EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt

Randomized controlled trial for the Attempted Suicide Short Intervention Program (ASSIP): An independent non-replication study

Following the call for rigorous replication practices in crisis intervention and suicide prevention research, this study re-evaluated the efficacy of a brief intervention (ASSIP - Attempted Suicide Short Intervention Program) for patients with a recent suicide attempt in reducing repeated suicidal behavior. In this open-label, randomized, controlled parallel-group trial, 92 patients were assigned to treatment as usual (TAU) or TAU plus ASSIP. The primary outcome was suicidal behavior (suicide attempts and suicide deaths) during a 12-month observation period. Secondary outcomes included the number of suicide attempts and psychiatric inpatient admissions. Twelve patients in the intervention group and six patients in the control group engaged in suicidal behavior, including one suicide death in each group. The intention-to-treat (ITT) analysis found no significant effect of ASSIP in reducing suicidal behavior or admission to psychiatric hospitals. Surprisingly, the per-protocol (PP) analysis revealed a significantly higher incidence rate of suicide re-attempts in the intervention group. Contrary to the original findings, this non-replication study suggests that ASSIP combined with TAU does not significantly reduce suicidal behavior compared to TAU alone. Further research is needed to refine indications for ASSIP therapy and enhance its effectiveness.

EEG-vigilance regulation is associated with and predicts ketamine response in major depressive disorder

Ketamine offers promising new therapeutic options for difficult-to-treat depression. The efficacy of treatment response, including ketamine, has been intricately linked to EEG measures of vigilance. This research investigated the interplay between intravenous ketamine and alterations in brain arousal, quantified through EEG vigilance assessments in two distinct cohorts of depressed patients (original dataset: n = 24; testing dataset: n = 24). Clinical response was defined as a decrease from baseline of >33% on the Montgomery-Åsberg Depression Rating Scale (MADRS) 24 h after infusion. EEG recordings were obtained pre-, start-, end- and 24 h post- infusion, and the resting EEG was automatically scored using the Vigilance Algorithm Leipzig (VIGALL). Relative to placebo (sodium chloride 0.9%), ketamine increased the amount of low-vigilance stage B1 at end-infusion. This increase in B1 was positively related to serum concentrations of ketamine, but not to norketamine, and was independent of clinical response. In contrast, treatment responders showed a distinct EEG pattern characterized by a decrease in high-vigilance stage A1 and an increase in low-vigilance B2/3, regardless of whether placebo or ketamine had been given. Furthermore, pretreatment EEG differed between responders and non-responders with responders showing a higher percentage of stage A1 (53% vs. 21%). The logistic regression fitted on the percent of A1 stages was able to predict treatment outcomes in the testing dataset with an area under the ROC curve of 0.7. Ketamine affects EEG vigilance in a distinct pattern observed only in responders. Consequently, the percentage of pretreatment stage A1 shows significant potential as a predictive biomarker of treatment response.Clinical Trials Registration: https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-000952-17/CZ Registration number: EudraCT Number: 2013-000952-17.