This study, titled "Neural Correlates of Suicidal Behavior in Youth: a Pre and Post CAMS Therapy Neuroimaging Study," aims to better understand the brain mechanisms underlying suicidal thoughts and behaviors in adolescents and young adults (ages 14-24). Suicide is a leading cause of death in this population, and current clinical approaches often fail to accurately predict or prevent suicidal behavior. This study seeks to identify objective neurobiological markers associated with suicide risk and treatment response.
Participants will be divided into three groups: (1) high-risk individuals recently hospitalized following a suicide attempt, (2) medium-risk individuals with chronic suicidal ideation but no attempts, and (3) low-risk healthy controls. All participants will undergo advanced neuroimaging, including magnetoencephalography (MEG) and magnetic resonance imaging (MRI), along with comprehensive psychiatric assessments.
The study focuses on brain regions and networks implicated in suicidality, including the anterior cingulate cortex and salience network, as well as neurochemical markers such as glutamate. It also examines electrophysiological activity and functional connectivity patterns associated with suicidal thoughts and behaviors.
High-risk participants will receive an evidence-based psychotherapy called the Collaborative Assessment and Management of Suicidality (CAMS). This therapeutic approach emphasizes collaboration between patient and clinician to identify and address the underlying drivers of suicidal thoughts, with a focus on increasing hope and reducing psychological distress. Neuroimaging and clinical assessments will be repeated after completion of CAMS to evaluate treatment-related changes.
The study's primary goals are to:
* Identify neural and electrophysiological correlates of suicide risk. * Distinguish biological differences between individuals with suicidal ideation and those who have attempted suicide. * Determine how CAMS therapy affects brain function and neurochemistry.
By integrating clinical and neurobiological data, this research aims to improve understanding of suicidality, enhance risk prediction, and inform more effective, personalized interventions for at-risk youth.
Subjects must be 14-24 years old
High Risk Subjects: Psychiatrically admitted due to a suicide attempt or history of 2 previous suicide attempts
Medium Risk Subjects: Suicide ideation for the past year with no suicide attempt
Minimal Risk Subjects: No previous history of suicidal ideation or behavior, not taking any psychiatric history or medication, and no family history of suicide
Subjects with known history of Autism Spectrum Disorder; non-verbal patients
Subjects with moderate or severe intellectual disability (IQ less than 70 and those patients in special education classes full time)
Subjects with Schizophrenia or history of any type of psychosis including mood related psychosis and brief reactive psychosis
Within 6 months before initial screening, urine toxicology positive for phencyclidine, cocaine or amphetamines (subjects prescribed amphetamines for the management of ADHD will not be excluded)
Parallel
CAMS
BehavioralCAMS weekly sessions will be started immediately as an inpatient at the start of the study for the high risk participants. CAMS will be continued weekly after the patient is discharged and followed up as an outpatient. Weekly CAMS sessions will be terminated after the subject, as an outpatient, has three consecutive outpatient CAMS sessions with an overall risk \< 2 (# 6 on the SSF Core Assessment) along with a positive response regarding their thoughts/feelings and clinician indicating behavioral stability (suicidal behavior).
MEG and suicidality
Measure the difference on the connectivity within the salience network. This will be quantified using phase-locking values (PLV) across different frequency bands in 10-second intervals. The average PLV-based connectivity will serve as an electrophysiological biomarker for correlation with SI. To test hypothesis 1, salience network connectivity will be compared between groups using ANOVA.
Suicidality & network connectivity
To study the relationship of suicidality with network connectivity, activation during an episodic future thinking task, and MRS measures. To test this, activation strength of the ventral medial prefrontal cortex will be tested using a between-group ANOVA. Using the MRS voxel locations as a guide, functional connectivity between the pregenual anterior cingula cortex and anterior insula will be calculated. Glutamine and myo-inositol levels and rsfMRI strength will be compared using between-group ANOVAs.
CAMS on MEG and MRS metabolites
To investigate the the changes of Baseline SSF scoring before and after CAMS on MEG and MRS metabolites in the HR group. MRS measures of Glutamine and myo-inositol and MEG salience network measures will be tested using a repeated measures ANOVA. To test this, the change in Glutamine and myo-inositol levels will be calculated and correlated with measures of hopelessness and SI using the Beck Hopelessness Scale and Optimism and Hope scale along with the Beck SSI.
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The Cleveland Clinic
Lead sponsor
MQ Mental Health Research
Collaborator
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