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 [202 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...

DBT-SS for Cognitively Challenged Individuals With Deliberate Self-harm

The study evaluates the effect of Dialectic Behavior Therapy Skills System (DBT-SS) in individuals with Intelligence Quotient 65-85 and recurrent self-harm. The study is primarily descript...

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 ...

PubMed Articles [645 Associated PubMed Articles listed on BioPortfolio]

Are bullying perpetration and victimization associated with adolescent deliberate self-harm? A meta-analysis.

To appraise internationally published literature investigating bullying in its association with deliberate self-harm (DSH).

Self Harm and Suicidality: an audit of follow-up in primary care.

Deliberate self harm is the strongest predictor of completed suicide. Primary care is often the entry point for those presenting with self harm and suicidality and so the primary care follow-up of suc...

Patterns of self-harm methods over time and the association with methods used at repeat episodes of non-fatal self-harm and suicide: A systematic review.

The risk of self-harm repetition and suicide may be influenced by self-harm method choice. However, there are mixed findings regarding whether there is a discernible pattern in self-harm methods over ...

Self-harm among children and adolescents.

Self-harm among children and adolescents is a prevalent health issue. Definitions of self-harm differ, and the distinction between attempted suicide or self-harm is often unclear. A recent large popul...

Deliberate Practice and Skill Acquisition in Nursing Practice.

The purpose of this article is to describe an educational process designed to accelerate skill acquisition for new nurse graduates through deliberate practice and situated learning experiences. The co...

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