VISN 19 Current Research

Current Research

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Suicide Research

Suicide Prevention

PI: Robert Freedman, Research Director

VA Therapeutic Development Team: Robert Freedman MD, Sherry Leonard PhD, Karen E. Stevens PhD, Laura Martin PhD, Jason Tregellas PhD, Josette Harris PhD, and Lynn Fenton, MD

Description: There are two problems in the prevention of suicide: (1) detection of individuals who are at risk, and (2) treatment to prevent suicides. Most of the major risk factors for suicide in young people, the focus of the VISN19 MIRECC's mission, are known: male sex, exposure to firearms, history of violence, mental illness, cigarette smoking, and other substance abuse. Work by VISN19 MIRECC investigators found that traumatic brain injury and chronic pain are two additional risk factors. Note that many of the risk factors-exposure to firearms and violence, for example-are common problems of combat Veterans that we cannot reverse.

Keywords: Suicide, Clozapine, Serotonin

Location:Denver

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OEF/OIF Veterans’ Experiences of Habituation to Painful Stimuli, Perceived Burdensomeness and Failed Belongingness

PI/Co-PI: Peter M. Gutierrez, Ph.D., Lisa A. Brenner, Ph.D.

Research team: Pamela Staves, RN CNS, Lisa Betthauser, MBA, Michelle Cornette, Ph.D.

Summary: This study was designed to determine, through qualitative interviews, the extent to which habituation to painful stimuli, perceived burdensomeness, and failed belongingness are relevant to veterans who have returned from OEF/OIF deployments. The second objective is to determine how they understand these constructs, the language they use in discussing them, and if they spontaneously indicate that in combination these factors could lead a person to think seriously about suicide.

Keywords: OEF/OIF veterans, Pain, Burden, Social Isolation, Suicide

Location: Denver

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Intensive Outpatient Treatment for Suicidal Veterans: A Randomized Clinical Trial and Feasibility Investigation

PI: Lisa A. Brenner, Ph.D., ABPP, VA VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado Health Sciences Center (UCHSC) Departments of Psychiatry and Physical Medicine and Rehabilitation

CO-PIs: Herbert Nagamoto, M.D., VA Eastern Colorado Health Care System, UCHSC Department of Psychiatry
David Jobes, Ph.D., ABPP, Catholic University
Peter M. Gutierrez, Ph.D., VA VISN 19 MIRECC, UCHSC Department of Psychiatry
Jan Kemp, RN, Ph.D., VA Center of Excellence for Suicide Prevention

Study Personnel: Joe Huggins, MSW, MSCIS

Summary: The proposed study will be a randomized clinical trial (RCT) designed to implement a novel way of working with suicidal patients, the Collaborative Assessment and Management of Suicidality (CAMS) (Jobes, 1995; 2000; 2006; Jobes et al., 2005). The primary purpose of the proposed project is to determine if it is possible to more rapidly resolve suicidal crises (i.e., decrease suicidal ideation to a rating of zero) of veterans being treated in the Mental Health Clinic (MHC) at the Denver VA Medical Center (VAMC).
Study in data collection.

Keywords: suicide, prevention, randomized clinical trial, veteran

Location: Denver

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Executive Dysfunction and Suicide: An Exploration of Risk Factors in Veterans with Traumatic Brain Injury

Research team: Beeta Y. Homaifar, Ph.D. (1), Lisa A. Brenner, Ph.D., ABPP (1,2,3) Sheila Saliman, Ph.D. (4), Herbert Nagamoto, M.D. (3,4)

Institutional Affiliations:
1. - VA VISN 19 MIRECC,
2. - University of Colorado Health Sciences Center (UCHSC) Department of Physical Medicine and Rehabilitation,
3. - UCHSC Department of Psychiatry,
4. - VA Eastern Colorado Health Care System

Summary: This study seeks to examine the relationship between executive dysfunction and suicidal behavior in an outpatient population. Executive functioning will be measured with instruments that assess decision-making, impulsivity, and aggression. Data collection is ongoing.

