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Coppersmith DDL, Jaroszewski AC, Gershman SJ, Cha CB, Millner AJ, Fortgang RG, Kleiman EM, Nock MK. Do people know how suicidal they will be? Understanding suicidal prospection. Suicide Life Threat Behav 2024; 54:750-761. [PMID: 38700375 PMCID: PMC11305949 DOI: 10.1111/sltb.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Little research has been done on how people mentally simulate future suicidal thoughts and urges, a process we term suicidal prospection. METHODS Participants were 94 adults with recent suicidal thoughts. Participants completed a 42-day real-time monitoring study and then a follow-up survey 28 days later. Each night, participants provided predictions for the severity of their suicidal thoughts the next day and ratings of the severity of suicidal thoughts over the past day. We measured three aspects of suicidal prospection: predicted levels of desire to kill self, urge to kill self, and intent to kill self. We generated prediction errors by subtracting participants' predictions of the severity of their suicidal thoughts from their experienced severity. RESULTS Participants tended to overestimate (although the average magnitude was small and the modal error was zero) the severity of their future suicidal thoughts. The best fitting models suggested that participants used both their current suicidal thinking and previous predictions of their suicidal thinking to generate predictions of their future suicidal thinking. Finally, the average severity of predicted future suicidal thoughts predicted the number of days participants thought about suicide during the follow-up period. CONCLUSIONS This study highlights prospection as a psychological process to better understand suicidal thoughts and behaviors.
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Affiliation(s)
| | - Adam C Jaroszewski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samuel J Gershman
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Center for Brains, Minds, and Machines, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Christine B Cha
- Counseling & Clinical Psychology Department, Teachers College, Columbia University, New York, New York, USA
| | - Alexander J Millner
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
| | - Rebecca G Fortgang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evan M Kleiman
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
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Tsypes A, Hallquist MN, Ianni A, Kaurin A, Wright AGC, Dombrovski AY. Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression. JAMA Psychiatry 2024:2821075. [PMID: 38985462 PMCID: PMC11238070 DOI: 10.1001/jamapsychiatry.2024.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/25/2024] [Indexed: 07/11/2024]
Abstract
Importance Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives. Objective To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning. Design, Setting, and Participants Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation. Main Outcomes and Measures Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation. Results The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P < .001) and MDD (χ24 = 36.34; P < .001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P < .001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity. Conclusions and Relevance The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By contrast, individuals in this study who engaged in low-lethality suicidal behavior displayed a low threshold for taking potentially disadvantageous actions.
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Affiliation(s)
- Aliona Tsypes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
| | - Angela Ianni
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Aleksandra Kaurin
- Department of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Aidan G. C. Wright
- Department of Psychology, University of Michigan, Ann Arbor
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor
| | - Alexandre Y. Dombrovski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Lee Y, Gilbert JR, Waldman LR, Zarate CA, Ballard ED. Potential association between suicide risk, aggression, impulsivity, and the somatosensory system. Soc Cogn Affect Neurosci 2024; 19:nsae041. [PMID: 38874947 PMCID: PMC11219302 DOI: 10.1093/scan/nsae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/05/2024] [Accepted: 06/13/2024] [Indexed: 06/15/2024] Open
Abstract
Aggression and impulsivity are linked to suicidal behaviors, but their relationship to the suicidal crisis remains unclear. This magnetoencephalography (MEG) study investigated the link between aggression, impulsivity, and resting-state MEG power and connectivity. Four risk groups were enrolled: high-risk (HR; n = 14), who had a recent suicidal crisis; lower-risk (LR; n = 41), who had a history of suicide attempts but no suicide attempt or ideation in the past year; clinical control (CC; n = 38), who had anxiety/mood disorders but no suicidal history; and minimal risk (MR; n = 28), who had no psychiatric/suicidal history. No difference in resting-state MEG power was observed between the groups. Individuals in the HR group with high self-reported aggression and impulsivity scores had reduced MEG power in regions responsible for sensory/emotion regulation vs. those in the HR group with low scores. The HR group also showed downregulated bidirectional glutamatergic feedback between the precuneus (PRE) and insula (INS) compared to the LR, CC, and MR groups. High self-reported impulsivity was linked to reduced PRE to INS feedback, whereas high risk-taking impulsivity was linked to upregulated INS to postcentral gyrus (PCG) and PCG to INS feedback. These preliminary findings suggest that glutamatergic-mediated sensory and emotion-regulation processes may function as potential suicide risk markers.
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Affiliation(s)
- Yoojin Lee
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Laura R Waldman
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
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Del Casale A, Mancino S, Arena JF, Spitoni GF, Campanini E, Adriani B, Tafaro L, Alcibiade A, Ciocca G, Romano A, Bozzao A, Ferracuti S. Neural Functioning in Late-Life Depression: An Activation Likelihood Estimation Meta-Analysis. Geriatrics (Basel) 2024; 9:87. [PMID: 39051251 PMCID: PMC11270429 DOI: 10.3390/geriatrics9040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/14/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Late-life depression (LLD) is a relatively common and debilitating mental disorder, also associated with cognitive dysfunctions and an increased risk of mortality. Considering the growing elderly population worldwide, LLD is increasingly emerging as a significant public health issue, also due to the rise in direct and indirect costs borne by healthcare systems. Understanding the neuroanatomical and neurofunctional correlates of LLD is crucial for developing more targeted and effective interventions, both from a preventive and therapeutic standpoint. This ALE meta-analysis aims to evaluate the involvement of specific neurofunctional changes in the neurophysiopathology of LLD by analysing functional neuroimaging studies conducted on patients with LLD compared to healthy subjects (HCs). We included 19 studies conducted on 844 subjects, divided into 439 patients with LLD and 405 HCs. Patients with LLD, compared to HCs, showed significant hypoactivation of the right superior and medial frontal gyri (Brodmann areas (Bas) 8, 9), left cingulate cortex (BA 24), left putamen, and left caudate body. The same patients exhibited significant hyperactivation of the left superior temporal gyrus (BA 42), left inferior frontal gyrus (BA 45), right anterior cingulate cortex (BA 24), right cerebellar culmen, and left cerebellar declive. In summary, we found significant changes in activation patterns and brain functioning in areas encompassed in the cortico-limbic-striatal network in LLD. Furthermore, our results suggest a potential role for areas within the cortico-striatal-cerebellar network in the neurophysiopathology of LLD.
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Affiliation(s)
- Antonio Del Casale
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Unit of Psychiatry, Emergency and Admissions Department, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Serena Mancino
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
| | - Jan Francesco Arena
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Elisa Campanini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
| | - Barbara Adriani
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
| | - Laura Tafaro
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy;
- Unit of Internal Medicine, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Alessandro Alcibiade
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
- Marina Militare Italiana (Italian Navy), Ministry of Defence, Piazza della Marina, 4, 00196 Rome, Italy
| | - Giacomo Ciocca
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Romano
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
- Unit of Neuroradiology, Department of Diagnostic Sciences, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Alessandro Bozzao
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
- Unit of Neuroradiology, Department of Diagnostic Sciences, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00185 Rome, Italy
- Unit of Risk Management, ‘Sant’Andrea’ University Hospital, 00189 Rome, Italy
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Aupperle RL, Kuplicki R, Tsuchiyagaito A, Akeman E, Sturycz-Taylor CA, DeVille D, Lasswell T, Misaki M, Berg H, McDermott TJ, Touthang J, Ballard ED, Cha C, Schacter DL, Paulus MP. Ventromedial prefrontal cortex activation and neurofeedback modulation during episodic future thinking for individuals with suicidal thoughts and behaviors. Behav Res Ther 2024; 176:104522. [PMID: 38547724 PMCID: PMC11103812 DOI: 10.1016/j.brat.2024.104522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/30/2024] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
Individuals experiencing suicidal thoughts and behaviors (STBs) show less specificity and positivity during episodic future thinking (EFT). Here, we present findings from two studies aiming to (1) further our understanding of how STBs may relate to neural responsivity during EFT and (2) examine the feasibility of modulating EFT-related activation using real-time fMRI neurofeedback (rtfMRI-nf). Study 1 involved 30 individuals with major depressive disorder (MDD; half with STBs) who performed an EFT task during fMRI, for which they imagined personally-relevant future positive, negative, or neutral events. Positive EFT elicited greater ventromedial prefrontal cortex (vmPFC) activation compared to negative EFT. Importantly, the MDD + STB group exhibited reduced vmPFC activation across all EFT conditions compared to MDD-STB; although EFT fluency and subjective experience remained consistent across groups. Study 2 included rtfMRI-nf focused on vmPFC modulation during positive EFT for six participants with MDD + STBs. Results support the feasibility and acceptability of the rtfMRI-nf protocol and quantitative and qualitative observations are provided to help inform future, larger studies aiming to examine similar neurofeedback protocols. Results implicate vmPFC blunting as a promising treatment target for MDD + STBs and suggest rtfMRI-nf as one potential technique to explore for enhancing vmPFC engagement.
