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: 8711561
• 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/8711561
• 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 Domain Criteria; 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（哥伦比亚大学奖学金培训的学术研究员和临床心理学家）以患者为导向的研究计划和职业发展。布朗博士的总体目标是发展成为一名独立的研究者，重点是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前途的途径，了解如何改善干预结果的老年患者诊断复杂的医疗和精神科合并症。这一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干预研究。因此，他在精神病学家、影响抗抑郁药反应的临床、人口统计学和治疗因素权威Steven鲁塞博士、心脏病学家Mathew Maurer博士和老年病学家、流行病学家和虚弱概念专家琳达弗里德博士的指导下，构建了一个多学科培训计划，沿着神经心理学、精神药理学、生物统计学和负责任的研究行为方面的顾问。布朗博士将通过课程作业，以患者为导向的经验和专家指导获得正式培训1）对脆弱和抑郁症常见的生物学，神经心理学和身体特征的评估和理解，2）治疗干预措施的设计，实施和分析，以及3）老年医学研究中复杂的伦理问题。这项研究的总体目标是了解抑郁症脆弱的表型。虽然抑郁症和虚弱单独导致可怕的结果，为患者和家庭，似乎是现象学和生理学相关，虚弱综合征从来没有明确研究的背景下，晚年抑郁症。基于他的试验数据和这两种疾病的诊断复杂性，Brown博士构建了这种表型的模型，并假设基线时特定虚弱特征的存在会降低抗抑郁药治疗的反应。为了研究这个模型，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，Brown博士还将评估老年抑郁虚弱人群中慢性炎症和营养不良的标志物，以开始评估表型背后的潜在机制，他将调查基线虚弱特征对活动水平和残疾长期改善的影响。在这项提案的最后，布朗博士将能够更好地回答虚弱综合征如何影响晚年抑郁症的诊断，以及虚弱综合征是否会降低抗抑郁药治疗的反应。有了这些经验和技能，布朗博士将联合收割机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，并个性化治疗干预，以最大限度地提高治疗效果。