Naltrexone for Nonsuicidal Self-Injury
A Randomized, Double-Blinded Clinical Trial to Evaluate the Effectiveness of Naltrexone in Improving Nonsuicidal Self-Injurious Behavior
This randomized, double-blinded, placebo-controlled clinical trial aims to evaluate the efficacy and safety of naltrexone in reducing nonsuicidal self-injurious behavior among individuals with nonsuicidal self-injury. Participants will be randomly assigned to receive either naltrexone plus treatment as usual or placebo plus treatment as usual for 6 weeks.
The primary objective is to determine whether naltrexone reduces the frequency of nonsuicidal self-injurious behavior compared with placebo. Secondary objectives include evaluating changes in clinical severity, suicidal ideation, self-injury-related urges, ecological momentary assessment measures, and safety outcomes.
研究概览
详细说明
Nonsuicidal self-injury is defined as the intentional destruction of one's own body tissue without suicidal intent. It is clinically important because it is associated with emotional dysregulation, impulsivity, psychiatric comorbidity, and increased risk of future suicidal behavior. However, evidence-based pharmacological treatments specifically targeting nonsuicidal self-injurious behavior remain limited.
Naltrexone is an opioid receptor antagonist that has been suggested to reduce repetitive self-injurious behaviors by modulating endogenous opioid-related reinforcement mechanisms. This study will investigate whether naltrexone is effective in reducing nonsuicidal self-injurious behavior in a randomized, double-blinded, placebo-controlled design.
A total of 150 participants will be enrolled across multiple study sites. Eligible participants will be randomly assigned in a 1:1 ratio to either the naltrexone group or the placebo group. The intervention period will last 6 weeks, with clinical evaluations conducted at baseline and every 2 weeks thereafter. Smartphone-based ecological momentary assessment will also be used to monitor self-injurious urges, mood states, and related behavioral variables during the study period.
Safety will be assessed throughout the study through adverse event monitoring, assessment of suicidal ideation and behavior, laboratory testing, urine testing, and electrocardiography according to the study schedule.
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Myeong-hyeon Mun, MD, Master's degree
- 电话号码:+821085171499
- 邮箱:psalms139@hanmail.net
学习地点
-
-
Gyeonggi-do
-
Uijeongbu-si、Gyeonggi-do、韩国、11759
- Uijeongbu Eulji Medical Center
-
接触:
- Minseok Hong, MD, PhD
- 电话号码:+821032289060
- 邮箱:garam21th@snu.ac.kr
-
-
Jongno-gu
-
Seoul、Jongno-gu、韩国、03080
- Seoul National University Hospital
-
接触:
- Myeong-hyeon Mun, MD, Master's degree
- 电话号码:+821085171499
- 邮箱:psalms139@hanmail.net
-
-
Songpa-gu
-
Seoul、Songpa-gu、韩国、05505
- Asan Medical Center
-
接触:
- Yujin Choi, Bachelor's Degree
- 电话号码:+821081194386
- 邮箱:dbwls14615@naver.com
-
-
参与标准
资格标准
适合学习的年龄
- 孩子
- 成人
- 年长者
接受健康志愿者
描述
Inclusion Criteria:
Participants must meet all of the following criteria:
- Individuals aged 16 years or older.
- Individuals with clinically significant nonsuicidal self-injurious behavior.
- Individuals who are able to understand the study procedures and provide written informed consent. For minors, consent from a legal guardian and assent from the participant will be obtained according to applicable regulations.
- Individuals who are able to comply with study procedures, including clinical visits, medication administration, and study assessments.
- Women of childbearing potential must have a negative urine pregnancy test at screening and agree to use appropriate contraception during the study period.
Exclusion Criteria:
Participants meeting any of the following criteria will be excluded:
- Current serious suicidal ideation or high suicide risk, as determined by the investigator.
- Current opioid use, opioid dependence, or use of opioid-containing medications.
- Current use of opioid antagonists or medications that may interact with naltrexone, including methadone or buprenorphine.
- Use of naltrexone within 1 week before screening.
- Positive naloxone challenge test or positive urine opioid test, if applicable.
- Known hypersensitivity to naltrexone or any component of the investigational product.
- Active liver disease, active hepatitis, or clinically significant hepatic impairment.
- Clinically significant renal impairment.
- Pregnancy or breastfeeding.
- Intellectual disability, organic brain disorder, or other condition that may interfere with the participant's ability to understand study procedures or complete assessments.
- Inability to read or write Korean sufficiently to complete study assessments.
- Documented prior non-response to naltrexone for nonsuicidal self-injury, as judged by the investigator.
- Any other clinically significant medical or psychiatric condition that, in the opinion of the investigator, would make participation inappropriate or unsafe.
