- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04905797
Aspects of Self-harm - Cognition, Imaging and Treatability
Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. This study aim at increased understanding of parameters associated with DSH with the long term goal to potentially improve and possibly personalise its treatment.
In short, the study will characterise cognitive, psychiatric and demographic factors with focus on executive function and will compare results from individuals with DSH, individuals who have ceased DSH as well as psychiatric patients without DSH and individuals who never engaged in DSH. Adequate statistical tests will be used to compare groups.
Participants will be interviewed by a trained physician for basic medical history, history of self-harm and treatment for that, demographic data and diagnostic evaluation. Thereafter the participants will undergo standardised neuropsychological testing focusing on emotional response inhibition, decision making and risk taking, attention set shifting, working memory, inhibition and planning. Some participants will redo parts of this testing during fMRI, as well as undergo DTI and volumetry.
Study Overview
Status
Intervention / Treatment
- Diagnostic test: Emotional Stop Signal Task
- Diagnostic test: Magnetic Resonance Imaging
- Other: World Health Organizations Disability Assessment Schedule (WHODAS 2.0)
- Diagnostic test: Personality Inventory for DSM-5 (PID-5)
- Diagnostic test: Stop Signal Task (CANTAB)
- Diagnostic test: Intra-Extra Dimensional Set Shift (CANTAB)
- Diagnostic test: Spatial Working Memory Test (CANTAB)
- Diagnostic test: Multitasking Test (CANTAB)
- Diagnostic test: Cambridge Gambling Task Test
Detailed Description
Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. Today, there is not sufficient knowledge as to why an individual continues to suffer from DSH, DSH is reduced or even ceased - regardless given treatment or not. The overall aim of this project is to characterise cognitive, psychiatric and demographic factors as well as perform brain imaging in individuals currently suffering from DSH, individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals. The intention is to gain more knowledge on factors associated with DSH and thereby potentially improve and possibly personalize treatment.
The following hypotheses will be tested:
Individuals currently suffering from DSH have lower scores on executive function than individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals.
Individuals currently suffering from DSH have lower level daily life functioning and more severe psychiatric symptoms than individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals.
Individuals currently suffering from DSH have higher scores of negative affectivity, lower scores of antagonism and lower scores of disinhibition measured with Personality Inventory for DSM-5 than individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals.
Individuals currently suffering from DSH have, when executing the neurocognitive tests in hypothesis 1, a significant lower blood flow in the prefrontal network, than individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals.
Individuals currently suffering from DSH have a decrease in local cerebral white matter compared to individuals with a prior history of DSH, individuals with psychiatric disease but no DSH and healthy individuals.
Material:
The aim is to recruit 300 participants in total, 75 participants to each group:
- individuals with psychiatric disorders and persistent DSH
- individuals with psychiatric disorders who have ceased DSH
- individuals with psychiatric disorders who never had DSH
- healthy controls who never had DSH
Participants will be interviewed by a trained physician for basic medical history, history of self-harm and treatment for that, demographic data and diagnostic evaluation. Thereafter the participants will undergo standardised neuropsychological testing focusing on emotional response inhibition, decision making and risk taking, attention set shifting, working memory, inhibition and planning. Some participants will redo parts of this testing during fMRI, as well as undergo DTI and volumetry.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Sofie Westling, MD PhD
- Phone Number: +46174901
- Email: sofie.westling@med.lu.se
Study Contact Backup
- Name: Christina Thylander, MD
- Email: Christina.thylander@med.lu.se
Study Locations
-
-
Skåne
-
Lund, Skåne, Sweden, 22185
- Recruiting
- Psykiatri och habilitering, Region Skåne
-
Contact:
- Sofie Westling, MD PhD
- Email: sofie.westling@med.lu.se
-
Contact:
- Christina Thylander, MD
- Email: Christina.thylander@med.lu.se
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Clinical participants will be recruited though a cohort listed on an out-patient psychiatric clinic in Lund.
Healthy controls will be recruited through through fliers placed on public advertisement boards.
Description
Inclusion criteria for persistent DSH group:
- Adults 18-65 years.
- Ability to leave informed consent.
- Understands and uses the Swedish language without significant difficulties.
- Psychiatric disorder and ongoing treatment at an adult psychiatric clinic.
- DSH at least five times during the last three months, and DSH at least ten times during at least one year.
