Establishing Relationships and Developing a Therapeutic Target for Impulsivity and Suicidality Among Veterans with Traumatic Brain Injury and Co-occurring Conditions

职业发展奖1级（CDA 1）有两个目标。首先，候选人将审查 创伤性脑损伤（TBI）退伍军人冲动性与自杀倾向之间的关系 范围广泛的严重性。这一点很重要，因为冲动，这是表现在高达40%的个人 与TBI，已被确定为一个独立的危险因素，完成自杀的人没有 TBI的历史由于冲动是自杀企图的主要风险因素，候选人将检查 冲动和自杀之间的关系在一个数据集汇编从现有的心理和 神经心理学测试数据收集了[200]退伍军人TBI从轻度到重度。她还将 对这些患者进行完整的病历审查，以补充收集的数据。退伍军人谁参加了 最初的研究有共同的共同发生的精神疾病。这将允许候选人探索如何 TBI和精神状况相互作用并影响冲动和自杀倾向。候选人的第二个目标是 利用现有的神经成像数据来识别与冲动和自杀有关的特定大脑区域 在TBI患者中。候选人将使用体积和静息状态功能连接MRI图像 实现第二个目标。完成这些目标是候选人的短期目标。 这项研究是至关重要的，因为自杀是退伍军人管理局系统内退伍军人的一个主要问题。退伍军人占22% 比平民更有可能自杀患有TBI的退伍军人更有可能死于自杀 没有TBI。重要的是要描述冲动和自杀之间的联系， 自杀倾向的治疗此外，识别这些行为问题的神经相关性将有助于 开发生物靶点。目前，还没有提出生物治疗来管理TBI相关 防止退伍军人自杀的冲动理解TBI冲动性与 自杀倾向将有助于确定关键的行为目标和潜在的神经相关性。这个项目将有助于 候选人和她的团队创建一个神经解剖学上知情的治疗策略。 最终，候选人的长期职业目标是成为VA的独立临床研究人员 专门研究创伤性脑损伤和自杀倾向的系统她希望利用这种专业知识来创造新的治疗方法。 因此，她将在强大的多学科培训的指导下完成精心的培训计划 该小组与上述研究领域的专家举行了大量会议， 研究技能和课程补充研究。 计划中的研究是创新的，因为它探索了新的自杀机制， 退伍军人这是重要的，因为它可能会导致一个新的，有效的治疗自杀的退伍军人与 创伤性脑损伤该项目的影响是多方面的。该项目将增进对创伤性脑损伤、 冲动和自杀倾向它还将加强候选人的研究技能，并投资于一个新的有前途的 年轻的VA临床医生-科学家，从事独立的TBI后康复研究，专注于 神经精神病学结果与自杀倾向的专业知识。

This Career Development Award level 1 (CDA1) has two aims. First, the candidate will examine the relationship between impulsivity and suicidality among Veterans with traumatic brain injury (TBI) across a broad range of severities. This is important because impulsivity, which is exhibited in up to 40% of individuals with TBI, has been identified as an independent risk factor for completing suicide among those without a history of TBI. Since impulsivity is a major risk factor for making a suicide attempt, the candidate will examine the relationship between impulsivity and suicidality in a dataset compiled from existing psychological and neuropsychological testing data collected for [200] Veterans with TBI from mild to severe. She will also complete chart reviews on these patients to supplement the collected data. Veterans who participated in the original studies had common co-occurring psychiatric conditions. This will allow the candidate to explore how TBI and psychiatric conditions interact and influence impulsivity and suicidality. The candidate’s second aim is to utilize existing neuroimaging data to identify specific brain areas implicated in impulsivity and suicidality among those with TBI. The candidate will use volumetric and resting state functional connectivity MRI images to accomplish the second aim. Completing these aims are the candidate’s short-term goals. This research is critical as suicide is a major issue among Veterans within the VA system. Veterans are 22% more likely to die by suicide than civilians. Veterans with TBI are even more likely to die by suicide than those without TBI. It is important to characterize the link between impulsivity and suicidality to create possible treatments for suicidality. Further, identifying a neural correlate of these behavioral problems will help to develop biologic targets. Presently, there are no proposed biologic treatments to manage TBI related impulsivity in Veterans to prevent suicide. Understanding the relationship between TBI impulsivity and suicidality will help to identify key behavioral targets and the underlying neural correlates. This project will help the candidate and her team to create a neuroanatomically informed treatment strategy. Ultimately, the candidate’s long-term career goal is to become an independent clinical researcher in the VA system with expertise in TBI and suicidality. She hopes to leverage this expertise to create novel treatments. As such, she will complete a careful training plan under the mentorship of a strong, multidisciplinary training team involving ample meetings with experts in fields relating to the above research, hands-on training in research skills and coursework complementary to the research. The planned research is innovative, as it explores novel proposed mechanisms underlying suicidality within the Veteran population. It is significant, as it may lead to a new, effective treatment for suicidality in Veterans with TBI. The impact of this project is multifaceted. The project will improve understanding of the links between TBI, impulsivity and suicidality. It will also strengthen the candidate’s research skills and invest in a new promising young VA clinician-scientist for a career in independent post-TBI rehabilitation research, focused on neuropsychiatric outcomes with expertise in suicidality.