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35th AM (2025) - Poster Session
Examining the Use of Off-Label Naltrexone for Impu ...
Examining the Use of Off-Label Naltrexone for Impulsivity in an Inpatient Adolescent Psychiatry Unit
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This study evaluates the off-label use of naltrexone, a μ-opioid antagonist, to manage impulsivity and self-injurious behavior in pediatric patients admitted to an adolescent inpatient psychiatry unit. Although naltrexone is FDA-approved for alcohol and opioid use disorders in adults, its use for behavioral dysregulation and impulsivity in children and adolescents without substance use disorders remains underexplored.<br /><br />The retrospective chart review at UTHealth Houston included 94 inpatients aged 9 to 17 years (mean age 14.7), predominantly female (64/94). The patients primarily had mood disorders without psychotic features and neurodevelopmental disorders. The most frequent indication for naltrexone was self-inflicted intentional injury. Despite the lack of formal impulsivity rating scales such as the UPPS or Barratt Impulsiveness Scale, continuation of naltrexone at discharge served as a surrogate marker of tolerability. Results showed good tolerability, with 86% of patients tolerating the medication well.<br /><br />The study found a relatively low frequency of off-label naltrexone use despite its mechanistic rationale for reducing impulsivity. Notably, many patients were marked as suicide risk, and co-morbid substance use disorders were documented in some cases. Dosage and diagnostic data were described, but no inferential statistics were conducted due to the exploratory nature and sample size.<br /><br />Future directions include qualitative thematic analysis of behavioral responses to naltrexone and prospective studies using standardized impulsivity measures to objectively assess treatment effects. This research underscores the potential for naltrexone as a treatment for impulsivity and self-injurious behavior in youth, highlighting the need for further systematic investigation.<br /><br />Acknowledgments were given for assistance with data extraction. The study was conducted by researchers from UTHealth Houston’s Department of Psychiatry and McGovern Medical School.
Keywords
naltrexone
off-label use
impulsivity
self-injurious behavior
pediatric psychiatry
adolescent inpatient unit
mood disorders
neurodevelopmental disorders
suicide risk
tolerability
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