Keywords: traumatic brain injury, suicide, executive dysfunction

Location: Denver

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MOCL: A Review of Suicide Literature: 2001 – 2006

PI/CO PI: Laurie Shroyer PhD

Research Team:Joseph Hasley, Gregory N. Gauthier, Joe Huggins

Summary:Suicide risk factors are past life events, personality or character dispositions, psychological dispositions or circumstance that make an individual inherently more susceptible to suicidality (pre-disposing risk factors); or acute life events or circumstances that precipitate suicidality (potentiating risk factors). Protective factors are pre-dispositions of an individual, conditions, or circumstances that insulate an individual from suicidality. Processes describe “the appropriateness, completeness, and redundancy of information obtained through clinical history, physical examination and diagnostic tests, justification of diagnosis and therapy, technical competence, evidence of preventive management in health and illness, coordination and continuity of care, acceptability of care to the patient, and so on” ([1] pg. 694). Structures refer to “the adequacy of facilities and equipment; the qualifications of medical staff and their organizations; the administrative structure and operations of programs and institutions providing care; fiscal organization and the like.” ([1] pg. 694) This paper focuses on the relationships between these factors and suicide and mental wellness outcomes, defined, respectively, as suicide ideation, attempts, or completions, and indications of patient psychological or psycho-somatic symptoms, functionality, or quality of life.

Keywords: Suicide, risk, intervention, veterans

Location: Denver

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Incidence of Chronic Pain in Suicide Completion in the Veteran Population

PI/Co-PI: Holly Martin LPN (PI), Pamela Bennett PhD, (Co-PI)

Summary: The purpose of this study will be to investigate the association of pain, particularly under-treated, non-malignant pain, in veterans who have completed suicide.

Keywords: Suicide, Chronic Pain, Veteran

Location: Salt Lake City

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Suicidality in Veterans

PI: Pamela Bennett PhD

Research Team: Holly Martin LPN

Summary: This study will characterize veterans who have completed suicide after accessing services at the George E. Wahlen VA Medical Center. Veterans who have completed suicide between 1997 and 2017 will be identified. Clinical information will be obtained by a review of the VISTA system. Next-of-kin will be contacted by phone. After verbal consent, a retrospective psychological questionnaire will be given. Next-of-kin will also be asked to give permission to notify the clinical arm of the VA as to the death of the veteran, in those cases where the VA has not been contacted. Clinical information regarding time and type of use of VA resources, psychiatric information and medical information will be compared to a cohort of deceased veterans, to develop a more accurate profile of the veteran suicide completer.

Keywords: Suicide, Veteran

Location: Salt lake City

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Aging with Traumatic Brain Injury: An Analysis of Beck Depression Inventory-II Scores

Research Team: Beeta Y. Homaifar, Ph.D. (1),
Lisa A. Brenner, Ph.D., ABPP (1,2,3),
Peter M. Gutierrez, Ph.D. (1,3),
Jeri E.F. Harwood, Ph.D. (4),
Caitlin Thompson, Ph.D. (1),
Christopher M. Filley, M.D. (1,3,5,6),
James P. Kelly, M.D. (2,7),
Lawrence E. Adler, M.D. (1,3)

Institutional Affiliations:
1. - VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC),
2. - University of Colorado Health Sciences Center (UCHSC) Department of Physical Medicine and Rehabilitation,
3. - UCHSC Department of Psychiatry,
4. - UCHSC Department of Pediatrics,
5. - VA Eastern Colorado Health Care System,
6. - UCHSC Department of Neurology,
7. - UCHSC Department of Neurosurgery

Summary: The goal of this exploratory study is to examine depressive symptoms, as measured by the Beck Depression Inventory-II, in individuals with a remote history of traumatic brain injury (TBI). As expected, we found that depression is an enduring phenomenon for individuals even decades after a TBI.

Keywords: traumatic brain injury, depression, rehabilitation

Location: Denver

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MOCL: Getting the Data Necessary to Make a Difference in Veteran’s Suicide - Data Integration with VISTA Application (“DIVA”)

PI/CO PI: Laurie Shroyer PhD

Research Team: Joe Huggins, Joseph Hasley, Gregory N. Gauthier

Summary: Retrieval of discrete data elements for clinical care assessments, educational programs, quality improvement programs, and research within the field of mental health remains a significant barrier. The Veterans Integrated Service Network (VISN) 19 MIRECC Mental Outcomes Core Lab (MOCL) team determined that key clinical indicators were too often “lost” within the patient progress note. Tools are being developed that combine existing clinical care templates in the VistA electronic patient record with the ability to store each form element as a discrete piece of usable data. This paper describes the method of determining key clinical indicators and the methods for capturing these same indicators for assessment and improvement purposes.

