Structural and functional alterations of the suicidal brain: An updated review of neuroimaging studies

Bani‐Fatemi, Ali; Tasmim, Samia; Graff‐Guerrero, Ariel; Gerretsen, Philip; Strauss, John S.; Kolla, Nathan J.; Spalletta, Gianfranco; Luca, Vincenzo De

doi:10.1016/j.pscychresns.2018.05.008

Cited by 83 publications

(57 citation statements)

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“…Overall, suicidality is indeed a highly complex and multifaceted phenomenon in which a large plethora of mechanisms and processes could be variable implicated, including the dysregulation of HPA activity, genetic load, epigenetics, cholesterol and triglyceride profile, specific neurocognitive and neuropsychological impaired domains, some personality traits and characters, sometimes state-dependent, and so on. 8,23,41,43,65,78,110,112,114,128,130,144,145,148,150,175,176 However, somewhat contrasting and sometimes inconclusive findings have been so far published, by enlarging the plethora of research fields yet to be furtherly deepened and investigated in the field of suicide risk amongst MDD subjects. As abovementioned, great deal of research has focused on dysfunction of the HPA axis and on alterations of main neurotransmitter system as well as a set of neuro-inflammatory modulators, even though concluding findings are still unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Neuroimaging studies show changes in several brain areas associated with an increased vulnerability to suicidality. 148 It has been documented that brain dysfunctions located in temporal, parietal and frontal (specifically dorsolateral and orbitofrontal areas) cortices are described in the suicidal brain. [148][149][150][151][152][153][154] Moreover, three structural areas, e.g., the left superior temporal gyrus, rectal gyrus, caudate nucleus; and three functional areas, e.g., right cingulate gyrus, the anterior cingulate and posterior cingulate have been identified as implicated in an increased suicidal vulnerability.…”

Section: Neuroimaging Studiesmentioning

confidence: 99%

“…148 It has been documented that brain dysfunctions located in temporal, parietal and frontal (specifically dorsolateral and orbitofrontal areas) cortices are described in the suicidal brain. [148][149][150][151][152][153][154] Moreover, three structural areas, e.g., the left superior temporal gyrus, rectal gyrus, caudate nucleus; and three functional areas, e.g., right cingulate gyrus, the anterior cingulate and posterior cingulate have been identified as implicated in an increased suicidal vulnerability. 151,[155][156][157] A smaller volume of the orbitofrontal cortex (right and left), lower left ventrolateral prefrontal cortex (VLPFC), frontal and temporal lobe volumes were observed amongst MDD patients with SA.…”

Section: Neuroimaging Studiesmentioning

confidence: 99%

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Understanding the Complex of Suicide in Depression: from Research to Clinics

Orsolini

Latini²,

Pompili³

et al. 2020

Psychiatry Investig

238

167

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Objective Amongst psychiatric disorders, major depressive disorder (MDD) is the most prevalent, by affecting approximately 15–17% of the population and showing a high suicide risk rate equivalent to around 15%. The present comprehensive overview aims at evaluating main research studies in the field of MDD at suicide risk, by proposing as well as a schematic suicide risk stratification and useful flow-chart for planning suicide preventive and therapeutic interventions for clinicians.Methods A broad and comprehensive overview has been here conducted by using PubMed/Medline, combining the search strategy of free text terms and exploded MESH headings for the topics of ‘Major Depressive Disorder’ and ‘Suicide’ as following: ((<i>suicide</i> [Title/Abstract]) AND (<i>major depressive disorder</i> [Title/Abstract])). All articles published in English through May 31, 2019 were summarized in a comprehensive way.Results Despite possible pathophysiological factors which may explain the complexity of suicide in MDD, scientific evidence supposed the synergic role of genetics, exogenous and endogenous stressors (i.e., interpersonal, professional, financial, as well as psychiatric disorders), epigenetic, the hypothalamic-pituitary-adrenal stress-response system, the involvement of the monoaminergic neurotransmitter systems, particularly the serotonergic ones, the lipid profile, neuro-immunological biomarkers, the Brain-derived neurotrophic factor and other neuromodulators.Conclusion The present overview reported that suicide is a highly complex and multifaceted phenomenon in which a large plethora of mechanisms could be variable implicated, particularly amongst MDD subjects. Beyond these consideration, modern psychiatry needs a better interpretation of suicide risk with a more careful assessment of suicide risk stratification and planning of clinical and treatment interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Neuroimaging Studiesmentioning

confidence: 99%

Section: Neuroimaging Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Understanding the Complex of Suicide in Depression: from Research to Clinics

