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. The adolescent must:

* be 11 to 18 years old;
* self-report an act of self-harm in the past 6 months,
* meet criteria for cut-off on two of the four underlying/maintaining factors (depression, emotion dysregulation, family conflict, substance use), and
* live with at least one parent-figure who agrees to participate in assessments and treatment Participants should be willing and able to participate fully in the protocol (e.g., to accept assignment to either condition, to provide sufficient locator information for follow-up, to allow their treatment sessions to be recorded for fidelity/process assessment and supervision).

Exclusion Criteria. Youth who:

* have a history of DSM V Developmental Disorders, Elective Mutism, Organic Mental Disorders, Schizophrenia, Delusional Disorder, Psychotic Disorder, and Bipolar Affective Disorder.
* are actively in crisis and reporting current ideation with a specific plan and with means to complete the plan.
B: Inclusion Criteria:

* meeting DSM-IV criteria for borderline personality disorder
* 18-60 years of age
* have had at least two episodes of suicidal or non-suicidal self-injurious episodes in the past 5 years,
* at least one episode of suicidal is in the 3 months preceding enrollment
* agreement to participate in evaluation of the program.

Exclusion Criteria:

* bipolar I disorder, delirium, dementia, mental retardation, or a diagnosis of substance dependence in the preceding 30 days
* living outside of Taipei area
* having any serious medical condition likely to require hospitalization within the next year (e.g. cancer)
* and having plans to leave the Taipei area in the next 1 year
C: Inclusion Criteria:

* At least 18 years old
* Engage in non-suicidal self-injury (NSSI) to reduce or lessen negative thoughts or feelings
* Not taking psychotropic medications, or meet criteria for stability on a particular dose and are willing to maintain a stable dosage throughout the study
* Meet the proposed Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for NSSI disorder, which includes:

  1. five or more days in which the individual has engaged in NSSI in the past year
  2. NSSI is associated with at least two two of the following: psychological precipitant (e.g., negative feelings or thoughts), urge prior to the act, preoccupation with NSSI, contingent response (e.g., expectation that the act will relieve a negative feeling state)
  3. clinically significant distress or interference caused by NSSI or its consequences
  4. NSSI does not occur exclusively during states of psychosis, delirium, or intoxication
  5. absence of suicidal intent

Exclusion Criteria:

* Current suicidal ideation and intent
* Currently receiving cognitive-behavioral therapy (CBT) or any psychotherapy to address NSSI, anxiety, depression, or other Axis I disorders (and are not willing to discontinue that treatment)
* Unwilling to refrain from initiating additional treatment during the course of the study
* Current or very recent symptoms that warrant immediate clinical attention, alternative treatment, and/or a higher level of care that cannot be provided through the study (e.g., florid delusions or hallucinations, rapid mood state, severe manic symptoms)
* Current or recent (within 3 months) history of substance use disorder (exception would be marijuana, caffeine, nicotine)
* Emotional symptomatology is due to a medical/physical condition
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