Early Study of N-Acetylcysteine to Treat Deliberate Self-Harm in Adolescents

2014-07-23 21:09:25 | BioPortfolio


Deliberate Self-Harm (DSH) among adolescents is a serious behavioral problem associated with significant injury, impaired functioning, reduced quality of life, and high rates of psychiatric hospitalizations. While DSH has not been shown to have a direct link to suicide attempts themselves, there is a clear link between individuals who engage in DSH and overall rates of suicide. There is currently no medication treatment approved by the FDA for the treatment of DSH.

The goal of this study is to evaluate the efficacy and safety of the dietary supplement N-Acetylcysteine in adolescents aged 16-21 with deliberate self-harm behaviors. We hypothesize that N-Acetylcysteine will reduce the severity of deliberate self harm behaviors because this supplement has been helpful in treating disorders that share some similar traits with DSH. We will be using this medication in 10 adolescents who deliberately harm themselves and we will assess the severity of their behaviors while being treated with this dietary supplement.


Deliberate Self-Harm (DSH) among adolescents is a serious behavioral problem associated with significant morbidity and mortality, impaired functioning, reduced quality of life, and high rates of psychiatric hospitalizations. Rates of DSH among high-school adolescents range between 14% and 21%, highlighting the need for effective behavioral and pharmacological interventions . Because DSH has been closely linked to Borderline Personality Disorder (BPD), treatments that have been used successfully for BPD such as Dialectical Behavior Therapy (DBT) have been used to treat adolescents with DSH. While DSH has not been shown to have a direct link to suicide attempts themselves, there is a clear link between individuals who engage in DSH and overall rates of suicide. In addition to these high rates of DSH in adolescents, research is continuing to show that similar to adult patients; adolescent DSH is related to high levels of impulsivity.

Considerable advances in the understanding of the neurobiology of risk and reward and impulsivity have improved the general understanding of the neuropathology of a behavior such as DSH. Our previous neuroimaging research of DSH in BPD found that frontal white matter integrity was significantly impaired in these individuals. One conceptualization of DSH is that it represents an imbalance between a strong desire for the reward of DSH (i.e. an overactive ventral tegmental area [VTA]) and an inability to inhibit the drive (i.e. impaired inferior frontal cortex). If the frontal cortex is impaired due to inadequate white matter integrity as our earlier study demonstrated, then reducing the drive for DSH may be the most beneficial target for treatment. Glutamate is known to activate dopamine neurons in the VTA. Because such activation can increase dopamine release in mesocorticolimbic targets, this glutamate-dopamine interaction in the VTA may underlie the chronic reward-seeking that underlies DSH. In fact, dysregulated prefrontal cortex-nucleus accumbens synaptic glutamate transmission appears to underlie the unmanageable motivation to engage in DSH.

Because interactions of glutamate with the dopaminergic system within the VTA mediate reward, N-acetyl cysteine (NAC), a glutamate modulating agent, should attenuate the rewarding properties of DSH by interfering with DSH-induced stimulation of the mesolimbic dopaminergic pathway. NAC increases the activity of cysteine-glutamate antiporters in the nucleus accumbens and abolishes reward-seeking behavior. Behaviorally, NAC administration should lead to diminished urges to engage in DSH. Increased extracellular glutamate by NAC may correct the underlying pathophysiology and symptoms of this compulsive drive to self-injure. NAC has been extensively studied in a variety of medical problems (e.g., cocaine dependence, acetaminophen overdose, AIDS, gambling), and its lack of significant side effects may present a marked advantage over pharmacological agents.

There is a need to develop effective treatment options that are well tolerated, widely available, and do not have prohibitive costs. NAC is an amino acid, available in health food stores, cheaper than the cost of most insurance co-payments, and is easily tolerated. If effective, NAC could be a treatment option available to people throughout the country that do not currently have insurance but are suffering from DSH.

The population to be studied for this trial is 10 men and women, ages 16-21, who engage in deliberate self-harm behaviors at least twice a month. Study participants will be recruited from outpatient mental health clinics.

The study consists of eight weeks of open label N-Acetylcysteine. All eligible study subjects will be treated with 600mg of N-Acetylcysteine twice a day for 2 weeks, then the dose will be increased to 1200mg twice a day for two weeks, and to 1800mg twice a day for 4 weeks. weeks. Subjects will be seen every two weeks during the 8-week study. Efficacy and safety assessments will be performed at each visit.

All participants will be given the 1) Personality Assessment Inventory (adult) or adolescent form of the Personality Assessment Inventory administered at the Initial Intake as well as the 2) MINI or MINI Kid dependent on age. The Deliberate Self Harm Inventory will also be administered at initial intake. The 3) McClean Symptom Inventory-Borderline Personality Disorder, a 10 item self administered assessment for borderline personality disorder, the 4) Symptom Check-List-90-R, 5) Self Injury Assessment Scale, 6) Barrett Impulsivity Scale, and the 7) Columbia Suicide Severity Rating Scale will all be administered at this initial assessment for symptom severity.

