BEHAVIORAL AND BIOCHEMICAL MECHANISMS OF SELF INJURY

自残的行为和生化机制

基本信息

批准号：
6387878
负责人：
FRANK J SYMONS
金额：
$ 10.36万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
1997
资助国家：
美国
起止时间：
1997-07-01 至 2004-08-31
项目状态：
已结题

项目摘要

Why some people with mental retardation and/or autism repeatedly and persistently injure themselves, some so severely to the point of tissue damage and often times permanent scarring, has remained a mystery eluding a single solution. Unraveling this mystery poses paradoxial biomedical and behavioral science questions and creates deeply troubling problems for practitioners and family members of affected individuals. Over the past decade, many cases of self-injurious behavior (SIB) have been treated successfully using behavioral interventions that teach communication and other functional skills. Practical problems of implementation, costs associated with long-term treatment, and cases with no clear social profile appearing about 1/3 of the time suggest, however, that there is still much to be learned about why people self-injure. Our overall goals are to improve treatment, refine diagnosis, and to clarify mechanisms underlying different forms of self-injury. Given the severity of self-injury, it is surprising that few of the models have examined in more detail the relation between variables common to SIB and the neurophysiology of pain regulation. The main objective of this project is to evaluate the validity of several of these variables as possible predictors of response to self-injury. Treatments will be based on the hypothesis that some forms of self-injury involve intense stimulation of body sites sufficient to elicit the release and receptor binding of endogenous opioid peptides. Accordingly, treatments will include transcutaneous electric nerve stimulation (TENS)(an opioid agonist treatment) or naltrexone (an opioid antagonist treatment). Predictors will include observationally- based measures of the environmental functions of self-injury, body site location and intensity of self-injury, and salivary baseline levels of three bioactive substances (substance P, metenkephalin, & cortisol). Following initial identification of subjects (age range 4-25) with mold to profound mental retardation and/or autism, our first aim is to observe and describe in detail how frequently self- injury occurs, what its duration and intensity is, and where on the body it is directed. Following this characterization, substance P, met-enkephalin, and cortisol will be noninvasively examined through saliva as markers for altered pain transmission and predictors of response to treatment. After screening and SIB subtyping (i.e., social, nonsocial, or mixed) 37 subjects whose self-injury is primarily nonsocial or mixed will be evaluated over a 16-week period with TENS and the opiate antagonist naltrexone for self-injury. Subjects whose self-injury is primarily socially motivated will be evaluated with TENS and the opiate antagonist naltrexone for self-injury. Subjects whose self-injury is primarily socially motivated will be evaluated with TENS and receive behavioral interventions through a technical assistance service delivery model. Three- and six-month follow-ups will be conducted for each subject.

为什么有些人患有精神障碍和/或自闭症反复、持续地伤害自己，有些人严重到组织损伤点，通常是永久性疤痕，仍然是一个谜，无法找到单一的解决方案。解开这个谜题谜团带来了矛盾的生物医学和行为科学问题并给从业者带来深感困扰的问题以及受影响个人的家庭成员。过去的事十年来，许多自残行为（SIB）案例已被使用教导的行为干预措施成功治疗沟通和其他功能技能。的实际问题实施、与长期治疗相关的费用，以及大约有 1/3 的时间出现没有明确社会形象的病例然而，表明对于其原因仍有很多东西需要了解人们会自残。我们的总体目标是改善治疗、完善诊断，并阐明不同机制背后的机制自残的形式。考虑到自伤的严重性，令人惊讶的是，很少有模型更详细地研究过 SIB 共有的变量之间的关系疼痛调节的神经生理学。此举的主要目标项目的目的是评估其中几个变量的有效性：对自伤反应的可能预测因素。治疗将是基于某些形式的自残涉及的假设对身体部位的强烈刺激足以引发释放和内源性阿片肽的受体结合。因此，治疗方法包括经皮神经电刺激 (TENS)（一种阿片类激动剂治疗）或纳曲酮（一种阿片类药物）拮抗剂治疗）。预测因素将包括观察- 基于自伤、身体环境功能的测量自伤部位和强度以及唾液基线三种生物活性物质（P 物质、甲氧啡肽、和皮质醇）。初步确定受试者后（年龄范围 4-25）患有严重智力低下和/或自闭症的人，我们的第一个目标是观察并详细描述自我调节的频率发生伤害、持续时间和强度以及发生在何处身体是被引导的。遵循这一特征，物质 P，甲硫脑啡肽和皮质醇将进行无创检查通过唾液作为改变疼痛传递的标记物治疗反应的预测因素。经过筛选和 SIB 后子类型（即社交、非社交或混合） 37 名受试者自伤主要是非社会性或混合性的，将进行评估为期 16 周的 TENS 和阿片拮抗剂纳曲酮治疗为了自伤。自伤主要是社交原因的受试者将使用 TENS 和阿片拮抗剂评估动机纳曲酮用于自伤。主要自伤行为的受试者社会动机将通过 TENS 进行评估并获得通过技术援助服务进行行为干预交付模式。将进行三个月和六个月的随访对每个科目进行。