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Multiple lines of experimental evidence point to the involvement of endogenous opiates in appetite regulation. Post brain injury patients often exhibit driven eating behaviour. Since this problem fails to respond to behaviour modification, appetite suppressants, lithium, or any other usual approach, the use of the oral narcotic antagonist, Naltrexone, was given to three such patients. Naltrexone binds multiple opiate receptor sites in the hypothalamus, including the kappa receptors which have been implicated in appetite regulation, the use of this narcotic antagonist in hypothalamic hyperphagia appears to be a rational approach to this intractable problem. In this open trial, lasting from 4 1/2 to 9 months, the minimal effective dose appeared to be in the range of 100 mg per day. No side-effects (for example elevations in liver enzymes) were noted. All of the patients had an improved sense of well-being and their behaviours were less difficult to manage when on the Naltrexone. The significance of this preliminary trial is that narcotic antagonists may have a role in the treatment of brain-injured patients with bulimia. Also, Naltrexone may be useful in treating other maladaptive behavioural consequences of head trauma such as stealing, manipulation, demandingness, and depression. Likewise, the effects on the deranged endocrine system, such as the hypogonadism, are significant and deserve further exploration.

Nine aggressive, retarded patients refractory to conventional care at a maximum security hospital were given a 3-month course of cranial electrotherapy stimulation. Aggressive episodes declined 59% from baseline; seclusions were down 72%; restraints were down 58%; and use of prescribed-as-needed sedative medications decreased 53%. The most dramatic change was that of a disorganized, schizophrenic patient whose aggressive episodes declined from 62 to 9, seclusions from 53 to 8, restraints from 9 to 1 and PRNs from 25 to 1. No patients discontinued cranial electrotherapy stimulation (CES) because of side effects. This preliminary report indicates that CES appears to be an efficacious, safe, and cost-effective addition to the treatment regimen in this patient population.