Influence of naloxone on brain and behavior of a self-injurious woman

Self-injurious behavior (SIB), a dramatic behavioral aberration, occurs in 40% of institutionalized psychotic children (Green 1967; Shodell and Reiter, 1968) and 7%-19% of mentally retarded individuals (Smeets 1971; McKay et al. 1974; Maisto and Baumeister 1978; Schroeder et al. 1978). This behavior remains resistant to most interventions (Romanczyk and Goren 1975). Although diseases with components of self-abuse, such as the Lesch-Nyhan syndrome, have genetic or physiological correlates (Cataldo and Harris 1982), the more common disorder has no known biological substrate. Recently, the endogenous opiate system, specifically P-endorphin, has been proposed as a possible mediating factor in SIB. Gillberg et al. (1985) reported elevated P-endorphin levels in the CSF of autistic patients who were self-injurious compared with autistic patients who were not. Recently, we (Sandman et al. 1986) found elevated g-endorphin in plasma of developmentally disabled patients with SIB. However, the strongest evidence linking SIB with the opiate system is its reduction by treatment with the opiate antagonist naloxone. Four separate reports (Davidson et al. 1983; Richardson and Zaleski 1983; Sandman et al. 1983; Sandyk 1985) have indicated that naloxone greatly attenuated or completely eliminated SIB in retarded patients. These effects have lasted from 1 hr (Sandman et al. 1983; Sandyk 1985) to 2 days (Richardson and Zaleski 1983). The present case study evaluated the influence of naloxone in a 2 1 -year-old girl of normal intelligence with a history of self-injurious acts.