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Affiliation(s)
- R L Aupperle
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA.
| | - R Kuplicki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - A Tsuchiyagaito
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E Akeman
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - C A Sturycz-Taylor
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - D DeVille
- Department of Psychiatry, University of California San Diego, 4510 Executive Drive, San Diego, CA, 92121, USA
| | - T Lasswell
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - M Misaki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - H Berg
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - T J McDermott
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - J Touthang
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E D Ballard
- Experimental Therapeutics and Pathophysiological Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - C Cha
- Department of Psychology, Columbia University, 428 Horace Mann, New York, NY, 10027, USA
| | - D L Schacter
- Department of Psychology, Harvard University, 33 Kirkland St., William James Hall, Cambridge, MA, 02138, USA
| | - M P Paulus
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA
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6
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Öğüt Ç, Öğüt ND. No association between isotretinoin and impulsivity in patients with moderate-to-severe acne vulgaris. Int J Dermatol 2024; 63:484-490. [PMID: 38140757 DOI: 10.1111/ijd.16997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Acne vulgaris (AV) is one of the common dermatologic diseases that usually affects people during adolescence. Reports have shown that isotretinoin, the first-line therapy option for moderate-to-severe AV, could lead to mood disturbances and suicidality. Impulsivity is the tendency to act prematurely without foresight and is a significant risk factor for suicidality. This study aimed to test the hypothesis that isotretinoin would lead to an increase in impulsivity. METHODS Seventeen patients with AV were enrolled. The study was planned as a naturalistic 3-month follow-up study. Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Barratt Impulsiveness Scale (BIS), Go/No-go Task (GNG), and Balloon Analog Risk Task (BART) were administered before and after the isotretinoin treatment. RESULTS We found a significant improvement in the severity of anxiety (P = 0.015; t = 2.72) and depression symptoms (P = 0.08; t = 3.04) in AV patients at the end of 3 months. Self-report impulsivity characteristics with BIS stayed unchanged (P = 0.434; t = 0.80). Besides, no statistically significant difference was found in behavioral task results associated with response inhibition with GNG (P = 0.52; t = 0.65) and impulsive decision-making with BART (P = 0.842; t = -0.20). However, there was a significant decrease in omission errors, with GNG suggesting improvement in attention domain (P = 0.020; W = 90.0) after the follow-up. CONCLUSIONS It has been demonstrated that isotretinoin treatment improves the severity of depression, anxiety symptoms, and attention performance in AV patients. However, there was no significant change in patients' impulsivity severity based on self-reports and behavioral performances based on GNG and BART.
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Affiliation(s)
- Çağrı Öğüt
- Department of Psychiatry, Uşak University Faculty of Medicine, Uşak, Turkey
| | - Neslihan D Öğüt
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Uşak, Turkey
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Lin C, Huang C, Chang W, Chang Y, Liu H, Ng S, Lin H, Lee TM, Lee S, Wu S. Predicting suicidality in late-life depression by 3D convolutional neural network and cross-sample entropy analysis of resting-state fMRI. Brain Behav 2024; 14:e3348. [PMID: 38376042 PMCID: PMC10790060 DOI: 10.1002/brb3.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Predicting suicide is a pressing issue among older adults; however, predicting its risk is difficult. Capitalizing on the recent development of machine learning, considerable progress has been made in predicting complex behavior such as suicide. As depression remained the strongest risk for suicide, we aimed to apply deep learning algorithms to identify suicidality in a group with late-life depression (LLD). METHODS We enrolled 83 patients with LLD, 35 of which were non-suicidal and 48 were suicidal, including 26 with only suicidal ideation and 22 with past suicide attempts, for resting-state functional magnetic resonance imaging (MRI). Cross-sample entropy (CSE) analysis was conducted to examine the complexity of MRI signals among brain regions. Three-dimensional (3D) convolutional neural networks (CNNs) were used, and the classification accuracy in each brain region was averaged to predict suicidality after sixfold cross-validation. RESULTS We found brain regions with a mean accuracy above 75% to predict suicidality located mostly in default mode, fronto-parietal, and cingulo-opercular resting-state networks. The models with right amygdala and left caudate provided the most reliable accuracy in all cross-validation folds, indicating their neurobiological importance in late-life suicide. CONCLUSION Combining CSE analysis and the 3D CNN, several brain regions were found to be associated with suicidality.
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Affiliation(s)
- Chemin Lin
- Department of PsychiatryKeelung Chang Gung Memorial HospitalKeelungTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
| | - Chih‐Mao Huang
- Department of Biological Science and TechnologyNational Yang Ming Chiao Tung UniversityHsinchuTaiwan
| | - Wei Chang
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
| | - You‐Xun Chang
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
| | - Ho‐Ling Liu
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shu‐Hang Ng
- Department of Head and Neck Oncology GroupLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
- Department of Diagnostic RadiologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Huang‐Li Lin
- Department of PsychiatryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Tatia Mei‐Chun Lee
- Community Medicine Research CenterChang Gung Memorial HospitalKeelungTaiwan
- Laboratory of Neuropsychology and Human NeuroscienceThe University of Hong KongPok Fu LamHong Kong
- State Key Laboratory of Brain and Cognitive ScienceThe University of Hong KongPok Fu LamHong Kong
| | - Shwu‐Hua Lee
- Department of PsychiatryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Shun‐Chi Wu
- Department of Engineering and System ScienceNational Tsing Hua UniversityHsinchuTaiwan
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Solomonov N. Improving social reward responsivity and social connectedness in psychotherapies for late-life depression: Engage & Connect as an example. Psychiatry Res 2023; 329:115469. [PMID: 37783093 PMCID: PMC10841452 DOI: 10.1016/j.psychres.2023.115469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
Psychotherapies are effective in reducing late-life depression. Yet, about half of patients remain depressed at treatment end. Advances in neuroscience can inform simplified interventions that target key brain networks impacted by depression. Behavioral activation therapies that increase social connectedness may improve social reward responsivity and alter abnormalities of the Positive Valence System (PVS). Engage & Connect is an example for a scalable and simple neuroscience-informed psychotherapy, aimed to improve PVS functions and social reward responsivity by increasing engagement in rewarding social activities. Interventions that improve social reward responsivity can be promising first-line treatments for late-life depression in the community.
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Affiliation(s)
- Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA.
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9
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Jin Y, Gao Q, Wang Y, Dietz M, Xiao L, Cai Y, Bliksted V, Zhou Y. Impaired social learning in patients with major depressive disorder revealed by a reinforcement learning model. Int J Clin Health Psychol 2023; 23:100389. [PMID: 37829189 PMCID: PMC10564931 DOI: 10.1016/j.ijchp.2023.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 10/14/2023] Open
Abstract
Background/objective Patients with major depressive disorder (MDD) have altered learning rates for rewards and losses in non-social learning paradigms. However, it is not well understood whether the ability to learn from social interactions is altered in MDD patients. Using reinforcement learning during the repeated Trust Game (rTG), we investigated how MDD patients learn to trust newly-met partners in MDD patients. Method Sixty-eight MDD patients and fifty-four controls each played as 'investor' and interacted with ten different partners. We manipulated both the level of trustworthiness by varying the chance of reciprocity (10, 30, 50, 70 and 90%) and reputation disclosure, where partners' reputation was either pre-disclosed or hidden. Results Our reinforcement learning model revealed that MDD patients had significantly higher learning rates for losses than the controls in both the reputation disclosure and non-disclosure condition. The difference was larger when reputation was not disclosed than disclosed. We observed no difference in learning rates for gains in either condition. Conclusions Our findings highlight that abnormal learning for losses underlies the social learning process in MDD patients. This abnormality is higher when situational unpredictability is high versus low. Our findings provide novel insights into social rehabilitation of MDD.
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Affiliation(s)
- Yuening Jin
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qinglin Gao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yun Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Martin Dietz
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Universitetsbyen 3, Aarhus C 8000, Denmark
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuyang Cai
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Vibeke Bliksted
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N 8200, Denmark
- Centre for Interacting Minds, Aarhus University, Jens Chr. Skous Vej 4, Building 1483, Aarhus C 8000, Denmark
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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10
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Bress JN, Arslanoglou E, Banerjee S, Alexopoulos GS, Kiosses DN. Positive valence system function and anhedonia in middle-aged and older adults at high suicide risk. Biol Psychol 2023; 182:108647. [PMID: 37499781 PMCID: PMC10529097 DOI: 10.1016/j.biopsycho.2023.108647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Positive valence systems are disrupted in late-life depression and in individuals at risk for suicide. The reward positivity (RewP) is an event-related potential measure of positive valence system function that relates to depression and anhedonia in children and young adults. However, it is unclear whether a reliable RewP signal can be elicited in middle-aged and older adults at high risk for suicide and, if so, whether this signal is similarly associated with clinical symptoms. In the current study, a RewP was elicited with a standard gambling task in middle-aged and older adults (N = 31) at discharge from a hospitalization for suicidal thought or behaviors. The resulting electrocortical response differed significantly for monetary wins compared to losses. Internal reliability of the RewP and the feedback negativity (FN) to monetary loss was good to excellent. Internal reliability of difference measures was lower but still largely acceptable, with residualized differences scores demonstrating stronger reliability than subtraction-based scores. A smaller residualized RewP, after accounting for the influence of the FN, was associated with greater severity of lassitude, an index of appetitive anhedonia. These findings set the groundwork for future studies of positive valence system function and depression in middle-aged and older adults at high risk for suicide.
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Affiliation(s)
- Jennifer N Bress
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York.
| | - Elizabeth Arslanoglou
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Dimitris N Kiosses
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
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Namaky N, Swearingen HR, Winter J, Bozzay M, Primack JM, Philip NS, Barredo J. Suicidal thoughts and behaviours among military veterans: protocol for a prospective, observational, neuroimaging study. BMJ Open 2023; 13:e070654. [PMID: 37586858 PMCID: PMC10432662 DOI: 10.1136/bmjopen-2022-070654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION This study's overarching goal is to examine the relationship between brain circuits and suicidal thoughts and behaviours (STBs) in a transdiagnostic sample of US military veterans. Because STBs have been linked with maladaptive decision-making and disorders linked to impulsivity, this investigation focuses on valence and inhibitory control circuits. METHODS AND ANALYSIS In this prospective, observational study, we will collect functional MRI (fMRI), cognitive and clinical data from 136 veterans (target sample size) recruited from the Providence VA Health System (PVAHS): 68 with STBs and 68 matched controls. Behavioural data will be collected using standardised measures of STBs, psychiatric symptoms, cognition, functioning and medical history. Neuroimaging data will include structural, task and resting fMRI. We will conduct follow-up interviews and assessments at 6, 12 and 24 months post-enrolment. Primary analyses will compare data from veterans with and without STBs and will also evaluate whether activation and connectivity within circuits of valence and inhibition covary with historical and prospective patterns of suicidal ideation and behaviour. ETHICS AND DISSEMINATION The PVAHS Institutional Review Board approved this study (2018-051). Written informed consent will be obtained from all participants. Findings from this study will be published in peer-reviewed journals and presented at local, regional, national and international conferences.Nauder Namaky, Ph.D.* nauder_namaky@brown.edu.