Keywords:Quality improvement, VistA, electronic patient record

Location: Denver

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DNA Risk Factors in Youth Suicide

PI:PI/Co-PI: Pamela Bennett PhD

Research team: Douglas Gray MD, Todd Grey MD, Mark Leppert PhD, William McMahon MD

Summary: Several studies have indicated that risk for suicide has a genetic basis. There are many psychiatric illnesses with an increased risk of suicide completion, including bipolar disorder, schizophrenia and depression. Research has demonstrated that there is an inherited risk for suicide in addition to the risk associated with mental illness. Due to the genetic and enviornmental complexity of this behavior, extremely large sample sets are needed for DNA analysis. DNA risk factors for suicide are being studied in Utah subjects. Blood samples are taken from deceased subjects by the OME and provided without personal identifiers. Several SNPs have been tested in the sample. We will continue to test SNPs and develop haplotypes across the sample set, in order to isolate candidate genes for suicidal behaviors and suicide completion.

Keywords: Suicide, Genotopes, Serotonin

Location:Salt Lake City

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Traumatic Brain Injury and Post-Traumatic Stress Disorder: The Exploration of a Combination Syndrome

PIs: Lisa A. Brenner, Ph.D., ABPP, VA VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado Health Sciences Center (UCHSC) Departments of Psychiatry and Physical Medicine and Rehabilitation
Susan O’Brien, M.D., UCHSC, Department of Physical Medicine and Rehabilitation

Co-PIs: Christopher M. Filley, M.D., VA Eastern Colorado Health Care System, UCHSC, Departments of Neurology and Psychiatry,
James P. Kelly, M.D., UCHSC, Departments of Neurosurgery and Physical Medicine and Rehabilitation
Lawrence E. Adler, M.D., VA VISN 19 MIRECC, UCHSC, Department of Psychiatry
Beeta Y. Homaifar, Ph.D., VA VISN 19 MIRECC
Jeri E.F. Harwood, Ph.D., UCHSC, Department of Pediatrics

Research team: Lisa M. Betthauser, MBA, Research Assistant

Summary: This observational study investigated the impact of having a history of both Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) on neuropsychological functioning, neurological examination, and imaging.
  ·  All subjects participated in a neurological examination and completed a battery of neuropsychological measures
  ·  Half of the subjects from each group (TBI & PTSD) were randomly selected to participate in an MRI study
Study in data analysis.

Keywords: traumatic brain injury, PTSD, neuropsychology, imaging, neurological

Location: Denver

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Applicability of the Personality Assessment Inventory to Veterans with Traumatic Brain Injury

PI/Co-PI: Caitlin Thompson, Ph.D., Peter M. Gutierrez, Ph.D.

Research team: Lisa A. Brenner, Ph.D., Beeta Y. Homaifar, Ph.D., Jeri F. Harwood, Ph.D.

Summary: The purpose of this study is to investigate the applicability of the Personality Assessment Inventory (PAI) to veterans with traumatic brain injury (TBI). Archival PAI profiles and chart data for 156 veterans with mild, moderate, or severe TBIs were analized and comparisons were made between valid and invalid profiles and PAI Scales across TBI severity groups.

Keywords: Personality Assessment Inventory, Traumatic Brain Injury, Test Norms

Location: Denver

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Functional and structural MRI of Traumatic Brain Injury Induced Cognitive Impairment

PI: Marchand

Research team: Suchy Y, Chelune G, Bigler E, Hsu E, Lee JN, Thatcher J, Gale P, Kreitschitz S, Barbara S, Franchow E, Kraybill M, Thorgusen S.

Summary: The primary aim of this study is to evaluate the use of motor activation paradigms as probes of frontal-subcortical brain circuit abnormalities in functional neuroimaging studies of TBI-induced cognitive impairment. A secondary goal is to enhance our understanding of normal frontal-subcortical brain circuit function. This work may provide a means of using functional neuroimaging to monitor and predict treatment response; both of which may improve our ability to treat TBI, which has a high risk of suicide.