Every two weeks the 1) Columbia Suicide Severity Rating Scale, the 2) Self Injury Assessment Scale, 3) Deliberate Self Harm Inventory Clinical Change Version will be utilized to assess the efficacy of current treatment.

At the end of the 8 week administration of NAC participants will complete the 1) Columbia Suicide Severity Rating Scale, 2) Deliberate Self Harm Inventory Clinical Change Version, 3) Self Injurious Assessment Scale, the 4) Barrett Impulsivity Scale to address overall efficacy of current level of intervention.

Study Design

Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment


Deliberate Self Harm




University of Minnesota Dept. of Psychiatry Ambulatory Research Center
United States


Not yet recruiting


University of Minnesota - Clinical and Translational Science Institute

Results (where available)

View Results


Published on BioPortfolio: 2014-07-23T21:09:25-0400

Clinical Trials [182 Associated Clinical Trials listed on BioPortfolio]

Treatment for Adolescents With Deliberate Self Harm

The purpose of the study is to evaluate the efficiency of dialectical behavior therapy (DBT) in treatment of adolescents with deliberate self harm compared to treatment-as-usual (TAU). 150...

Adapted Dialectical Behaviour Therapy for Adolescents With Deliberate Self-Harm: A Pre-post Observational Study

We conducted a pre-post naturalistic study regarding changes observed associated with a 15-week course of an adapted form of dialectical behaviour therapy for adolescents. We measured freq...

Long Term Efficacy of DBT-A in Adolescents With Repetitive Self-harming and Suicidal Behaviours

The purpose of the study is to evaluate the long-term efficacy of dialectical behavior therapy (DBT) in treatment of adolescents with deliberate self harm compared to enhanced usual care (...

Mentalization-Based Group Therapy for Adolescents

This is a prospective parallel group design of group-based Mentalization-Based Therapy for Adolescents (MBT-A) through a pilot randomised controlled trial comparing group-based MBT-A plus ...

Effect of N-acetylcysteine on Alcohol and Cocaine Use Disorders: A Double-Blind Randomized Controlled Trial.

This study evaluates the use of N-acetylcysteine in the treatment of alcohol and cocaine use disorders. Alcohol users will be split in two groups, one will receive the active N-acetylcyste...

PubMed Articles [642 Associated PubMed Articles listed on BioPortfolio]

Is the association of deliberate self-harm with emotional relief stable or dependent on emotional context?

Despite strong support for the role of emotional relief in deliberate self-harm (DSH), no research has examined the impact of emotional distress on the strength of the DSH-relief association. Thus, it...

The role of emotional clarity and distress tolerance in deliberate self-harm in a sample of trauma-exposed inpatient adolescents at risk for suicide.

The purpose of this study was to examine distress tolerance as a moderator of the relationship between emotional clarity and deliberate self-harm (DSH) in a diverse sample of trauma-exposed adolescent...

Self-harm and suicide attempts in Schizophrenia.

The risk of suicide among persons with schizophrenia (SZ) is higher than in general population, with multiple contributory factors. We assessed the prevalence of risk of deliberate self-harm and suici...

Mental health follow-up after deliberate self-harm and risk for repeat self-harm and death.

Morbidity and mortality after deliberate self-harm (DSH) are high, so mental health care shortly after DSH is recommended. Using population-level health data we determined the association between a me...

Correction: Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design.

Medical and Biotech [MESH] Definitions

The application of methods designed to reduce the risk of harm associated with certain behaviors without reduction in frequency of those behaviors. The risk-associated behaviors include ongoing and active addictive behaviors.

A measure of PATIENT SAFETY considering errors or mistakes which result in harm to the patient. They include errors in the administration of drugs and other medications (MEDICATION ERRORS), errors in the performance of procedures or the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings and preventable accidents involving patients.

The N-acetyl derivative of CYSTEINE. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates.

Deliberate introduction of air into the peritoneal cavity.

Deliberate introduction of air or gas into the mediastinum as an aid to examination and diagnosis.

More From BioPortfolio on "Early Study of N-Acetylcysteine to Treat Deliberate Self-Harm in Adolescents"

Quick Search


Relevant Topics

Psychiatry is the study of mental disorders and their diagnosis, management and prevention.  Conditions include schizophrenia, severe depression and panic disorders among others. There are pharmaceutical treatments as well as other therapies to help...

Pharmacy is the science and technique of preparing as well as dispensing drugs and medicines. It is a health profession that links health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. The scope of...

Searches Linking to this Trial