Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Faculty of Medicine, Minia University, Egypt.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
Psychiatry Res Neuroimaging. 2019 Jan 30;283:16-23. doi: 10.1016/j.pscychresns.2018.11.007. Epub 2018 Nov 14.
Structural brain deficits are linked to risk for suicidal behavior. However, there is disagreement about the nature of these deficits, probably due to the heterogeneity of suicidal behavior in terms of the suicidal act's lethality. We hypothesized that individuals with major depressive disorder (MDD) and history of more lethal suicide attempts would have lower gray matter volume (GMV) of the prefrontal regions and insula compared with MDD lower-lethality attempters and MDD non-attempters. We collected structural MRI scans on 91 individuals with MDD; 11 with history of higher-lethality suicide attempts, 14 with lower-lethality attempts, and 66 were non-attempters. Differences in GMV between these three groups were examined using both regions-of-interest (ROI) and brain-wide voxel-based morphometry (VBM) analyses. Both ROI and VBM analyses showed that higher-lethality suicide attempters have greater GMV of the prefrontal cortical regions and insula, compared with the other two groups. Although this contrasts with our hypothesis, the observed larger prefrontal cortex GMV in higher-lethality suicide attempters may underlie the set of attributes observed previously in this suicidal subgroup, including enhanced suicide attempt planning, greater response inhibition, and delayed reward capabilities. Future studies should further examine the role of these brain regions in relation to suicidal intent and planning.
结构性脑缺陷与自杀行为风险相关。然而，这些缺陷的性质存在争议，这可能是由于自杀行为在自杀行为的致命性方面存在异质性。我们假设，有过更致命自杀企图的重度抑郁症（MDD）患者与 MDD 低致命性企图者和 MDD 非企图者相比，其前额叶区域和脑岛的灰质体积（GMV）较低。我们对 91 名 MDD 患者进行了结构 MRI 扫描；其中 11 名有过更高致命性自杀企图的历史，14 名有过更低致命性自杀企图的历史，66 名是无自杀企图者。使用基于体素的形态测量学（VBM）和基于感兴趣区域（ROI）的分析方法，检查了这三组之间 GMV 的差异。ROI 和 VBM 分析均显示，高致命性自杀企图者的前额皮质区域和脑岛的 GMV 大于其他两组。尽管这与我们的假设相反，但在高致命性自杀企图者中观察到的更大的前额叶皮质 GMV 可能是该自杀亚组先前观察到的一系列特征的基础，包括增强的自杀企图计划、更大的反应抑制和延迟的奖励能力。未来的研究应进一步研究这些大脑区域与自杀意图和计划的关系。