Keywords: Traumatic brain injury, functional MRI, diffusion tensor imaging, basal ganglia

Location: Salt Lake City

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Psychiatric hospitalization and traumatically brain injured veterans: a retrospective study

PI: Lisa A. Brenner, Ph.D., ABPP, VA VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado Health Sciences Center (UCHSC) Departments of Psychiatry and Physical Medicine and Rehabilitation

Co-PIs: Jeri E.F. Harwood, Ph.D., UCHSC, Department of Pediatrics
Beeta Y. Homaifar, Ph.D., VA VISN 19 MIRECC
Ellen Cawthra, R.N., VA VISN 19 MIRECC, UCHSC, Department of Psychiatry
Jeffrey Waldman, B.A., VA VISN 19 MIRECC
Lawrence E. Adler, M.D., VA VISN 19 MIRECC, UCHSC, Department of Psychiatry

Summary: The purpose of this study was to determine risk factors for psychiatric hospitalization post-traumatic brain injury (TBI). Computerized medical records (1985-2005) of 96 patients with known histories of TBI who were receiving medical treatment within the Veterans Affairs (VA) system were reviewed. Data abstracted included TBI-related factors, history of psychiatric symptoms, and problematic substance use.
Manuscript in submission.

Keywords: traumatic brain injury, psychiatric hospitalization, substance abuse, drug, alcohol, health care utilization

Location: Denver

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Prognostic Value and Cognitive Correlates of Primitive Reflexes in Traumatic Brain Injury

PI: Hal Wortzel

Research team: David Arciniegas, C. Alan Anderson, Larry Adler

Summary: Primitive reflexes commonly occur in the setting of traumatic brain injury, along with cognitive impairment and functional limitations. Assessment of primitive reflexes may offer a rapid means to screen for significant cognitive impairment in brain-injured patients. A retrospective review to identify relationships between primitive reflexes, the FAB, the Clock Drawing Task, and FIM scores is under way.

Keywords: Traumatic Brain Injury, Primitive Reflexes, FAB, Clock Drawing Task

Location: Denver

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Longitudinal functional MRI of the brain in bipolar disorder (phase 1)

PI: Marchand

Research Team: Lee JN, Thatcher GW, Jensen C, Stewart D, Dilda V, Thatcher J, Creem-Regher S, Starr, J

Summary: The primary aim of this study was to evaluate the use of motor activation paradigms as probes of frontal-subcortical brain circuit abnormalities in bipolar disorder. A secondary goal was to enhance our understanding of normal frontal-subcortical brain circuit function. This work may provide a means of using functional neuroimaging to monitor and predict treatment response; both of which may improve our ability to treat this disorder, which has a high risk of suicide. Our findings were that motor activation paradigms clearly reveal different activation of frontal-subcortical circuits among individuals with bipolar disorder as compared to controls.

Selected Publications:
  · Marchand WR, Lee JN, Thatcher GW, Jensen C, Stewart D, Dilda V, Thatcher J, Creem-Regher S. (2007) A functional MRI study of a paced motor activation task to evaluate frontal-subcortical circuit function in bipolar depression. Psychiatry Research: Neuroimaging 155:221-230.
  · Marchand WR, Lee JN, Thatcher J, Thatcher GW, Jensen C, Starr J. (2007) An fMRI study of frontal-subcortical skeletomotor circuit and dorsolateral prefrontal cortex function using a paced motor activation paradigm. Brain Imaging and Behavior doi: 10.1007/s11682-007-9006-z

Keywords: Bipolar disorder, functional MRI, basal ganglia

Location: Salt Lake City

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Longitudinal functional MRI of the brain in bipolar disorder (phase 2)

PI: Marchand

Research Team: Lee JN, Thatcher GW, Jensen C, Stewart D, Dilda V, Thatcher J, Creem-Regher S, Starr, J

Summary: The primary aim of this study was to evaluate the use of motor activation paradigms as probes of frontal-subcortical brain circuit abnormalities in longitudinal functional neuroimaging studies of bipolar disorder. A secondary goal was to enhance our understanding of normal frontal-subcortical brain circuit function. This work may provide a means of using functional neuroimaging to monitor and predict treatment response; both of which may improve our ability to treat this disorder, which has a high risk of suicide. Our main findings were that motor activation paradigms provide information about activation specific to phase of illness as well as findings that may persist regardless of mood state.

