Johnston Jennifer A Y, Wang Fei, Liu Jie, Blond Benjamin N, Wallace Amanda, Liu Jiacheng, Spencer Linda, Cox Lippard Elizabeth T, Purves Kirstin L, Landeros-Weisenberger Angeli, Hermes Eric, Pittman Brian, Zhang Sheng, King Robert, Martin Andrés, Oquendo Maria A, Blumberg Hilary P
From the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Division of Psychology and Language Sciences, University College London; and the Department of Psychiatry, Columbia University Medical Center, New York.
Am J Psychiatry. 2017 Jul 1;174(7):667-675. doi: 10.1176/appi.ajp.2016.15050652. Epub 2017 Jan 31.
Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems.
The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors.
Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality.
Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.
双相情感障碍与自杀行为的高风险相关，自杀行为常发生于青少年期和青年期。阐明相关的神经系统对于预防至关重要。本研究对有或无自杀未遂史的双相情感障碍青少年和青年进行了研究，结合结构磁共振成像、扩散张量成像和功能磁共振成像方法，以探究额边缘系统内形态学、结构和功能连接方面的相关异常。
该研究纳入了26名有过自杀未遂史的双相情感障碍患者（自杀未遂组）和42名无自杀未遂史的双相情感障碍患者（非自杀未遂组）。比较了两组在处理情绪刺激时的区域灰质体积、白质完整性和功能连接性，并探讨了成像方式之间的差异以及与自杀相关症状和行为的关联。
与非自杀未遂组相比，自杀未遂组在眶额皮质、海马体和小脑中的灰质体积显著减少；钩束、腹侧额叶和右侧小脑区域的白质完整性降低；杏仁核与左侧腹侧和右侧前额叶皮质的功能连接性降低。在探索性分析中，在自杀未遂者中，右侧前额叶连接性与自杀意念之间以及左侧腹侧前额叶连接性与自杀未遂致死性之间存在显著负相关。
患有双相情感障碍的青少年和青年自杀未遂者在一个服务于情绪调节的腹侧额边缘神经系统中表现出灰质体积减少以及结构和功能连接性降低。在自杀未遂者中，杏仁核-前额叶功能连接性的降低可能与自杀意念的严重程度和自杀未遂致死性有关。
