Prefrontal activation in suicide attempters during decision making with emotional feedback

Abstract

Emotional feedback, such as faces showing emotions, can influence decision making. Decision making and emotional face processing, mainly mediated by the prefrontal and cingulate cortices, are impaired in suicide attempters. Here, we used functional MRI (fMRI) to study prefrontal activation in suicide attempters during a modified version of the Iowa Gambling Task (IGT) that included emotional face feedback. We randomly distributed the 116 euthymic women (n = 45 suicide attempters, n = 41 affective controls with history of depression without suicide attempt, and n = 30 healthy controls) included in the study in three emotional IGT groups: concordant (safe and risky choices followed by happy and angry faces, respectively), discordant (safe and risky choices followed by angry and happy faces, respectively), and neutral condition (safe and risky choices followed by neutral faces). Considering the two IGT phases (ambiguous and risky), we then analyzed five regions of interest during the risky vs. safe choices: orbitofrontal (OFC), anterior cingulate (ACC), ventrolateral (VLPFC), medial (MPFC) and dorsal prefrontal (DPFC) cortices. We found: (1) impaired decision making and increased DPFC and OFC activation in suicide attempters vs. controls in the discordant condition during the risky phase; (2) reduced VLPFC activation in suicide attempters in the concordant condition during the ambiguous phase; and (3) decreased OFC, ACC and DPFC activation in both control groups in the concordant condition during the ambiguous phase. Suicide attempters showed prefrontal alterations during reward-learning decision making with emotional feedback. Suicide attempters may guide their decisions to avoid social negative feedback despite the expected outcome.

The associations between suicide-related behaviors, prefrontal dysfunction in emotional cognition, and personality traits in mood disorders

“…Disruption of the combination of the DLPFC and inferior frontal gyrus regions (which control cognition) and the OFC and ventral anterior cingulate gyrus regions (which are associated with low self-esteem and future pessimism) may lead to SRB 22 . In an fMRI study using a decision-making task with emotional facial feedback, MDSA and MDNSA displayed different activations of the OFC and DLPFC 60 . Another fMRI study using a similar decision-making task demonstrated that MDSA patients showed higher activation of the OFC and DLPFC during a financial win compared to MDNSA, suggesting that these regions are associated with the impairment of decision-making in MDSA 50 .…”

The amplitude of low-frequency fluctuation characteristics in depressed adolescents with suicide attempts: a resting-state fMRI study

“…There is some evidence to support this idea. For example, studies have found that suicide attempters show prefrontal activation deficits during decision-making and inhibited increases in prefrontal blood flow compared to healthy controls (37). These findings suggest that suicide attempts may have an impact on brain function.…”

Translating Interventional Neuroscience to Suicide: It’s About Time

“…Emotional regulation is the control-dependent modification of reactions to emotionally evocative events (77); this regulation evokes DLPFC activation (reviewed in (78)). The inclusion of emotional feedback in decision-making tasks generally alters prefrontal dynamics, but more so in adult suicide attempters than clinical controls (79).…”