The NIMH Psychiatric Consultation Liaison Service (PCLS) provides important psychiatric services to the many constituencies of the NIH. While providing such services to the NIH Community, PCLS clinicians conduct research and collaborate with NIH investigators by providing expertise in the areas of psychiatric, neurocognitive, and psychosocial functioning in NIH research subjects who often have complex medical and neuropsychiatric symptoms. Patient-subjects enrolled in research trials in other Institutes/Centers at the NIH offer unparalleled opportunities to explore the roles of specific genes (e.g., monogenic diseases such as methylmalonic acidemia (MMA)) and specific therapies (e.g., interferon in hepatitis) in psychiatry and neurodevelopment. Psychosomatic medicine trainees on the PCLS are encouraged during their rotations to pursue research projects that result in publications in peer reviewed journals, including literature reviews, case reports and poster presentations at national conferences. Active NIH research collaborators include the CC Bioethics Department, NCI Pediatric Oncology Branch (POB), and the NIAID HIV/AIDS Service to name just a few. The PCLS Neuropsychology Consultation Service performs neuropsychological evaluations for neurocognitive phenotyping of medical disorders resulting in research collaborations with other Institutes. The PCLS conducts collaborative research with the NCI POB and provides research support to the Pediatric Oncology Psychosocial Research Program which studies palliative care, psychopharmacologic management in pediatric oncology patients, sibling, parent and caregivers concerns, and screening for distress in adolescents and young adults with pediatric cancers as compared to other chronic diseases, among other topics. This active research program on psychiatric and psychosocial aspects of pediatric oncology care has led to several shared protocols including: 1) evaluation of a distress thermometer in pediatric medically ill population as well as the benefit/burden of participating in research (09-M-0022, NCT#00824278), 2) characterization of """"""""lone"""""""" parenting (09-M-0194, NCT#00969579), 3) a protocol (14-I-N088, with NIAID, NCT02233036) to understand the experiences and needs of youth with chronic illnesses transitioning into adulthood and 4) a Pilot Study to Extend the K-SADS-PL to Adolescents and Young Adults (13-M-0019, NCT#01778478). The PCLS research group provides mental health consultation on a number of educational brochures and booklets and developed """"""""Voicing My Choices,"""""""" an advance care planning guide for adolescents and young adults. Since 2012, over 15,000 copies of """"""""Voicing My Choices"""""""" have been distributed nationally and internationally, and continued education on how to implement the guide is provided at national meetings across the country. It has been translated into Spanish and Italian. The PCLS research team has taken a central role in NIMH's collaboration with NIAID and the District of Columbia (DC) in establishing an interdisciplinary, cross-institutional research collaborative effort with local investigators (see list of extramural collaborators), the DC-NIH Partnership for AIDS Progress (DC PFAP), to enhance knowledge of the biopsychosocial mental health aspects of HIV/AIDS. PCLS staff are working with DC Government leaders, clinical providers and administration, and community groups to identify gaps in services and knowledge to develop related research opportunities. PCLS researchers have co-founded and co-chaired the DC CFAR """"""""Mental Health and Neuroscience"""""""" Scientific Interest Group which includes more than 50 investigators from DC based universities and meets monthly to discuss research collaborations. PCLS researchers have also co-founded and co-chaired the Intramural NeuroHIV Research Program and co-chaired the groups Steering Committee, which meets monthly and oversees and coordinates five intramural research protocols at various stages of development;two protocols were co-authored and are co-led by PCLS researchers while all five receive substantial logistical support from PCLS, including neuropsychological testing and mental health screening which are among the key outcome measures for all these protocols. This year, the intramural collaboration expanded to include investigators from the Uniformed Services University of the Health Sciences (USUHS) and began recruiting additional research participants who receive medical care at USUHS-affiliated medical centers in Bethesda and San Diego using neuropsychological testing and mental health screening procedures in accordance with the procedures used in the Intramural NeuroHIV Research Program. The PCLS research group continues to describe the processes involved in developing adequate programs for the protection of healthy volunteers as well as vulnerable subjects while conducting cutting-edge research. An informed consent training video produced by the Clinical Research Advocates (CRAs) of the Human Subjects Protections Unit (HSPU), in the Office of the Clinical Director, is now being used for training in all the Graduate Medical Education programs at the NIH as well as throughout the CC. The CRAs continue to provide training courses as well as present at national meetings on their experiences regarding implementing processes to standardize the evaluation and protection of vulnerable subjects in research. They continue to serve on the Ability to Consent Assessment Team (ACAT) with the CC Bioethics Department and are utilized frequently throughout the CC to provide additional safeguards to vulnerable subjects. The PCLS also assigns a mental health professional to serve on the NICHD IRB. PCLS faculty regularly serve as reviewers for peer reviewed journals in mental health, psychosomatic medicine, pediatrics, neuropsychology, ethics, and public health. The PCLS research group is involved in several timely research projects that align with NIMH's mission to improve suicide prevention strategies. Four suicide screening projects address suicide screening in the medical setting. We continue to publish data from a multisite study of pediatric EDs at Children's National Medical Center, Boston Children's Hospital and Nationwide Children's Hospital in Columbus, Ohio led by the PCLS group (08-M-N070, NCT#00623493). A four-item screening instrument was developed, the ASQ (Ask Suicide-Screening Questions), and published by Archives of Pediatrics and Adolescent Medicine (now JAMA Pediatrics). To address the issue of suicidality in hospital settings, the PCLS research group created a suicide screening instrument and educational program to assist nurses on inpatient medical units with suicide assessment. The Ask Suicide-Screening Questions to Everyone in Medical Settings (asQem) Quality Improvement Project was initiated in January 2012 and was published in Psychosomatics in 2013. The asQem validation study is currently enrolling participants in the NIH CC (14-M-0109, NCT#02140177). This is planned to be a multi-site study. The third project involves an international collaboration and is focused on developing a suicide screening tool for youth with developmental delay and adults with intellectual disabilities;data collection is ongoing at Surrey Place Centre in Toronto, Canada (12-M-N034, NCT#01517126). The fourth study, the ASQ-Inpatient study, involves validating the ASQ on a pediatric medical inpatient unit in the 3 childrens hospitals where the instrument was created (Boston, DC and Columbus). One site has completed data collection and the other two sites are in progress (14-M-N044, NCT#02050867). Due to the PCLS's expertise in this area of research, PCLS members have presented in-services to NIH staff on the topic of suicide prevention and nationally at conferences and on Twitter for Suicide Awareness day.
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