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Affiliation(s)
- Nauder Namaky
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Hannah R Swearingen
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Jake Winter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA Long Term Services and Support Center of Innovation, Providence, Rhode Island, USA
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
| | - Jennifer Barredo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island, USA
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12
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Gorka SM, Manzler CA, Jones EE, Smith RJ, Bryan CJ. Reward-related neural dysfunction in youth with a history of suicidal ideation: The importance of temporal predictability. J Psychiatr Res 2023; 158:20-26. [PMID: 36549196 DOI: 10.1016/j.jpsychires.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/09/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
Abnormal reward processing is an important yet understudied risk factor for suicide. Recent neuroimaging studies have found that suicidality is associated with abnormal reward-related neural reactivity and connectivity across a wide range of brain regions and circuits. The varying, and oftentimes discrepant, findings have hindered progress in elucidating the neurobiological link between reward processing dysfunction and suicide risk. Some of this variability is likely related to different reward-related paradigms that are utilized across studies. The primary aim of the current study was to address these issues by comparing neural reactivity between youth with and without a history of suicidal ideation during direct manipulation of reward parameters. A total of 108 unmedicated youth, ages 17-19, were classified into two groups: 1) history of suicidal ideation (n = 39) and 2) no history of suicidal ideation (n = 69). All participants completed a novel reward anticipation task probing anticipation of predictable (P-reward) and unpredictable (U-reward) monetary reward. Results revealed that compared with controls, youth with a history of suicidal ideation exhibited increased neural activation in the dorsal anterior cingulate cortex (dACC) and right anterior insula (aINS) during anticipation of U-reward. There were no group differences during anticipation of P-reward. These findings suggest that propensity for suicidal ideation may be related to specific abnormalities during anticipation of U-reward, but not P-reward.
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Affiliation(s)
- Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Charles A Manzler
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Emily E Jones
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Reid J Smith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH, 43210, USA
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13
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Saulnier KG, Marr NS, van Geen C, Babinski DE, Mukherjee D. Reinforcement-based responsiveness, depression, and anhedonia: A multi-method investigation of intergenerational risk. J Psychiatr Res 2023; 158:373-381. [PMID: 36641974 DOI: 10.1016/j.jpsychires.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/29/2022] [Accepted: 01/02/2023] [Indexed: 01/04/2023]
Abstract
Offspring of depressed parents are at an increased risk for depression. Reward- and punishment-based systems might be mechanisms linking maternal outcomes to offspring depression and anhedonia. The current study was designed to investigate the intergenerational relations between maternal markers of reward and punishment responsiveness and their offspring's depression and anhedonia in a community sample of 40 mother (mean age = 44.5; SD = 6.82) and adolescent (mean age = 14.73; SD = 1.25; 52.5% female) dyads. Maternal markers of reward and punishment responsiveness were captured using self-report, behavioral, and neurophysiological methods, and self-reported depression and anhedonia symptoms were used as outcomes among the adolescent offspring. Maternal self-reported reward responsiveness and punishment learning rates were differentially associated with depression across male and female offspring. Regarding anhedonia, maternal punishment learning rate was positively related to adolescent anhedonia regardless of offspring biological sex. Maternal reward learning rate was also positively associated with anhedonia among male offspring. In general, low concurrence across self-report, behavioral, and neurophysiological markers of reward and punishment responsiveness was found. The results from the current study suggest that learning-rates on reinforcement-based behavioral tasks may be important objective markers to consider when evaluating intergenerational risk.
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Affiliation(s)
- Kevin G Saulnier
- Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, PA, USA
| | - Natalie S Marr
- Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, PA, USA
| | - Camilla van Geen
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, PA, USA
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, College of Medicine, Penn State University, Hershey, PA, USA.
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14
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Terpstra AR, Vila-Rodriguez F, LeMoult J, Chakrabarty T, Nair M, Humaira A, Gregory EC, Todd RM. Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression. J Affect Disord 2023; 321:182-190. [PMID: 36341803 DOI: 10.1016/j.jad.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment. METHODS Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five. RESULTS Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline. LIMITATIONS The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results. CONCLUSIONS Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.
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Affiliation(s)
- Alex R Terpstra
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
| | - Joelle LeMoult
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Medha Nair
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Afifa Humaira
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth C Gregory
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca M Todd
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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15
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Bettis AH, Benningfield MM, Dao A, Dickey L, Pegg S, Venanzi L, Kujawa A. Self-injurious thoughts and behaviors and alterations in positive valence systems: A systematic review of the literature. J Psychiatr Res 2022; 156:579-593. [PMID: 36370537 PMCID: PMC9742322 DOI: 10.1016/j.jpsychires.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/20/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs), which include suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI), are prevalent and associated with impairments in functioning and elevated risk of suicide deaths. Preventing suicide is a complex problem, with numerous systems likely contributing to the onset and maintenance of SITBs, and there is a critical need to identify more precise predictors of risk. Positive valence systems (PVS) are an understudied domain with promise for improving understanding of risk processes underlying SITBs. In this systematic review, we evaluate the evidence for the potential role of altered PVS function in SI, SA, and/or NSSI, including alterations in reward responsiveness, learning, and valuation assessed through behavioral, physiological and circuit measures. Results provide preliminary support for associations between distinct aspects of PVS function and alterations in SITBs. Specifically, SI appears to be characterized by low reward responsiveness, whereas little research has examined reward responsiveness in SA, and NSSI has been characterized by hyper-responsiveness to rewards. Alterations in reward learning and valuation are commonly examined in SA, with some evidence that they may be more strongly associated with attempts than SI or NSSI. At the same time, the literature is limited in that some constructs are commonly examined in one form of SITBs but not others. Further, research is predominantly cross-sectional and focused on adults, raising questions about the role of PVS function in developmental pathways to SITBs. We conclude by integrating the research to date and highlighting promising directions for future research.
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Affiliation(s)
- Alexandra H Bettis
- Vanderbilt University Medical Center, Department of Psychiatry & Behavioral Sciences, USA.
| | | | - Anh Dao
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lindsay Dickey
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Samantha Pegg
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lisa Venanzi
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Autumn Kujawa
- Vanderbilt University, Department of Psychology and Human Development, USA
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Oestreich LKL, Wright P, O’Sullivan MJ. Hyperconnectivity and altered interactions of a nucleus accumbens network in post-stroke depression. Brain Commun 2022; 4:fcac281. [PMCID: PMC9677459 DOI: 10.1093/braincomms/fcac281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract
Post-stroke depression is a common complication of stroke. To date, no consistent locus of injury is associated with this complication. Here, we probed network dynamics and structural alterations in post-stroke depression in four functional circuits linked to major depressive disorder and a visual network, which served as a control network. Forty-four participants with recent stroke (mean age = 69.03, standard deviation age = 8.59, age range = 51–86 and gender: female = 10) and 16 healthy volunteers (mean age = 71.53, standard deviation age = 10.62, age range = 51–84 and gender: female = 11) were imaged with 3-Tesla structural, diffusion and resting-state functional MRI. The Geriatric Depression Scale was administered to measure depression severity. Associations between depression severity and functional connectivity were investigated within networks seeded from nucleus accumbens, amygdala, dorsolateral prefrontal cortex and primary visual cortex. In addition, the default mode network was identified by connectivity with medial prefrontal cortex and posterior cingulate cortex. Circuits that exhibited altered activity associated with depression severity were further investigated by extracting within-network volumetric and microstructural measures from structural images. In the stroke group, functional connectivity within the nucleus accumbens-seeded network (left hemisphere: P = 0.001; and right hemisphere: P = 0.004) and default mode network (cluster one: P < 0.001; and cluster two: P < 0.001) correlated positively with depressive symptoms. Normal anticorrelations between these two networks were absent in patients with post-stroke depression. Grey matter volume of the right posterior cingulate cortex (Pearson correlation coefficient = −0.286, P = 0.03), as well as microstructural measures in the posterior cingulate cortex (right: Pearson correlation coefficient = 0.4, P = 0.024; and left: Pearson correlation coefficient = 0.3, P = 0.048), right medial prefrontal cortex (Pearson correlation coefficient = 0.312, P = 0.039) and the medial forebrain bundle (Pearson correlation coefficient = 0.450, P = 0.003), a major projection pathway interconnecting the nucleus accumbens-seeded network and linking to medial prefrontal cortex, were associated with depression severity. Depression after stroke is marked by reduced mutual inhibition between functional circuits involving nucleus accumbens and default mode network as well as volumetric and microstructural changes within these networks. Aberrant network dynamics present in patients with post-stroke depression are therefore likely to be influenced by secondary, pervasive alterations in grey and white matter, remote from the site of injury.
