Relapse Prevention for Suicidal Dually Diagnosed Youths

说明(由申请人提供)：针对自杀青少年的干预措施的开发和测试是公共卫生优先事项。酒精和物质使用障碍以及抑郁障碍都与青少年自杀行为的风险增加有关，而且通常是同时发生的。然而，还没有专门为被诊断为自杀的双重诊断的青少年制定干预措施。这项研究的目的是为这一人群开发、完善和试点测试认知行为复发预防干预(CBT-RP)。CBT-RP是基于Mariatt和Gordon(1985)的复发预防模型。CBT-RP融合了认知行为复发预防、动机增强方法和正念冥想，并将最初关于酒精和药物使用的复发预防模型的重点扩展到自杀结果和抑郁。治疗的开发将遵循Rounaville等人的建议。(2001)，并将在一项试点随机对照试验(RCT)中达到高潮，以确定与CBT-RP相关的疗效(n=36)。该项目的第一个目标是制定和完善CBT-RP和“增强型支持性护理”(试验性随机对照试验中的对照干预)的治疗手册和程序。第二个目标是开发和试点培训CBT-RP疗法和加强支持性护理的测试程序。第三个目标是通过监测受试者的招募和保留，监测治疗师对治疗方案的依从性，以及监测不良事件，评估CBT-RP和增强支持性护理的可行性。第四个目标是评估评估方法的可行性，这反映在完成评估的负担上。第五个目的是评估CBT-RP+氟西汀相对于加强支持护理+氟西汀对主要结果(自杀意念、抑郁症状和药物滥用问题严重程度)的反应的变化程度和变异性。氟西汀是为研究中的所有青少年开的，(A)为了提高研究结果的普适性(考虑到大多数抑郁症、寻求治疗的年轻人都接受抗抑郁药物治疗)，以及(B)出于对阻止弱势群体有效治疗抑郁症的伦理考虑。最终目的是通过退出访谈和患者满意度评分来评估CBT-RP的可接受性。这些结果将被用来设计一种动力充足的多部位随机对照试验，以检验CBT-RP对被诊断为自杀的青少年的疗效。

DESCRIPTION (provided by applicant): Development and testing of interventions for suicidal adolescents are public health priorities. Alcohol and substance use disorders and depressive disorders are both associated with increased risk of suicidal behavior in adolescents and commonly co-occur. However, interventions have not been specifically developed for suicidal dually diagnosed youths. The purpose of this study is to develop, refine, and pilot test a cognitive behavioral relapse prevention intervention (CBT-RP) for this population. CBT-RP is based on the relapse prevention model of Mariatt and Gordon (1985). CBT-RP melds cognitive behavioral relapse prevention, motivational enhancement approaches, and mindfulness meditation, and extends the original focus of the relapse prevention model on alcohol and substance use to suicidal outcomes and depression. Treatment development will follow recommendations of Rounsaville et al. (2001) and will culminate in a pilot randomized controlled trial (RCT) to determine the effects associated with CBT-RP (n=36). The first aim of this project is to develop and refine treatment manuals and procedures for CBT-RP and for "enhanced supportive care" (the comparison intervention in the pilot RCT). The second aim is to develop and pilot test procedures for training CBT-RP therapy and enhanced supportive care. The third aim is to assess the feasibility of CBT-RP and enhanced supportive care via monitoring of recruitment and retention of subjects, monitoring of therapist adherence to the protocol, and monitoring of adverse events. The fourth aim is to assess the feasibility of assessment methods as reflected in the burden of completing assessments. The fifth aim is to estimate the degree of change and variability of response to CBT-RP + fluoxetine relative to enhanced supportive care + fluoxetine on the primary outcomes (suicidal ideation, depressive symptoms, and substance abuse problem severity). Fluoxetine is prescribed for all adolescents in the study (a) to improve the generalizability of findings (given that the majority of depressed, treatment -seeking youths receive antidepressant medication), and (b) because of ethical concerns about withholding an efficacious treatment for depression with a vulnerable group. The final aim is to assess the acceptability of CBT-RP via exit interviews and ratings of patient satisfaction. These results will be used to design an adequately powered, multi-site RCT examining the efficacy of CBT-RP for suicidal dually diagnosed adolescents.