Neural Correlates of Treatment in Adolescents with Bipolar Depression During Response Inhibition

Abstract Objective: Abnormal prefrontal and subcortical activity during cognitive control tasks is identified in non-depressed adolescents with bipolar disorder (BD); however, little is known about the neural correlates of bipolar adolescents in a depressed state (BDd). We aimed to investigate baseline versus after-treatment patterns of neural activity underlying motor response and response inhibition in adolescents with BDd. Methods: In this functional magnetic resonance imaging (fMRI) study, 10 adolescents with BDd relative to 10 age-and sexmatched healthy controls (HC) completed a well-validated go/no go block-design cognitive control task at baseline and after 6 weeks of naturalistic treatment. We used whole-brain analysis and controlled our results for multiple comparisons. Results: There was significant improvement in depression scores (mean change: 57% -28). There was no behavioral difference in BDd baseline versus HC and after treatment. BDd adolescents relative to HC had higher baseline cortical, but not subcortical, neural activity (e.g., bilateral ventrolateral prefrontal during both the go [motor control] and the no go [response inhibition] conditions, and left superior temporal during the no go condition). However, after-treatment activity relative to baseline neural activity during response inhibition was significantly increased in subcortical (e.g., right hippocampus and left thalamus), but not cortical, regions. In addition, at baseline, lower left thalamus activity was correlated with higher depression scores. Conclusions: Adolescents with BDd had baseline prefrontal and temporal hyperactivity underlying motor control and response inhibition that did not change after treatment in contrast to relatively decreased baseline subcortical activity underlying response inhibition associated with the depressive state that was increased after the treatment

Examining Alternative Treatment Settings for Adolescents With Suicidal Thoughts During the COVID-19 Pandemic

Objective: Suicide is a leading cause of death for adolescents in the United States. Alternative settings to treat suicidal ideation (SI) are needed. Study primary objectives include evaluating the safety and effectiveness of telehealth crisis intervention services (CIS) and in-person outpatient crisis intervention clinics (OCIC) relative to the current standard of care of inpatient psychiatric hospitalization. A secondary aim seeks to assess changes in suicidal ideation, and patient and parent treatment satisfaction. Method: The study team, consisting of study staff at 4 sites, conducted an observational longitudinal study of patients (12-18 years of age) who were seen in the Emergency Department (ED) for suicidality and were referred to inpatient treatment, in-person OCIC, or telehealth CIS. Primary outcome data, including recurrent ED visits and hospitalizations because of SI, suicide attempts, and life satisfaction, were collected for 24 weeks. All analyses were adjusted for age, sex, and baseline suicidality severity scores. A total of 249 patients were enrolled. Results: There were no statistically significant differences in suicide attempts, time to first suicide attempt, ED visits, hospitalizations, and life satisfaction among the 3 treatment arms. There was no statistically significant difference in outcomes for treatment satisfaction among the treatment groups. Conclusion: In this observational study, in-person OCIC and telehealth CIS did not have significantly different outcomes from the current standard of care of inpatient psychiatric hospitalization. This broadens the scope of services that appear to be safe and effective for adolescents experiencing moderate suicidal thoughts. Future research using randomized controlled trials to clarify the causal effect of different interventions is warranted. Clinical trial registration information: Observational Study to Compare Outcomes of Different Psychiatric Treatment of Suicidal Adolescents (Pre-START); https://clinicaltrials.gov/study/NCT04625686. Plain language summary: The PreSTART study sought to explore treatment outcomes for adolescents experiencing suicidal thoughts. Inpatient treatment, outpatient crisis intervention centers, and telehealth crisis interventions were explored and compared to evaluate safety and effectiveness over a 24-week period. Results found no statistical difference in recurrent suicidal events or treatment satisfaction among the different treatments. Diversity Inclusion Statement: We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work