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Grey abnormalities associate with suicide related behaviour in first episode non-affective psychosis patients1Neuroimaging Unit, Technological Facilities, IDIVAL, Santander, Spain, 2CIBERSAM, Santander, Spain, 3University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria, IDIVAL, Santander, Spain
Synopsis
Little is known about brain abnormalities associated with suicide-related behaviours in first episode psychosis patients and controversial results have been reported. The main aim of the present study was to examine brain abnormalities related with suicidal behaviours in a large sample of first episode psychosis (FEP) patients. In particular, we found reduction grey matter volume in frontal area, middle temporal gyrus as well as posterior cingulate gyrus and precuneus. These areas appear to be associated with some of the greatest features related to suicidal behaviour such as impulsivity, emotional processing information, responses to pain and aggressiveness.
Introduction
Suicide represents the main cause of premature dead in first episode psychosis (FEP) patients. However, our understanding of suicidal behaviour in this population is limited. During the last decade, several works have related suicidal behaviour in FEP patients with structural abnormalities in frontal and temporal areas as well as specific structures such as hippocampus, insula and amygdala. The main aim of this work was to analyse the possible structural brain abnormalities associated with suicide-related-behaviour in a large sample of FEP patients.Methods
We use a voxel-based morphometry (VBM) analysis in 146 FEP individuals: 24 FEP with and 122 without suicidal behaviour. All images were taken in the same 3T Phillips scanner. The CAT 12 toolbox, which is implemented in SPM12 was used for VBM analysis of the data. A two-sample t-test was set with sex, age, handedness, total intracraneal volume and global dissability score as nuisance covariables. We applied threshold-free cluster enhacement (TFCE) with 5000 permutations and corrected for multiple comparisons (FWE) at p<0.05.Results
A gradual reduction of grey matter volume related to presence of suicide-related-behaviour was found in frontal area, specifically in superior frontal gyrus, middle frontal gyrus, precentral gyrus, inferior frontal gyrus and orbital gyrus. In addition, significant reduction was found in middle temporal gyrus as well as in posterior cingulate gyrus and precuneus.Discussion
Our results are in line with previous works which related reduced frontal regions with suicidal behaviours. Frontal area is involved in: i) cognitive analysis; ii) foresight and weighing consequences of behaviour; iii) considering future and making predictions; iv) impulse control; v) delaying gratification; vi) inhibiting inappropriate behaviour; vii) initiating appropriate behaviour. On the other hand, precuneus is involved in: i) episode memories; ii) reflective self-awareness; iii) executive function; and iv) it is activated when people make judgments. Finally, cingulate gyrus has been strongly associated with emotional responses to pain, regulation of aggressive behaviour and decision making. Finally, middle temporal gyrus appears to play an important role in retrieving semantic information.Conclusion
This study provides some insights about brain abnormalities associated with suicide-related-behaviours in FEP patients. In particular, the areas reported in this study are related with important functions such as impulsivity, emotional processing information, responses to pain and aggressiveness which are strongly associated with suicide-related-behaviours. Further studies are necessary to replicate the relevance of these structures in suicidal behaviour in FEP patients.Acknowledgements
The authors wish to thank all PAFIP research team and all patients and family members who participated in the study.We wish to acknowledge IDIVAL Neuroimaging Unit for imaging acquirement. The present study was performed under the following grant support of the Institute of Health Carlos III: PI14/00918, PI14/00639.References
Giakoumatos, C. I., Tandon, N., Shah, J., Mathew, I. T., Brady, R. O., Clementz, B. A., … Keshavan, M. S. (2013). Are structural brain abnormalities associated with suicidal behavior in patients with psychotic disorders? Journal of Psychiatric Research, 47(10), 1389–95. https://doi.org/10.1016/j.jpsychires.2013.06.011
Van Heeringen, K., & Mann, J. J. (2014). The neurobiology of suicide. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(14)70220-2
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