Request for Funding

Medical Student Research Fellowship for Summer 2004

Mentor: Cindy Claassen, Ph.D.
Department: Psychiatry
Room number: FL13.1331
Mail Code: 9119
Phone number: 214-648-0164
E-mail: Cindy.Claassen@UTSouthwestern.edu
Project title:

Human subjects IRB approved project number (where applicable): IRB File#: 0703-471

Title: "Temporal Stability of Dimensional Personality Trait Expression
Found In Acutely Suicidal Patients"
Cindy Claassen, Ph.D., A. John Rush, M.D. Mentor

Project Type This is patient-based research examining suicidal behavior.

Brief Description of Project: Impulsive aggressivity was first defined in criminal populations as present in "aggressive acts in which the perpetrator gets 'carried away' by certain features of the environment so that [his] 'crime of passion' is at least partially involuntary" (Berkowitz, 1974). From a psychiatric point of view, there is substantial neurobiological and clinical research evidence suggesting that this behavioral paradigm is a discrete, measurable phenomenon associated with significant psychiatric morbidity & mortality and with a distinct biological substrate. High levels of impulsivity and aggression are a central characteristic of a variety of Axis I disorders, and have significant correlations with Cluster "B" borderline and antisocial personality disorders. This behavioral dimension has been described as a personality "trait" and is heritable, (Coccaro et al 1993). Laboratory testing paradigms and self-report inventories have successfully correlated impulsive aggressivity with violent criminal acts and other aggressivity (e.g., Cherek 1997a; Cherek 1997b; Barratt 1997). Abnormalities of 5-HT and noradrenergic functioning have been implicated in aggression against both self and others using animal models, as well as drug challenge, CSF, and genetic studies in humans; the role of dopamine and GABA in human studies appears to be significant but requires further investigation (Oquendo, 2000). As Skodol comments, promising initial genetic findings "suggest that the association between reduction of serotonin and impulsive aggression may be contributed to in part by individual genetic differences and point to the need to assess impulsivity/aggression, suicide attempts, and traits of neuroticism or novelty-seeking" (2002b).
Significant research initiatives are suggested by recent work in this area. One well-defined study found that aggression/impulsivity was the only significant predictor of suicide attempter status among psychiatric inpatients when compared with other potential predictors such as psychosis, depression/ hopelessness, comorbid borderline personality disorder, past head injury, abuse in childhood, and a family history of suicidal behavior (Mann et al., 1999). However, while impulsive aggression may predispose both self- and other-directed aggressive behavior, it likely does not trigger such behavior. To be clinically useful, the core phenotypic dimensions of the trait that are associated with injury behaviors should be identified, and the specific conditions under which they begin to interfere with functioning should be clearly understood. Also, if impulsive aggressiveness is indeed a core personality dimension dysregulated in patients with BPD characteristics, it is possible that impulsive aggressiveness may predict not only self-harm, but a wider spectrum of injury-prone behavior. Significant numbers of patients who sustain traumatic injuries also have high rates of self-reported risky, antisocial and violent behaviors (Claassen, submitted for publication).
Funded by the Borderline Personality Disorder Research Foundation this study is an investigation comparing impulsive aggressive trait expression in self- and accidentally-injured patients. The study seeks to examine clinical status, level of trait expression, and life stressors at the time of the index injury and three-months post-crisis.

Previous Research Activities or Publications with Medical Students:

Medical Student Abstracts from Summer, 2003

Occult Suicidality in an ED Population
Daniel Moon Mentor: Dr. Cindy Claassen, Dr. Gregory Larkin

Prevalence And Spectrum Of Psychopathology In A Cohort Of Injured Emergency Department Patients
David Farman Mentors: Dr. Gregory Larkin, Dr. Cindy Claassen

Prevalence of Depressive Symptomatology in a General Emergency Department Population
Luis A. Villarreal Mentor: Dr. Gregory Larkin, Dr. Cindy Claassen

Occult Intimate Partner Violence in an ED Population
Gabriela Blanco Mentor: Dr. Gregory Larkin, Dr. Cindy Claassen

Posters / Oral Presentations Accepted for presentation at meetings, based on the above thusfar:

Claassen C, Larkin GLL, Blanco G, Farman D, Moon D, Villarreal L. Prevalence and Spectrum of Psychopathology in a Cohort of Injured Emergency Department Patients, accepted for presentation at the 7th World Conference on Injury Prevention and Safety Promotion, June 6-9, 2004.

Claassen C, Larkin GLL, Moon D, Blanco G, Farman D, Villarreal L. Outcomes of Occult Suicidality In A Multiethnic Emergency Department Population, accepted for presentation at the 7th World Conference on Injury Prevention and Safety Promotion, Vienna, Austria, June 6-9, 2004.

Larkin GLL, Claassen C, Blanco G, Farman D, Moon D, Villarreal L, Hood A, Shedler J.Psychiatric Comorbidity in Victims of Intimate Partner Violence in a Multiethnic Emergency Department Population, Accepted for oral presentation at the SAEM Annual Meeting in Orlando, May 16-19, 2004.

Return to UT Southwestern Homepage

Return to Student Research Projects Index