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:三倍
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
实验性的:Naltrexone Group
Participants will receive Naltrexone 50mg orally once daily for 6 weeks, in addition to their current Treatment as Usual (TAU).
|
Pure opioid antagonist administered 50mg once daily.
|
|
安慰剂比较:Placebo Group
Participants will receive a matching placebo orally once daily for 6 weeks, in addition to their current Treatment as Usual (TAU).
|
Matching placebo indistinguishable from the active drug, administered once daily.
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Total Number of Nonsuicidal Self-Injury Episodes During the 6-Week Treatment Period
大体时间:Baseline to Week 6
|
The total number of nonsuicidal self-injury episodes during the 6-week treatment period will be assessed by blinded clinical evaluators.
A lower number indicates fewer nonsuicidal self-injury episodes.
|
Baseline to Week 6
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Change From Baseline in Modified Obsessive Compulsive Drinking Scale Adapted for Nonsuicidal Self-Injury Urges Total Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Self-injurious urges will be assessed using the Modified Obsessive Compulsive Drinking Scale adapted for nonsuicidal self-injury urges.
The total score ranges from 0 to 56, with higher scores indicating more severe self-injurious urges.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Columbia-Suicide Severity Rating Scale Suicidal Ideation Severity Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Suicidal ideation will be assessed using the Columbia-Suicide Severity Rating Scale suicidal ideation severity score.
The score ranges from 0 to 5, with higher scores indicating more severe suicidal ideation.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Clinical Global Impressions-Severity Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Overall clinical severity will be assessed using the Clinical Global Impressions-Severity scale.
The score ranges from 1 to 7, with higher scores indicating greater illness severity.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Number of Event-Based Ecological Momentary Assessment Reports of Nonsuicidal Self-Injury Urges
大体时间:During the 6-week intervention period
|
Participants will complete an event-based smartphone ecological momentary assessment entry when they experience nonsuicidal self-injury urges.
The outcome will be reported as the total number of event-based reports of nonsuicidal self-injury urges.
A higher number indicates more frequent self-injurious urges.
|
During the 6-week intervention period
|
|
Number of Event-Based Ecological Momentary Assessment Reports of Nonsuicidal Self-Injury Behavior
大体时间:During the 6-week intervention period
|
Participants will complete an event-based smartphone ecological momentary assessment entry when nonsuicidal self-injury behavior occurs.
The outcome will be reported as the total number of event-based reports of nonsuicidal self-injury behavior.
A higher number indicates more frequent nonsuicidal self-injury behavior.
|
During the 6-week intervention period
|
|
Percentage of Planned Investigational Product Doses Taken as Assessed by Pill Count
大体时间:Week 2, Week 4, and Week 6
|
Medication adherence will be assessed using pill count.
Adherence will be calculated as the number of doses taken divided by the number of planned doses, multiplied by 100.
The percentage ranges from 0% to 100%, with higher percentages indicating greater adherence.
|
Week 2, Week 4, and Week 6
|
|
Number of Participants With Treatment-Emergent Adverse Events
大体时间:Baseline through Week 6
|
Treatment-emergent adverse events will be assessed throughout the study period.
The outcome will be reported as the number of participants with one or more treatment-emergent adverse events.
|
Baseline through Week 6
|
|
Number of Participants With Clinically Significant Laboratory Abnormalities
大体时间:Baseline and Week 6
|
Laboratory safety will be assessed using prespecified blood and urine tests.
The outcome will be reported as the number of participants with clinically significant laboratory abnormalities as judged by the investigator.
|
Baseline and Week 6
|
|
Number of Participants With Clinically Significant Electrocardiogram Abnormalities
大体时间:Baseline and Week 6
|
Electrocardiogram safety will be assessed using standard electrocardiography.
The outcome will be reported as the number of participants with clinically significant electrocardiogram abnormalities as judged by the investigator.
|
Baseline and Week 6
|
|
Change From Baseline in Montgomery-Åsberg Depression Rating Scale Total Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Depressive symptoms will be assessed using the Montgomery-Åsberg Depression Rating Scale.
The total score ranges from 0 to 60, with higher scores indicating more severe depressive symptoms.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Hamilton Rating Scale for Anxiety Total Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Anxiety symptoms will be assessed using the Hamilton Rating Scale for Anxiety.
The total score ranges from 0 to 56, with higher scores indicating more severe anxiety symptoms.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Patient Health Questionnaire-9 Total Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Self-reported depressive symptoms will be assessed using the Patient Health Questionnaire-9.
The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Generalized Anxiety Disorder-7 Total Score
大体时间:Baseline, Week 2, Week 4, and Week 6
|
Self-reported anxiety symptoms will be assessed using the Generalized Anxiety Disorder-7 scale.
The total score ranges from 0 to 21, with higher scores indicating more severe anxiety symptoms.
|
Baseline, Week 2, Week 4, and Week 6
|
|
Change From Baseline in Eating Disorder Examination-Questionnaire Global Score
大体时间:Baseline and Week 6
|
Eating disorder-related psychopathology will be assessed using the Eating Disorder Examination-Questionnaire global score.
