Case study: paradoxical response to naltrexone treatment of self-injurious behavior

UMMS Affiliation

Department of Psychiatry



Document Type


Medical Subject Headings

Adult; Autistic Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Male; Mental Retardation; Naltrexone; Self-Injurious Behavior




Opioid receptor antagonists have been studied in the management of self-injurious behavior (SIB) in developmentally disabled individuals. The authors present a case of a severely retarded, autistic man whose SIB increased dramatically during a trial of naltrexone. A paradoxical increase in SIB, attributed to the extinction burst phenomenon during the initial period of nonreward, is known to occur during treatment with naloxone, a short-acting parenteral opioid antagonist. It has only once been reported during treatment with naltrexone, a long-acting orally administered agent. Opioid analgesic effects and learning theory can explain both increases and decreases in SIB after opioid blockade.

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Citation: J Am Acad Child Adolesc Psychiatry. 1995 Feb;34(2):238-42. Link to article on publisher's site

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