- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05696691
Ketamine & Crisis Response Plan for Suicidal Ideation in the ED
A Randomized Pilot Trial of Intramuscular Ketamine and Crisis Response Planning for Suicide Prevention in the Emergency Department
The goal of this randomized pilot trial is to assess the feasibility of administering a combination of 100mg intramuscular (IM) ketamine and Crisis Response Plan (a short psychosocial intervention) for patients with acute suicidality in the context of the Emergency Department setting. This study will assess a combination of a pharmacologic intervention and a psychosocial one. The pharmacologic intervention is a one-time dose of 100mg ketamine delivered intramuscularly (IM) while the patient is in the ED. The psychosocial intervention under study is a brief, patient-centered therapy which takes, on average, 30 minutes to administer. Both interventions will be administered only once. The main questions this study aims to answer are:
- Determine if 100mg of IM ketamine and Crisis Response Plan in combination results in greater short-term reductions in suicidal ideation in adult patients who report acutely elevated suicide risk during an ED visit.
- Examine potential weight-based dose response differences in the reductions in suicidal ideation to determine if future treatment protocols with IM ketamine may benefit from weight-based dosing.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Contact
- Name: Stehanie Perez, MHA
- Phone Number: 2104508973
- Email: perezs11@uthscsa.edu
Study Locations
-
-
Texas
-
San Antonio, Texas, United States, 78229
- Recruiting
- University Hospital
-
Contact:
- Robert DeLorenzo, MD
- Phone Number: 210-567-4292
- Email: delorenzo@uthscsa.edu
-
Principal Investigator:
- Robert A De Lorenzo, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult men and women between the ages of 18 and 70 presenting to the Emergency Department with acute suicidal ideation.
- Patient cleared for admission to the University Hospital inpatient psychiatric unit.
- Decision to admit the patient to the inpatient unit or psychiatric stabilization unit made prior to consent to prevent study procedures from complicating or influencing the disposition and treatment as usual for suicidal patients reporting to the ED.
- Individuals presenting to the ED for other complaints but found to have suicidal ideation necessitating admission will also be eligible.
- Able to read and write English.
Exclusion Criteria:
- Serious mental illness with active and significant signs of psychosis, mania, hallucinations, paranoia, agitation, and drug-induced or other toxidromic symptoms.
- Acute intoxication with clinically significant symptoms (as defined by the attending clinician's assessment of patients' clinical sobriety).
- The patient is not capable of understanding the research procedures and providing informed consent for themselves.
- Lack of reliable means to be available for follow-up assessments (e.g, working mobile phone).
- Persistent resting blood pressure lower than 90/60 or higher than 180/110, or persistent resting heart rate lower than 45 beats/minute or higher than 120 beats/minute.
- Injuries requiring procedural sedation.
- Pregnancy or breast feeding.
- Known hypersensitivity to ketamine.
- Legal or illegal use of ketamine in the previous 90 days.
- End-stage or severe cardiovascular (e.g., ACS or decompensated heart failure), liver, or kidney disease.
- Patient is a prisoner.
- Patient is physically restrained or actively under custody of law enforcement. Once a patient is no longer under custody of law enforcement or physically restrained, the patient may be considered eligible and may consent to voluntary enrollment in the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ketamine and Crisis Response Plan (CRP)
Individuals randomized to the experimental arm will receive 100mg intramuscular ketamine injection before completing the Crisis Response Plan.
The average timeframe for the experimental arm is anticipated to be approximately 60 minutes of active treatment.
Following ketamine administration, the subject will be monitored for 45 minutes with pulse oximetry and recurrent vital signs.
The study team will record when the CRP is completed in relation to the ketamine injection.
|
100mg IM ketamine to be administered in conjunction with CRP.
The ketamine injection will be administered first.
Participants will be observed and have vital signs monitored for the first 45 minutes after administering medication in the ED, observing for immediate reactions.
Afterwards, participants will continue to be monitored for potential late-term side effects on the inpatient unit.
Ketamine will be given only after initial standard of care (SOC) treatment and screening studies have been initiated.
Other Names:
Crisis Response Plan is a brief, empirically-validated, Cognitive-Behavioral Therapy-based one-time therapy, and its administration typically takes 30-60 minutes.
It begins with a narrative assessment (allowing patients to "tell their story") and concludes with collaboratively constructed plan that outlines strategies for the patient's self-management of future acute suicidal crises.
Patients who engage in CRP are given an index card to keep with them that summarizes the emotional management strategies that they collaboratively generate with the CRP provider.
