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Kitay BM, Murphy E, Macaluso M, Corlett PR, Hershenberg R, Joormann J, Martinez-Kaigi V, Nikayin S, Rhee TG, Sanacora G, Shelton RC, Thase ME, Wilkinson ST. Cognitive behavioral therapy following esketamine for major depression and suicidal ideation for relapse prevention: The CBT-ENDURE randomized clinical trial study protocol. Psychiatry Res 2023; 330:115585. [PMID: 37935086 DOI: 10.1016/j.psychres.2023.115585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
In 2020, esketamine received a supplemental indication as a therapy for major depression with suicidal ideation (MDSI), based on protocols enrolling hospitalized patients. Given the high risk of suicide following hospital discharge and the high relapse rates following discontinuation of esketamine, the optimal long-term treatment approach remains unclear. Cognitive behavioral therapy (CBT) is highly effective in relapse prevention and has been shown to prevent suicide attempts in high-risk populations. Here we describe the study protocol for the CBT-ENDURE trial: Cognitive Behavioral Therapy Following Esketamine for Major Depression and SUicidal Ideation for RElapse Prevention. Patients with depression (N = 100) who are admitted to hospital or are outpatients with clinically significant suicidal ideation will be enrolled in the study. All patients will receive esketamine (twice weekly for four weeks) and will be randomly assigned (1:1 ratio) to receive a 16-week course of CBT plus treatment as usual (CBT group) or treatment as usual only (TAU only group). Patients are followed for a total of 6 months. Supported under a funding announcement from NIMH to conduct safety and feasibility trials for patients at high risk for suicide, the primary outcome of the CBT-ENDURE study is feasibility (as measured by recruitment and retention), with a key secondary outcome being relapse among those who experience substantial benefit following two weeks of esketamine.
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Affiliation(s)
- Brandon M Kitay
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Eva Murphy
- Department of Psychiatry, Yale School of Medicine, United States
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Philip R Corlett
- Department of Psychiatry, Yale School of Medicine, United States
| | - Rachel Hershenberg
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, United States
| | | | - Sina Nikayin
- Department of Psychiatry, Yale School of Medicine, United States
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, United States; Department of Public Health Science, School of Medicine, University of Connecticut, United States
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, United States
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Tinaz S, Para K, Vives-Rodriguez A, Martinez-Kaigi V, Nalamada K, Sezgin M, Scheinost D, Hampson M, Louis ED, Constable RT. Insula as the Interface Between Body Awareness and Movement: A Neurofeedback-Guided Kinesthetic Motor Imagery Study in Parkinson's Disease. Front Hum Neurosci 2018; 12:496. [PMID: 30581383 PMCID: PMC6292989 DOI: 10.3389/fnhum.2018.00496] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Intentional movement is an internally driven process that requires the integration of motivational and sensory cues with motor preparedness. In addition to the motor cortical-basal ganglia circuits, the limbic circuits are also involved in the integration of these cues. Individuals with Parkinson's disease (PD) have a particular difficulty with internally generating intentional movements and maintaining the speed, size, and vigor of movements. This difficulty improves when they are provided with external cues suggesting that there is a problem with the internal motivation of movement in PD. The prevailing view attributes this difficulty in PD to the dysfunction of motor cortical-basal ganglia circuits. First, we argue that the standard cortical-basal ganglia circuit model of motor dysfunction in PD needs to be expanded to include the insula which is a major hub within the limbic circuits. We propose a neural circuit model highlighting the interaction between the insula and dorsomedial frontal cortex which is involved in generating intentional movements. The insula processes a wide range of sensory signals arising from the body and integrates them with the emotional and motivational context. In doing so, it provides the impetus to the dorsomedial frontal cortex to initiate and sustain movement. Second, we present the results of our proof-of-concept experiment demonstrating that the functional connectivity of the insula-dorsomedial frontal cortex circuit can be enhanced with neurofeedback-guided kinesthetic motor imagery using functional magnetic resonance imaging in subjects with PD. Specifically, we found that the intensity and quality of body sensations evoked during motor imagery and the emotional and motivational context of motor imagery determined the direction (i.e., negative or positive) of the insula-dorsomedial frontal cortex functional connectivity. After 10-12 neurofeedback sessions and "off-line" practice of the successful motor imagery strategies all subjects showed a significant increase in the insula-dorsomedial frontal cortex functional connectivity. Finally, we discuss the implications of these results regarding motor function in patients with PD and propose suggestions for future studies.
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Affiliation(s)
- Sule Tinaz
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Kiran Para
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Ana Vives-Rodriguez
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Valeria Martinez-Kaigi
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Keerthana Nalamada
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Mine Sezgin
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dustin Scheinost
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Michelle Hampson
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Elan D. Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - R. Todd Constable
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
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