Orsolini

Latini²,

Pompili³

et al. 2020

Psychiatry Investig

238

167

View full text Add to dashboard Cite

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“…1). In the last 10 years, a number of excellent reviews on aspects of this research have emerged [6][7][8][9][10]. Here we review research across structural, functional, and neurochemical neuroimaging modalities, providing a narrative review of 131 neuroimaging studies with a focus on the most researched brain circuitries and findings that converge across studies.…”

Section: Introductionmentioning

confidence: 99%

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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“…Second, results of these studies have been inconsistent. Whereas systematic reviews on the topic suggest that suicidality is associated with abnormalities in regions involved in affective processing and impulsive regulation, the specific regions highlighted in each review differ, and all emphasize the modest sample sizes, heterogeneity, and lack of replicability across studies [18][19][20][21] . In addition, metaanalyses of structural and functional imaging studies have failed to find differences between suicidal and non-suicidal participants [22][23][24] , and those that found differences were either based on a small number of studies or reported inconsistent findings 24,25 .…”

Section: Introductionmentioning

confidence: 99%

Multimodal neuroimaging and suicidality in a US population-based sample of school-aged children

Vidal‐Ribas¹,

Janiri

Doucet

et al. 2019

Preprint

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Importance: Suicide deaths and suicidality are considered a public health emergency, yet their brain underpinnings remain elusive. Objective: To examine individual, environmental, and clinical characteristics, as well as multimodal brain imaging correlates of suicidality in a US population-based sample of school-aged children. Design: Cross-sectional analysis of the first wave of data from the Adolescent Brain Cognitive Development study Setting: Multicenter population-based study Participants: Children aged 9-10 years from unreferred, community samples with suicidality data available (n=7,994). Following quality control, we examined structural magnetic resonance imaging (sMRI) (n=6,238), resting state functional MRI (rs-fMRI) (n=4,134), and task-based fMRI (range n=4,075 to 4,608). Exposure: Lifetime suicidality, defined as suicidal ideation, plans and attempts reported by children or/and caregivers. Main Outcomes and Measures: Multimodal neuroimaging analyses examined differences with Welch t-test and Equivalence Tests, with observed effect sizes (ES, Cohen d) and their 90% confidence interval (CI) < |0.15|. Predictive values were examined using the area under precision-recall curves (AUPRC). Measures included, cortical volume and thickness, large-scale network connectivity and task-based MRI of reward processing, inhibitory control and working memory. Results: Among the 7,994 unrelated children (3,757 females [47.0%]), those will lifetime suicidality based on children (n=684 [8.6%]; 276 females [40.4%]), caregiver (n=654 [8.2%]; 233 females [35.6%]) or concordant reports (n=198 [2.5%]; 67 females [33.8%]), presented higher levels of social adversity and psychopathology on themselves and their caregivers compared to never-suicidal children (n=6,854 [85.7%]; 3,315 females [48.3%]). A wide range of brain areas was associated with suicidality, but only one test (0.06%) survived statistical correction: children with caregiver-reported suicidality had a thinner left bank of the superior temporal sulcus compared to never-suicidal children (ES=-0.17, 95%CI -0.26, -0.08, pFDR=0.019). Based on the prespecified bounds of |0.15|, ~48% of the group mean differences for child-reported suicidality comparisons and a ~22% for parent-reported suicidality comparisons were considered equivalent. All observed ES were relatively small (d≤|0.20|) and with low predictive value (AUPRC≤0.10). Conclusion and Relevance: Using commonly-applied neuroimaging measures, we were unable to find a discrete brain signature related to suicidality in youth. There is a great need for improved approaches to the neurobiology of suicide.

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Structural and functional alterations of the suicidal brain: An updated review of neuroimaging studies

Cited by 83 publications

References 82 publications

Understanding the Complex of Suicide in Depression: from Research to Clinics

Understanding the Complex of Suicide in Depression: from Research to Clinics

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

Multimodal neuroimaging and suicidality in a US population-based sample of school-aged children

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