Neural, cognitive, and neuroimaging markers of the suicidal brain

Thomas Sobanski,1 Karl-Jürgen Bär,2 Gerd Wagner2 1Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Thüringen-Kliniken "Georgius Agricola" GmbH, Saalfeld, Germany; 2Department of Psychiatry and Psychotherapy, Psychiatric Brain and Body Research Group Jena, Jena University Hospital, Jena, GermanyAbstract: Suicidal behavior (SB) is characterized by the occurrence of suicide attempts with substantial intent to die. SB is a major health problem worldwide. In the great majority of cases, SB occurs in patients suffering from psychiatric disorders, mainly from affective disorders or schizophrenia. Despite this high association, there is growing evidence from genetic studies that SB might represent a psychiatric condition on its own. This review provides an overview of the most significant neurobiological and neurocognitive findings in SB. We provide evidence for specific dysfunctions within the serotonergic system, for distinct morphological abnormalities in the gray and white matter composition as well as for neurofunctional alterations in the fronto-striatal network. Additionally, the putative role of impulsivity and hopelessness as trait-like risk factors for SB is outlined. Both the personality traits are associated with altered prefrontal cortex function and deficits in cognitive and affective control similar to the findings in SB. Given the difficulties of clinical risk assessment, there is a need to identify specific markers that can predict SB more reliably. Some recent neurocognitive and functional/structural neuroimaging findings might be appropriate to use as SB indicators in the close future.Keywords: suicidal behavior, biological markers, serotonin, hopelessness, impulsivity, major depressive disorder, fMRI, PET, SPECT