Other Names:
|
No Intervention: Treatment as Usual
Individuals randomized to the no intervention arm will receive routine care from emergency providers and psychiatry staff.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of study interventions
Time Frame: 30 days
|
Number of enrolled subjects completing treatment within study parameters, with safety and side-effect profiles at or lower than published rates.
|
30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Beck Scale for Suicidal Ideation (SSI) Score
Time Frame: Baseline to 30 days
|
The Beck Scale for Suicidal Ideation (SSI) is a 21-item measurement that evaluates the presence and intensity of suicidal thoughts.
Each item is scored on a scale from 0-2 with a total score of 0-38; with higher scores indicating higher levels of suicidal ideation.
|
Baseline to 30 days
|
Change in Depressive Symptoms Index-Suicidality Subscale (DSI-SS) Score
Time Frame: Baseline to 30 days
|
The Depressive Symptoms Index-Suicidality Subscale (DSI-SS) is a 4-item measure of suicidal ideation.
Respondents rate each item on a 4-point scale ranging from 0-3.
Responses are summed, and higher scores reflect more severe suicidal ideation (range: 0-12).
|
Baseline to 30 days
|
Change in Suicide Visual Analog Scale (S-VAS) Score
Time Frame: Baseline to 30 days
|
The Suicide Visual Analog Scale is a 1-item momentary assessment to evaluate severity of suicidal ideation.
The item is scored from 0-100 and the total possible score range for the scale is therefore also 0-100.
Lower scores indicate less extreme current urges toward self harm, whereas higher scores are indicative of more severe urges.
|
Baseline to 30 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: Robert De Lorenzo, MD, MSM, UT Health San Antonio
- Study Director: Romeo Fairley, MD, MPH, UT Health San Antonio
- Study Director: Alan Peterson, PhD, ABPP, UT Health San Antonio
- Study Director: Stacey Young-McCaughan, RN, PhD, UT Health San Antonio
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
Keywords
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Self-Injurious Behavior
- Suicide
- Suicidal Ideation
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Dissociative
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Ketamine
Other Study ID Numbers
- HSC20220426H
- UL1TR002645 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Suicide
-
Syeda AYAT E ZAINAB AliUniversity of Leicester; University of WuerzburgRecruitingSuicide, Attempted | Suicide | Suicide Prevention | Completed SuicidePakistan
-
Seattle Children's HospitalNationwide Children's HospitalRecruitingSuicidal Ideation | Suicide Threat | Suicide and Self-harm | Suicide AttemptsUnited States
-
Vestre Viken Hospital TrustSouth-Eastern Norway Regional Health AuthorityActive, not recruitingEcological Momentary Assessment | Suicide Risk | Suicide Attempt | Suicide Ideation | Suicide PreventionNorway
-
Mental Health Services in the Capital Region, DenmarkCompletedSuicide Prevention | Suicidal Thoughts | Suicide AttemptsDenmark
-
VA Office of Research and DevelopmentNot yet recruitingSuicidal Ideation | Suicide Attempt | Suicide PreventionUnited States
-
Franciscan Hospital For Children, INC.National Institute of Mental Health (NIMH); Harvard UniversityRecruitingSuicidal Ideation | Self-Injurious Behavior | Suicide AttemptsUnited States
-
Boston UniversityUnited States Department of Defense; The University of Texas Health Science... and other collaboratorsNot yet recruiting
-
Kaiser PermanenteNational Institute of Mental Health (NIMH); Henry Ford Health System; HealthPartners...Enrolling by invitationSuicide, Attempted | Suicide, FatalUnited States
-
University Hospital, MontpellierINSERM U960 - Cognitive Neuroscience Laboratory - Paris, FranceTerminatedDepression | History of Suicide AttemptFrance
Clinical Trials on Ketamine Hydrochloride
-
Ciusss de L'Est de l'Île de MontréalRecruiting
-
Juvenile Bipolar Research FoundationTerminatedBipolar DisorderUnited States
-
Gil YosipovitchTerminated
-
Rajmonda Nallbani-KomoniUnknownAnalgesic Drug DependenceKosovo
-
National Cancer Institute, EgyptCompleted
-
Cairo UniversityUnknownSeptic Shock | AnesthesiaEgypt
-
The University of Texas Health Science Center,...TerminatedPost Partum DepressionUnited States
-
Lawson Health Research InstituteUnknownBone Fractures | Dislocations
-
University Health Network, TorontoPrincess Margaret Hospital, CanadaCompletedBreast Neoplasms | LymphedemaCanada