Performance and FMRI BOLD Signal Changes in Impulsive Patients

A Trial to Explore Performance and FMRI BOLD Signal Changes During Impulsivity Tasks in Impulsive Patients with Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder

This study is a preceding study conducted to validate the methodology for assessing impulsivity by tasks and task-based fMRI measurements in patients with Attention Deficit Hyperactivity Disorder (ADHD) or Borderline Personality Disorder (BPD).

Study Overview

• Status: Completed
• Conditions: Attention Deficit Hyperactivity Disorder; Borderline Personality Disorder

Detailed Description

It is planned to conduct a clinical trial to test pharmacodynamic effects of a new drug under development for impulsivity including patients with ADHD or BPD. For the preparation of this planned trial, a preceding study will be conducted. The results of this preceding study will be needed to prepare and plan the upcoming proof-of-clinical-principle-study regarding behavioral effects, involved brain regions, effect sizes, patient experience, and task design. Testing and optimizing the study procedures in advance in this preceding study will help to define the objectives and endpoints of the planned pharmacodynamic trial.

• Study Type: Observational
• Enrollment (Actual): 20

Contacts and Locations

Study Locations

• Germany
  • Berlin, Germany
    • Charité Research Organisation GmbH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population includes individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and with Borderline Personality Disorder (BPD). Subjects must meet current DSM-5 criteria for ADHD or BPD as a primary diagnosis as assessed by SCID and SCID-PD. Subjects must score higher than 70 on the Barratt Impulsiveness Scale (BIS) to be included in the study.

Description

Inclusion Criteria:

1. meet current DSM-5 criteria for ADHD or BPD as a primary diagnosis as assessed by SCID and SCID-PD
2. between 18 and 45 years, inclusive
3. BIS-11 score of ≥ 70
4. completely fluent German speaker who, in the opinion of the Investigator, is capable of completing the fMRI and behavioral tasks
5. must have signed the informed consent form prior to the first study-related procedure indicating they understand the purpose of, and procedures required for the study and are willing to participate in the study.

Exclusion Criteria:

1. Lifetime diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, bipolar I or II disorder, delusional disorder, or autism spectrum disorder as confirmed by the SCID at screening visit
2. Moderate or severe substance use disorder within the last 6 months.
3. Any other psychiatric disorder that is not currently stable in symptoms and treatment. Stable is defined as have no significant changes in symptom acuity or medication treatment in the 3 months prior to enrollment
4. Positive results on a urine drug screen or alcohol breath test, or any signs or symptoms of acute intoxication at screening or enrollment visit
5. A female subject with a positive pregnancy test at screening or enrollment visit
6. Unstable medical condition, history of seizure disorders, stroke, brain tumor, or any other major neurological illness

7. Subjects deemed to be at significant risk of serious violence or suicide based on any one of the following:

   • Significant risk of committing violent acts, homicide, serious self-harm, or suicide based on history, routine psychiatric status examination, or according to the investigator's experience OR
   • Any suicide attempt in the past 6 months (i.e. actual attempt, interrupted attempt, aborted attempt) prior to enrollment OR
   • Any suicidal ideation of type 4 or 5 in the Columbia-Suicide Severity Rating Scale (C-SSRS) in the past 6 months prior to enrollment
8. Subjects not expected to comply with the protocol requirements or not expected to complete the trial as scheduled (that, in the investigator's opinion, makes the subject an unreliable trial subject)

9. Concomitant use of restricted psychotropic medication. All restricted psychotropic medications must be washed out at least 5 half-lives prior to enrollment (including ADHD medications such as amphetamine or methylphenidate derivates). Allowed medications must be stable in agent, dose, and frequency for > 3 month prior to enrollment:

   • a single antidepressant of the Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin-Noradrenaline Reuptake Inhibitor (SNRI) class
   • A single second-generation antipsychotic at a low dose (1 thorazine dose equivalent or less, which translates to ≤ 2 mg/day for risperidone, 5 mg/day for olanzapine, 75 mg/day for quetiapine, 60 mg/day for ziprasidone, and 7.5 mg/day for aripiprazole)
   • Permitted sleep medications must be nightly scheduled medications (not PRN) and may include non-benzodiazepines, antihistamines, melatonin, trazodone, low dose doxepin (≤ 50mg), and low dose quetiapine (≤75mg qhs).

10. Any contraindication to undergo an MRI radiography (e.g. history of surgery involving metal implants), including but not limited the following:

    • A planned medical treatment within the study period that might interfere with the study procedures
    • Subjects who have undergone operations to the head
    • Subjects with significant hearing impairments which, in the opinion of the investigator, may interfere with the performance of fMRI tasks
    • Subjects with a significant visual impairment including color blindness, or history of ocular treatment including corrective laser eye surgery, or ongoing condition, which in the opinion of the investigator may interfere with the performance of the behavioral or fMRI tasks
11. Subject is a staff member or the relative of a staff member or is in a subordinate relationship with the Investigator
12. Signs or symptoms of Post-Covid disease
13. Inability or unwillingness to comply with study procedures, including study prohibitions and restrictions
14. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments
15. Vulnerable subject who lives in an institution on court or authority order
16. Participation in another clinical trial.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Attention Deficit Hyperactivity Disorder; Subjects eligible for enrolment in this study must the following criteria: meet current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD as a primary diagnosis as assessed by the Structured Clinical Interview for DSM Disorders (SCID) and the Structured Clinical Interview for DSM Personality Disorders (SCID-PD); between 18 and 45 years, inclusive; BIS-11 score of ≥ 70
Borderline Personality Disorder; Subjects eligible for enrolment in this study must meet all of the following criteria: meet current DSM-5 criteria for BPD as a primary diagnosis as assessed by SCID and SCID-PD; between 18 and 45 years, inclusive; BIS-11 score of ≥ 70