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Affiliation(s)
- Lena K L Oestreich
- UQ Centre for Clinical Research, The University of Queensland , Brisbane 4072 , Australia
- Centre for Advanced Imaging, The University of Queensland , Brisbane 4072 , Australia
| | - Paul Wright
- Biomedical Engineering Department, King’s College London , London , UK
| | - Michael J O’Sullivan
- UQ Centre for Clinical Research, The University of Queensland , Brisbane 4072 , Australia
- Biomedical Engineering Department, King’s College London , London , UK
- Department of Neurology, Royal Brisbane and Women’s Hospital , Brisbane 4072 , Australia
- Institute of Molecular Bioscience, The University of Queensland , Brisbane 4072 , Australia
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Rzeszutek MJ, DeFulio A, Sylvester GE. A Systematic Review of Behavior-Outcome Psychological Assessments as Correlates of Suicidality. Arch Suicide Res 2022; 26:1757-1793. [PMID: 35023805 DOI: 10.1080/13811118.2021.2022049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AIM Identifying correlates of suicidality is an important goal for suicide researchers because these correlates may predict suicidal behaviors. Psychological tasks that assess sensitivity to the outcomes of actions (i.e., consequence-based learning) have been commonly used by researchers seeking to identify correlates of suicidality. This is likely due to the straightforward integration of the tasks within most theoretical frameworks for understanding suicidality. Contextual factors have been shown to have a substantial effect on responding in behavior-outcome tasks. However, the direct relevance of these factors as determinants of behavior in suicide research is not clear. Thus, the purpose of this review was to assess the role of context in tasks involving behavior-outcome relations in suicide research. METHODS Four databases were searched using terms from general learning theory. Articles that featured evaluation of tasks with hypothetical or real outcomes to differentiate suicidality were included. RESULTS Eighty-two studies met inclusion criteria. Across studies there were 27 different tasks. Most instances of tasks across studies involved rewards (76.9%), while others emphasized punishment (15.7%), social (5.6%), or virtual suicide (1.8%) outcomes. Differentiation of suicidality was detected by 43.4%, 64.7%, 83.3%, and 50% of tasks featuring reward, punishment, social contexts, and virtual suicide respectively. All but five studies were retrospective. CONCLUSION Tasks that more closely mimic contexts and outcomes related to suicide appear to produce more pronounced differentiation of people with suicidality from people without suicidality. The lack of prospective designs is an important limitation of the literature.HIGHLIGHTSTasks that involve punishment or social outcomes better discriminate suicidality.Reward-based tasks are overused in suicide research.The conditioning hypothesis of suicidality is closely aligned with the literature.Only 5 of 82 studies incorporated prospective measures.
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18
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AG. Momentary interpersonal processes of suicidal surges in borderline personality disorder. Psychol Med 2022; 52:2702-2712. [PMID: 33298227 PMCID: PMC8190164 DOI: 10.1017/s0033291720004791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. METHODS A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. RESULTS Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. CONCLUSION This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.
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Affiliation(s)
| | | | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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Chattun MR, Amdanee N, Zhang X, Yao Z. Suicidality in the geriatric population. Asian J Psychiatr 2022; 75:103213. [PMID: 35917739 DOI: 10.1016/j.ajp.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.
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Affiliation(s)
- Mohammad Ridwan Chattun
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Medical School of Nanjing University, Nanjing Brain Hospital, 22 Hankou Road, Nanjing 210093, China.
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He Z, Ao X, Muhlert N, Elliott R, Zhang D. Neural substrates of expectancy violation associated with social feedback in individuals with subthreshold depression. Psychol Med 2022; 52:2043-2051. [PMID: 33109293 DOI: 10.1017/s0033291720003864] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abnormal processing of social feedback is an important contributor to social dysfunction in depression, however the exact mechanisms remain unclear. One important factor may be the extent to which social processing depends on expectations, in particular whether social feedback confirms or violates expectations. METHODS To answer this question, we studied behavioral and brain responses during the evaluative processing of social feedback in 25 individuals with subthreshold depression (SD) and 25 healthy controls (HCs). Participants completed a Social Judgment Task in which they first indicated expectation about whether a peer would like them or not, and then received peer's feedback indicating acceptance or rejection. RESULTS Individuals with SD who reported greater depressive symptoms gave fewer positive expectations. Compared to HCs, individuals with SD showed reduced activation in the medial prefrontal cortex when expecting positive feedback. They also exhibited increased dorsal anterior cingulate cortex after receipt of unexpected social rejection, and reduced ventral striatum activity after receipt of unexpected social acceptance. CONCLUSIONS The observed alternations are specific to unexpected social feedback processing and highlight an important role of expectancy violation in the brain dysfunction of social feedback perception and evaluation in individuals at risk for depression.
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Affiliation(s)
- Zhenhong He
- Division of Neuroscience and Experimental Psychology, School of Biological Science, University of Manchester, Manchester, M13 9PL, UK
- School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Xiang Ao
- School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Nils Muhlert
- Division of Neuroscience and Experimental Psychology, School of Biological Science, University of Manchester, Manchester, M13 9PL, UK
| | - Rebecca Elliott
- Division of Neuroscience and Experimental Psychology, School of Biological Science, University of Manchester, Manchester, M13 9PL, UK
| | - Dandan Zhang
- School of Psychology, Shenzhen University, Shenzhen, 518060, China
- Shenzhen Institute of Neuroscience, Shenzhen 518060, China
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Lan DCL, Browning M. What Can Reinforcement Learning Models of Dopamine and Serotonin Tell Us about the Action of Antidepressants? COMPUTATIONAL PSYCHIATRY (CAMBRIDGE, MASS.) 2022; 6:166-188. [PMID: 38774776 PMCID: PMC11104395 DOI: 10.5334/cpsy.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
Abstract
Although evidence suggests that antidepressants are effective at treating depression, the mechanisms behind antidepressant action remain unclear, especially at the cognitive/computational level. In recent years, reinforcement learning (RL) models have increasingly been used to characterise the roles of neurotransmitters and to probe the computations that might be altered in psychiatric disorders like depression. Hence, RL models might present an opportunity for us to better understand the computational mechanisms underlying antidepressant effects. Moreover, RL models may also help us shed light on how these computations may be implemented in the brain (e.g., in midbrain, striatal, and prefrontal regions) and how these neural mechanisms may be altered in depression and remediated by antidepressant treatments. In this paper, we evaluate the ability of RL models to help us understand the processes underlying antidepressant action. To do this, we review the preclinical literature on the roles of dopamine and serotonin in RL, draw links between these findings and clinical work investigating computations altered in depression, and appraise the evidence linking modification of RL processes to antidepressant function. Overall, while there is no shortage of promising ideas about the computational mechanisms underlying antidepressant effects, there is insufficient evidence directly implicating these mechanisms in the response of depressed patients to antidepressant treatment. Consequently, future studies should investigate these mechanisms in samples of depressed patients and assess whether modifications in RL processes mediate the clinical effect of antidepressant treatments.
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Affiliation(s)
- Denis C. L. Lan
- Department of Experimental Psychology, University of Oxford, Oxford, GB
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22
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Li W, Wang C, Lan X, Fu L, Zhang F, Ye Y, Liu H, Wu K, Lao G, Chen J, Li G, Zhou Y, Ning Y. Aberrant Dynamic Functional Connectivity of Posterior Cingulate Cortex Subregions in Major Depressive Disorder With Suicidal Ideation. Front Neurosci 2022; 16:937145. [PMID: 35928017 PMCID: PMC9344055 DOI: 10.3389/fnins.2022.937145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/17/2022] [Indexed: 01/08/2023] Open
Abstract
Accumulating evidence indicates the presence of structural and functional abnormalities of the posterior cingulate cortex (PCC) in patients with major depressive disorder (MDD) with suicidal ideation (SI). Nevertheless, the subregional-level dynamic functional connectivity (dFC) of the PCC has not been investigated in MDD with SI. We therefore sought to investigate the presence of aberrant dFC variability in PCC subregions in MDD patients with SI. We analyzed resting-state functional magnetic resonance imaging (fMRI) data from 31 unmedicated MDD patients with SI (SI group), 56 unmedicated MDD patients without SI (NSI group), and 48 matched healthy control (HC) subjects. The sliding-window method was applied to characterize the whole-brain dFC of each PCC subregion [the ventral PCC (vPCC) and dorsal PCC (dPCC)]. In addition, we evaluated associations between clinical variables and the aberrant dFC variability of those brain regions showing significant between-group differences. Compared with HCS, the SI and the NSI groups exhibited higher dFC variability between the left dPCC and left fusiform gyrus and between the right vPCC and left inferior frontal gyrus (IFG). The SI group showed higher dFC variability between the left vPCC and left IFG than the NSI group. Furthermore, the dFC variability between the left vPCC and left IFG was positively correlated with Scale for Suicidal Ideation (SSI) score in patients with MDD (i.e., the SI and NSI groups). Our results indicate that aberrant dFC variability between the vPCC and IFG might provide a neural-network explanation for SI and may provide a potential target for future therapeutic interventions in MDD patients with SI.
