The Effects of Stanford Accelerated Intelligent Neuromodulation Therapy on Explicit and Implicit Suicidal Cognition

摘要 这项建议的首要目标是测试高效和个性化的 重复经颅磁刺激(RTMS)方法--斯坦福加速智能 神经调节疗法(SANT)。在本提案中，我们将使用SAINT作为快速干预措施 在紧急精神病住院治疗的背景下减少外显和内隐自杀认知 自杀的念头和行为。尽管rTMS被FDA批准用于治疗难治性抑郁症(TRD)，但 平均所需的治疗应用是在症状改善前6周，这不是 对急性自杀危机进行症状治疗的最佳策略。这项申请的动机是三个 神经调节领域的最新发现。首先是一项虚假对照的初步研究，评估加速的 传统的rTMS方案，其中多次刺激会话被安全地输送到左侧背外侧 自杀意念患者三天前额叶皮质(L-DLPFC)的研究这项研究表明， 传统的rTMS可以加速，并显示出减少显性自杀倾向的信号。 认知力。其次，有两个值得注意的随机试验，将间歇性电刺激应用于 L-DLPFC，展示了间歇性电刺激(ITBS)对TRD的疗效， 通常与自杀认知有关的情况。ITBS已被证明具有5倍的脉搏 传统rTMS的效力，与传统rTMS相比，它允许大大减少刺激会话时间 传统的rTMS，因此使每天多次治疗成为可行的干预措施。最终的创新是 利用静息状态功能连接的rTMS靶向改善了rTMS的抗抑郁效果。我们 设计了一种方法，我们称之为SAINT，它每天使用ITBS的许多应用程序，根据 功能连通性内的间隔学习理论原理(优化的会话间隔) 目标(L-DLPFC-sgACC)。在TRD中，我们观察到情绪的戏剧性变化和相关的明显自杀倾向 使用圣徒的认知。我们建议利用SAINT来调制作为显性和非特异性基础的神经回路。 内隐的自杀认知以及调节/调节因素(绝望、快感缺乏和抑郁)。我们会 将SAINT应用于L-DLPFC-SGACC的随机对照试验，以评估其疗效 减少住院精神病患者自杀认知的途径。

ABSTRACT The overarching aim of this proposal is to test the efficacy and safety of a highly efficient and personalized repetitive transcranial magnetic stimulation (rTMS) method, termed Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT). In this proposal, we will utilize SAINT as a rapid-acting intervention for the reduction of explicit and implicit suicidal cognition within the context of an emergency psychiatric admission for suicidal thoughts and behaviors. Although rTMS is FDA approved for treatment-resistant depression (TRD), the average required treatment application is 6 weeks before signs of symptomatic improvement, which is not an optimal strategy for symptomatic treatment of an acute suicidal crisis. This application is motivated by three recent findings in the neuromodulation field. First is a sham-controlled pilot study evaluating an accelerated conventional rTMS protocol, where multiple stimulation sessions were safely delivered to the left dorsolateral prefrontal cortex (L-DLPFC) across three days in patients with suicidal ideation. This study demonstrated that conventional rTMS can be ‘accelerated’ as well as demonstrated a signal of reductions in explicit suicidal cognition. Second, there are two notable randomized trials of intermittent theta-burst stimulation applied to the L-DLPFC that demonstrated the efficacy of intermittent theta burst stimulation (iTBS) as a treatment for TRD, a condition commonly associated with suicidal cognition. iTBS has been demonstrated to have 5X the pulse potency of conventional rTMS, which allows for a much-reduced stimulation session time in comparison to traditional rTMS and therefore makes multiple treatments per day a feasible intervention. The final innovation is that rTMS targeting utilizing resting state functional connectivity improves antidepressant outcomes of rTMS. We designed an approach, which we termed SAINT, which utilizes numerous applications of iTBS per day, as per principles of spaced learning theory (optimized intersession-intervals), within a functional connectivity derived target (L-DLPFC-sgACC). In TRD, we have observed dramatic changes in mood and associated explicit suicidal cognition using SAINT. We propose utilizing SAINT to modulate the neural circuitry that underlies explicit and implicit suicidal cognition along with moderators/mediators (hopelessness, anhedonia, and depression). We will conduct a randomized, controlled trial of SAINT applied to the L-DLPFC-sgACC to assess efficacy of the approach in reducing suicidal cognition in hospitalized psychiatric inpatients.