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

斯坦福大学加速智能神经调节疗法对外显和内隐自杀认知的影响

• 批准号: 10263271
• 负责人: Nolan R. Williams
• 金额: $ 61.92万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10263271
• 关键词: Acceleration; Acute; Admission activity; Anhedonia; Anterior; Antidepressive Agents; Brain; Caring; Cognition; Cognitive; Coupled; Data; Depressed mood; Development; Disease remission; Electroconvulsive Therapy; FDA approved; Feeling hopeless; Feeling suicidal; Future; Hospitalization; Hospitals; Implicit Association Test; Individual; Inpatients; Intelligence; Intervention; Ketamine; Learning; Left; Length; Mediating; Mediator of activation protein; Mental Depression; Methods; Moods; Nature; Neurobiology; Outcome; Outpatients; Patients; Pattern; Physiologic pulse; Pilot Projects; Prefrontal Cortex; Protocols documentation; Publishing; Randomized Controlled Trials; Rest; Safety; Schedule; Signal Transduction; Structure; Suicide; Suicide prevention; Sum; Therapeutic; Therapeutic Effect; Time; antidepressant effect; base; cingulate cortex; depressive symptoms; design; efficacy testing; implementation intervention; improved; indexing; innovation; modifiable risk; neural circuit; neuroregulation; novel; preservation; prospective; psychiatric emergency; randomized trial; reducing suicide; repetitive transcranial magnetic stimulation; side effect; social stigma; suicidal; suicidal behavior; suicidal risk; suicide rate; symptom treatment; symptomatic improvement; theories; treatment-resistant depression; ward

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.

抽象的 该提案的总体目的是测试高效和个性化的效率和安全性 重复的thrancranial磁刺激（RTMS）方法称为斯坦福 神经调节疗法（SAINT）。在此提案中，我们将利用圣经作为快速行动的干预措施 在紧急精神病患者的背景下，减少明确和隐性自杀认知 自杀思想和行为。尽管RTM被FDA批准用于耐治疗抑郁症（TRD），但 平均要求的治疗应用是在症状改善迹象之前的6周，这不是 急性自杀危机的症状治疗的最佳策略。该应用是由三个动机 神经调节场的最新发现。首先是一项虚假对照的试点研究，评估了加速 常规的RTMS协议，其中将多个模拟会话安全地交付到左侧背侧 自杀想法的患者三天的前额叶皮层（L-DLPFC）。这项研究表明 常规的RTM可以“加速”，并显示出明显自杀的信号 认识。其次，有两项明显的随机试验，用于应用于 L-DLPFC证明了间歇性theta爆发刺激（ITB）的效率作为TRD的治疗 通常与自杀认知有关的状况。 ITB已被证明具有5倍的脉冲 常规RTM的效力，相比 传统的RTMS，因此每天进行多次治疗是可行的干预措施。最后的创新是 使用静止状态功能连接的RTMS靶向可改善RTMS的抗抑郁剂结果。我们 设计了一种我们称为圣人的方法，该方法每天使用ITB的大量应用，根据 间隔学习理论的原理（优化的间隔间隔），在得出的功能连接中 目标（L-DLPFC-SGACC）。在TRD中，我们观察到情绪和相关明确自杀的戏剧性变化 使用圣人的认知。我们建议使用圣徒调节明确的神经电路，并 隐式自杀认知以及主持人/调解人（绝望，抗议和抑郁症）。我们将 对L-DLPFC-SGACC进行的随机对照试验进行随机对照试验，以评估 减少住院的精神病患者自杀认知的方法。