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Affiliation(s)
- Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ling Fu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fan Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yanxiang Ye
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haiyan Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Kai Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Guohui Lao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Jun Chen
- Guangdong Institute of Medical Instruments, Guangzhou, China
| | - Guixiang Li
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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23
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BIS sensitivity, BAS sensitivity, and recent suicide attempts. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Wang H, Zhu R, Tian S, Zhang S, Dai Z, Shao J, Xue L, Yao Z, Lu Q. Dynamic connectivity alterations in anterior cingulate cortex associated with suicide attempts in bipolar disorders with a current major depressive episode. J Psychiatr Res 2022; 149:307-314. [PMID: 35325759 DOI: 10.1016/j.jpsychires.2022.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Considering that the physiological mechanism of the anterior cingulate cortex (ACC) in suicide brain remains elusive for bipolar disorder (BD) patients. The study aims to investigate the intrinsic relevance between ACC and suicide attempts (SA) through transient functional connectivity (FC). METHODS We enrolled 50 un-medicated BD patients with at least one SA, 67 none-suicide attempt patients (NSA) and 75 healthy controls (HCs). The sliding window approach was utilized to study the dynamic FC of ACC via resting-state functional MRI data. Subsequently, we probed into the temporal properties of dynamic FC and then estimated the relationship between dynamic characteristics and clinical variables using the Pearson correlation. RESULTS We found six distinct FC states in all populations, with one of them being more associated with SA. Compared with NSA and HCs, the suicide-related functional state showed significantly reduced dwell time in SA patients, accompanied by a significantly increased FC strength between the right ACC and the regions within the subcortical (SubC) network. In addition, the number of transitions was significantly increased in SA patients relative to other groups. All these altered indicators were significantly correlated with the suicide risk. CONCLUSIONS The results suggested that the dysfunction of ACC was relevant to SA from a dynamic FC perspective in BD patients. It highlights the temporal properties in dynamic FC of ACC that could be used as a putative target of suicide risk assessment for BD patients.
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Affiliation(s)
- Huan Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Rongxin Zhu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shui Tian
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Siqi Zhang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Junneng Shao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Li Xue
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhijian Yao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China.
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25
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Pike AC, Robinson OJ. Reinforcement Learning in Patients With Mood and Anxiety Disorders vs Control Individuals: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:313-322. [PMID: 35234834 PMCID: PMC8892374 DOI: 10.1001/jamapsychiatry.2022.0051] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Computational psychiatry studies have investigated how reinforcement learning may be different in individuals with mood and anxiety disorders compared with control individuals, but results are inconsistent. OBJECTIVE To assess whether there are consistent differences in reinforcement-learning parameters between patients with depression or anxiety and control individuals. DATA SOURCES Web of Knowledge, PubMed, Embase, and Google Scholar searches were performed between November 15, 2019, and December 6, 2019, and repeated on December 3, 2020, and February 23, 2021, with keywords (reinforcement learning) AND (computational OR model) AND (depression OR anxiety OR mood). STUDY SELECTION Studies were included if they fit reinforcement-learning models to human choice data from a cognitive task with rewards or punishments, had a case-control design including participants with mood and/or anxiety disorders and healthy control individuals, and included sufficient information about all parameters in the models. DATA EXTRACTION AND SYNTHESIS Articles were assessed for inclusion according to MOOSE guidelines. Participant-level parameters were extracted from included articles, and a conventional meta-analysis was performed using a random-effects model. Subsequently, these parameters were used to simulate choice performance for each participant on benchmarking tasks in a simulation meta-analysis. Models were fitted, parameters were extracted using bayesian model averaging, and differences between patients and control individuals were examined. Overall effect sizes across analytic strategies were inspected. MAIN OUTCOMES AND MEASURES The primary outcomes were estimated reinforcement-learning parameters (learning rate, inverse temperature, reward learning rate, and punishment learning rate). RESULTS A total of 27 articles were included (3085 participants, 1242 of whom had depression and/or anxiety). In the conventional meta-analysis, patients showed lower inverse temperature than control individuals (standardized mean difference [SMD], -0.215; 95% CI, -0.354 to -0.077), although no parameters were common across all studies, limiting the ability to infer differences. In the simulation meta-analysis, patients showed greater punishment learning rates (SMD, 0.107; 95% CI, 0.107 to 0.108) and slightly lower reward learning rates (SMD, -0.021; 95% CI, -0.022 to -0.020) relative to control individuals. The simulation meta-analysis showed no meaningful difference in inverse temperature between patients and control individuals (SMD, 0.003; 95% CI, 0.002 to 0.004). CONCLUSIONS AND RELEVANCE The simulation meta-analytic approach introduced in this article for inferring meta-group differences from heterogeneous computational psychiatry studies indicated elevated punishment learning rates in patients compared with control individuals. This difference may promote and uphold negative affective bias symptoms and hence constitute a potential mechanistic treatment target for mood and anxiety disorders.
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Affiliation(s)
- Alexandra C. Pike
- Anxiety Lab, Neuroscience and Mental Health Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Oliver J. Robinson
- Anxiety Lab, Neuroscience and Mental Health Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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26
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Gilbert JR, Wusinich C, Zarate CA. A Predictive Coding Framework for Understanding Major Depression. Front Hum Neurosci 2022; 16:787495. [PMID: 35308621 PMCID: PMC8927302 DOI: 10.3389/fnhum.2022.787495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
Predictive coding models of brain processing propose that top-down cortical signals promote efficient neural signaling by carrying predictions about incoming sensory information. These "priors" serve to constrain bottom-up signal propagation where prediction errors are carried via feedforward mechanisms. Depression, traditionally viewed as a disorder characterized by negative cognitive biases, is associated with disrupted reward prediction error encoding and signaling. Accumulating evidence also suggests that depression is characterized by impaired local and long-range prediction signaling across multiple sensory domains. This review highlights the electrophysiological and neuroimaging evidence for disrupted predictive processing in depression. The discussion is framed around the manner in which disrupted generative predictions about the sensorium could lead to depressive symptomatology, including anhedonia and negative bias. In particular, the review focuses on studies of sensory deviance detection and reward processing, highlighting research evidence for both disrupted generative predictions and prediction error signaling in depression. The role of the monoaminergic and glutamatergic systems in predictive coding processes is also discussed. This review provides a novel framework for understanding depression using predictive coding principles and establishes a foundational roadmap for potential future research.
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Affiliation(s)
- Jessica R. Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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27
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Learning from gain and loss: Links to suicide risk. J Psychiatr Res 2022; 147:126-134. [PMID: 35032945 DOI: 10.1016/j.jpsychires.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/27/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022]
Abstract
Despite preliminary evidence that people with suicide attempt histories demonstrate deficits in processing feedback, no studies have examined the interrelations of learning from feedback and emotional state on suicide risk. This study examined the influence of suicide risk and negative emotions on learning accuracy and rates among individuals with a range of borderline personality features (N = 145). Participants completed a reinforcement learning task after neutral and negative emotion inductions. Results revealed interactions between suicide risk and emotion condition, with elevated risk linked to greater increases in loss learning rate (training phase models) and gain learning rate (test phase models) post-negative emotion induction. Emotion-dependent fluctuations in learning performance may be markers of decision-making that are associated with greater suicide risk. This line of work has the potential to identify the contexts that confer greater risk for suicidal behaviors.
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28
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Chenini S, Barateau L, Guiraud L, Denis C, Rassu AL, Lopez R, Jaussent I, Dauvilliers Y. Depressive Symptoms and Suicidal Thoughts in Restless Legs Syndrome. Mov Disord 2022; 37:812-825. [PMID: 34985142 DOI: 10.1002/mds.28903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Whether depression and suicide thoughts relate to restless legs syndrome (RLS) or comorbidities associated with RLS remain unclear. OBJECTIVES To determine frequency of depressive symptoms and suicidal thoughts in patients with RLS and their change after RLS treatment, associated clinical and polysomnographic factors, and current major depressive episode (MDE) frequency and suicide risk in RLS. METHODS Overall, 549 untreated patients with RLS and 549 age-, sex-, and education level-matched controls completed a standardized evaluation, including the Beck Depression Inventory-II that has one item on suicide thoughts. Patients underwent a polysomnographic recording and completed the Urgency, Premeditation, Perseverance, Sensation Seeking Impulsive Behavior scale. In a subgroup of 153 patients, current MDE and suicide risk were assessed with the face-to-face Mini-International Neuropsychiatric Interview (MINI). A subgroup of 152 patients were evaluated in untreated and treated conditions. RESULTS The frequency of depressive symptoms (32.5%) and suicidal thoughts (28%) was 10-fold and 3-fold higher, respectively, in patients with RLS than controls. Current MDE (10.5%) and suicidal risk (19.9%) (MINI) were also high. Moderate-to-severe depressive symptoms were associated with young age, female sex, insomnia symptoms, and urgency dimension. The suicide risk was associated with depression, impulsiveness, and RLS severity. RLS treatment improved depressive symptoms but not suicidal thoughts. CONCLUSION The rate of depressive symptoms, depression, and suicidal thoughts/risk was higher in patients with RLS, with key associations with insomnia symptoms, urgency dimension, and RLS severity. These results emphasize the importance of detecting these symptoms in current practice and of evaluating their change after treatment, especially in young women, to improve RLS management. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sofiene Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Ana Laura Rassu
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Isabelle Jaussent
- National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
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29
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Tsypes A, Szanto K, Bridge JA, Brown VM, Keilp JG, Dombrovski AY. Delay discounting in suicidal behavior: Myopic preference or inconsistent valuation? JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:34-44. [PMID: 34843269 PMCID: PMC8893041 DOI: 10.1037/abn0000717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Prior studies sought to explain the predisposition to suicidal behavior in terms of myopic preference for immediate versus delayed reward, generating mixed evidence. Data from gambling and bandit tasks, however, suggest that suboptimal decisions in suicidal individuals are explained by inconsistent valuation rather than myopic preferences. We tested these two alternative hypotheses using a delay discounting task in 622 adults (suicide attempters with depression, suicide ideators with depression, nonsuicidal participants with depression, and healthy controls) recruited across three sites through inpatient psychiatric units, mood disorders clinics, primary care, and advertisements. Multilevel models revealed group differences in valuation consistencies in all three samples, with high-lethality suicide attempters exhibiting less consistent valuation than all other groups in Samples 1 and 3 and less consistent valuation than the healthy controls or participants with depression in Sample 2. In contrast, group differences in preference for immediate versus delayed reward were observed only in Sample 1 and were due to the high-lethality suicide attempters displaying a weaker preference for immediate reward than low-lethality suicide attempters. The findings were robust to confounds such as cognitive functioning and comorbidities. Seemingly impulsive choices in suicidal behavior are explained by inconsistent reward valuation rather than a true preference for immediate reward. In a suicidal crisis, this inconsistency may result in a misestimation of the value of suicide relative to constructive alternatives and deterrents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Aliona Tsypes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH
| | - Vanessa M. Brown
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - John G. Keilp
- Department of Psychiatry, Columbia University, New York, NY
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30
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Abstract
Suicide is a leading cause of death, and presently, there is no definitive clinical indicator of future suicide behaviors. Anhedonia, a transdiagnostic symptom reflecting diminished ability to experience pleasure, has recently emerged as a risk factor for suicidal thoughts and behaviors (STBs). This overview, therefore, has the following aims. First, prior research relating anhedonia to STBs will be reviewed, with a particular focus on clarifying whether anhedonia is more closely associated with suicidal thoughts versus behaviors. Second, the National Institute of Mental Health's Research Domain Criteria Positive Valence Systems provide a useful heuristic to probe anhedonia across different units of analysis, including clinical symptoms, behaviors, neural mechanisms, and molecular targets. Accordingly, anhedonia-related constructs linked to STBs will be detailed as well as promising next steps for future research. Third, although anhedonia is not directly addressed in leading suicide theories, this review will provide potential inroads to explore anhedonia within diathesis-stress and interpersonal suicide frameworks. Last, novel approaches to treat anhedonia as a means of reducing STBs will be examined.
