Validation of an fMRI measure of Real Time Non-Suicidal Self-Injury

非自杀性自伤(NSSI)，指对身体组织的直接和故意的破坏或改变，而非自杀性 意图，是一个重大的公共卫生问题，可能导致严重的残疾后果，包括永久性的身体 受伤和反复住院。此外，NSSI和相关行为产生了巨大的社会成本， 仅医疗和生产力损失一项，每年就总计约330亿美元。 神经成像研究还显示，有和没有脑血管疾病病史的个体之间存在皮质边缘的差异。 NSSI负责情绪调节和身体疼痛，最显著的是前额叶皮质和杏仁核. 然而，到目前为止，还没有研究直接检查体内NSSI行为的神经回路。这是一个很大的问题 部分原因是缺乏体内NSSI的fMRI任务。自我攻击范式(SAP)是一种行为NSSI 使用自己选择的电击作为NSSI模拟的任务。除了是为数不多的经过验证的 NSSI行为任务，SAP是NSSI中唯一一个既决定自我伤害又决定 自我伤害的强度完全由参与者控制，就像在实际的NSSI中一样。SAP拥有 用于确定NSSI的假定危险因素(例如，酒精中毒、 抑郁、5-羟色胺耗竭)和自我伤害。为了满足直接研究大脑机制的需要 为了实时参与NSSI和NSSI的变化，研究团队开发了fMRI版本的 萨普。在本申请中提出的研究将允许我们(1)评估fMRI-SAP的有效性和(2) 对与实时自残相关的神经激活和连接模式进行试验性检查 在有(或没有)有临床意义的NSSI病史的个体中。30名NSSI障碍患者 (NSSI+：N=30)和30名没有NSSI病史的匹配参与者(NSSI+：N=30)将完成临床试验 访谈评估精神病理学(包括NSSI障碍)，然后是NSSI的自我报告测量- 相关的危险因素和疼痛耐受性的行为测量。参与者随后将经历一段短暂的情绪 诱导急剧增加负面情绪(NSSI的一个常见前置因素)，然后是功能性 在功能磁共振成像SAP期间进行神经成像。我们假设NSSI参与者将选择更高的震荡 FMRI SAP和那些患有NSSI的人中，自我休克的水平将与NSSI的严重性相关(证据 FMRI-SAP效度)。我们还假设前额叶减少，杏仁核增加 激活以及眼眶额叶-前扣带回和眼眶额叶-杏仁核连接性降低 NSSI+(vs NSSI-)参与者在fMRI-SAP上进行休克试验。

Non-suicidal self-injury (NSSI), the direct and deliberate destruction or alteration of body tissue without suicidal intent, is a major public health issue that can lead to severely disabling outcomes including permanent physical injuries and recurrent hospitalizations. Furthermore, NSSI and related acts of produce a great societal cost, with medical treatment and lost productivity alone summing to approximately $33 billion dollars per year. Neuroimaging studies also show cortico-limbic differences between individuals with and without a history of NSSI the on tasks of emotion regulation and physical pain, most notably the prefrontal cortex and amygdala. However, to date no studies have directly examined the neurocircuitry of in-vivo NSSI behavior. This is in large part due to the dearth of fMRI tasks of in-vivo NSSI. The Self Aggression Paradigm (SAP) is a behavioral NSSI task that uses self-selected shock as an NSSI analogue. In addition to being one of the very few validated NSSI behavioral tasks, the SAP is the only NSSI analogue in which both the decision to self-harm as well as the intensity of self-harm is completely under the control of the participant, as it is in actual NSSI. The SAP has been used to identify the causal relationship between putative risk factor for NSSI (e.g. alcohol intoxication, depression, serotonin depletion) and self-harm. To address the need to directly study brain mechanisms involved in NSSI and changes in NSSI in real time, the research team has developed an fMRI version of the SAP. The study proposed in this application would allow us to (1) assess the validity of the fMRI-SAP and (2) conduct a pilot examination of neural activation and connectivity patterns associated with real time self-harm among individuals with (and without) a clinically significant NSSI history. Thirty participants with NSSI disorder (NSSI+: n= 30) and 30 matched participants with no history of NSSI (NSSI+: n =30) will complete a clinical interview assessing psychopathology (including NSSI disorder) followed by self-report measures of NSSI- related risk factors and a behavioral measure of pain tolerance. Participants will then undergo a brief mood induction to acutely increase negative affect (a common antecedent of NSSI) followed by functional neuroimaging during the fMRI SAP. We hypothesize that NSSI participants will select higher shocks on the fMRI SAP and that among those with NSSI, the level of self-shock will correlate with NSSI severity (evidence of fMRI–SAP validity). We also hypothesize there will be decreased prefrontal and increased amygdala activation as well as decreased orbitofrontal-anterior cingulate and orbitofrontal-amygdala connectivity for NSSI+ (vs NSSI-) participants on shock trials on the fMRI-SAP.