Igor Galynker - US grants

Methadone maintenance therapy (MMT), a standard treatment for opiate- dependent patients purportedly produces beneficial effects through its action as a substitute in an endogenous opioid deficiency syndrome. Nonetheless, direct evidence of persistant abnormalities in brain function of opiate-dependent patients, who are free of medication and illicit drugs of abuse, is lacking. The purpose of this study is to address this question by using the [F-18] fluorodeoxy glucose (FDG) method and positron emission tomography (PET) to assay regional cerebral metabolic rate(s) for glucose (rCMRglc), and index of local brain function. Subjects who have histories of opiate dependence will be compared with nonopiate-abusing control subjects matched for socioeconomic status, gender, and age. The proposed research will ask the following questions: 1) Is opiate dependence associated with persistent abnormalities in regional brain function, as assessed by measurement (as evidenced by differences in) of rCMRglc; and 2) Are potential abnormalities in rCMRglc, seen in abstinent patients at least six months after cessation of MMT as compared with controls, absent in patients who have received MMT for at least 6 months? Answers to these questions would have bearing on the theory that long-term deficiency of endogenous opioids leads to persistent cerebral dysfunction that can be ameliorated by MMT. The long-term goals of this project and its possible extensions are a comprehensive understanding of the relationship between neuroanatomical, neurochemical and clinical factors pertaining to opiate addiction, and its treatment, and the design of more effective therapeutic strategies.

Project Summary/Abstract Despite years of research and intensified public attention, suicide rates continue to climb and suicide remains a leading cause of death for 18-65 year-olds in the United States. Half of suicide decedents see a clinician in the months prior to dying by suicide providing a unique opportunity for a potentially life-saving intervention. Working with suicidal patients is highly stressful for clinicians and often elicits powerful negative emotional responses that may adversely affect suicidal outcomes. Possible reasons lie in that negative emotional responses may result in less empathic communication and unwitting rejection of the patient, which are liable to damage the therapeutic alliance. Thus there is a need for clinician training in effective management of their negative emotions towards suicidal patients, which would result in the improvement of suicidal outcomes. To be impactful, the training must be web-based, scalable and easy to disseminate. In this project, we will adress this critical need and use Vitrual Human Interaction (VHI) to train outpatient clinicians in emotional self-awarenss (ESA), which includes both recognition of one's own negative emotional respones and ability to engage in verbal empathic communication with acutely suicidal patients. Further, we will establish if the VHI ESA training intervention for clinicians will be superior to the VHI Control condition of risk assessment in reducing their patients' suicidal ideation and the severity of their Suicide Crisis Syndrome. We will also determine if therapeutic alliance is a mediator of the relationship between clinicians' ESA and their patients' suicidal outcomes. For this purpose, we will use our established empathy- teaching platform and we will assess verbal empathy with the Empathic Communication Coding System, and will assess the impact of clinician training with our novel validated instruments: the Therapist Response Questionnaire ? Suicide Form which assesses negative emotional responses to suicidal patients, and the Suicide Crisis Inventory, which predicts near-term suicidal behavior. If we are sucessful, the proposed work may have a broad impact on clinician training and practice by adding an ESA dimension to clinicians' training in evidence-based suicide risk assessment. Suicide is preventable and it is our goal to create an industry-standard platform to train clinicians in ESA, thereby improving their skills and confidence in interacting with suicidal patients, which can ultimately save lives.