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Affiliation(s)
- Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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31
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Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature. Eur Child Adolesc Psychiatry 2021; 30:1839-1855. [PMID: 32388626 DOI: 10.1007/s00787-020-01550-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Suicide and suicidal behaviors represent a leading cause of morbidity and mortality during adolescence. While several lines of evidence suggest that suicidal behaviors are associated with risky decisions and deficient cognitive control in laboratory tasks in adults, comparatively less is known about adolescents. Here, we systematically reviewed the literature on the association between these neurocognitive variables and adolescent suicidal behaviors. The online search strategy identified 17 neurocognitive studies examining either cognitive control or decision-making processes in adolescents with past suicidal behaviors. Several studies have reported that adolescents with a history of suicidal behaviors present neuropsychological differences in the cognitive control (using Go/NoGo, suicide Stroop Test, continuous performance test, suicide/death Implicit Association Test), and decision-making (Iowa Gambling Task, Cambridge Gambling Task, cost computation, delay discounting, loss aversion tasks) domains. Due to a lack of replication or conflicting findings, our systematic review suggests that no firm conclusion can be drawn as to whether altered decision-making or poor cognitive control contribute to adolescent suicidal behaviors. However, these results collectively suggest that further research is warranted. Limitations included scarcity of longitudinal studies and a lack of homogeneity in study designs, which precluded quantitative analysis. We propose remediating ways to continue neuropsychological investigations of suicide risk in adolescence, which could lead to the identification of novel therapeutic targets and predictive markers, enabling early intervention in suicidal youth.
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32
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Ji X, Zhao J, Fan L, Li H, Lin P, Zhang P, Fang S, Law S, Yao S, Wang X. Highlighting psychological pain avoidance and decision-making bias as key predictors of suicide attempt in major depressive disorder-A novel investigative approach using machine learning. J Clin Psychol 2021; 78:671-691. [PMID: 34542183 DOI: 10.1002/jclp.23246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/05/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Predicting suicide is notoriously difficult and complex, but a serious public health issue. An innovative approach utilizing machine learning (ML) that incorporates features of psychological mechanisms and decision-making characteristics related to suicidality could create an improved model for identifying suicide risk in patients with major depressive disorder (MDD). METHOD Forty-four patients with MDD and past suicide attempts (MDD_SA, N = 44); 48 patients with MDD but without past suicide attempts (MDD_NS, N = 48-42 of whom with suicide ideation [MDD_SI, N = 42]), and healthy controls (HCs, N = 51) completed seven psychometric assessments including the Three-dimensional Psychological Pain Scale (TDPPS), and one behavioral assessment, the Balloon Analogue Risk Task (BART). Descriptive statistics, group comparisons, logistic regressions, and ML were used to explore and compare the groups and generate predictors of suicidal acts. RESULTS MDD_SA and MDD_NS differed in TDPPS total score, pain arousal and avoidance subscale scores, suicidal ideation scores, and relevant decision-making indicators in BART. Logistic regression tests linked suicide attempts to psychological pain avoidance and a risk decision-making indicator. The resultant key ML model distinguished MDD_SA/MDD_NS with 88.2% accuracy. The model could also distinguish MDD_SA/MDD_SI with 81.25% accuracy. The ML model using hopelessness could classify MDD_SI/HC with 94.4% accuracy. CONCLUSION ML analyses showed that motivation to avoid intolerable psychological pain, coupled with impaired decision-making bias toward under-valuing life's worth are highly predictive of suicide attempts. Analyses also demonstrated that suicidal ideation and attempts differed in potential mechanisms, as suicidal ideation was more related to hopelessness. ML algorithms show useful promises as a predictive instrument.
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Affiliation(s)
- Xinlei Ji
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiahui Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lejia Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China
| | - Pan Lin
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, Hunan, China
| | - Panwen Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shulin Fang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Samuel Law
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Medical Psychological Institute of Central South University, Changsha, Hunan, China.,China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
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Hutchinson EA, Sequeira SL, Silk JS, Jones NP, Oppenheimer C, Scott L, Ladouceur CD. Peer Connectedness and Pre-Existing Social Reward Processing Predicts U.S. Adolescent Girls' Suicidal Ideation During COVID-19. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:703-716. [PMID: 34448297 PMCID: PMC8407247 DOI: 10.1111/jora.12652] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 05/03/2023]
Abstract
There is major concern about the impact of the COVID-19 pandemic on adolescent suicidal ideation (SI) and peer relationships. We investigated (1) rates of SI and (2) the extent to which peer connectedness and pre-existing neural activation to social reward predicted SI during the initial stay-at-home orders of the pandemic (April-May 2020) in a longitudinal sample of adolescent girls (N = 93; Mage = 15.06; 69% White non-Hispanic). Daily diary and fMRI methods were used to assess peer connectedness and neural activation to social reward, respectively. Nearly 40% of girls endorsed SI during the initial stay-at-home orders. Greater peer connectedness and neural responsivity to anticipated social reward were associated with a reduced odds of SI during the pandemic among girls.
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Stanley B, Itzhaky L, Oquendo MA. Identifying Neurobiological Underpinnings of Two Suicidal Subtypes. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210016. [PMID: 34926832 PMCID: PMC8681698 DOI: 10.20900/jpbs.20210016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite substantial suicide prevention efforts, US suicide rates continue to climb, currently reaching about 14 per 100,000 individuals. Suicidal behavior has been linked to neurobiological, neurocognitive and behavioral factors; however, integrative, multi-modal studies are rare. Furthermore, prospective studies, crucial to understanding future risk factors, have focused on a single predictor and a single outcome, implying that suicidal behavior is homogeneous. But recent research shows suicidal behavior is complex and heterogeneous, with the possible existence of subtypes. The present report describes a project testing a model that posits two putative subtypes, using a prospective, multi-model design. The subtypes differ in regard to the patterns of suicidal ideation and underlying mechanisms. One hundred subjects diagnosed with a Major Depressive episode, half of whom have attempted suicide in the past, are enrolled and followed for two years, notably the highest risk period for suicidal behavior. Baseline assessments include a clinical assessment, neurocognitive and behavioral tasks, Ecological Momentary Assessments (EMA), PET imaging, and a cognitive emotion regulation task in the MRI scanner. The follow-up assessment includes a clinical assessment and EMA. The study findings have the potential to pave the way for a clearer understanding of suicidal ideation and behaviors and to improve our ability to treat those at risk for suicide by developing tailored approaches that will allow for more accurate pharmacological and psychosocial interventions.
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Affiliation(s)
- Barbara Stanley
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Unit 42, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Liat Itzhaky
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Unit 42, 1051 Riverside Drive, New York, NY 10032, USA
- Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 200, Philadelphia, PA 19104, USA
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35
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Ciria LF, Suárez-Pinilla M, Williams AG, Jagannathan SR, Sanabria D, Bekinschtein TA. Different underlying mechanisms for high and low arousal in probabilistic learning in humans. Cortex 2021; 143:180-194. [PMID: 34450566 DOI: 10.1016/j.cortex.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Humans are uniquely capable of adapting to highly changing environments by updating relevant information and adjusting ongoing behaviour accordingly. Here we show how this ability -termed cognitive flexibility- is differentially modulated by high and low arousal fluctuations. We implemented a probabilistic reversal learning paradigm in healthy participants as they transitioned towards sleep or physical extenuation. The results revealed, in line with our pre-registered hypotheses, that low arousal leads to diminished behavioural performance through increased decision volatility, while performance decline under high arousal was attributed to increased perseverative behaviour. These findings provide evidence for distinct patterns of maladaptive decision-making on each side of the arousal inverted u-shaped curve, differentially affecting participants' ability to generate stable evidence-based strategies, and introduces wake-sleep and physical exercise transitions as complementary experimental models for investigating neural and cognitive dynamics.