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average percent BOLD signal change during the 4-Choice Serial-Reaction Time Task (4-CSRTT)	Blood oxygen level dependent (BOLD) fMRI signal changes will be analyzed to identify brain regions with significant activation during the 4-CSRTT	During the 4-CSRTT on experimental day (visit number 2 (study day 1))
Average percent BOLD signal change during the Stop Signal Task (SST)	Blood oxygen level dependent (BOLD) fMRI signal changes will be analyzed to identify brain regions with significant activation during the SST	During the SST on experimental day (visit number 2 (study day 1))
Average percent BOLD signal change during resting state	Blood oxygen level dependent (BOLD) fMRI signal magnitude and BOLD signal standard deviation during resting state	During resting state on experimental day (visit number 2 (study day 1))
Assessment of brain perfusion	Change in relative and absolute cerebral blood flow are measured through Arterial Spin Labeling (ASL)	During asl on experimental day (visit number 2 (study day 1))

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between BOLD signal during the 4-CSRTT and impulsivity scores on the BIS-11	Correlation between magnitude of BOLD signal during the 4-CSRTT and impulsivity scores on the BIS-11	Impulsivity scores were assessed on the screening day (visit number 1 (study days -28 to -1)), while BOLD signal changes during the 4-CSRTT were measured on the experimental day (visit number 2 (study day 1))
Correlation between BOLD signal during the SST and impulsivity scores on the BIS-11	Correlation between magnitude of BOLD signal during the SST and impulsivity scores on the BIS-11	Impulsivity scores were assessed on the screening day (visit number 1 (study days -28 to -1)), while BOLD signal changes during the SST were measured on the experimental day (visit number 2 (study day 1))
Correlation between BOLD signal during the 4-CSRTT and impulsivity scores on the S-UPPS	Correlation between magnitude of BOLD signal during the 4-CSRTT and impulsivity scores on the S-UPPS	Impulsivity scores were assessed on the screening day (visit number 1 (study days -28 to -1)), while BOLD signal changes during the 4-CSRTT were measured on the experimental day (visit number 2 (study day 1))
Correlation between BOLD signal during the SST and impulsivity scores on the S-UPPS	Correlation between magnitude of BOLD signal during the SST and impulsivity scores on the S-UPPS	Impulsivity scores were assessed on the screening day (visit number 1 (study days -28 to -1)), while BOLD signal changes during the SST were measured on the experimental day (visit number 2 (study day 1))
Reaction times in ms	Reaction times in ms extracted from the in- scanner protocol log files	During all tasks on experimental day (visit number 2 (study day 1))
Premature responses	Number of premature responses extracted from the in- scanner protocol log files	During all tasks on experimental day (visit number 2 (study day 1))
Reaction times during the 4-CSRTT after stress induction	Task performance is measured based on the reaction times (RTs) for choices. Stress is induced using the Mannheim Multicomponent Stress Test (MMST).	During the 4-CSRTT after stress is induced on experimental day (visit number 2 (study day 1))
Premature responses during the 4-CSRTT after stress induction	Task performance is measured based on the number of premature responses. Stress is induced using the Mannheim Multicomponent Stress Test (MMST).	During the 4-CSRTT after stress is induced on experimental day (visit number 2 (study day 1))
Impulsive choice ratio during the 4-CSRTT after stress induction	Task performance is measured based on the impulsive choice ratio. Stress is induced using the Mannheim Multicomponent Stress Test (MMST).	During the 4-CSRTT after stress is induced on experimental day (visit number 2 (study day 1))
Reaction times during the DDT after stress induction	Task performance is measured based on reaction times (RTs) for choices. Stress is induced using the Mannheim Multicomponent Stress Test (MMST).	During the DDT after stress is induced on experimental day (visit number 2 (study day 1))
Premature responses during the DDT after stress induction	Task performance is measured based on the number of premature responses. Stress is induced using the Mannheim Multicomponent Stress Test (MMST).	During the DDT after stress is induced on experimental day (visit number 2 (study day 1))
Correlation between BOLD signal and behavioral measures during 4-CSRTT	Correlation between magnitude of BOLD signal during 4-CSRTT and behavioral measures of the 4-CSRTT	during the 4-CSRTT conducted in the scanner on experimental day (visit number 2 (study day 1))
Correlation between BOLD signal and behavioral measures during SST	Correlation between magnitude of BOLD signal during SST and behavioral measures of the SST	during the SST conducted in the scanner on experimental day (visit number 2 (study day 1))

Collaborators and Investigators

• Sponsor: Simone Grimm
• Collaborators: Boehringer Ingelheim; Charité Research Organisation GmbH
• Investigators: Principal Investigator: Christian Keicher, Dr. med., Charité Research Organisation, Berlin, Germany

Study record dates

Study Major Dates

• Study Start (Actual): August 6, 2024
• Primary Completion (Actual): October 30, 2024
• Study Completion (Actual): October 30, 2024

Study Registration Dates

• First Submitted: June 6, 2024
• First Submitted That Met QC Criteria: July 3, 2024
• First Posted (Actual): July 8, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 2, 2025
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Attention Deficit Hyperactivity Disorder; Borderline Personality Disorder; Functional Brain Changes; BOLD responses
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Neurodevelopmental Disorders; Attention Deficit and Disruptive Behavior Disorders; Dyskinesias; Hyperkinesis; Attention Deficit Disorder with Hyperactivity; Personality Disorders; Borderline Personality Disorder
• Other Study ID Numbers: MSBC004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No