Psychiatry Consultation Liaison Service Research

National Institute Of Mental Health

Investigators

Linked publications, trials & patents

Abstract

The main areas of OCD research are: Suicide Risk Screening in the Medical Setting Suicide is an international public health threat. In the U.S., it is the 2nd leading cause of death for youth and the 10th leading cause of death for adults. The Director of NIMH, Dr. Joshua Gordon has made suicide prevention research an NIMH priority and has a mission to reduce the national suicide rate by 20% by the year 2025. As suicide risk screening becomes a national priority for medical settings, non-mental health clinicians require valid, psychometrically-sound screening instruments for assessing suicide risk. However, there are very few suicide risk screening instruments that have been validated empirically with medically ill patients in hospital settings. Recognizing this gap early and capitalizing on clinical and research expertise within our group, we began developing a risk of suicide screen for pediatric patients in the emergency room in 2008 that resulted in a validated tool, the ASQ (Ask Suicide Screening Questions). Due to public demand, the ASQ has now been translated into 12 languages including Spanish, French, Dutch, Arabic, Portuguese, Hebrew, Korean, Japanese, Russian, Vietnamese, Somali and Chinese and is currently being implemented in emergency departments, inpatient medical units and outpatient primary care clinics in the U.S. and abroad. The tool has now been expanded to include the materials necessary for hospitals to begin to implement their own suicide risk screening programs, including scripts for nurses, flyers for parents, and other helpful resources. The ASQ toolkit can be found at the NIMH website http://www.nimh.nih.gov/ASQ for public use. The ASQ Toolkit has been viewed by the public over 220,000 times and has guided medical practitioners in hospital settings across the country. Since the development of the ASQ, the focus of our ongoing suicide risk screening studies has been to develop and validate brief screening instruments that can be administered by non-mental health clinicians in other medical settings and with specific patient populations. We currently have 5 IRB-approved protocols addressing suicide screening in different medical settings (NCT00623493, NCT02140177, NCT02050867, NCT02830334). We are addressing areas of need, including pediatric and adult emergency department patients, pediatric and adult medical inpatients, and are developing a screening tools for individuals with Autism Spectrum Disorder and Intellectual Disabilities. We are beginning to collaborate with the Indian Health Service (IHS) to integrate universal suicide risk screening in all medical facilities, and with school and detention facilities to assist in their utilization of the ASQ to screen students and inmates, respectively. Our research team worked closely with NIH Clinical Center leadership to meet the Joint Commission recommendations and were on the team of leaders that rolled out suicide risk screening in both adult and pediatric inpatients at the NIH Clinical Center. Turning research into practice, we are utilizing our research to inform implementation of suicide risk screening at the NIH CC and hospitals and pediatric outpatient primary care and specialty clinics nationwide. Public health outreach has been increased by intense media attention after Dr. Horowitz was part of a group of researchers who published a study on the increase in suicide rate after the release of a popular Netflix Series 13 Reasons Why. Mental Health Aspects of Coping with Chronic Medical Illness Born out of our clinical work on the PCLS and Neuropsychology Assessment Service for the past decade, a natural research focus has emerged from our collaborative work with other Institutes at NIH. For example, working with the Pediatric Oncology Branch we began to study distress and its correlates in medically ill children, particularly those with life-limiting illnesses, through several protocols over the past 6 years ( NCT02423031). The collaboration has been highly productive leading to the development of the first advance care planning guide for adolescents and young adults with life-limiting illnesses, Voicing My CHOiCES. This planning guide is available at www.agingwithdignity.org. Based on focus group interviews with patients an updated version of this tool is in progress. In addition, our work in quantifying distress using a thermometer was implemented in a pilot assessment of adult patients undergoing radiation treatment at the Clinical Center in 2018. Development and validation of Checking In, a brief electronic interactive screening measure of distress designed to identify emotional, physical, social, practical and spiritual concerns of pediatric patients, is now in a feasibility testing phase, with a plan to test the instrument in several different community settings. An accompanying provider summary sheet that delineates patient report of distress will allow providers to triage services to patients and their families, thereby enhancing patient quality of life throughout their treatment trajectoryconsistent with the standards of psychosocial care for children with cancer and their families. Neuropsychiatric Aspects of Immune and Infectious Disorders (including HIV/AIDS), Genetic, and other Disorders The OCD Neuropsychology Assessment Service is involved in a broad range of research protocols that are studying cognitive and emotional functioning in various medical groups. These research protocols include genetic disorders (such as Mobius syndrome, methylmalonic academia, McCune-Albright syndrome, Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy (CADASIL)), infectious and immune diseases (HIV, progressive multifocal leukoencephalopathy, Ebola, anti-NMDA receptor encephalitis), brain tumor (re-irradiation effects), and chronic fatigue syndrome. In addition, the OCD Neuropsychology Assessment Service also plays a vital role in assisting NINDS researchers who are studying Parkinson's disease, epilepsy and other disorders. A large focus of these neuropsychiatric studies is HIV/AIDS. HIV-related research activities in the OCD fall into two categories: 1) NIH Intramural NeuroHIV Program, and 2) Collaborations with multi-site research networks, including an NIH DoD HIV/AIDS associated neurocognitive disorder protocol. Given the opioid crisis, we are developing a clinical trial protocol to assess the mental health and substance abuse status of HIV patients and build a comprehensive interdisciplinary approach to HIV, mental health and substance use services in DC with colleagues in NIAID, the CC and NIDA. NIMH Clinical Research Support The aim of the Research Volunteer (RV) protocol (17-M-0181) is to find and screen adult volunteers in good health for participation in research studies at the NIMH Intramural studies (NCT03304665). The study also includes optional brain MRI and MEG that will help build a normative set of scans that are linked to clinical information collected from healthy research volunteers. Deidentified data from volunteers are broadly shared with other researchers to maximize scientific impact. Study highlights include the use of an online website for initial consent and self-report survey measures, followed by an in-person appointment for clinical evaluation for study eligibility. Since the inception of the study in fall 2017, approximately 800 volunteers, most of whom are new to NIH, have consented and undergone initial screening; over 200 have been enrolled and had the in-person assessment; more than 100 have had a brain MRI. There is a strong interest by NIMH research groups for referrals of RVs from our pool of volunteers and recruitment of RVs is ongoing. Data from the study have been submitted to the NIMH Data Archive (NDA) repository.