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

基本信息

批准号：
10394121
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
项目类别：
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

项目摘要

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.

该职业发展奖1级（CDA1）有两个目标。首先，候选人将检查脑部外伤（TBI）的冲动性与自杀性之间的关系广泛的严重性。这很重要，因为冲动性（多达40％的个体都暴露于使用TBI，已被确定为在没有A的人中完成自杀的独立危险因素 TBI的历史。由于冲动是自杀企图的主要危险因素，候选人将检查从现有心理和 [200]退伍军人收集的TBI从轻度到重度收集的神经心理测试数据。她也会对这些患者进行完整的图表审查，以补充收集的数据。参加的退伍军人原始研究具有常见的共同精神病。这将使候选人能够探索如何 TBI和精神病条件相互作用并影响冲动和自杀。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有TBI的人中。候选人将使用体积和静止状态功能连接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。这项研究至关重要，因为自杀是VA系统中退伍军人的主要问题。退伍军人是22％比平民更有可能因自杀而死。与TBI的退伍军人相比没有TBI。表征冲动性和自杀性之间的联系很重要，以创造可能自杀的治疗方法。此外，确定这些行为问题的神经元相关性将有助于开发生物学靶标。目前，尚无建议的生物治疗来管理与TBI有关的退伍军人的冲动性防止自杀。了解TBI冲动与自杀性将有助于确定关键的行为目标和潜在的神经相关性。这个项目将有所帮助候选人和她的团队制定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VA的独立临床研究人员具有TBI和自杀性专业知识的系统。她希望利用这种专业知识来创造新颖的治疗方法。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团队涉及与上述研究，动手培训有关的领域专家的充分会议研究技能和课程完善的研究。该计划的研究具有创新性，因为它探讨了自杀性的新型机制资深人口。这很重要，因为这可能会导致对自杀的新的，有效的治疗 TBI。该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。它还将增强候选人的研究技能并投资新的诺言年轻的VA临床科学家从事独立TBI康复研究的职业，专注于具有自杀专业知识的神经精神症状。