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Affiliation(s)
- Luis F Ciria
- Mind, Brain & Behavior Research Center and Department of Experimental Psychology, University of Granada, Spain; Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Downing Site, Cambridge, UK.
| | - Marta Suárez-Pinilla
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Downing Site, Cambridge, UK; Office of the National Director for Dementia Research, Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, UK
| | - Alex G Williams
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Downing Site, Cambridge, UK
| | - Sridhar R Jagannathan
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Downing Site, Cambridge, UK
| | - Daniel Sanabria
- Mind, Brain & Behavior Research Center and Department of Experimental Psychology, University of Granada, Spain
| | - Tristán A Bekinschtein
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Downing Site, Cambridge, UK.
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Lutz J, Van Orden KA, Bruce ML, Conwell Y. Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions. Am J Geriatr Psychiatry 2021; 29:731-744. [PMID: 33622593 PMCID: PMC8286287 DOI: 10.1016/j.jagp.2021.01.137] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.
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Affiliation(s)
- Julie Lutz
- Center for the Study and Prevention of Suicide, Department of Psychiatry (JL), University of Rochester Medical Center, Rochester, NY.
| | - Kimberly A Van Orden
- Center for the Study and Prevention of Suicide, Department of Psychiatry (KAVO), University of Rochester Medical Center, Rochester, NY
| | - Martha L Bruce
- Department of Psychiatry (MLB), Geisel School of Medicine, Dartmouth, NH
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, Department of Psychiatry (YC), University of Rochester Medical Center, Rochester, NY
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37
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Saberi A, Mohammadi E, Zarei M, Eickhoff SB, Tahmasian M. Structural and functional neuroimaging of late-life depression: a coordinate-based meta-analysis. Brain Imaging Behav 2021; 16:518-531. [PMID: 34331655 DOI: 10.1007/s11682-021-00494-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Several neuroimaging studies have investigated localized aberrations in brain structure, function or connectivity in late-life depression, but the ensuing results are equivocal and often conflicting. Here, we provide a quantitative consolidation of neuroimaging in late-life depression using coordinate-based meta-analysis by searching multiple databases up to March 2020. Our search revealed 3252 unique records, among which we identified 32 eligible whole-brain neuroimaging publications comparing 674 patients with 568 controls. The peak coordinates of group comparisons between the patients and the controls were extracted and then analyzed using activation likelihood estimation method. Our sufficiently powered analysis on all the experiments, and more homogenous subsections of the data (patients > controls, controls > patients, and functional imaging experiments) revealed no significant convergent regional abnormality in late-life depression. This inconsistency might be due to clinical and biological heterogeneity of LLD, as well as experimental (e.g., choice of tasks, image modalities) and analytic flexibility (e.g., preprocessing and analytic parameters), and distributed patterns of neural abnormalities. Our findings highlight the importance of clinical/biological heterogeneity of late-life depression, in addition to the need for more reproducible research by using pre-registered and standardized protocols on more homogenous populations to identify potential consistent brain abnormalities in late-life depression.
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Affiliation(s)
- Amin Saberi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Esmaeil Mohammadi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.
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Del-Monte J, Graziani P. Anticipatory, Relief-Oriented and Permissive Beliefs in Patients with Suicidal Behaviors: An Exploratory Case-Control Study. Arch Suicide Res 2021; 25:629-640. [PMID: 32202480 DOI: 10.1080/13811118.2020.1738969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective is to propose a specific understanding of decision-making in suicidal behavior by using a psychometric instrument, namely the Suicidal Ambivalence Scale (SAS). The SAS, initially used in addictive disorders, allows to distinguish 3 types of thoughts: first anticipatory beliefs [A] (positive expectations regarding behavior); second relief-oriented beliefs [R] (aim to reduce the feeling of suffering) and finally, permissive beliefs [P] (authorize the passage to the act). In addictions disorders, these thoughts favor craving and the act of consumption. We make the hypothesis that the processes of suicidal thoughts function similarly to thought processes in addiction and that all thoughts [A, S and P] are significantly more present in suicidal patients. METHODS 120 suicidal crisis patients and 161 healthy controls were compared on clinical dimensions (levels of depression, hopelessness). Anticipatory, relief-oriented and permissive beliefs were evaluated with the suicidal ambivalence scale. RESULTS Patients have statistically more of beliefs in favor of suicidal behavior to compared healthy controls (t = 2.375, p = 0.019, d = 0.57), more particularly, anticipatory and permissive beliefs. Conversely, patients have statistically less of protective thoughts against the suicidal behavior to compared healthy controls (t = 2.195, p = 0.03, d = 0.499). CONCLUSION This study showed the role of anticipatory, relief-oriented and permissive beliefs in the suicidal crisis and the need to create a simple and easy to use clinical tool for more accurate assessments of beliefs in patients with the suicidal crisis.
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Ji X, Zhao J, Li H, Pizzagalli DA, Law S, Lin P, Fan L, Zhang P, Fang S, Wang X, Yao S, Wang X. From motivation, decision-making to action: An fMRI study on suicidal behavior in patients with major depressive disorder. J Psychiatr Res 2021; 139:14-24. [PMID: 34004553 DOI: 10.1016/j.jpsychires.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We explored the neural mechanisms underlying disadvantageous risk decision making in un-medicated major depressive disorder patients who had recent suicide attempts. METHODS 53 patients with major depressive disorder (MDD), including 23 with a history of suicide attempts (SA) and 30 without (NS), and 30 healthy controls (HCs) completed pertinent psychometric assessments, and the dynamic decision making balloon analogue risk task (BART) under fMRI. We also built a 4-parameter Bayesian computational modeling for decision making analyses. RESULTS Several distinct findings emerged. First, SA patients had no depression intensity difference but higher pain avoidance in psychometrics, and more risk aversion in the BART when compared to the NS patients, with computational modeling confirming such reduced risk-taking propensity. Second, SA patients showed smaller left insular cortex activation than NS patients during the high risk, decisional phase of BART, and the modulation correlated with pain avoidance in both SA and NS groups. Third, during feedback phase of loss trials of the BART, SA patients had greater activation in the left dorsolateral prefrontal cortex (dlPFC) than NS patients. CONCLUSION Taken together, we present novel findings and propose interpretations that the differential insula activation likely relates to high uncertainty-aversion in SA patients, contrary to the typical view that they are impulsive and risk prone. The differential left dlPFC activation likely suggests hypersensitivity to loss, contributing to conservative decision-making at large, and extreme choices such as suicide when value estimations are compromised and emotionally overwhelmed. The interactive interpretation places a renewed focus on psychological pain avoidance as a robust motivator for suicidal behavior.
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Affiliation(s)
- Xinlei Ji
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Jiahui Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Samuel Law
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pan Lin
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, Hunan, China
| | - Lejia Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Panwen Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Shulin Fang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Xiaosheng Wang
- Department of Human Anatomy and Neurobiology, Xiangya School of Medicine, Central South University, Central South University, Changsha, Hunan, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China.
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40
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Barredo J, Berlow Y, Swearingen HR, Greenberg BD, Carpenter LL, Philip NS. Multimodal Elements of Suicidality Reduction After Transcranial Magnetic Stimulation. Neuromodulation 2021; 24:930-937. [PMID: 33650209 PMCID: PMC8295183 DOI: 10.1111/ner.13376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (TMS) is a promising treatment for suicidality, but it is underlying neural mechanisms remain poorly understood. Our prior findings indicated that frontostriatal functional connectivity correlates with the severity of suicidal thoughts and behaviors. In this secondary analysis of data from an open label trial, we evaluated whether changes in frontostriatal functional connectivity would accompany suicidality reductions following TMS. We also explored the relationship between frontostriatal connectivity change and underlying white matter (WM) organization. MATERIALS AND METHODS We conducted seed-based functional connectivity analysis on participants (N = 25) with comorbid post-traumatic stress disorder and depression who received eight weeks of 5 Hz TMS to left dorsolateral prefrontal cortex. We measured clinical symptoms with the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and the PTSD Checklist for DSM-5 (PCL-5). We derived suicidality from IDS-SR item 18. Magnetic resonance imaging data were collected before TMS, and at treatment end point. These data were entered into analyses of covariance, evaluating the effect of suicidality change across treatment on striatal and thalamic functional connectivity. Changes in other PTSD and depression symptoms were included as covariates and results were corrected for multiple comparisons. Diffusion connectometry in a participant subsample (N = 17) explored the relationship between frontal WM integrity at treatment baseline and subsequent functional connectivity changes correlated with differences in suicidality. RESULTS Suicidal ideation decreased in 65% of participants. Reductions in suicidality and functional connectivity between the dorsal striatum and frontopolar cortex were correlated (p-False Discover Rate-corrected < 0.001), after covariance for clinical symptom change. All other results were nonsignificant. Our connectometry results indicated that the integrity of frontostriatal WM may circumscribe functional connectivity response to TMS for suicide. CONCLUSIONS Targeted reduction of fronto-striatal connectivity with TMS may be a promising treatment for suicidality. Future research can build on this multimodal approach to advance individualized stimulation approaches in high-risk patients.
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Affiliation(s)
- Jennifer Barredo
- Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceRIUSA
- Center for Neurorestoration and Neurotechnology, Providence VA Medical CenterProvidenceRIUSA
- COBRE Center for Neuromodulation at Butler HospitalProvidenceRIUSA
| | - Yosef Berlow
- Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceRIUSA
- Center for Neurorestoration and Neurotechnology, Providence VA Medical CenterProvidenceRIUSA
| | - Hannah R. Swearingen
- Center for Neurorestoration and Neurotechnology, Providence VA Medical CenterProvidenceRIUSA
| | - Benjamin D. Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceRIUSA
- Center for Neurorestoration and Neurotechnology, Providence VA Medical CenterProvidenceRIUSA
- COBRE Center for Neuromodulation at Butler HospitalProvidenceRIUSA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceRIUSA
- COBRE Center for Neuromodulation at Butler HospitalProvidenceRIUSA
| | - Noah S. Philip
- Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceRIUSA
- Center for Neurorestoration and Neurotechnology, Providence VA Medical CenterProvidenceRIUSA
- COBRE Center for Neuromodulation at Butler HospitalProvidenceRIUSA
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Barredo J, Bozzay ML, Primack JM, Schatten HT, Armey MF, Carpenter LL, Philip NS. Translating Interventional Neuroscience to Suicide: It's About Time. Biol Psychiatry 2021; 89:1073-1083. [PMID: 33820628 PMCID: PMC8603185 DOI: 10.1016/j.biopsych.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research.
