title: Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly.
abstract: OBJECTIVE
  Abnormal responses to social stimuli are seen in people vulnerable to suicidal behavior, indicating possible disruptions in the neural circuitry mediating the interpretation of socioemotional cues. These disruptions have not been empirically related to psychological and cognitive pathways to suicide. In the present study of older suicide attempters, we examined neural responses to emotional faces and their relationship to impulsivity, one of the components of the suicidal diathesis.
  
  
  METHODS
  Using functional magnetic resonance imaging, we recorded neurohemodynamic responses to angry faces in a carefully characterized sample of 18 depressed elderly with history of suicide attempts, 13 depressed nonsuicidal patients, and 18 healthy individuals, all aged 60+. Impulsivity was assessed with the Social Problem Solving Inventory Impulsivity/Carelessness Style subscale and Barratt Impulsiveness Scale. The Suicide Intent Scale planning subscale was used to describe the degree of planning associated with the most lethal attempt.
  
  
  RESULTS
  Depression and history of attempted suicide were not associated with neural responses to angry faces, failing to replicate earlier studies. Higher impulsivity, however, predicted exaggerated responses to angry faces in fronto-opercular and dorsomedial prefrontal cortex (pcorr <0.05). Poorly planned suicide attempts also predicted increased fronto-opercular responses. Results were robust to effects of medication exposure, comorbid anxiety and addiction, severity of depression, burden of physical illness, and possible brain injury from suicide attempts.
  
  
  CONCLUSIONS
  Impulsive traits and history of unplanned suicide attempts partly explain the heterogeneity in neural responses to angry faces in depressed elderly. Displays of social emotion command excessive cortical processing in impulsive suicide attempters.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Polina M
authors.initials: PM
authors.lastname: Vanyukov
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Katalin
authors.initials: K
authors.lastname: Szanto
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Siegle
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Hallquist
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Aizenstein
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: dombax@upmc.edu.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
mesh_terms: D000368:Aged; D000786:Anger; D016022:Case-Control Studies; D003863:Depression / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007175:Impulsive Behavior; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology*
keywords: Aging; impulsivity; neuroimaging; prefrontal cortex; social threat; suicide