Dissociation of POMC peptides after self-injury predicts responses to centrally acting opiate blockers

Am J Ment Retard. 1997 Sep;102(2):182-99. doi: 10.1352/0895-8017(1997)102<0182:DOPPAS>2.0.CO;2.


Apparent insensitivity to pain, ritualistic patterns of behavior, and improvement in symptoms after administration of opiate receptor blockers implicated the endogenous opioid system in the initiation and maintenance of SIB. This study was designed to determine whether plasma levels of proopiomelanocortin (POMC)-derived peptides, beta-endorphin-like activity (beta E), ACTH, and adrenal cortisol immediately after an episode of SIB predicted subsequent response to an opiate blocker. Blood samples were collected from 10 patients with mental retardation within minutes of a self-injuring act and during an SIB-free control period. On another day, morning and afternoon samples were collected at least one week apart from the other samples. Effects on SIB of naltrexone hydrochloride (NTX) were examined in a double-blind, placebo-controlled crossover study. After an SIB episode, beta E, but not ACTH, was elevated compared with morning levels, p < .003. Patients with increased plasma levels of beta E after SIB had the most positive response to 2 mg/kg NTX, p < .03. Results suggest that changes in the hypothalamic-pituitary-adrenal axis after SIB may predict differences in individual patient response to opiate blockers.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenocorticotropic Hormone / blood
  • Adult
  • Aged
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / drug effects
  • Male
  • Naltrexone / therapeutic use*
  • Narcotic Antagonists / therapeutic use*
  • Pituitary-Adrenal System / drug effects
  • Self-Injurious Behavior / blood
  • Self-Injurious Behavior / drug therapy*
  • Time Factors
  • beta-Endorphin / blood


  • Narcotic Antagonists
  • Naltrexone
  • beta-Endorphin
  • Adrenocorticotropic Hormone
  • Hydrocortisone