Social Integration During Psychiatric Inpatient Therapy as Predictor of Treatment Response (SANITY)   

Team:  Khadije Bekdach, Nick Michalek, Dirk Scheele, Jella Voelter

Social connections have a strong impact on mental and physical health. Surprisingly, however, there is a paucity of studies probing the predictive validity of perceived social connections such as subjective social support and loneliness for the outcomes of inpatient treatment of BPD. Although social impairments are key features of BPD psychopathology, social integration has been largely neglected, which may therefore explain the minimal translation of predictive molecular or imaging-based biomarkers into the clinic. We hypothesize that the assessment of negative cognitive biases at baseline will help to identify BPD patients who will experience less social support and more loneliness during inpatient treatment. Furthermore, we expect that the inclusion of social integration indices will increase the incremental validity for the biomarker-based prediction of treatment response.

In this longitudinal, observational study, we plan to recruit 60 BPD patients from the Department of Psychiatry (University of Oldenburg) to assess negative cognitive biases and the underlying neurobiological mechanisms with behavioral, neuroendocrine, psychophysiological, and neural readouts before and after a four-week inpatient treatment. To evaluate pathological biases, we will compare the patients' data with a control group of 30 healthy participants, who will also be tested twice. Neural readouts include structural and functional magnetic resonance imaging (fMRI) measurements. The fMRI tasks will probe the processing of social touch, interpersonal trust, and interoception. To further investigate pathological distortions of social touch, the tactile detection threshold will be assessed and participants will indicate the bodily areas where others are allowed to touch. Further, patients and healthy participants will perform a positive social interaction task, accompanied by psychophysiological and neuroendocrinological measures. Psychometric questionnaires and semi-structured interviews will be used to monitor symptom load and social indices before, after, and during the inpatient treatment. Long-term effects will be assessed by online questionnaires 8,12, 20 and 24 weeks after inpatient treatment (follow-ups). We plan to conduct uni- and multivariate analyses of the baseline measurements to predict patients' social integration and treatment response during the inpatient therapy and examine treatment-related changes. The findings of this project may help identify vulnerable patients that benefit from adjunct therapies targeting negative social biases and improve biomarker-based models of treatment prediction.

This project is funded by a "Forschungspool" grant from the University of Oldenburg.