Relapse Prevention for Suicidal Dually Diagnosed Youths

双重诊断自杀青少年的复发预防

• 批准号: 7097350
• 负责人: DAVID B. GOLDSTON
• 金额: $ 20.33万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-19 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7097350
• 关键词: adolescence (12-20); behavioral /social science research tag; clinical depression; clinical research; cognitive behavior therapy; comorbidity; fluoxetine; human subject; human therapy evaluation; mental disorder prevention; outcomes research; patient oriented research; relapse /recurrence; substance abuse related disorder; suicide

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.

描述（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。酒精和药物滥用障碍以及抑郁症都与青少年自杀行为的风险增加有关，并且通常同时发生。然而，尚未专门针对双重诊断出自杀倾向的青少年制定干预措施。本研究的目的是针对该人群开发、完善和试点测试认知行为复发预防干预措施 (CBT-RP)。 CBT-RP 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，并将复发预防模型最初对酒精和药物使用的关注点扩展到自杀结果和抑郁症。治疗方案的开发将遵循 Ronsaville 等人的建议。 (2001) 并将最终进行一项试点随机对照试验 (RCT)，以确定与 CBT-RP 相关的效果 (n=36)。该项目的首要目标是开发和完善 CBT-RP 和“强化支持护理”（试点 RCT 中的比较干预）的治疗手册和程序。第二个目标是开发和试点测试程序，用于培训 CBT-RP 治疗和加强支持性护理。第三个目标是通过监测受试者的招募和保留、监测治疗师对方案的遵守情况以及监测不良事件来评估 CBT-RP 和加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。第五个目标是评估 CBT-RP + 氟西汀相对于强化支持治疗 + 氟西汀在主要结局（自杀意念、抑郁症状和药物滥用问题严重程度）方面的反应变化程度和变异性。研究中为所有青少年开了氟西汀 (a) 是为了提高研究结果的普遍性（考虑到大多数抑郁的、寻求治疗的青少年都接受抗抑郁药物治疗），(b) 出于道德方面的考虑，拒绝对抑郁症进行有效的治疗与弱势群体。最终目标是通过离职面谈和患者满意度评级来评估 CBT-RP 的可接受性。这些结果将用于设计一项动力充足的多中心随机对照试验，检验 CBT-RP 对双重诊断的自杀青少年的疗效。