History of Suicide Attempt Is Associated with Reduced Medial Prefrontal Cortex Activity during Emotional Decision-Making among Men with Schizophrenia: An Exploratory fMRI Study

Abstract

Despite the high prevalence of suicidal ideas/attempts in schizophrenia, only a handful of neuroimaging studies have examined the neurobiological differences associated with suicide risk in this population. The main objective of the current exploratory study is to examine the neurofunctional correlates associated with a history of suicide attempt in schizophrenia, using a risky decision-making task, in order to show alterations in brain reward regions in this population. Thirty-two male outpatients with schizophrenia were recruited: 13 patients with (SCZ + S) and 19 without a history of suicidal attempt (SCZ − S). Twenty-one healthy men with no history of mental disorders or suicidal attempt/idea were also recruited. Participants were scanned using fMRI while performing the Balloon Analogue Risk Task. A rapid event-related fMRI paradigm was used, separating decision and outcome events, and the explosion probabilities were included as parametric modulators. The most important finding of this study is that SCZ + S patients had reduced activations of the medial prefrontal cortex during the success outcome event (with parametric modulation), relative to both SCZ − S patients and controls, as illustrated by a spatial conjunction analysis. These exploratory results suggest that a history of suicidal attempt in schizophrenia is associated with blunted brain reward activity during emotional decision-making.

Machine Learning-Based Identification of Suicidal Risk in Patients With Schizophrenia Using Multi-Level Resting-State fMRI Features

“…Numerous fMRI studies indicate the association of suicide-related behaviors and prefrontal cortex alterations due to its role in decision-making as well as action planning ( Potvin et al, 2018 ; Brown et al, 2020 ). Other studies suggest decreased connectivity between ACC and PFC to be related to suicidal behavior ( Minzenberg et al, 2015 ; Chase et al, 2017 ).…”

“…Previous studies indicate gray matter volume reduction in dorsolateral prefrontal cortex (DLPFC), superior temporal gyrus, as well as insular cortex in patients after suicide attempt, compared to the ones without suicide attempt in the past ( Besteher et al, 2016 ; Zhang et al, 2020 ), whereas fMRI studies revealed that during a simple task based on cognitive control, suicide thoughts were associated with decreased activity in PFC and the history of previous suicide attempt resulted in decreased activity of premotor cortex ( Minzenberg et al, 2014 ; Potvin et al, 2018 ). Previous results from volumetric as well as functional task fMRI analyses indicate the potential resting-state brain activity changes in the regions included in Default Mode Network (DMN), Salience Network (SN), and Sensorimotor Network (SMN).…”

Exploring the Benefits of Virtual Reality-Assisted Therapy Following Cognitive-Behavioral Therapy for Auditory Hallucinations in Patients with Treatment-Resistant Schizophrenia: A Proof of Concept

“…The therapy was delivered by an experienced clinician (AD) who has around seven years of experience as a psychiatrist and treated over one thousand patients with major psychiatric disorders including schizophrenia [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. The therapy consisted on average of nine-weekly sessions.…”

The neurobiology of suicide in psychosis: A systematic review

“…fMRI studies have revealed that, among 17 patients with recent-onset schizophrenia, past suicidal behavior was associated with relatively higher activation during a reactive control task (Stroop) in the left-hemisphere supplementary motor area (SMA), pre-SMA, premotor cortex, and dorsolateral prefrontal, all ipsilateral to the active primary motor cortex (Minzenberg et al, 2015). Patients with schizophrenia and a history of suicide attempts have also been shown to demonstrate reduced activation of the medial prefrontal cortex during a risky-decision making task (Potvin et al, 2018).…”