SSRIs and Self-harm in Borderline Personality Disorder

SSRIs 与边缘性人格障碍中的自残

• 批准号: 8308694
• 负责人: EMIL Frank COCCARO
• 金额: $ 52.86万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-25 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8308694
• 关键词: Acute; Affective; Age; Aggressive behavior; Auditory Evoked Potentials; Behavior; Borderline Personality Disorder; Boxing; Case Study; Clinical Trials; Data; Dependence; Depressed mood; Depressive disorder; Diagnosis; Disease; Double-Blind Method; Emotions; Escitalopram; Exposure to; Feeling suicidal; Functional disorder; Genetic; Genetic Polymorphism; Home environment; Impulsivity; Individual; Institutes; Label; Laboratories; Lead; Link; Loudness; Major Depressive Disorder; Measurement; Measures; Medical; Mental Depression; Meta-Analysis; Methodology; Methods; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Placebos; Population; Psychophysiology; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Sampling; Selective Serotonin Reuptake Inhibitor; Self-Injurious Behavior; Serotonin; Suicide; Suicide prevention; Symptoms; Thinking; Time; analog; base; blind; clinically relevant; economic cost; ideation; indexing; information processing; promoter; prospective; public health relevance; randomized trial; reducing suicide; response; social; suicidal; suicide rate; trait; translational approach; trial comparing; week trial

DESCRIPTION: Suicide and lesser forms of intentional self-harm behaviors produce devastating medical, social and economic costs. Self-harm is integrally related to depressive disorders and Borderline Personality Disorder. Selective Serotonin Reuptake Inhibitors (SSRIs), like escitalopram, are front-line pharmacological treatments for these disorders, putatively regulating depressed mood and reducing suicidality. However, data from case studies and retrospective meta-analyses of depression clinical trials is mixed, with some (but not all ) studies suggesting that during the first months of treatment, SSRIs may increase the risk of suicidal ideation in select individuals, particularly younger individuals. These post-hoc analyses, though informative, are based on studies that provide limited sampling of the self-harm domain. No study, to date, has implemented a direct prospective examination of the effects of early SSRI use on self-harm thoughts and behaviors using a multi-method measurement involving both the laboratory (standard self-aggression paradigm: SAP) and home environments (ecological momentary assessment: EMA). Also, no study has examined the influence of impaired 5-HT function and emotion dysregulation as moderators of outcome with escitalopram. The proposed randomized clinical trial will prospectively assess the impact of eight weeks exposure to SSRI treatment on self-harm ideation and behavior among a sample of 200 subjects with Borderline Personality Disorder and current major depression. After a one week single-blind placebo lead-in, participants will be randomly assigned double blind to either placebo or escitalopram for eight (8) weeks. The primary dependent variable will be EMA of self-harm ideation and behavior obtained several times each day. Self-harm will also be assessed using a laboratory analogue task (SAP) at baseline and again after the eight week trial. Age will be evaluated as a moderator of SSRI response. 5-HT dysfunction and emotion dysregulation will be evaluated as candidate moderators of SSRI response. 5-HT functioning will be assessed using psychophysiological (loudness dependence of the auditory evoked potential: LDAEP) and genetic (5-HT transporter promoter polymorphism: 5-HTTLPR) markers. Measures of emotion dysregulation will include trait aggression, impulsivity and socioemotional information processing. At the conclusion of the eight-week randomized trial, all participants will receive eight weeks of escitalopram administered single-blind, with continued EMA and other assessment. PUBLIC HEALTH RELEVANCE: The proposed randomized clinical trial will prospectively assess the impact of 8 weeks exposure to SSRI treatment on self-harm ideation and behavior among a sample of 200 subjects with Borderline Personality Disorder and current major depression. After a one week single-blind placebo lead-in, participants will be randomly assigned double blind to either placebo or escitalopram daily for eight (8) weeks. The primary dependent variable will be EMA of self-harm ideation and behavior obtained several times each day. Selfharm will also be assessed using a laboratory analogue task (SAP) at baseline and again after the eight week trial. Age, 5-HT dysfunction and emotion dysregulation will be evaluated as potential moderators of SSRI response.

描述：自杀和较小形式的故意自残行为会产生毁灭性的医疗、社会和经济成本。自残与抑郁症和边缘型人格障碍有着内在的联系。选择性5 -羟色胺再摄取抑制剂（SSRIs），如艾司西酞普兰，是这些疾病的前沿药物治疗方法，被认为可以调节抑郁情绪