The global score ranges from 0 to 6, with higher scores indicating greater eating disorder-related psychopathology.
|
Baseline and Week 6
|
|
Clinical Global Impressions-Improvement Score
大体时间:Week 2, Week 4, and Week 6
|
Overall clinical improvement will be assessed using the Clinical Global Impressions-Improvement scale.
The score ranges from 1 to 7, where 1 indicates very much improved and 7 indicates very much worse.
Lower scores indicate greater improvement.
|
Week 2, Week 4, and Week 6
|
|
Weekly Positive Affect Score as Assessed by the Positive and Negative Affect Schedule
大体时间:Weekly during the 6-week intervention period
|
Positive affect will be assessed weekly using the Positive and Negative Affect Schedule positive affect subscale through smartphone-based ecological momentary assessment.
The positive affect subscale score ranges from 10 to 50, with higher scores indicating greater positive affect.
|
Weekly during the 6-week intervention period
|
|
Weekly Negative Affect Score as Assessed by the Positive and Negative Affect Schedule
大体时间:Weekly during the 6-week intervention period
|
Negative affect will be assessed weekly using the Positive and Negative Affect Schedule negative affect subscale through smartphone-based ecological momentary assessment.
The negative affect subscale score ranges from 10 to 50, with higher scores indicating greater negative affect.
|
Weekly during the 6-week intervention period
|
合作者和调查者
出版物和有用的链接
一般刊物
- Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. doi: 10.1016/j.jbi.2019.103208. Epub 2019 May 9.
- Bradburn NM, Rips LJ, Shevell SK. Answering autobiographical questions: the impact of memory and inference on surveys. Science. 1987 Apr 10;236(4798):157-61. doi: 10.1126/science.3563494.
- Clark DM, Teasdale JD. Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences. J Abnorm Psychol. 1982 Apr;91(2):87-95. doi: 10.1037//0021-843x.91.2.87. No abstract available.
- Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1-32. doi: 10.1146/annurev.clinpsy.3.022806.091415.
- Sonne S, Rubey R, Brady K, Malcolm R, Morris T. Naltrexone treatment of self-injurious thoughts and behaviors. J Nerv Ment Dis. 1996 Mar;184(3):192-5. doi: 10.1097/00005053-199603000-00011. No abstract available.
- Casner JA, Weinheimer B, Gualtieri CT. Naltrexone and self-injurious behavior: a retrospective population study. J Clin Psychopharmacol. 1996 Oct;16(5):389-94. doi: 10.1097/00004714-199610000-00008.
- Buzan RD, Thomas M, Dubovsky SL, Treadway J. The use of opiate antagonists for recurrent self-injurious behavior. J Neuropsychiatry Clin Neurosci. 1995 Fall;7(4):437-44. doi: 10.1176/jnp.7.4.437.
- Kars H, Broekema W, Glaudemans-van Gelderen I, Verhoeven WM, van Ree JM. Naltrexone attenuates self-injurious behavior in mentally retarded subjects. Biol Psychiatry. 1990 Apr 1;27(7):741-6. doi: 10.1016/0006-3223(90)90589-t.
- McCauley E, Berk MS, Asarnow JR, Adrian M, Cohen J, Korslund K, Avina C, Hughes J, Harned M, Gallop R, Linehan MM. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018 Aug 1;75(8):777-785. doi: 10.1001/jamapsychiatry.2018.1109.
- Mehlum L, Tormoen AJ, Ramberg M, Haga E, Diep LM, Laberg S, Larsson BS, Stanley BH, Miller AL, Sund AM, Groholt B. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. J Am Acad Child Adolesc Psychiatry. 2014 Oct;53(10):1082-91. doi: 10.1016/j.jaac.2014.07.003. Epub 2014 Jul 22.
- Aboujaoude E, Salame WO. Naltrexone: A Pan-Addiction Treatment? CNS Drugs. 2016 Aug;30(8):719-33. doi: 10.1007/s40263-016-0373-0.
- Bresin K, Gordon KH. Endogenous opioids and nonsuicidal self-injury: a mechanism of affect regulation. Neurosci Biobehav Rev. 2013 Mar;37(3):374-83. doi: 10.1016/j.neubiorev.2013.01.020. Epub 2013 Jan 20.
- Blasco-Fontecilla H, Fernandez-Fernandez R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry. 2016 Feb 1;7:8. doi: 10.3389/fpsyt.2016.00008. eCollection 2016.
- Vega D, Sintes A, Fernandez M, Punti J, Soler J, Santamarina P, Soto A, Lara A, Mendez I, Martinez-Gimenez R, Romero S, Pascual JC. Review and update on non-suicidal self-injury: who, how and why? Actas Esp Psiquiatr. 2018 Jul;46(4):146-55. Epub 2018 Jul 1.
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- 2024-0057
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
IPD 计划说明
药物和器械信息、研究文件
研究美国 FDA 监管的药品
研究美国 FDA 监管的设备产品
在美国制造并从美国出口的产品
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.