Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

Johnston, Jennifer; Wang, Fei; Liu, Jie; Blond, Benjamin N.; Wallace, Amanda; Liu, Jiacheng; Spencer, Linda; Lippard, Elizabeth; Purves, Kirstin; Landeros-Weisenberger, Angeli; Hermes, Eric; Pittman, Brian; Zhang, Sheng; King, Robert; Martin, Andrés; Oquendo, María A.; Blumberg, Hilary P.

doi:10.1176/appi.ajp.2016.15050652

Cited by 191 publications

(187 citation statements)

References 48 publications

(68 reference statements)

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“…Gray matter volume decreases in VLPFC were also associated with high lethality of prior SA in MDD [24] and BPD [35,36]. This converges with longstanding findings from both postmortem studies demonstrating VPFC (ROIs including both VLPFC and VMPFC) differences in people who died by suicide [38], and PET studies of high lethality or high intent SAs, showing VPFC (VLPFC and VMPFC) alterations in serotonin (5-HT) synthesis, transporters and 5-HT1a receptors [39,40] (Supplementary Table 2).…”

Section: Vlpfcmentioning

confidence: 94%

“…Structural MRI studies have consistently shown lower gray matter volumes of the VLPFC in adult SAs, including SAs with MDD [31][32][33], BD [34,35], and schizoaffective disorder (SZA) [36]. Findings of lateral OFC volume decreases, extending to medial OFC, in adolescent and young adult SAs with BD [35], suggest these may be early differences. Lower VLPFC thickness, but not volume, is one of the rare findings related to SI in adults with MDD [37], suggesting the VLPFC may be involved not only in suicide behavior but also in the ideation that may generate it.…”

Section: Vlpfcmentioning

confidence: 99%

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Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

et al. 2019

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Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

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Section: Vlpfcmentioning

confidence: 94%

Section: Vlpfcmentioning

confidence: 99%

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

et al. 2019

Self Cite

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“…Decreased structural and functional connectivity in the amygdala–prefrontal neural system impairs emotional regulation and is associated with increased suicide risk 98. The cingulate cortex is known to recruit other brain regions in response to conflict 99.…”

Section: Introductionmentioning

confidence: 99%

Suicide and Lyme and associated diseases

Bransfield¹

2017

NDT

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PurposeThe aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject.IntroductionMultiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD.MethodA retrospective chart review and epidemiological calculations were performed.ResultsLAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital–urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year.ConclusionSuicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.

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“…One fMRI study found that deficits in reward processing were associated with a lifetime history of suicide attempts in older adults (Dombrovski et al, 2013), and a PET study found that serotonin1A binding in the raphe nuclei was associated with more lethal suicide attempts (Oquendo et al, 2016). In addition, a recent multimodal imaging study found that changes in functional connectivity in regions underlying emotion regulation were associated with history of suicide attempts in adolescents with BD (Johnston et al, 2017). …”

Section: Discussionmentioning

confidence: 99%

Active suicidal ideation during clinical antidepressant trials

Ballard

Snider

Nugent

et al. 2017

Psychiatry Research

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Suicidal patients are often excluded from clinical trials of psychiatric medications and from investigations using neurobiological techniques. To evaluate the presence, impact, and stability of active suicidal ideation (SI) across a range of antidepressant trials, we reviewed 14 clinical trials conducted in patients with either major depressive disorder (MDD) or bipolar disorder (BD) (N=269). Active SI at any time point in the clinical trial was identified and linked to participation in other research procedures. Stability of active SI across subsequent days was evaluated using intraclass correlation coefficients (ICCs) and compared to other depressive symptoms. Across 14 clinical trials, 63 participants (23%) reported active SI at some point during study participation. Of these participants, 33 completed a neuroimaging procedure and 16 completed polysomnography within a week of active SI. When active SI was subsequently assessed, only 39% of patients continued to report active SI after three days of assessment, despite receiving no additional treatment. ICCs were not significant for either SI or pessimism; other depressive symptoms showed stability over time. The results suggest that research can be conducted in depressed patients with active SI if such research coincides with careful observation. Active SI and pessimism may be particularly vulnerable to fluctuation.

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Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

Cited by 191 publications

References 48 publications

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Suicide and Lyme and associated diseases

Active suicidal ideation during clinical antidepressant trials

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