Impaired Risk Avoidance in Bipolar Disorder and Substance Use Disorders

双相情感障碍和药物使用障碍的风险规避能力受损

• 批准号: 10094000
• 负责人: Alexandra Kate Gold
• 金额: $ 2.15万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094000
• 关键词: Affect; Applications Grants; Automobile Driving; Behavior; Bipolar Disorder; Characteristics; Clinical; Clinical Markers; Cognitive; Cognitive deficits; Cues; Dangerous Behavior; Dangerousness; Data Collection; Decision Making; Depressed mood; Disease; Economic Burden; Exhibits; Failure; Frequencies; Fright; Future; Gambling; General Population; Goals; HIV; Hepatitis; Hospitalization; Impairment; Imprisonment; Impulsivity; Individual; Intervention; Iowa; Knowledge; Laboratories; Lead; Learning; Legal; Life Style; Link; Malignant Neoplasms; Manic; Measures; Medical; Methods; Mood Disorders; Moods; Morbidity - disease rate; National Institute of Mental Health; Nature; Needle Sharing; Outcome; Patient Self-Report; Patients; Pattern; Performance; Population; Psychophysiology; Psychosocial Assessment and Care; Punishment; Quality of life; Reading; Recovery; Research; Research Methodology; Research Personnel; Risk; Risk Assessment; Risk Behaviors; Risk-Taking; Role; Severities; Signal Transduction; Socioeconomic Status; Strategic Planning; Substance Use Disorder; Suicide attempt; Task Performances; Testing; Time; Training; Translational Research; Treatment outcome; Unsafe Sex; Variant; Withdrawal; analog; base; burden of illness; career; cigarette smoking; clinical risk; clinically significant; cognitive function; cognitive task; cognitive testing; comorbidity; conditioned fear; design; disability; discounting; dual diagnosis; early onset; effective therapy; experience; high risk; impaired capacity; improved; knowledge base; mood symptom; mortality; novel; overdose risk; patient population; patient subsets; physical conditioning; profiles in patients; severe mental illness; sexual risk taking; social; substance use; sustained attention; therapy development; transmission process; treatment adherence; unhealthy lifestyle

PROJECT SUMMARY/ABSTRACT Bipolar disorder (BD) comorbid to substance use disorders (SUD) is linked to high rates of morbidity and mortality, increased frequency and severity of mood episodes, early onset of mood symptoms, poor role and cognitive functioning, and reduced quality of life, among other negative illness characteristics. Despite the significant illness burden carried by patients with these co-occurring conditions, existing treatments hold limited efficacy, suggesting the need for a re-consideration of mechanisms that may be impacting treatment outcomes in this population. Common to BD and SUDs are illness characteristics such as increased impulsivity, heightened novelty-seeking, and poor decision-making. Clinically, such characteristics are presented through high-risk tendencies such as excessive spending practices, HIV transmission risk behaviors (e.g., unprotected intercourse, needle sharing), and engagement with illegal activities, among other examples. Thus, one mechanism that may explain poor outcomes in patients with these co-occurring conditions is impaired risk avoidance, or a tendency to engage in a persistent pattern of behaviors despite poor outcomes resulting from such behaviors. The proposed study is focused on characterizing the nature and profile of laboratory-based risk avoidance deficits and determining the associations among risk avoidance, cognitive, and clinical risk behaviors to inform improved, focused, and novel intervention efforts across patient populations (NIMH Strategic Plan, 3.2). This study aims to 1) examine the profile of laboratory-derived risk avoidance impairments in those with BD with and without comorbid SUDs to inform future treatment advances for intervening with hazardous behaviors, and 2) investigate the association among monetary and fear-based laboratory risk avoidance assessments, cognitive assessments, and clinical risk behaviors to aid in formation of specific profiles of patients with comorbid BD and SUDs. Overall, the proposed project will enable the applicant to gain hands-on training with cognitive assessment and interpretation, fear conditioning, and psychophysiological data collection methods. Further, through this study, the applicant will 1) gain expertise in translational research methods, 2) enhance her knowledge base on historical and current research in the confluence of BD and SUDs (e.g., through coursework and readings), 3) receive training in empirically-supported psychosocial treatments for these co-occurring conditions, and 4) forge fruitful professional connections with researchers in the field who will collaborate with the applicant on future grant applications and thus allow her to achieve her translational science career goals. Patterns of laboratory-based risk avoidance, cognitive deficits, and clinical risk behaviors in this population will represent novel targets for treatment development that underlie mechanisms of comorbid BD and SUDs (NIMH Strategic Plan, 3.1). Thus, the proposed study represents an initial step towards improved, more effective treatments for co-occurring BD and SUDs.

项目摘要/摘要 对物质使用障碍（SUD）合并症的躁郁症（BD）与高发病率相关， 死亡率，情绪发作的频率和严重程度的增加，情绪症状的早期发作，角色差和 认知功能和降低生活质量以及其他负面疾病特征。尽管有 患有这些同时发生疾病的患者承担的重大疾病负担，现有治疗有限 功效，表明需要重新考虑可能影响治疗结果的机制 在这个人群中。 BD和SUD共同是疾病特征，例如冲动性的增加， 寻求新颖的新颖性和决策不良。临床上，这种特征是通过 高风险的趋势，例如过度支出惯例，HIV传播风险行为（例如，未受保护） 性交，针共享）以及与非法活动的参与以及其他例子。因此，一个 可能解释这些同时发生条件患者预后不佳的机制是风险受损 避免，或倾向于持续的行为模式，尽管结果是由 这样的行为。拟议的研究重点是表征基于实验室的性质和概况 避免风险赤字并确定避免风险，认知和临床风险之间的关联 为跨患者人群提供改善，集中和新颖的干预工作的行为（NIMH） 战略计划，3.2）。这项研究的目的是1）检查实验室衍生的避免风险障碍的概况 在患有和没有合并症的BD的人中，以告知未来的治疗进展 危险行为以及2）调查货币和基于恐惧的实验室风险之间的关联 回避评估，认知评估和临床风险行为，以帮助形成特定 合并BD和SUD患者的特征。总体而言，拟议的项目将使申请人获得 通过认知评估和解释，恐惧调节和心理生理学的动手培训 数据收集方法。此外，通过这项研究，申请人将1）获得翻译方面的专业知识 研究方法，2）增强她在BD汇合的历史和当前研究的知识基础 和SUD（例如，通过课程和阅读），3）接受经验支持的心理社会培训 这些同时发生条件的治疗方法，以及4）与研究人员建立富有成果的专业联系 将与申请人合作就未来赠款申请合作的领域，从而使她能够实现她 转化科学职业目标。基于实验室的风险避免，认知缺陷和临床的模式 该人群中的风险行为将代表治疗开发的新目标 合并BD和SUDS的机制（NIMH战略计划，3.1）。因此，拟议的研究代表 朝着改善同时发生的BD和SUDS迈向改进，更有效的治疗方法的第一步。