Select publications:
  · Marchand WR, Lee JN, Thatcher JW, Thatcher GW, Jensen Cody, Starr Jennifer. (2007) A preliminary longitudinal fMRI study of frontal-subcortical circuits in bipolar disorder using a paced motor activation paradigm. Journal of Affective Disorders 103:237-241.
  · Marchand WR, Lee JN, Thatcher, JW, Thatcher GW, Jensen C, Starr J. (2007) Motor deactivation in the human cortex and basal ganglia. NeuroImage 38:538-548.

Keywords:Bipolar disorder, functional MRI, basal ganglia

Location:Salt Lake City

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Functional MRI and Diffusion Tensor Imaging of Brain Frontal-Subcortical Circuits in Panic Disorder

PI:Marchand

Research Team:Hsu E, Raskin E, Lee JN, Thatcher J, Starr, J

Summary:The primary aim of this study is to evaluate the use of motor activation paradigms as probes of frontal-subcortical brain circuit abnormalities in longitudinal functional neuroimaging studies of panic disorder. A secondary goal is to enhance our understanding of normal frontal-subcortical brain circuit function. This work may provide a means of using functional neuroimaging to monitor and predict treatment response; both of which may improve our ability to treat panic disorder, which has an increased risk of suicide.

Keywords:Panic disorder, functional MRI, diffusion tensor imaging, basal ganglia

Location:Salt Lake City

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Functional MRI of Brain Frontal-Subcortical Circuits in Bipolar Depression

PI:Marchand

Research Team:Hsu E, Lee JN, Thatcher J, Gale P, Kreitschitz S,

Summary:The primary aim of this study is to extend our previous findings and further evaluate the use of motor activation paradigms as probes of frontal-subcortical brain circuit abnormalities in functional neuroimaging studies of bipolar disorder. A secondary goal is to enhance our understanding of normal frontal-subcortical brain circuit function. This work may provide a means of using functional neuroimaging to monitor and predict treatment response; both of which may improve our ability to treat bipolar disorder, which has a high risk of suicide.

Keywords:Bipolar disorder, functional MRI, diffusion tensor imaging, basal ganglia

Location: Salt Lake City

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Development of a neural circuit based treatment model for impaired memory using repetitive transcranial magnetic stimulation (rTMS).

PI: Gilbert Preston, M.D. (1, 2)

Research team: Michael Funke, M.D., PhD. (3); Claudio Silva, Ph.D. (4); Eric Wassermann, M.D. (5); Terry Goldberg, Ph.D. (6)

Institutional Affiliations:
1. - VA VISN 19 MIRECC
2. - University of Utah School of Medicine (UUSOM) Department of Psychiatry
3. - University of Utah School of Medicine (UUSOM) Department of Neurology
4. - University of Utah School of Engineering, Scientific Computing and Imaging (SCI) group
5. - Chief, laboratory of Brain Stimulation; NIH - NINDS, Bethesda, Md.
6. - Director of Research in Neurocognition, Professor of Psychiatry; Albert Einstein College of Medicine, New York, NY

Summary: Impaired memory and executive function are critical features of neuropsychiatric disorders with high risk for suicide such as Major Depressive Disorder (MDD), Schizophrenia, PTSD, for example. Such brain based disorders are closely associated with functional impairments of brain rhythms. This study has found preliminary evidence that supports the concept of developing a rTMS model for treatment of this key abnormality underlying the common ground of apparently dissimilar illnesses.

Keywords: Depression; suicide; executive function; memory; transcranial magnetic stimulation; neural synchrony

Location: Salt Lake City

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Improving Access to and Quality of Mental Health Care for OEF/OIF Veterans

PI/CO PI:Pamela Staves, RN, MS, NP, Bradford Felker MD, Matthew Jakupcak PhD, Tracy Stecker PhD, Ashley Hedeen MD, Daniel Conybeare, Ellen Li MD

Summary:The purpose of this study is to understand the structure of care being used to address OEF/OIF veterans who are suffering from depressive and or anxiety disorders and to determine the extent that evidence-based care treatment guidelines are being implemented or are effective.

Phone survey results from site managers were obtained from 11 of 12 primary care clinics and 12 of 12 mental health clinics in VISN 16, 19, and 20 medical centers. Although all sites are using clinical reminders, many report limited clinical utility from these reminders. While common mental disorders include PTSD, Major Depression and Substance use Disorders, few sites use the PHQ-9, PCL or ADUIT as objective measures. Site managers noted that traditional models of mental health care and clinic hours seem less effective than ones that offer outreach activities, after hour appointments, phone-based care, case management and individual therapy that includes families.

