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

在患有创伤性脑损伤和并发病症的退伍军人中建立关系并制定冲动和自杀的治疗目标

• 批准号: 10091315
• 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: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091315
• 关键词: Affect; Area; Attenuated; Behavior; Behavioral; Biological; Biological Response Modifier Therapy; Brain; Cause of Death; Clinical; Data; Data Reporting; Data Set; Development; Diagnosis; Ensure; Exhibits; Feeling suicidal; Future; Goals; Health; Image; Impulsive Behavior; Impulsivity; Individual; K-Series Research Career Programs; Knowledge; Lead; Limbic System; Link; Magnetic Resonance Imaging; Mental disorders; Mentorship; Neuropsychological Tests; Outcome; Pathologic; Pathology; Patient Self-Report; Patients; Persons; Play; Population; Post-Traumatic Stress Disorders; Predisposing Factor; Prefrontal Cortex; Problem behavior; Psychological Tests; Recording of previous events; Rehabilitation therapy; Reporting; Research; Research Personnel; Rest; Risk; Risk Factors; Role; Scientist; Self-Direction; Severities; Substance Use Disorder; Suicide; Suicide attempt; Suicide prevention; System; Testing; Thinking; Training; Traumatic Brain Injury; Variant; Veterans; Violence; active duty; career; comorbidity; completed suicide; density; effective therapy; gray matter; improved; injured; innovation; meetings; mild traumatic brain injury; military service; military veteran; multidisciplinary; neural correlate; neuroimaging; neuroimaging marker; neuropsychiatry; novel; rehabilitation research; relating to nervous system; service member; skills; suicidal risk; suicide rate; therapeutic target; therapy development; treatment strategy

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.

这一职业发展奖1级(CDA1)有两个目标。首先，考生将考查 退伍军人颅脑损伤后冲动性与自杀性的关系 严重度范围很广。这一点很重要，因为冲动表现在高达40%的人身上 在没有脑损伤的人中，脑外伤已被确定为完成自杀的独立危险因素 TBI的历史。由于冲动是自杀未遂的一个主要风险因素，候选人将审查 从现有的心理学和自杀性数据集中收集的冲动和自杀之间的关系 收集了[200]名退伍军人颅脑损伤患者从轻度到重度的神经心理测试数据。她还会 完成对这些患者的图表审查，以补充收集的数据。参加比赛的退伍军人 最初的研究有常见的共生精神疾病。这将允许应聘者探索如何 脑外伤和精神疾病相互作用，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确定与冲动和自杀有关的特定大脑区域 在那些患有脑损伤的人中。候选人将使用容量和静息状态功能连接MRI图像 以实现第二个目标。实现这些目标是候选人的短期目标。 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。退伍军人占22% 比平民更有可能死于自杀。患有脑外伤的退伍军人比那些 而不使用TBI。重要的是要刻画冲动和自杀之间的联系，以创造可能 对自杀的治疗。此外，确定这些行为问题的神经关联将有助于 开发生物靶标。目前，还没有提出生物疗法来治疗与脑外伤相关的疾病。 退伍军人防止自杀的冲动。理解脑外伤冲动性与脑损伤的关系 自杀将有助于识别关键的行为目标和潜在的神经关联。这个项目将会有所帮助 候选人和她的团队创造了一种神经解剖学知情的治疗策略。 最终，候选人的长期职业目标是成为退伍军人事务部的一名独立临床研究员 在脑外伤和自杀方面有专业知识的系统。她希望利用这一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仔细的培训计划 小组与与上述研究有关的领域的专家举行了大量会议，并在 研究技能和课程作业是对研究的补充。 这项计划中的研究是创新的，因为它探索了自杀背后的新的拟议机制 退伍军人。它具有重要意义，因为它可能导致一种新的、有效的治疗退伍军人自杀的方法 TBI。这个项目的影响是多方面的。该项目将提高对TBI之间联系的理解， 冲动和自杀倾向。它还将加强候选人的研究技能，并投资于一种新的有前途的 年轻的退伍军人事务部临床医生兼科学家，从事独立的脑损伤后康复研究，专注于 在自杀方面有专长的神经精神病学结果。