Multihand. Pers. 2: 43–50.
Panksepp, J., and Lensing, P. (1991). Brief report: A synopsis of an open-trial of naltrexone treatment of autism with four children.J. Aut. Devel. Dis. 21: 243–249.
Richardson, J. S., and Zaleski, W. A. (1983). Naloxone and self-mutilation.Biol. Psychiatry 18: 99–101.
Ricketts, R. W., Goza, A. B., and Matese M. (1992). Effects of naltrexone and SIBIS on self-injury. Behav. Resident. Treat. 4: 315–326.
Rivinus, T. M., Grofer, L. M., Feinstein, C., and Barrett, R. P. (1989). Psychopharmacology in the mentally retarded individual: New approaches, new directions.J. Multihand. Pers. 2: 1–22.
Ryan, E. P., Helsle, W. J., Lubetsky, M. J., Miewald, B. K., Hersen, M., and Bridge, J. (1989). Use of naltrexone in reducing self-injurious behavior: A single case analysis.J. Multihand. Pers. 2: 295–310.
Sandman, C. A. (1988). B-endorphin disregulation in autistic and self-injurious behavior: A neurodevelopmental hypothesis.Synapse 2: 193–199.
Sandman, C. A. (1990/1991). The opiate hypothesis in autism and self-injury.J. Child Adol. Psychopharmacol. 1: 237–248.
Sandman, C. A., Barron, J. L., and Colman, H. (1990). An orally administered opiate blocker, naltrexone, attenuates self-injurious behavior.Am. J. Ment. Retard. 95: 93–102.
Sandman, C. A., Barron, J. L., Crinella, F. M., and Donnelly, J. F. (1987). Influence of naloxone on brain and behavior of a self-injurious woman.Biol. Psychiatry 22: 899–906.
Sandman, C. A., Datta, P. C., Barron, J., Hoehler, F. K., Williams, C., and Swanson, J. M., (1983). Naloxone attenuates self-abusive behavior in developmentally disabled clients.Appl. Res. Ment. Retard. 4: 5–11.
Sandyk, R. (1985). Naloxone abolishes self-injury in a mentally retarded child.Annal. Neurol. 17: 520.
Singh, Y. N., Ricketts, R. W., Ellis, C. R., and Singh, N. N. (1992). Opiate antagonists. I.: Pharmacology and rationale for use in treating self-injury.J. Devel. Phys. Dis., 5: 5–15.
Sokol, M. S., and Campbell, M. (1988). Novel psychoactive agents in the treatment of developmental disorders. In Aman, M. G., and Singh, N. N. (eds.),Psychopharmacology of the Developmental Disabilities, Springer-Verlag, New York, pp. 146–167.
Szymanski, L., Kedesdy, J., Sulkes, S., Cutler, A., and Stevens-Our, P. (1987). Naltrexone in the treatment of self-injurious behavior: A clinical study.Res. Devel. Dis. 8: 179–190.
Taylor, D. V., Hetrick, W. P., Neri, C. L., Touchette, P., Barron, J. L., and Sandman, C. A. (1991). Effect of naltrexone upon self-injurious behavior, learning and activity: A case study.Pharmacol. Biochem. Behav. 40, 79–82.
Verebey, K. G., Volavka, J., Mule, S. J., and Resnick, R. B. (1976). Naltrexone: Disposition, metabolism and effects after acute and chronic dosing.Clinical Pharmacol. Ther. 20: 315–328.
Walters, A. S., Barrett, R. P., Feinstein, C., Mercurio, A., and Hole, H. T. (1990). A case report of naltrexone treatment of self-injury and social withdrawal in autism.J. Aut. Devel. Dis. 20: 169–176.
Watkins, L. R., Cobelli, D. A., Faris, P., Aceto, M. D., and Mayer, D. J. (1982). Opiate vs. non-opiate footshock induced analgesia (FSIA): The body region shocked is a critical factor.Brain Res. 242: 299–308.
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Ricketts, R.W., Ellis, C.R., Singh, Y.N. et al. Opioid antagonists. II: Clinical effects in the treatment of self-injury in individuals with developmental disabilities. J Dev Phys Disabil 5, 17–28 (1993). https://doi.org/10.1007/BF01046595
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DOI: https://doi.org/10.1007/BF01046595