Keywords: OEF/OIF, veterans, access to healthcare

Location: Denver

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Atypical Antipsychotics and P50 Sensory Gating

PI/CO PI: Lawrence E. Adler, MD, Merilyne C. Waldo, Ph.D.

Research Team: Laurie Woodward, REEGT

Summary: This is a double blind cross over, placebo controlled study of the acute and chronic effects of ondansetron, a specific 5HT3 antagonist in schizophrenia. The purpose of this study is to determine whether the acute addition of ondansetron to ongoing treatment with atypical antipsychotics for schizophrenia will improve neurophysiologic and neurocognitive functioning and whether these changes can be sustained with chronic treatment.

Location: Denver

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Hippocampal Functioning and the Virtual Water Maze Test

PI/CO PI: Lawrence E. Adler, MD, Merilyne C. Waldo, Ph.D.

Research Team: Laurie Woodward, REEGT

Summary: In animals, the Morris Water Maze is know to be a sensitive indicator of hippocampal functioning. This relationship has not been established in humans. This project is designed to examine the role of hippocampal functioning in controls and in patients with schizophrenia (who, as a group, are known to have deficits in both the anatomy of and functioning in the hippocampus) and performance on a virtual Morris Water Task (VMWT), and to compare it with hippocampal functioning during sensory gating of auditory stimuli.

Location: Denver

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Verenicline as an Adjunct Treatment in Schizophrenia and Bipolar Disorder

PI/CO PI: Lawrence E. Adler, MD, Merilyne C. Waldo, Ph.D.

Research Team: Laurie Woodward, REEGT

Summary: This experiment is designed to determine if adding varenicline, a partial agonist selective for a4ß2 nicotinic acetylcholine receptor subtypes as well as a full a7 agonist, acutely to ongoing treatment in patients with schizophrenia or bipolar disorder results in an improvement in P50 auditory gating. This is a pilot study designed to help us determine if further investigation of the effects of this drug is warranted.

Location: Denver

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A Longitudinal Study of Cerebral and Neurocognitive Function in HIV-Infected Persons with a History of Advanced Disease on HAART

PI:Bradford Navia, MD

Consultant:Kristin Brousseau, DO MIRECC Psychiatry Fellow

Research team: The National Institute of Neurological Disorders and Stroke and the MRS Consortium

Summary: This is an observational longitudinal study to assess the pattern and frequency of metabolic and structural brain injury as measured by MRS and MRI among neurologically asymptomatic HIV-infected subjects who have undergone partial immune reconstitution in response to HAART. These results will be compared to those of subjects with the AIDS dementia complex (ADC). The study also serves to identify those at risk for brain injury and subsequent neurocognitive impairment in the setting of HAART and advanced disease.

Keywords: HIV, AIDS, AIDS Dementia Complex, structural neuroimaging, functional neuroimaging, neuropsychological testing

Location: Denver

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HIV Neurocognitive Impairment (HNCI): Improving Detection of HNCI with Cognitive Screening

PI/CO-PI:Kristin Brousseau, DO MIRECC Psychiatry Fellow, Lawrence E. Adler, M.D.

Research team: Christopher Filley, MD; Samantha MaWhinney, ScD, Elizabeth Connick, MD

Summary: This project is a cross-sectional prospective study on HIV Neurocognitive impairment (HNCI) comparing three cognitive screening tools in 25 HIV+ outpatients from an infectious disease clinic with no known other possible causes of cognitive impairment. We compared the relative sensitivities of the Mini-Mental State Examination (MMSE), the HIV Dementia Scale (HDS) and the Frontal Assessment Battery (FAB) in their abilities to detect HNCI. Subjects also were administered a review of cognitive, emotional, behavioral and neurological symptoms (including suicidal ideation), and an elemental neurologic examination. This project also compared the frequency of HNCI identified by these cognitive- screening measures to that documented in these subjects’ medical records. This study demonstrated that HNCI is underrecognized and that cognitive screening helps improve its detection. The FAB appears to be more sensitive than the MMSE and the HDS in the detection of HNCI, especially in its earlier stages.

