Brain Imaging Findings Shed Light on Suicidal Behavior

Megan Brooks

December 15, 2014

Adolescents with bipolar disorder who have attempted suicide have abnormalities in the prefrontal cortex and related brain areas, preliminary research indicates.

"We observed differences in brain circuitry in adolescents and young adults who have bipolar disorder and made suicide attempts," Hilary P. Blumberg, MD, director, Mood Disorders Research Program, Yale University, in New Haven, Connecticut, told Medscape Medical News.

"These were especially in the frontal cortex and its connections. The frontal cortex is important in behaviors that may play a role in suicide behavior ― for example, in mood, decision-making, and in inhibiting impulses to take action," explained Dr Blumberg, professor of psychiatry and diagnostic radiology at the Yale School of Medicine.

She presented her research at the recently held American College of Neuropsychopharmacology 53rd Annual Meeting, in Phoenix, Arizona.

Poor Connections

Using MRI, the researchers examined brain structure and function in a group of adolescents and young adults aged 14 to 25 years. Sixty-eight participants had bipolar disorder, of whom 26 had attempted suicide. They were compared with 45 healthy volunteers matched for age and sex.

Compared with bipolar patients who had not attempted suicide and healthy volunteers, those who had attempted suicide showed less integrity of white matter in key frontal brain systems, including the uncinate fasciculus, a fiber tract that connects the frontal lobe with key brain areas that control emotion, motivation, and memory, Dr Blumberg reported.

The deficits in the structural connections were associated with weaker connections between the prefrontal cortex and the amygdala, suggesting that the white matter abnormalities may disrupt the ability of these system components to work together. The researchers also found ties between the circuitry deficits and suicidal ideation, the number of suicide attempts, and the relative lethality of prior suicide attempts.

Bipolar disorder often develops in the late teen or early adult years. At least half of all cases start before the patient is aged 25 years. The condition affects an estimated 3% to 4% of Americans, and 25% to 50% of those affected attempt suicide, according to a conference statement.

Dr Blumberg said that the current findings represent "an important step in working towards understanding of how suicide behavior develops and improved methods to detect risk earlier and to design improved interventions to reduce risk of suicide."

The research is supported by grants from the National Institute on Mental Health, the American Foundation for Suicide Prevention, and the International Bipolar Foundation. Dr Blumberg reports no relevant financial relationships.

American College of Neuropsychopharmacology 53rd Annual Meeting. Abstract 15.1. Presented December 9, 2014.

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