BEHAVIORAL AND BIOCHEMICAL MECHANISMS OF SELF INJURY

为什么有些智障和/或自闭症患者 反复不断地伤害自己，有些人甚至严重到 组织损伤的要点，往往是永久性的疤痕，有 仍然是一个谜，没有一个单一的解决方案。解开这一切 神秘带来了自相矛盾的生物医学和行为科学 质疑并给从业者带来深深的困扰 以及受影响个人的家庭成员。在过去的时间里 十年来，许多自残行为(SIB)的案例 使用教会我们的行为干预成功治疗 沟通和其他职能技能。的实际问题 实施，与长期治疗相关的费用，以及 没有明确社会背景的案例约有三分之一的时间出现 然而，这表明为什么还有很多东西需要了解 人们会自我伤害。我们的总体目标是改善治疗， 改进诊断，并澄清不同 各种形式的自我伤害。考虑到自伤的严重性，这是 令人惊讶的是，很少有模型更详细地研究 SIB共有的变量与 疼痛调节的神经生理学。这项工作的主要目标是 项目的目的是评估这些变量中的几个变量的有效性 自我伤害反应的可能预测因子。治疗将是 基于这样一种假设，即某些形式的自我伤害 对身体部位的强烈刺激足以引起释放和 内源性阿片肽的受体结合。因此， 治疗将包括经皮电神经刺激。 (TENS)(阿片类激动剂治疗)或纳曲酮(阿片类药物 拮抗剂治疗)。预报器将包括观测上的- 基于环境功能的自我伤害测量，身体 自我伤害的部位和强度，以及唾液基线 三种生物活性物质(P物质、甲脑啡肽、 和皮质醇)。在初步确定受试者之后(年龄范围 4-25)严重的智力低下和/或自闭症，我们的 第一个目标是详细地观察和描述自我 伤害的发生，其持续时间和强度是什么，以及在哪里 身体，它是定向的。根据这一特征，P物质， 甲硫氨酸脑啡肽和皮质醇将进行非侵入性检测 通过唾液作为疼痛传递和改变的标志 治疗反应的预测指标。在筛选和SIB之后 分型(即社会型、非社会型或混合型)37名受试者，其 自我伤害主要是非社会性的或混合性的，将通过 使用TENS和阿片类拮抗剂纳曲酮治疗16周 为了自我伤害。自我伤害主要是社交行为的受试者 激励性将用TENS和阿片类拮抗剂进行评估 纳曲酮治疗自伤。以自伤为主的受试者 社交积极性将用十分进行评估，并获得 通过技术援助服务进行的行为干预 交付模式。三个月和六个月的随访将是 针对每个科目进行的。

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.