Keywords: HIV, AIDS dementia complex, screening, cognition

Location: Denver

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MOCL: Mental Outcomes Core Lab

PI/CO PI: Laurie Shroyer PhD

Research Team: Joe Huggins, Joseph Hasley, Gregory N. Gauthier

Summary: The overarching goal of the Mental Outcomes Core Lab (MOCL) – as part of the Mental Illness Research, Education, and Clinical Centers (MIRECC) - is to identify veterans who are at risk for suicide and apply appropriate interventions and treatment for such patients. Our vision is to develop an innovative, values driven VA MIRECC registry for suicidology, where the focus will be on the mental health of veterans, especially with service-related conditions, in order to evaluate the suicidal-related endpoints.

Keywords: Suicide, risk, intervention, veterans

Location: Denver

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MOCL: Death Determination and Cause of Death Concordance

PI/CO PI: Laurie Shroyer PhD

Research Team: Gregory N. Gauthier, Joseph Hasley, Joe Huggins

Summary: This quality improvement program examined the data integrity related to deaths with a focus on classification for cause of death data (suicidal-related and non-related) for the VA electronic medical record system (VistA). To-date, no evaluations for suicide versus non-suicide cause of death in VistA has been completed.
As a first step, the reliability of death data in VistA was compared to the VA “Gold Standard” for death events using the Beneficiary Identification Records Locator System - BIRLS. Second, an independent clinical assessment for the cause of death for all identified deaths was compared with the Colorado “Gold Standard” (vital records).
Preliminary analysis indicates that VistA reliably records patient death events as well as classifies causes adequately. This suggests that VistA cause of death data may be appropriate to use for quality improvement endeavors and/or development of a future VA-based suicide registry.

Keywords: Suicide, risk, intervention, veterans

Location: Denver

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MOCL: VistA Database Extraction Comparison (“VDEX”)

PI/CO PI: Laurie Shroyer PhD

Research Team: Gregory N. Gauthier, Joseph Hasley, Joe Huggins

Summary: To demonstrate the following two main points:
a) Data pertinent to the MIRECC Mental Health Core Outcome Lab (MOCL) study that is contained in VistA (Veterans Health Information Systems & Technology Architecture) system can be obtained via extraction from the VISN 19 Data Warehouse.
b) Both the completeness and quality of data from the VISN 19 Data Warehouse (DW) has been verified through comparison against a second, independent national repository of data obtained from the VistA system, the VISN 19 Decision Support System (DSS).

Keywords:Data quality, VistA, electronic patient record

Location: Denver

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Genetic Risk Factors in Post-Traumatic Stress Disorder and Alcoholism

PI: Pamela Bennett PhD

Research Team: Stephen Allen PhD, Christopher Stock PharmD.

Summary: The study involves the collection of DNA samples and family history information from veterans diagnosed with post-traumatic stress disorder and/or alcohol dependence. The study also includes the colleciton of DNA samples from a population of case-matched control veterans (matched for race, sex, and combat exposure) without a history of mood disorder or substance abuse. The study aims to identify hereditary risk factors (genetic polymorphisms0 that contribute to the risk of PTSD and or AD by examining candidate genes in combat-exposed veterans suffering from these disorders.

Keywords: Alcohol Dependence, Posttraumatic Stress Disorder, Genotype

Location: Salt Lake City

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Family Association Study of Genetic Susceptibility for Schizophrenia

PI: Gilbert A. Preston M.D., PI of Utah Satellite of the NIH-NIMH TRIOS Study.

Research Team: Lisa Ord, MSW; LCSW; PhD. Candidate, Department of Behavioral and Social Sciences, University of Utah; Daniel Weinberger, M.D., Chief, Clinical Brain Disorders Branch, NIH-NIMH, Bethesda, Md.

Summary: Schizophrenia is a severe and disabling mental illness with the highest rate of suicide of all mental illnesses; at any given time 1% of the population is diagnosed with Schizophrenia; it is also one of the most expensive medical disorders in the VA system inasmuch as it strikes post-adolescent men and women who will require multi-faceted medical, financial and psychosocial support for the rest of their lives. This national, multi-center study aims to identify genes of risk in this illness that are associated with impairment of critical features such as memory, for which there is no current treatment.

Keywords: Schizophrenia, Genes; Family studies; Memory; Endophenotypes

Location: Salt Lake City

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