涉及从自杀意念到行为转变的潜在神经心理学机制 - 一项涉及脑岛的静息态 fMRI 研究。
Potential neuropsychological mechanism involved in the transition from suicide ideation to action - a resting-state fMRI study implicating the insula.
机构信息
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.
出版信息
Eur Psychiatry. 2023 Sep 11;66(1):e69. doi: 10.1192/j.eurpsy.2023.2444.
BACKGROUND
Understanding the neural mechanism underlying the transition from suicidal ideation to action is crucial but remains unclear. To explore this mechanism, we combined resting-state functional connectivity (rsFC) and computational modeling to investigate differences between those who attempted suicide(SA) and those who hold only high levels of suicidal ideation(HSI).
METHODS
A total of 120 MDD patients were categorized into SA group (n=47) and HSI group (n=73). All participants completed a resting-state functional MRI scan, with three subregions of the insula and the dorsal anterior cingulate cortex (dACC) being chosen as the region of interest (ROI) in seed-to-voxel analyses. Additionally, 86 participants completed the balloon analogue risk task (BART), and a five-parameter Bayesian modeling of BART was estimated.
RESULTS
In the SA group, the FC between the ventral anterior insula (vAI) and the superior/middle frontal gyrus (vAI-SFG, vAI-MFG), as well as the FC between posterior insula (pI) and MFG (pI-MFG), were lower than those in HSI group. The correlation analysis showed a negative correlation between the FC of vAI-SFG and psychological pain avoidance in SA group, whereas a positive correlation in HSI group. Furthermore, the FC of vAI-MFG displayed a negative correlation with loss aversion in SA group, while a positive correlation was found with psychological pain avoidance in HSI group.
CONCLUSION
In current study, two distinct neural mechanisms were identified in the insula which involving in the progression from suicidal ideation to action. Dysfunction in vAI FCs may gradually stabilize as individuals experience heightened psychological pain, and a shift from positive to negative correlation patterns of vAI-MFC may indicate a transition from state to trait impairment. Additionally, the dysfunction in PI FC may lead to a lowered threshold for suicide by blunting the perception of physical harm.
背景
了解从自杀意念到自杀行为的转变的神经机制至关重要，但目前仍不清楚。为了探索这一机制，我们结合静息态功能连接（rsFC）和计算模型，研究了有自杀企图（SA）和只有高自杀意念（HSI）的个体之间的差异。
方法
共有 120 名 MDD 患者被分为 SA 组（n=47）和 HSI 组（n=73）。所有参与者均完成了静息态功能磁共振成像扫描，以岛叶的三个亚区和背侧前扣带回皮层（dACC）作为种子点到体素分析的感兴趣区（ROI）。此外，86 名参与者完成了气球模拟风险任务（BART），并对 BART 进行了五参数贝叶斯建模。
结果
在 SA 组中，腹侧前岛叶（vAI）与额上/中回（vAI-SFG，vAI-MFG）之间的 FC 以及后岛叶（pI）与 MFG（pI-MFG）之间的 FC 均低于 HSI 组。相关性分析显示，SA 组中 vAI-SFG 的 FC 与心理疼痛回避呈负相关，而 HSI 组中呈正相关。此外，SA 组中 vAI-MFG 的 FC 与损失厌恶呈负相关，而 HSI 组中与心理疼痛回避呈正相关。
结论
在本研究中，我们发现岛叶中存在两种不同的神经机制，涉及从自杀意念到自杀行为的进展。随着个体经历更高的心理疼痛，vAI 的 FC 功能障碍可能逐渐稳定，而 vAI-MFC 的相关性模式从正相关变为负相关，可能表明从状态到特质损伤的转变。此外，PI 的 FC 功能障碍可能会通过削弱对身体伤害的感知，导致自杀的阈值降低。
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