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; 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）代表候选人执行飞行员的努力 研究了一种新型的老兵神经调节治疗[社会和占领功能]，冲动性和 [杀菌的想法]轻度脑损伤（MTBI）。候选人的第一个目标将研究 额头间歇性theta爆发刺激（ITB）的耐受性，安全性和可行性 创伤性脑损伤（MTBI），阴性冲动，[和自杀的想法]。这很重要，因为 冲动性在多达40％的TBI个人中暴露在内，是死亡的独立危险因素 自杀，与TBI之后的功能结果较差有关。目前，没有广泛的 接受冲动的公认治疗策略，[成功的构想，社会和职业功能缺陷] 遵循TBI。候选人的第二个目的是确定额叶ITB对社交和 社区功能，负面的紧迫性冲动和[sucidal Ideas]。这将允许科学 社区更好地了解额叶ITB的治疗如何影响[社会和社区]功能 和心理健康结果。最后，候选人旨在评估ITB是否提高连接性 使用静止状态功能连接MRI，在VMPFC和边缘系统之间。完成此目标 将使我们能够更好地了解ITB如何影响神经连通性以及这些更改是否相关 实现功能和心理健康成果。 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 自杀的可能性比平民高22％。与TBI的退伍军人更有可能因自杀而死 那些没有TBI的人。重要的是创建一种治疗方法，以防止不必要的退伍军人死亡，同时帮助 退伍军人在社区中感到有能力和功能。 [自杀和TBI不是退伍军人所独有的， 然而。与没有TBI的平民相比，与没有TBI的平民更有可能死于自杀。那是从中的发现 研究也可能有助于改善平民部门的神经精神护理。]该项目作为一个 允许候选人和她的团队制定生物学知识的治疗策略的关键第一步 对于许多与MTBI斗争的人，[社会和占据的功能不足]，冲动性和 [Sucidal Idea]。 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系统具有TBI，自杀，神经刺激和神经影像学专业知识。因此，她将完成一个 在一个强大的多学科培训团队的心态下进行仔细的培训计划，涉及机会 与与上述研究，必要研究技能的动手培训有关的领域专家建立联系 和研究项目的课程完成。 计划的研究具有重要的，创新的和有影响力的作用，因为它将是首次对一项新的试点研究 ITBS处理范式，旨在改善MTBI之后的退伍军人生活和功能结果。它也会 加强候选人的知识库和研究技能，为她做好准备 TBI后康复研究，具有冲动性，自杀性和神经调节方面的专业知识。