Non-Suicidal Self-Injury in Children: Brain/behavior Alterations and Risk for Suicidal Behavior

项目总结/摘要： 背景：非自杀性自伤（NSSI）-定义为在自杀过程中故意破坏自己的身体。 没有死亡意图（最常见的是自我切割）-占7-24岁急诊奥尔兹的25% 每年都有自杀未遂（SA）的风险增加了7倍。 此外，自杀是美国10-24岁奥尔兹死亡的第二大原因。 需要确定NSSI本身的大脑/行为机制以及回路/行为/症状 青年人，是第一个被称为“青年人”的人，是第一个被称为“青年人”的人。的 主要目的是（1）识别功能性磁共振成像（fMRI）与 参与NSSI的青少年与没有精神病理学的对照组相比，（2）确定电路，行为， 与首次发作SA相关的症状因素，以及（3）测试这种关系的调节剂，包括 易怒、社交功能和冲动性攻击。我们的中心假设，基于初步的 美国自杀预防基金会对只参加NSSI的青少年进行的研究数据是：（a） 参与NSSI的青少年-仅在没有先前SA的情况下，前额叶皮层（PFC）的行为/回路发生改变- 杏仁核回路在任务中挖掘与自杀的内隐关联和对同伴接受的反应， 拒绝，和（B）这些电路的改变，由易怒，冲动的侵略，和社会调节 功能障碍，使年轻人在未来的自杀行为的风险更大。研究方法：我们将对此进行测试 通过比较150名仅参与NSSI（没有事先SA）的年轻人与50名典型发展中国家的年轻人， 对照组（TDC）的年轻人对电路，行为和症状的措施，然后按照样本为18 几个月来描述是什么区分那些谁进展到自杀行为。这样做的理由 建议是，更多地了解NSSI背后的大脑/行为机制以及 随后的首次发作SA将最终导致更多基于大脑的分类和治疗方法 这反过来又会降低风险，并加强预防，自杀行为， 儿童和青少年。创新：我们的研究是创新的，因为它将独特地协同电路和 基于可靠的初步数据的行为方法， NSSI/自杀和易怒，社会功能的真实世界评估，纵向随访，以及承诺 多学科团队。意义：我们的研究意义重大，因为它解决了知识的差距 关于NSSI和NIMH/National强调的首次发作SA的生物行为机制 预防自杀行动联盟（NAASP）的“预防自杀优先研究议程”和 2016年6月NIMH主办的“自杀风险机制”会议-因为这些机制提供了 基于生物机制的NSSI和自杀分类和治疗的基础。

PROJECT SUMMARY/ABSTRACT: BACKGROUND: Non-suicidal self-injury (NSSI)—defined as deliberate destruction of one's body in the absence of intent to die (most commonly self-cutting)—accounts for 25% of 7-24 year olds seen in emergency departments annually for self-harm and increases the risk for a suicide attempt (SA) by as much as 7-fold. Moreover, suicide is the second leading cause of death of 10-24 year olds in the U.S. Thus, there is a critical need to identify the brain/behavior mechanisms underlying NSSI itself and also the circuit/behavior/symptoms predictors of which youths engaged in NSSI-only will make a first-onset SA (and which will not). THE PRIMARY OBJECTIVES are (1) to identify functional magnetic resonance imaging (fMRI) differences between youths engaged in NSSI vs. controls without psychopathology, (2) to determine the circuit, behavior, and symptom factors associated with first-onset SA, and (3) to test moderators of this relationship including irritability, social function, and impulsive aggression. OUR CENTRAL HYPOTHESIS, based on preliminary data from our American Foundation for Suicide Prevention study of teens engaged in NSSI-only is that (a) youths engaged in NSSI-only without a prior SA have behavior/circuit alterations in a prefrontal cortex (PFC)- amygdala circuit during tasks tapping implicit associations with suicide and response to peer acceptance vs. rejection, and (b) these circuit alterations, moderated by irritability, impulsive aggression, and social dysfunction, put youths at greater risk for future suicidal behavior. RESEARCH METHOD: We will test this hypothesis by comparing 150 youths engaged in NSSI-only (without prior SA) vs. 50 typically-developing control (TDC) youths on circuit, behavior, and symptom measures, and then following the sample for 18 months to delineate what distinguishes those who progress to suicidal behavior. THE RATIONALE FOR THIS PROPOSAL is that greater knowledge of the brain/behavior mechanisms underlying NSSI and the relationship to subsequent first-onset SA will ultimately lead to a more brain-based classification and treatment approach for NSSI and suicide, which in turn would reduce risk, and enhance prevention for, suicidal behavior among children and adolescents. INNOVATION: Our study is innovative because it will uniquely synergize circuit and behavioral methods based on solid preliminary data with innovative ecological momentary assessments of NSSI/suicide and irritability, real-world assessment of social function, longitudinal follow up, and a committed multi-disciplinary team. SIGNIFICANCE: Our study is significant because it addresses gaps in knowledge about bio-behavioral mechanisms of both NSSI and also of a first-onset SA highlighted by the NIMH/National Action Alliance for Suicide Prevention's (NAASP) “Prioritized Research Agenda for Suicide Prevention” and the June 2016 NIMH-sponsored meeting on “Mechanisms of Suicide Risk”—as these mechanisms provide the foundation for biological mechanism-based classification and treatments for NSSI and suicide.