Please select the eligibility criteria that correspond to the clinical trial below.
Title: Reducing Suicidal Ideation Through Insomnia Treatment
Brief Summary: Epidemiologic reports have linked insomnia to suicidal ideation and suicide death. However, no studies have determined whether treating insomnia decreases the risk of suicidality. We have new data indicating that (1) the link between insomnia and suicidal ideation holds true in clinical trials of depressed insomniacs, (2) dysfunctional cognitions about sleep are related to suicidal ideas, and (3) treatment of insomnia with hypnotics leads to a reduction of suicidal ideation. We now propose to test whether cautious use of hypnotics in suicidal, depressed insomniacs may reduce suicide risk in a multi-site clinical trial.


Options:
A: Inclusion Criteria:

* Meets criteria for diagnosis of borderline personality disorder
* History of at least one suicide attempt or self-mutilation episode 12 months prior to study entry
* Experiences continued urges to self-mutilate or attempt suicide
* Stable living situation
* Use of effective birth control if sexually active
* Clinically stable enough to tolerate placebo condition
* Not participating in other forms of treatment during the study

Exclusion Criteria:

* Any current organic mental syndromes, lifetime schizophrenic or bipolar disorders, psychotic disorders, or mental retardation
* Inability to complete psychiatric interview due to lack of cooperation or lack of comprehension
* Unable to tolerate fluoxetine or DBT
* Currently receiving treatment for an acute medical illness or other debilitating problem, including substance abuse or anorexia nervosa
* History of major depression lasting more than 3 months
* Current Hamilton depression score above 22 and not receiving treatment
* Pregnant or breastfeeding
B: Inclusion Criteria:

* Patients age 12-18 years presenting to the participating GPs, emergency departments or admitted after an episode of self-harm to the participating hospitals or self-referrals.
* History of recent self-harm. Recent self-harm is defined as self-harm occurring within the last 3 months (from the initial identification of a potential participant).
* Participants living within the catchment area of the participating practices and hospitals.
* Not needing inpatient psychiatric treatment.

Exclusion Criteria:

* Severe mental illness (such as Psychotic disorder) as Self-harm commonly co- occurs with other mental health difficulties.
* Conditions limiting engagement with assessment or intervention, including developmental and communication disorders, intellectual disabilities and autistic spectrum disorders.
* Temporary resident unlikely to be available for follow up.
C: Inclusion Criteria:

* Aged 18 and over
* Have a history of self-harm
* Good verbal and written understanding of English

Exclusion Criteria:

* Aged under 18 years of age
* No history of self-harm
* Poor verbal and written understanding of English
* Not currently resident of an inpatient facility for mental illness
D: Inclusion Criteria:

* Persons 18-65 years of age
* Persons with confirmed DSM-IV diagnosis of MDE by SCID
* Persons with Research Diagnostic Criteria diagnosis of insomnia
* Persons free of all psychotropic medications for one week before baseline assessment, except that prior FLX treatment will require 4 weeks of abstinence, and MAOIs will require 2 weeks of abstinence.
* Persons with Scale for Suicide Ideation (SSI) scores \>2
* Persons with Hamilton Rating Scale for Depression (HRSD24) score \>20
* Persons with Mini Mental State Exam (MMSE) score \>24
* Persons with Insomnia Severity Index (ISI) score \> 7
* Persons with habitual sleep latency \> or = 30 minutes or wake time in the middle of the night of \> or = 30 minutes, and sleep efficiency \< 85%

Exclusion Criteria:

* Non-English speaking, reading, writing persons
* Persons who pose imminent danger to self or others
* Persons with severe suicidal ideation (C-SSRS Suicidal Ideation Score \>3)
* Persons with clinical diagnosis of dementia
* Persons with active or past diagnosis of alcohol or substance abuse, bipolar disorder, schizophrenia per the SCID
* Persons who screen positive for moderate-severe sleep apnea (AHI \>10) or a prior sleep laboratory-confirmed diagnosis of a primary sleep disorder, such as sleep apnea or periodic limb movement disorder.
* Persons with BMI \> 50
* Persons with a self-reported history of napping \> 2 times per week (as these are associated with sleep apnea and periodic limb movement disorder in depressed insomniacs)
* Persons who might be harmed by exposure to hypnotics, including pregnant women and patients with respiratory conditions

Answer: D