The Phenomenology and Antidepressant Treatment of Depressed, Frail Older Adults

抑郁、虚弱老年人的现象学和抗抑郁治疗

• 批准号: 8581067
• 负责人: Patrick J Brown
• 金额: $ 18.59万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8581067
• 关键词: Academic Training; Acute; Affect; Age; Antidepressive Agents; Attenuated; Award; Behavioral; Biological; Biometry; Body Weight decreased; C-reactive protein; Cardiovascular system; Cessation of life; Characteristics; Chronic; Classification; Clinical; Cognition; Cognitive; Comorbidity; Complex; DSM-IV; Data; Depressed mood; Diagnosis; Diagnostic; Disease; Doctor of Philosophy; Dysthymic Disorder; Elderly; Epidemiologist; Escitalopram; Ethical Issues; Family; Fellowship; Frail Elderly; Frail Older Adults; Gait; Geriatric Psychiatry; Geriatrics; Goals; Hamilton Rating Scale for Depression; Health; Health Care Costs; Hospitalization; Inflammation; Institutionalization; Interleukin-6; Intervention; Intervention Studies; K-Series Research Career Programs; Knowledge; Long-Term Effects; Major Depressive Disorder; Malnutrition; Measures; Medical; Mental Depression; Mentors; Mentorship; Modeling; Neuropsychology; Outcome; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Phase; Phenotype; Physical activity; Physiological; Placebo Control; Population; Program Development; Psychiatric therapeutic procedure; Psychiatrist; Psychologist; Psychopharmacology; Quality of life; Research; Research Personnel; Research Proposals; Risk; Sampling; Serum Albumin; Speed; Syndrome; System; Techniques; Testing; Therapeutic Intervention; Time; Training; Treatment Factor; Treatment outcome; Universities; World Health Organization; age related; authority; base; career; career development; depressive symptoms; design; disability; duloxetine; exhaustion; experience; falls; follow-up; frailty; geriatric depression; grasp; improved; inflammatory marker; interest; meetings; multidisciplinary; neuropsychiatry; neuropsychological; older patient; open label; patient oriented; patient oriented research; public health relevance; response; skills; white matter

DESCRIPTION (provided by applicant): The purpose of this application is to support the patient-oriented research program and career development of Patrick J. Brown, PhD, a fellowship-trained academic researcher and clinical psychologist at Columbia University. Dr. Brown's overall goal is to develop into an independent investigator with a focus on the assessment and treatment of diagnostically complex geriatric patients with neuropsychiatric disorders. The depressed, frail phenotype represents the most promising avenue to understand how to improve intervention outcomes for geriatric patients with diagnostically complex medical and psychiatric comorbidity. The complexity of this clinical population requires Dr. Brown receive cross training in the principles of geriatric medicine to apply these principles to psychiatric interventions research. As such, he has constructed a multidisciplinary training plan under the mentorship of Dr. Steven Roose, a psychiatrist and authority on the clinical, demographic, and treatment factors affecting response to antidepressants, Dr. Mathew Maurer, a cardiologist with research interests in cardiovascular health and anergia in older patients, and Dr. Linda Fried, a geriatrician, epidemiologist and expert in the concept of frailty, along with advisors in neuropsychology, psychopharmacology, biostatistics, and responsible conduct in research. During the proposed award, Dr. Brown will obtain formal training via coursework, patient-oriented experiences, and expert tutelage in 1) the assessment and understanding of the biological, neuropsychological, and physical characteristics common to frailty and depression, 2) the design, conduct, and analysis of therapeutic interventions, and 3) the complex ethical issues in geriatric research. The overall goal of this research proposal is to understand the depressed frail phenotype. Although depression and frailty individually result in dire outcomes for patients and families and appear to be phenomenologically and physiologically associated, the syndrome of frailty has never been explicitly studied in the context of late life depression. Based on his pilot data and the diagnostic complexities of these two conditions, Dr. Brown had constructed a model of this phenotype and hypothesized that the presence of specific frailty characteristics at baseline will diminish response to antidepressant treatment. To investigate this model, Dr. Brown will conduct a 12-month deconstruction of the depressed, frail phenotype using antidepressant medication. In doing so, Dr. Brown will also assess markers of chronic inflammation and malnutrition in this older depressed frail population to begin to evaluate the potential mechanisms underlying the phenotype, and he will investigate the impact of baseline frailty characteristics on long-term improvement in activity levels and disability. At the end of this proposal, Dr. Brown will be better able to answer how the syndrome of frailty impacts the diagnosis of late life depression, and whether the syndrome of frailty diminishes response to antidepressant treatment. With this experience and skill set, Dr. Brown will combine the knowledge gained from both geriatric medicine and psychiatry to use multidisciplinary assessment techniques to refine our understanding of diagnostically complex geriatric patients with neuropsychiatric disorders and personalize therapeutic interventions targeted to maximize treatment outcome.

描述（由申请人提供）：本申请的目的是支持以患者为导向的研究计划和职业发展，Patrick J. Brown，Patrick J. Brown博士，哥伦比亚大学受过奖学金培训的学术研究员和临床心理学家。布朗博士的总体目标是发展成为独立研究者，重点是评估和治疗神经精神疾病的诊断复杂的老年患者。沮丧的脆弱表型是了解如何改善诊断复杂的医学和精神病合并症的老年患者的干预效果的最有希望的途径。该临床人群的复杂性要求布朗博士接受老年医学原理的交叉培训，将这些原理应用于精神病干预研究。 As such, he has constructed a multidisciplinary training plan under the mentorship of Dr. Steven Roose, a psychiatrist and authority on the clinical, demographic, and treatment factors affecting response to antidepressants, Dr. Mathew Maurer, a cardiologist with research interests in cardiovascular health and anergia in older patients, and Dr. Linda Fried, a geriatrician, epidemiologist and expert in the concept of frailty, along with神经心理学，心理药理学，生物统计学和负责任的顾问。在拟议的奖励期间，布朗博士将通过课程，面向患者的经验以及专家指导进行正式培训，以评估和理解脆弱和抑郁症常见的生物学，神经心理学和身体特征，2）治疗性干预措施的设计，行为和分析，以及3）在囊肿研究中的复杂伦理问题。该研究建议的总体目标是了解抑郁症的脆弱表型。尽管抑郁症和脆弱单独导致患者和家庭带来可怕的结果，并且在现象学和生理学上似乎是与之相关的，但在晚期抑郁症的背景下，从未明确研究过脆弱的综合征。基于他的试验数据和这两种情况的诊断复杂性，布朗博士构建了这种表型的模型，并假设基线时存在特定的脆弱特征会减少对抗抑郁治疗的反应。为了研究该模型，布朗博士将使用抗抑郁药对抑郁症的脆弱表型进行12个月的解构。在此过程中，布朗博士还将评估这个较老的弱体弱人群中慢性炎症和营养不良的标志物，以开始评估表型的潜在机制，他将研究基线脆弱特征对活动水平和残疾的长期改善的影响。在该提案的结尾，布朗博士将更好地回答脆弱综合征如何影响晚期抑郁症的诊断，以及脆弱综合征是否会减少对抗抑郁治疗的反应。借助这种经验和技能，布朗博士将结合老年医学和精神病学获得的知识，以使用多学科评估技术来完善我们对具有神经精神疾病的诊断复杂的老年患者的理解，并为患有治疗干预措施的个性化治疗措施，以最大程度地提高治疗结果。