Exclusion criteria for persistent DSH group:
- No history of DSH, and/or DSH fewer than five times during the last three months and fewer than ten times during at least one year
- Diagnosis of Intellectual disability
- Diagnosis of chronic psychotic disorder
- Hearing disability, visual impairment or motor disorder that rules out the ability to complete neurocognitive tasks
Inclusion criteria for those who have ceased DSH group:
- Adults 18-65 years.
- Ability to leave informed consent.
- Understands and uses the Swedish language without significant difficulties.
- Psychiatric disorder and ongoing treatment at an adult psychiatric clinic.
- No DSH during the last three months, but DSH at least ten times during at least one year.
Exclusion criteria for those who have ceased DSH group:
- Any DSH during the last three months, and/or fewer than ten times during the at least one year
- Diagnosis of Intellectual disability
- Diagnosis of chronic psychotic disorder
- Hearing disability, visual impairment or motor disorder that rules out the ability to complete neurocognitive tasks
Inclusion criteria for psychiatric disorder with no history of DSH group:
- Adults 18-65 years.
- Ability to leave informed consent.
- Understands and uses the Swedish language without significant difficulties.
- Psychiatric disorder and ongoing treatment at an adult psychiatric clinic.
Exclusion criteria for psychiatric disorder with no history of DSH group:
- Any DSH during the last three months, and more than two times during lifetime
- Diagnosis of Intellectual disability
- Diagnosis of chronic psychotic disorder
- Hearing disability, visual impairment or motor disorder that rules out the ability to complete neurocognitive tasks
Inclusion criteria for healthy control group:
- Adults 18-65 years.
- Ability to leave informed consent.
- Understands and uses the Swedish language without significant difficulties.
Exclusion criteria for healthy control group:
- Diagnosed with any psychiatric disorder
- Any DSH during the last three months, and more than two times during lifetime
- Hearing disability, visual impairment or motor disorder that rules out the ability to complete neurocognitive tasks
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Cross-Sectional
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Deliberate self-harm
Individuals with psychiatric disorders and persistent DSH
|
Emotional Stop Signal Task (modified version from CANTAB).
Outcome Measure is commission and omission errors - higher score (percentage) indicate worse performance.
Functional Magnetic Resonance Imaging (fMRI) Diffusion Tensor Imaging (DTI) Volumetry
Self-reported data on World Health Organizations Disability Assessment Schedule - 36 items self-administered (WHODAS 2.0).
Assessing six domains of functional disability in daily life.
Each item is rated on a Likert scale ranging from 0-4.
Total range 0 - 144.
High scores scores indicate more severe disability.
Self-rated personality traits through Personality Inventory for DSM-5 (PID-5).
Self-reported scores on domains of personality traits.
Higher scores in one domain indicate more pronounced traits in this domain.
The estimate of time where an individual can successfully inhibit their responses 50% of the time.
|
Clinical cases who ceased self-harm
Individuals with psychiatric disorders who have ceased DSH
|
Emotional Stop Signal Task (modified version from CANTAB).
Outcome Measure is commission and omission errors - higher score (percentage) indicate worse performance.
Functional Magnetic Resonance Imaging (fMRI) Diffusion Tensor Imaging (DTI) Volumetry
Self-reported data on World Health Organizations Disability Assessment Schedule - 36 items self-administered (WHODAS 2.0).
Assessing six domains of functional disability in daily life.
Each item is rated on a Likert scale ranging from 0-4.
Total range 0 - 144.
High scores scores indicate more severe disability.
Self-rated personality traits through Personality Inventory for DSM-5 (PID-5).
Self-reported scores on domains of personality traits.
Higher scores in one domain indicate more pronounced traits in this domain.
The estimate of time where an individual can successfully inhibit their responses 50% of the time.
|
Clinical cases with no self-harm
Individuals with psychiatric disorders who never had DSH
|
Emotional Stop Signal Task (modified version from CANTAB).
Outcome Measure is commission and omission errors - higher score (percentage) indicate worse performance.
Functional Magnetic Resonance Imaging (fMRI) Diffusion Tensor Imaging (DTI) Volumetry
Self-reported data on World Health Organizations Disability Assessment Schedule - 36 items self-administered (WHODAS 2.0).
Assessing six domains of functional disability in daily life.
Each item is rated on a Likert scale ranging from 0-4.
Total range 0 - 144.
High scores scores indicate more severe disability.
Self-rated personality traits through Personality Inventory for DSM-5 (PID-5).
Self-reported scores on domains of personality traits.
Higher scores in one domain indicate more pronounced traits in this domain.
The estimate of time where an individual can successfully inhibit their responses 50% of the time.
|
Healthy controls
Healthy controls who never had DSH
|
Emotional Stop Signal Task (modified version from CANTAB).
