The Phenomenology and Antidepressant Treatment of Depressed, Frail Older Adults

抑郁、虚弱老年人的现象学和抗抑郁治疗

• 批准号: 8581067
• 负责人: Patrick J Brown
• 金额: $ 18.59万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8581067
• 关键词: Academic Training; Acute; Affect; Age; Antidepressive Agents; Attenuated; Award; Behavioral; Biological; Biometry; Body Weight decreased; C-reactive protein; Cardiovascular system; Cessation of life; Characteristics; Chronic; Classification; Clinical; Cognition; Cognitive; Comorbidity; Complex; DSM-IV; Data; Depressed mood; Diagnosis; Diagnostic; Disease; Doctor of Philosophy; Dysthymic Disorder; Elderly; Epidemiologist; Escitalopram; Ethical Issues; Family; Fellowship; Frail Elderly; Frail Older Adults; Gait; Geriatric Psychiatry; Geriatrics; Goals; Hamilton Rating Scale for Depression; Health; Health Care Costs; Hospitalization; Inflammation; Institutionalization; Interleukin-6; Intervention; Intervention Studies; K-Series Research Career Programs; Knowledge; Long-Term Effects; Major Depressive Disorder; Malnutrition; Measures; Medical; Mental Depression; Mentors; Mentorship; Modeling; Neuropsychology; Outcome; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Phase; Phenotype; Physical activity; Physiological; Placebo Control; Population; Program Development; Psychiatric therapeutic procedure; Psychiatrist; Psychologist; Psychopharmacology; Quality of life; Research; Research Personnel; Research Proposals; Risk; Sampling; Serum Albumin; Speed; Syndrome; System; Techniques; Testing; Therapeutic Intervention; Time; Training; Treatment Factor; Treatment outcome; Universities; World Health Organization; age related; authority; base; career; career development; depressive symptoms; design; disability; duloxetine; exhaustion; experience; falls; follow-up; frailty; geriatric depression; grasp; improved; inflammatory marker; interest; meetings; multidisciplinary; neuropsychiatry; neuropsychological; older patient; open label; patient oriented; patient oriented research; public health relevance; response; skills; white matter

DESCRIPTION (provided by applicant): The purpose of this application is to support the patient-oriented research program and career development of Patrick J. Brown, PhD, a fellowship-trained academic researcher and clinical psychologist at Columbia University. Dr. Brown's overall goal is to develop into an independent investigator with a focus on the assessment and treatment of diagnostically complex geriatric patients with neuropsychiatric disorders. The depressed, frail phenotype represents the most promising avenue to understand how to improve intervention outcomes for geriatric patients with diagnostically complex medical and psychiatric comorbidity. The complexity of this clinical population requires Dr. Brown receive cross training in the principles of geriatric medicine to apply these principles to psychiatric interventions research. As such, he has constructed a multidisciplinary training plan under the mentorship of Dr. Steven Roose, a psychiatrist and authority on the clinical, demographic, and treatment factors affecting response to antidepressants, Dr. Mathew Maurer, a cardiologist with research interests in cardiovascular health and anergia in older patients, and Dr. Linda Fried, a geriatrician, epidemiologist and expert in the concept of frailty, along with advisors in neuropsychology, psychopharmacology, biostatistics, and responsible conduct in research. During the proposed award, Dr. Brown will obtain formal training via coursework, patient-oriented experiences, and expert tutelage in 1) the assessment and understanding of the biological, neuropsychological, and physical characteristics common to frailty and depression, 2) the design, conduct, and analysis of therapeutic interventions, and 3) the complex ethical issues in geriatric research. The overall goal of this research proposal is to understand the depressed frail phenotype. Although depression and frailty individually result in dire outcomes for patients and families and appear to be phenomenologically and physiologically associated, the syndrome of frailty has never been explicitly studied in the context of late life depression. Based on his pilot data and the diagnostic complexities of these two conditions, Dr. Brown had constructed a model of this phenotype and hypothesized that the presence of specific frailty characteristics at baseline will diminish response to antidepressant treatment. To investigate this model, Dr. Brown will conduct a 12-month deconstruction of the depressed, frail phenotype using antidepressant medication. In doing so, Dr. Brown will also assess markers of chronic inflammation and malnutrition in this older depressed frail population to begin to evaluate the potential mechanisms underlying the phenotype, and he will investigate the impact of baseline frailty characteristics on long-term improvement in activity levels and disability. At the end of this proposal, Dr. Brown will be better able to answer how the syndrome of frailty impacts the diagnosis of late life depression, and whether the syndrome of frailty diminishes response to antidepressant treatment. With this experience and skill set, Dr. Brown will combine the knowledge gained from both geriatric medicine and psychiatry to use multidisciplinary assessment techniques to refine our understanding of diagnostically complex geriatric patients with neuropsychiatric disorders and personalize therapeutic interventions targeted to maximize treatment outcome.

描述（由申请人提供）：本申请的目的是支持帕特里克·j·布朗博士的以病人为导向的研究项目和职业发展，帕特里克·j·布朗博士是哥伦比亚大学获得奖学金培训的学术研究人员和临床心理学家。布朗博士的总体目标是发展成为一名独立的研究者，专注于评估和治疗诊断复杂的老年神经精神疾病患者。抑郁，虚弱的表型代表了最有希望的途径来了解如何改善诊断复杂的医学和精神合并症的老年患者的干预结果。临床人群的复杂性要求布朗博士接受老年医学原则的交叉培训，将这些原则应用于精神病学干预研究。因此，他在精神科医生Steven Roose博士的指导下构建了一个多学科培训计划，Steven Roose博士是影响抗抑郁药反应的临床、人口统计学和治疗因素方面的权威，Mathew Maurer博士是研究老年患者心血管健康和神经症的心脏病专家，Linda Fried博士是老年病学专家、流行病学家和虚弱概念专家，以及神经心理学、精神药理学、心理学和心理学的顾问。生物统计学和负责任的研究行为。在拟议的奖励期间，布朗博士将通过课程，以病人为导向的经验和专家指导获得正式的培训：1)评估和理解脆弱和抑郁的生物，神经心理学和物理特征，2)治疗干预的设计，实施和分析，以及3)老年研究中的复杂伦理问题。这项研究计划的总体目标是了解抑郁虚弱的表型。尽管抑郁和虚弱各自会给患者和家庭带来可怕的后果，并且在现象和生理学上似乎是相关的，但在晚年抑郁症的背景下，虚弱综合征从未被明确研究过。基于他的试验数据和这两种情况的诊断复杂性，布朗博士构建了一个这种表型的模型，并假设在基线时存在特定的脆弱特征会减少对抗抑郁治疗的反应。为了研究这一模型，布朗博士将使用抗抑郁药物对抑郁、虚弱的表型进行为期12个月的解构。在此过程中，布朗博士还将评估老年抑郁虚弱人群的慢性炎症和营养不良标志物，开始评估潜在的表型机制，他将调查基线虚弱特征对长期改善活动水平和残疾的影响。在本提案的最后，布朗博士将能够更好地回答虚弱综合症如何影响晚年抑郁症的诊断，以及虚弱综合症是否会减少对抗抑郁治疗的反应。凭借这些经验和技能，Brown博士将结合从老年医学和精神病学获得的知识，使用多学科评估技术来完善我们对诊断复杂的老年神经精神疾病患者的理解，并针对个性化治疗干预措施，以最大限度地提高治疗效果。