Functional Connectivity Alterations in Suicidal Patients Among Opioid Users

The OFC is functionally connected to other cortical brain regions (e.g., prefrontal and parietal cortices) but also subcortical areas in the dorsal striatum, a core reward circuitry region. The functional connectivity between the OFC and the dorsal striatum also plays an important role in addiction, particularly opioid abuse, and suicide behaviors. Thus, it is clear that the investigators need a better understanding of the therapeutic mechanisms using non-invasive brain stimulation (e.g., TMS) treatment to the OFC as applied to opioid users. As such, the investigators propose to use a combination of interleaved TMS-fMRI, a novel method to observe and characterize causal manipulations of functional neural circuits, targeting the OFC and resting state functional magnetic resonance imaging (fMRI) to longitudinally study psychiatric symptoms (e.g., opioid craving, suicidal behaviors) changes in opioid users.

Inclusion criteria

Opioid Use Patients:

Each potential subject will be eligible for inclusion in this study only if the specific criteria listed below are met:

• Be male or female aged 18-60 years old
• Participation in H-22611;
• Meets a World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST) score of 4+ in the opioid category;
• Has depressive symptoms according to the Patient Health Questionnaire (PHQ)-9;
• Has active suicidal thoughts according to Suicide Behaviors Questionnaire-Revised (SBQ-R);
• Be able to verbalize understanding of consent form, able to provide written informed consent, and verbalize willingness to complete study procedures;
• Female subjects must be non-nursing and not pregnant at the times of fMRI experiments and rTMS treatment;
• Has no contraindications to MRI (pacemaker, cochlear implants, metal in eyes, other metal implants, etc.); Meets the pre-screening magnetic resonance imaging (MRI) questions provided by the Center for Advanced MR Imaging (CAMRI);
• Has no contraindications to TMS (any types of non-removable metal in their head except the mouth, or within 12 inches of the coil, etc.).

Inclusion criteria

Healthy Controls:

Each potential subject will be eligible for inclusion in this study only if the specific criteria listed below are met:

• Be male or female aged 18-60 years old;
• No history of severe medical or neurological illnesses per history;
• Be able to verbalize understanding of consent form, able to provide written informed consent, and verbalize willingness to complete study procedures;
• Female subjects must be non-nursing and not pregnant at the time of fMRI experiments;
• Has no contraindications to MRI (pacemaker, cochlear implants, metal in eyes, other metal implants, etc.): Meets the pre-screening MRI questions provided by the Center for Advanced MR Imaging (CAMRI);
• Has no contraindications to TMS (any types of non-removable metal in their head except the mouth, or within 12 inches of the TMS coil, etc.).

Exclusion criteria

Any potential subject who meets any of the following criteria will be excluded from participating in the study if s/he has

• In the opinion of the clinician and the research team at admission, be expected to fail to complete the study protocol due to not tolerable to receive rTMS;
• Unable to understand the design and requirements of the study;
• Unable to sign informed consent for any reason;
• Has an unstable medical condition, including Acquired immunodeficiency syndrome (AIDS), acute hepatitis, active TB, unstable cardiac disease, unstable diabetes, hepatic or renal insufficiency;
• Female subjects who are pregnant or nursing;
• Contraindications to MRI (pacemaker, cochlear implants, metal in the eye, other metal implants, etc.): Do not meet the pre-screening MRI questions provided by the CAMRI;
• Contraindications to the noninvasive brain stimulation (NIBS) (any types of non- removable metal in their head except the mouth, or within 12 inches of the coil, etc.) Additional exclusion criteria for the TMS experiments are based on the recommendations described by the international consensus panel on brain stimulation;
• Non-English speaking subjects (we do not have the staff and resources to include other languages)