Naltrexone self-injurious behavior

Additionally, an opioid antagonist, naltrexone, has been used to treat children with autism. The results from these studies have been mixed, with some studies showing a mild decrease in hyperactivity and self-injurious behavior, and improved attention (Gillberg, 1995). The children who respond best to this medication appear to have more severe abnormalities in their beta endorphin levels (Bouvard et al., 1995). Overall, the research suggests that the endogenous opioid system, which is important in the reward aspects of affiliation, may also play a role in the neurobiology of autism. 

Sandman, C.A., Hetrick, W, Taylor, D.V., Marion, S.D., Touchette, R, Barron, J.L., Martinezzi, V., Steinberg, R.M., and Crinella, EM. (2000) Long-term effects of naltrexone on self-injurious behavior. Am J Ment Retard 105 103-117. 

To test the hypothesis that elevated endogenous opiate levels contribute to autism and/or to self-injurious behavior, 33 adult subjects with autism and/or self-injurious behavior were treated for 4 weeks with 50 or 150 mg/day naltrexone in a double-blind, placebo-controlled crossover trial. Naltrexone was not superior to placebo with respect to either frequency of self-injurious behavior or CGI and ABC measures of autistic symptoms (Zingarelli et al., 1992). 

The anticonvulsant topiramate has also been reported to be effective in reducing binge and purge frequencies in comparison with placebo. However, bothersome side-effects such as paresthesias, impaired cognition, and renal calculi may lessen its usefulness. Naltrexone is a possible adjunct in patients who are refractory to SSRIs, especially those with comorbid alcoholism and/or self-injurious behavior. ... 

Willemsen-Swinkels, S.H.N., Buitelaar, J.K., Nijhof, G., and Van Engeland, H. (1995a) Failure of naltrexone hydrochloride to reduce self-injurious and autistic behavior in mentally retarded adults. Double-blind placebo-controlled studies. Arch Gen Psychiatry 52 766-773. 

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