Death by suicide is the 2nd leading cause of death among young adults in the United States. While most patients who die by suicide have had recent contact with their health care providers, the medical delivery system is poorly equipped to address this preventable issue. EMA (ecological momentary assessment) systems show promise as indicators of suicide risk and as a means of enhancing existing resources. However, little is known about how to apply these methods in the context of clinical care. The AMPERE study leverages existing work on EMAs and human-centered design principles to develop and pilot a prototype suicide risk monitoring system to support suicide risk management for adolescents and young adults (ages 16-30) within the UW Medicine Primary Care system.
Geographic Area: University of Washington
Behaviors and Executive Skills in T21 (BEST21)
We are conducting a study to understand the role of problem-solving in challenging behaviors for children with Down syndrome so that we can better understand the development of and treat these behaviors. If you agree to participate, this study will involve questionnaires, some of which may be completed at home. You would also attend an in-person visit that involves measuring your child’s naturally-occurring brain activity with EEG as well as cognitive assessments. We would schedule your visit around your schedule to the best of our ability and we can schedule this visit in a location that is convenient for you (UW, home visits, etc.). Participants will receive an $80 gift card to thank them for their time.
Improving treatment strategies and clinical outcomes in patients with first-episode psychosis and substance use disorders
Our project will seek to identify factors associated with gaps in transitions of care for psychiatric inpatients who presented with substance-induced psychosis (SIP) for the first time. We will analyze historical electronic health record data of patients who were treated for psychosis at Harborview Medical Center. We will test the hypotheses that (1) treatment with long-acting injectable antipsychotics (LAI) and referrals to outpatient behavioral health are lower for patients diagnosed with first-episode SIP compared to those diagnosed with first-episode psychosis and that (2) patients diagnosed with first-episode SIP will have worse post-discharge outcomes (rehospitalization, ED utilization), in part due to lower use of LAI.
Strengthening financial literacy for people living with serious mental illness
Improved financial literacy among people living with serious mental illness (SMI) is associated with a higher quality of life, fewer hospitalizations, and better treatment adherence. Yet people living with SMI frequently express how their lack of financial knowledge has negative personal consequences and that they don’t know where to turn for assistance. This project will gather qualitative and quantitative data from people admitted to the Center for Behavioral Health and Learning, a psychiatric hospital, to understand the need and desire for a financial skills intervention and its role in discharge planning. The assessment will also seek input from family members/caregivers, representative payees/fiduciaries and experts in the community. Ultimately, we hope to create a replicable, standardized intervention that can be evaluated and implemented in inpatient settings and modified as necessary for outpatient settings.
Once-weekly GLP-1R agonist dulaglutide for treatment of fentanyl use disorder and modulation of lateral habenula activity in male and female rats
Current pharmacological treatments for fentanyl use disorder, primarily opioid replacements, have proven insufficient to stem the tide of fentanyl related suffering and deaths. Novel pharmacotherapies are desperately needed, ideally ones that are non-opioid, highly convenient, and produce minimal side effects. One promising class of drugs that meets these criteria are glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) agonists. Endogenous GLP-1 is released in response to food intake, but GLP-1Rs are present in many tissues throughout the body, including brain regions involved in addiction. Early studies have shown GLP-1R agonists may reduce drug seeking. Here, we aim to determine if the long acting GLP-1R agonist dulaglutide, given once weekly, can reduce fentanyl SA for a substantial period of time (3 weeks), even after SA has been established.
Determining if activity in specific lateral habenula output pathways motivates avoidance of synthetic opioid withdrawal or cue induced reinstatement
Fentanyl abuse has reached epidemic proportions in the United States and is responsible for more than 70,000 overdose deaths each year. Avoidance of significant physical and emotional turmoil during withdrawal and exposure to drug-associated cues are two key deterrents to voluntary abstinence in those suffering from substance abuse disorder. By investigating the localized neuronal projections responsible for motivating avoidance of withdrawal, and processing reward cues, we may be able to produce targeted pharmacotherapies or genetic therapies to improve the rate of voluntary abstinence.
Default mode network impairments in comorbid anxiety and cannabis use disorders
Social anxiety disorder (SAD) is characterized by maladaptive self-focused attention (SFA), which itself is correlated with large scale brain network connectivity impairments. Cannabis use disorder (CUD) is commonly conceptualized as impaired reward processing within the ventral dopaminergic network, however, it is also implicated in connectivity disturbances in other critical cortical circuits. In the current study we will characterize the large scale brain network impairment in comorbid SAD and CUD given commonly overlapping symptoms and population prevalence
Psychosis beyond symptoms: Cognitive and genetic biomarkers of schizophrenia
Schizophrenia is a prevalent, debilitating psychiatric disorder that is diagnosed based on clinical interviews that are subjective and highly variable; in fact, two patients can have no overlapping symptoms and be diagnosed with the same disease. While cardiologists have blood tests to help diagnose heart attacks and oncologists have PET scans to find hidden cancers, psychiatrists don’t have objective diagnostic tests. This proposal will utilize machine learning to analyze cognitive tests, brain electrical activity, and genetic signatures from 1,415 patients with schizophrenia and 1,062 controls to uncover biomarkers of schizophrenia. By incorporating biomarkers into diagnostic standards, psychiatrists could one day order a simple test that could help them confidently diagnose schizophrenia and make better treatment decisions based on quantitative rather than subjective measures.
Self-directed mindfulness in medically hospitalized patients: a pragmatic trial
Consultation-liaison psychiatrists are often asked to manage mood and anxiety symptoms experienced by patients admitted to medical and surgical floors of the hospital. This study aims to determine the feasibility and effectiveness of a self-directed mindfulness intervention as an adjunctive treatment for improving mood, anxiety, and perceived stress in medically hospitalized patients. Participants, consisting of patients evaluated by the consultation-liaison psychiatry service, will be randomized to an adjunctive mindfulness intervention group or a treatment-as-usual control group. Feasibility and acceptability of implementing a mindfulness intervention will be assessed. Group differences in the changes in symptom severity and psychotropic medication administration will be investigated.
Family and Caregiver Training and Support Program (FACTS) pilot
We know from decades of research that caregiver involvement, including family and non‐family members, in a patient’s mental health treatment can make a tremendous difference in the trajectory of their loved one’s life by supporting recovery, reducing relapse, and decreasing mental health crises. Family and caregiver involvement also decreases provider stress, improves caregiver well-being, and can lead to lower patient healthcare utilization and costs. But despite their importance, many family members and caregivers struggle to engage in the kind of support that can benefit the patient and themselves. They often lack access to education, resources, or skills to step into this critical role despite a desire to help. Our initiative intends to develop a pilot Family and Caregiver Training and Support Program (FACTS) program that aims to decrease barriers to caregiver involvement and improve caregiver support.
Our team will develop online training that will include an orientation to having a loved one who is psychiatrically hospitalized and will teach families and caregivers practical communication skills while their loved one is in our care. These topics would be relevant regardless of a patient’s diagnosis and will be adapted from existing evidence‐based models. The pilot will be tested with caregivers of patients hospitalized at the new Center for Behavioral Health and Learning and we will proactively integrate input and feedback from participants to inform program improvements along the way.
We will also build a public-facing website to host FACTS training materials as well as mental health information and resources that we will curate for accuracy and reliability. We expect the FACTS pilot content will serve as a foundation for additional offerings that will include diagnosis specific skills trainings as well opportunities for in-person sessions and Family Peer Support programming.