Outcome Measure is commission and omission errors - higher score (percentage) indicate worse performance.
Functional Magnetic Resonance Imaging (fMRI) Diffusion Tensor Imaging (DTI) Volumetry
Self-reported data on World Health Organizations Disability Assessment Schedule - 36 items self-administered (WHODAS 2.0).
Assessing six domains of functional disability in daily life.
Each item is rated on a Likert scale ranging from 0-4.
Total range 0 - 144.
High scores scores indicate more severe disability.
Self-rated personality traits through Personality Inventory for DSM-5 (PID-5).
Self-reported scores on domains of personality traits.
Higher scores in one domain indicate more pronounced traits in this domain.
The estimate of time where an individual can successfully inhibit their responses 50% of the time.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Executive functioning
Time Frame: Up to 1 hour
|
Scores on cognitive tests measuring executive functioning
|
Up to 1 hour
|
Level of function in daily life
Time Frame: 30 days
|
Scores on WHODAS 2.0
|
30 days
|
Personality traits
Time Frame: More than 1 year (stable)
|
Scores on Personality Inventory for DSM-5
|
More than 1 year (stable)
|
Blood flow
Time Frame: Up to 1 hour
|
Blood flow in prefrontal cortex during neurocognitive tests
|
Up to 1 hour
|
Volumetry
Time Frame: Up to 1 hour
|
Volumes of local cerebral white matter
|
Up to 1 hour
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sofie Westling, MD PhD, Region Skane
Publications and helpful links
General Publications
- Allen KJ, Hooley JM. Inhibitory control in people who self-injure: evidence for impairment and enhancement. Psychiatry Res. 2015 Feb 28;225(3):631-7. doi: 10.1016/j.psychres.2014.11.033. Epub 2014 Dec 2.
- Allen KJ, Hooley JM. Negative mood and interference control in nonsuicidal self-injury. Compr Psychiatry. 2017 Feb;73:35-42. doi: 10.1016/j.comppsych.2016.10.011. Epub 2016 Nov 4.
- Allen KJD, Hooley JM. Negative Emotional Action Termination (NEAT): Support for a Cognitive Mechanism Underlying Negative Urgency in Nonsuicidal Self-Injury. Behav Ther. 2019 Sep;50(5):924-937. doi: 10.1016/j.beth.2019.02.001. Epub 2019 Feb 14.
- McHugh CM, Chun Lee RS, Hermens DF, Corderoy A, Large M, Hickie IB. Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. J Psychiatr Res. 2019 Sep;116:51-60. doi: 10.1016/j.jpsychires.2019.05.012. Epub 2019 May 17.
- Ackerman JP, McBee-Strayer SM, Mendoza K, Stevens J, Sheftall AH, Campo JV, Bridge JA. Risk-sensitive decision-making deficit in adolescent suicide attempters. J Child Adolesc Psychopharmacol. 2015 Mar;25(2):109-13. doi: 10.1089/cap.2014.0041. Epub 2014 Sep 29.
- Oldershaw A, Grima E, Jollant F, Richards C, Simic M, Taylor L, Schmidt U. Decision making and problem solving in adolescents who deliberately self-harm. Psychol Med. 2009 Jan;39(1):95-104. doi: 10.1017/S0033291708003693. Epub 2008 Jun 23.
- Chamberlain SR, Odlaug BL, Schreiber LR, Grant JE. Clinical and neurocognitive markers of suicidality in young adults. J Psychiatr Res. 2013 May;47(5):586-91. doi: 10.1016/j.jpsychires.2012.12.016. Epub 2013 Jan 26.
- Fikke LT, Melinder A, Landro NI. Executive functions are impaired in adolescents engaging in non-suicidal self-injury. Psychol Med. 2011 Mar;41(3):601-10. doi: 10.1017/S0033291710001030. Epub 2010 May 19.
- Gvirts HZ, Braw Y, Harari H, Lozin M, Bloch Y, Fefer K, Levkovitz Y. Executive dysfunction in bipolar disorder and borderline personality disorder. Eur Psychiatry. 2015 Nov;30(8):959-64. doi: 10.1016/j.eurpsy.2014.12.009. Epub 2015 Oct 21.
- Thompson C, Ong ELC. The Association Between Suicidal Behavior, Attentional Control, and Frontal Asymmetry. Front Psychiatry. 2018 Mar 14;9:79. doi: 10.3389/fpsyt.2018.00079. eCollection 2018.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2020-02732
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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