Neuromodulation for impulsivity and suicidality in Veterans with mildtraumatic brain injury and common co-occurring mental health conditions

神经调节对患有轻度脑损伤和常见并发心理健康状况的退伍军人的冲动和自杀倾向

• 批准号: 10640567
• 负责人: Alexandra Leigh Aaronson
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640567
• 关键词: Address; Affect; Aftercare; Area; Behavior; Brain; Brain Injuries; Caring; Cessation of life; Clinical; Clinical Trials; Communities; Data; Data Analyses; Development; Double-Blind Method; Elements; Enrollment; Evidence based treatment; Exhibits; Feeling suicidal; Forehead; Foundations; Funding; Generations; Goals; Health; Image; Impulsive Behavior; Impulsivity; Individual; K-Series Research Career Programs; Knowledge; Limbic System; Link; Magnetic Resonance Imaging; Mediating; Medical Records; Mental Depression; Mental Health; Mentors; Mentorship; Mission; Neuronal Plasticity; Occupational; Outcome; Pain; Participant; Persons; Physicians; Physiologic pulse; Pilot Projects; Play; Population; Prefrontal Cortex; Publishing; Randomized; Recording of previous events; Rehabilitation therapy; Reporting; Research; Research Personnel; Research Project Grants; Rest; Risk; Risk Factors; Safety; Sampling; Scientist; Self-Injurious Behavior; Serious Adverse Event; Side; Suicide; System; Testing; Therapeutic; Training; Transcranial magnetic stimulation; Veterans; brain magnetic resonance imaging; career; design; effective therapy; empowerment; experience; functional improvement; functional outcomes; improved; innovation; knowledge base; mild traumatic brain injury; multidisciplinary; neural; neuroimaging; neurological rehabilitation; neuropsychiatry; neuroregulation; novel; precision medicine; prevent; rational design; rehabilitation research; response; safety and feasibility; safety testing; skills; social; suicidal; therapy design; treatment strategy

This Career Development Award Level 2 (CDA2) represents the candidate’s effort to execute a pilot study of a novel neuromodulatory treatment for Veteran [social and occupational functioning], impulsivity and [suicidal ideation] following mild traumatic brain injury (mTBI). The candidate’s first aim will examine the tolerability, safety and feasibility of frontal pole intermittent theta burst stimulation (iTBS) for Veterans with mild traumatic brain injury (mTBI), negative urgency impulsivity, [and suicidal ideation]. This is important because impulsivity, which is exhibited in up to 40% of individuals with TBI, is an independent risk factor for dying by suicide and is associated with poorer functional outcomes following TBI. Presently, there are no widely accepted treatment strategies for impulsivity, [suicidal ideation and social and occupational functional deficits] following TBI. The candidate’s second aim is to determine the effects of frontal pole iTBS on social and community functioning, negative urgency impulsivity and [suicidal ideation]. This will allow the scientific community to better understand how frontal pole iTBS treatment impacts [social and community] functioning and mental health outcomes. Finally, the candidate aims to evaluate whether iTBS improves connectivity between the VMPFC and limbic system, using resting state functional connectivity MRI. Completing this aim will allow us to better understand how iTBS affects neural connectivity and whether these changes are related to functional and mental health outcomes. 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 create a treatment to prevent unnecessary Veteran deaths while helping Veterans feel empowered and functional within their communities. [Suicide and TBI are not unique to Veterans, however. Civilians with TBI are also more likely to die by suicide than those without. Thus, findings from this research could serve to improve neuropsychiatric care in the civilian sector, as well.] This project serves as a critical first step in allowing the candidate and her team to develop a biologically-informed treatment strategy for the many individuals who struggle with mTBI, [social and occupational functional deficits], impulsivity and [suicidal ideation]. Ultimately, the candidate’s long-term career goal is to become an independent clinical researcher in the VA system with expertise in TBI, suicidality, neurostimulation and neuroimaging. As such, she will complete a careful training plan under the mentorship of a strong, multidisciplinary training team involving opportunities for networking with experts in fields relating to the above research, hands-on training in necessary research skills and coursework complementary to the research project. The planned research is significant, innovative, and impactful, as it will be the first pilot study of a new iTBS treatment paradigm, designed to improve Veteran lives and functional outcomes after mTBI. It will also strengthen the candidate’s knowledge base and research skills, preparing her for an independent career in post-TBI rehabilitation research, with expertise in impulsivity, suicidality and neuromodulation.

该职业发展奖2级(CDA2)代表候选人在执行试点工作方面所做的努力 一种新的神经调节疗法对退伍军人[社会和职业功能]、冲动和 [自杀意念]在轻度创伤性脑损伤(MTBI)后。候选人的第一个目标是审查 轻度退伍军人额极间歇性theta爆发刺激(ITBS)的耐受性、安全性和可行性 创伤性脑损伤(MTBI)、负性紧急冲动和自杀意念。这一点很重要，因为 冲动在多达40%的脑外伤患者身上表现出来，是死于脑损伤的独立危险因素 自杀，并与脑外伤后较差的功能结局有关。目前，还没有广泛的 冲动、[自杀意念及社会和职业功能缺陷]的公认治疗策略 跟随着TBI。候选人的第二个目标是确定额极ITBS对社会和 社区功能、消极紧迫感、冲动和[自杀念头]。这将允许科学的 社区更好地了解额极ITBS治疗如何影响[社会和社区]功能 和心理健康结果。最后，候选人的目标是评估ITBS是否改善了连接性 在VMPFC和边缘系统之间，使用静息状态功能连接性MRI。完成这一目标 将使我们更好地了解ITBS是如何影响神经连接的，以及这些变化是否相关 对功能和精神健康的影响。 这项研究至关重要，因为自杀是退伍军人在退伍军人制度中的一个主要问题。退伍军人 自杀死亡的可能性比平民高22%。患有脑外伤的退伍军人自杀死亡的可能性甚至比 那些没有脑外伤的人。重要的是创造一种治疗方法，防止不必要的退伍军人死亡，同时帮助 退伍军人感到自己在社区中获得了力量，发挥了作用。[自杀和脑外伤并不是退伍军人独有的， 然而。患有脑外伤的平民也比没有的平民更有可能自杀身亡。因此，这一发现 研究还可有助于改善平民部门的神经精神护理。]这个项目是一个 允许候选人和她的团队开发基于生物信息的治疗策略的关键第一步 对于许多与mTBI作斗争的人来说，[社会和职业功能缺陷]，冲动和 [自杀意念]。 最终，候选人的长期职业目标是成为一名独立的临床研究人员 VA系统，在脑外伤、自杀、神经刺激和神经成像方面具有专业知识。因此，她将完成一项 在强大的多学科培训团队的指导下制定仔细的培训计划，包括 与上述研究相关领域的专家建立联系，在必要的研究技能方面进行实践培训 与研究项目相辅相成的课程。 计划中的研究是重要的、创新的和有影响的，因为这将是新的 ITBS治疗模式，旨在改善mTBI后退伍军人的生活和功能结果。它还将 加强应聘者的知识基础和研究技能，为她的独立职业生涯做好准备 脑外伤后康复研究，具有冲动、自杀和神经调节方面的专长。