Effect of naloxone therapy on depersonalization: a pilot study

Abstract

To test the hypothesis of the role for the opioid system in the pathogenesis of depersonalization, the effect of naloxone (an opioid receptor blocker) on the symptoms and corticosteroids secretion was studied in patients with depersonalization syndrome. Fourteen depersonalization patients were treated with naloxone: 11 patients received single doses (1.6 or 4 mg i.v.) and three others received multiple infusions, with the maximal dosage being 10 mg, and the effect of naloxone on symptom severity was determined. In eight patients, the cortisol, cortisone and corticosterone content in the blood plasma was determined prior to and after the 4 mg naloxone infusion. A reversed-phase microcolumn high-performance liquid chromatography with ultraviolet detection was applied for assessment of glucocorticoids. In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization.

Keywords

depersonalization glucocorticoids naloxone

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References

Abrams A , Braff D , Janowsky D S , Holl S , Segal D S (1978) Unresponsiveness of catatonic symptoms to naloxone. Pharmakopsychiatry 11: 177–179

Abugova M A (1996) Indices of pain threshold as a method of objective assessment of depersonalization therapy efficacy. Bekhterev Rev Psychiatry Med Psychol 4: 120–122

American Psychiatric Association (1994) DSM-lV: diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DC

Banki C V , Araio M (1987) Multiple hormonal responses to morphine: relationship to diagnosis and dexamethasone supression. Psychoendocrinology 12: 3–11

Delitala G , Trainer P S , Oliva O , Fanciully G , Grossman A B (1994) Opioid peptide and alpha-adrenoreceptor pathways in the regulation of the pituitary–adrenal axis in man. Endocrinology 141: 163–168

Gamper N L , Velicanova L I , Korolyova N M (1996) Determination of six corticosteroids in human serum by reversed phase microcolumn HPLC. Proceedings of the 18th International Symposium on capillary chromatography V111, pp. 1655–1663

Gelder M , Gath D , Mayou R (1989) Oxford textbook of psychiatry, 2nd edn. Oxford University Press, Oxford

Janowsky D S , Judd L L , Huey L Y , Rish S C , Segal D S (1983) Behavioral effects of opioid receptor antagonists in psychopathological states. Psychiatry Clin North Am 6: 403–414

Keuler D J , Altemus M , Michelson D , Greenberg B , Murphy D L (1996) Behavioral effects of naloxone infusion in obsessive–compulsive disorder. Biol Psychiatry 40: 154–156

10.

Moroz B T , Nuller Y L , Ustimova I N , Andreev B V (1990) Study of pain sensitivity based on the indicators of electroodontometry in patients with depersonalization and depressive disorders. Zhurnal Nevropatologii Psichiatrii 90: 81–82

11.

Nuller Y L (1982) Depersonalisazion – symptoms, meaning, therapy. Acta Psychiatr Scand 66: 451–458

12.

Nuller Y L , Mickalenko I N (1988) Affective psychoses. Meditsina, Leningrad

13.

Shader R I (1994) Manuel of psychiatric therapeutics, 2nd edn. Little, Brown and Company, Boston

14.

Volavka J , Anderson B , Koz G (1982) Naloxone and naltrexone in mental illness and tardive dyskinesia. Ann NY Acad Sci 97–102