The main areas of OCD research are: Suicide Risk in the Medical Setting Suicide is an international public health threat. In the U.S., it is the 2nd leading cause of death for youth and the 10th leading cause of death for adults. The Director of NIMH, Dr. Joshua Gordon has made suicide prevention research an NIMH priority and has a mission to reduce the national suicide rate by 20% by the year 2025. As suicide risk screening becomes a national priority for medical settings, non-mental health clinicians require valid, psychometrically-sound screening instruments for assessing suicide risk. However, there are very few suicide risk screening instruments that have been validated empirically with medically ill patients in hospital settings. Recognizing this gap early and capitalizing on clinical and research expertise within our group, we began developing a risk of suicide screen for pediatric patients in the emergency room in 2008 that resulted in a validated tool, the ASQ (Ask Suicide Screening Questions). Due to public demand, the ASQ has now been translated into 12 languages including Spanish, French, Dutch, Arabic, Portuguese, Hebrew, Korean, Japanese, Russian, Vietnamese, Somali and Chinese and is currently being implemented in emergency departments, inpatient medical units and outpatient primary care clinics in the U.S. and abroad. The tool has now been expanded to include the materials necessary for hospitals to begin to implement their own suicide risk screening programs, including scripts for nurses, flyers for parents, and other helpful resources. The ASQ toolkit can be found at the NIMH website www.nimh.nih.gov/ASQ for public use. The ASQ Toolkit has been viewed by the public over 54,000 times and has guided medical practitioners in hospital settings across the country. Since the development of the ASQ, the focus of our ongoing suicide risk screening studies has been to develop and validate brief screening instruments that can be administered by non-mental health clinicians in other medical settings and with specific patient populations. We currently have 5 IRB-approved protocols addressing suicide screening in different medical settings (NCT00623493, NCT01517126, NCT02140177, NCT02050867, NCT02830334). We are addressing areas of need, including pediatric and adult emergency department patients, pediatric and adult medical inpatients, and are developing a screening tools for individuals with Autism Spectrum Disorder and Intellectual Disabilities. Our research team worked closely with NIH Clinical Center leadership to meet the Joint Commission recommendations and were on the team of leaders that rolled out suicide risk screening in both adult and pediatric inpatients at the NIH Clinical Center. Turning research into practice, we are utilizing our research to inform implementation of suicide risk screening at the NIH CC and hospitals and pediatric outpatient primary care and specialty clinics nationwide. Mental Health Aspects of Coping with Chronic Medical Illness Born out of our clinical work on the PCLS and Neuropsychology Assessment Service for the past decade, a natural research focus has emerged from our collaborative work with other Institutes at NIH. For example, working with the Pediatric Oncology Branch we began to study distress and its correlates in medically ill children, particularly those with life-limiting illnesses, through 3 protocols over the past 6 years (NCT00824278, NCT00969579, NCT02423031). The collaboration has been highly productive leading to the development of the first advance care planning guide for adolescents and young adults with life-limiting illnesses, Voicing My CHOiCES. This planning guide is available at www.agingwithdignity.org. In addition, our work in quantifying distress using a thermometer was implemented in a pilot assessment of adult patients undergoing radiation treatment at the Clinical Center in 2018. Development and validation of Checking In, a brief electronic interactive screening measure of distress designed to identify emotional, physical, social, practical and spiritual concerns of pediatric patients, is now in a feasibility testing phase, with a plan to test the instrument in several different community settings. An accompanying provider summary sheet that delineates patient report of distress will allow providers to triage services to patients and their families, thereby enhancing patient quality of life throughout their treatment trajectory. Neuropsychiatric Aspects of Immune and Infectious Disorders (including HIV/AIDS), Genetic, and other Disorders The OCD Neuropsychology Assessment Service is involved in a broad range of research protocols that are studying cognitive and emotional functioning in various medical groups. These research protocols include genetic disorders (such as Mobius syndrome, methylmalonic academia, McCune-Albright syndrome, Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy (CADASIL)), infectious and immune diseases (HIV, progressive multifocal leukoencephalopathy, Ebola, anti-NMDA receptor encephalitis), brain tumor (re-irradiation effects), and chronic fatigue syndrome. In addition, the OCD Neuropsychology Assessment Service also plays a vital role in assisting NINDS researchers who are studying Parkinson's disease, epilepsy and other disorders. A large focus of these neuropsychiatric studies is HIV/AIDS. HIV-related research activities in the OCD fall into two categories: 1) NIH Intramural NeuroHIV Program, and 2) Collaborations with multi-site research networks, including an NIH DoD HIV/AIDS associated neurocognitive disorder protocol. The NIMH OCD, NINDS and NIAID have developed 2 intramural protocols (NCT01875588; NCT01692236) investigating HIV-related neurocognitive disorders, which are a clinical challenge and threat to the long-term health of people living with HIV/AIDS. We have worked to assess the mental health needs of HIV patients and build an interdisciplinary approach to HIV and mental health in DC, leading to funded projects being initiated at other DC institutions. NIMH Clinical Research Support In 2017, the Office of the Clinical Director established a new protocol, Recruitment and characterization of healthy research volunteers for NIMH Intramural studies (NCT03304665). The study objectives are to screen and create a list of adult volunteers in good health for participation in research studies conducted in the NIMH Intramural Research Program; to develop a normative set of brain MRI scans that are linked to clinical information collected from healthy research volunteers; and to maximize the scientific impact of data from healthy volunteers by broadly sharing data with other researchers. The study was developed to address several needs; heathy volunteers are used in 80% of NIMH clinical studies. Centralizing recruitment more efficiently utilizes existing resources, provides consistent clinical characterization and screening, and mobilizes the ability to share data through public repositories. Study highlights include the use of an online website for initial consent and self-report survey measures, followed by an in-person appointment for clinical evaluation for study eligibility. Participants must agree to broad data sharing or will not be enrolled. The optional MRI scan (structural and functional) can serve as the annual clinical scan.
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