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Affiliation(s)
- Jennifer Barredo
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island.
| | - Melanie L Bozzay
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Linda L Carpenter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
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Dombrovski AY, Hallquist MN. Search for solutions, learning, simulation, and choice processes in suicidal behavior. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 13:e1561. [PMID: 34008338 PMCID: PMC9285563 DOI: 10.1002/wcs.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value‐based choices. Can individual‐level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case–control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision‐making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood‐congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case–control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real‐time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under:Economics > Individual Decision‐Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior
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Affiliation(s)
| | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
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Leone C, Galosi S, Mollica C, Fortunato M, Possidente C, Milone V, Misuraca S, Berillo L, Truini A, Cruccu G, Ferrara M, Terrinoni A. Dissecting pain processing in adolescents with Non-Suicidal Self Injury: Could suicide risk lurk among the electrodes? Eur J Pain 2021; 25:1815-1828. [PMID: 33982830 PMCID: PMC8453562 DOI: 10.1002/ejp.1793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 12/13/2022]
Abstract
Background Although non‐suicidal self‐injury (NSSI) disorder is highly prevalent in adolescents, its relationship with pain system function and suicidality is still controversial. The present study was designed to assess the function of the nociceptive afferent pathways and the endogenous pain modulation in adolescent patients with NSSI and to longitudinally register any suicide attempt, describe its frequency and find a possible association between suicide, neurophysiological measures and psychological measures. Methods We enrolled 30 adolescents suffering from NSSI and 20 age‐ and gender‐matched healthy controls. Patients underwent a comprehensive psychological evaluation. Each participant underwent thermal pain thresholds of the quantitative sensory testing, laser‐evoked potential recording to study the ascending nociceptive pathway and the conditioned pain modulation testing to test the endogenous pain modulation. Results We found that patients with NSSI had a reduced amplitude of the N2 component of laser‐evoked potentials and an abnormal conditioned pain modulation. The amplitude of the N2 was associated with suicidal risk. Conclusions The deficit of the endogenous pain modulation likely depends on a saturation due to continuous pain solicitation. The strong association of a reduced amplitude of the N2 component with suicide suggests that it may serve as a possible biomarker in self‐harming adolescents. Significance The present study identifies the N2 component of laser‐evoked potentials as a possible neurophysiological biomarker of suicidal risk in patients with non‐suicidal self‐injury, therefore, raising the possibility for a non‐invasive test to identify subjects at higher risk of suicide among self‐harming patients.
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Affiliation(s)
- Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cristina Mollica
- Department of Methods and Models for Economics, Territory and Finance, Sapienza University, Rome, Italy
| | - Mattia Fortunato
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Valeria Milone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Sofia Misuraca
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Luana Berillo
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Mauro Ferrara
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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Deciding to Die: the Relations of Decision-making Styles to Suicide Ideation and Attempts. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Lin C, Huang CM, Karim HT, Liu HL, Lee TMC, Wu CW, Toh CH, Tsai YF, Yen TH, Lee SH. Greater white matter hyperintensities and the association with executive function in suicide attempters with late-life depression. Neurobiol Aging 2021; 103:60-67. [PMID: 33845397 DOI: 10.1016/j.neurobiolaging.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 10/21/2022]
Abstract
Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensities (WMH), which are also found in suicide attempters regardless of age. Greater periventricular WMH are related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 older adult controls (individuals without LLD or history of suicide attempt). WMH were quantified by an automated segmentation algorithm and were classified into different regions. Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p = 0.014) compared to other groups. Suicide attempters with high WMH had significantly lower executive function, which could be an underlying mechanism for cognitive decline in older adults with suicidality.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatia Mei-Chun Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong
| | - Changwei W Wu
- Brain and Consciousness Research Center, Shuang-Ho Hospital, New Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan County, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan.
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46
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Bryan CJ, Bryan AO, Anestis MA. Positive and Negative Affective Processes Associated With Firearm Acquisition and Ownership. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.10.861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: To examine positive and negative affective processes associated with firearm acquisition and firearm ownership. Methods: An online cross-sectional survey assessing firearm ownership, reasons for firearm ownership, intentions to acquire a firearm in the next 12 months, and positive and negative affective states was administered to 6,200 U.S. adults (49.0% male, 51.0% female). Results: Mean negative and positive affect were significantly elevated among protective firearm owners (i.e., those who kept firearms for the primary purpose of self-protection) and participants intending to acquire a firearm. Protective firearm owners intending to acquire another firearm reported significantly higher negative affect than all other subgroups. Within this subgroup, negative affect and positive affect were positively correlated. Among all other subgroups, negative and positive affect were either negatively correlated or uncorrelated. Discussion: The intention to acquire firearms and protective firearm ownership are associated with both positive and negative affectivity. Typical cognitive-affective processes may be disrupted among protective firearm owners intending to acquire another firearm.
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47
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Affiliation(s)
- J John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
| | - Mina M Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
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48
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Abstract
Differences in the prevalence and presentation of psychiatric illnesses in men and women suggest that neurobiological sex differences confer vulnerability or resilience in these disorders. Rodent behavioral models are critical for understanding the mechanisms of these differences. Reward processing and punishment avoidance are fundamental dimensions of the symptoms of psychiatric disorders. Here we explored sex differences along these dimensions using multiple and distinct behavioral paradigms. We found no sex difference in reward-guided associative learning but a faster punishment-avoidance learning in females. After learning, females were more sensitive than males to probabilistic punishment but less sensitive when punishment could be avoided with certainty. No sex differences were found in reward-guided cognitive flexibility. Thus, sex differences in goal-directed behaviors emerged selectively when there was an aversive context. These differences were critically sensitive to whether the punishment was certain or unpredictable. Our findings with these new paradigms provide conceptual and practical tools for investigating brain mechanisms that account for sex differences in susceptibility to anxiety and impulsivity. They may also provide insight for understanding the evolution of sex-specific optimal behavioral strategies in dynamic environments.
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49
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Rupprechter S, Romaniuk L, Series P, Hirose Y, Hawkins E, Sandu AL, Waiter GD, McNeil CJ, Shen X, Harris MA, Campbell A, Porteous D, Macfarlane JA, Lawrie SM, Murray AD, Delgado MR, McIntosh AM, Whalley HC, Steele JD. Blunted medial prefrontal cortico-limbic reward-related effective connectivity and depression. Brain 2020; 143:1946-1956. [PMID: 32385498 PMCID: PMC7296844 DOI: 10.1093/brain/awaa106] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Major depressive disorder is a leading cause of disability and significant mortality, yet mechanistic understanding remains limited. Over the past decade evidence has accumulated from case-control studies that depressive illness is associated with blunted reward activation in the basal ganglia and other regions such as the medial prefrontal cortex. However it is unclear whether this finding can be replicated in a large number of subjects. The functional anatomy of the medial prefrontal cortex and basal ganglia has been extensively studied and the former has excitatory glutamatergic projections to the latter. Reduced effect of glutamatergic projections from the prefrontal cortex to the nucleus accumbens has been argued to underlie motivational disorders such as depression, and many prominent theories of major depressive disorder propose a role for abnormal cortico-limbic connectivity. However, it is unclear whether there is abnormal reward-linked effective connectivity between the medial prefrontal cortex and basal ganglia related to depression. While resting state connectivity abnormalities have been frequently reported in depression, it has not been possible to directly link these findings to reward-learning studies. Here, we tested two main hypotheses. First, mood symptoms are associated with blunted striatal reward prediction error signals in a large community-based sample of recovered and currently ill patients, similar to reports from a number of studies. Second, event-related directed medial prefrontal cortex to basal ganglia effective connectivity is abnormally increased or decreased related to the severity of mood symptoms. Using a Research Domain Criteria approach, data were acquired from a large community-based sample of subjects who participated in a probabilistic reward learning task during event-related functional MRI. Computational modelling of behaviour, model-free and model-based functional MRI, and effective connectivity dynamic causal modelling analyses were used to test hypotheses. Increased depressive symptom severity was related to decreased reward signals in areas which included the nucleus accumbens in 475 participants. Decreased reward-related effective connectivity from the medial prefrontal cortex to striatum was associated with increased depressive symptom severity in 165 participants. Decreased striatal activity may have been due to decreased cortical to striatal connectivity consistent with glutamatergic and cortical-limbic related theories of depression and resulted in reduced direct pathway basal ganglia output. Further study of basal ganglia pathophysiology is required to better understand these abnormalities in patients with depressive symptoms and syndromes.
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Affiliation(s)
| | - Liana Romaniuk
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Peggy Series
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Yoriko Hirose
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Emma Hawkins
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - Gordon D Waiter
- Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | | | - Xueyi Shen
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Mathew A Harris
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - David Porteous
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer A Macfarlane
- Division of Imaging Science and Technology, Medical School, University of Dundee, Dundee, UK
| | | | - Alison D Murray
- Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | | | | | | | - J Douglas Steele
- Division of Imaging Science and Technology, Medical School, University of Dundee, Dundee, UK
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50
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Steinberg LJ, Mann JJ. Abnormal stress responsiveness and suicidal behavior: A risk phenotype. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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