title: Self-harm in schizophrenia is associated with dorsolateral prefrontal and posterior cingulate activity.
abstract: Self-harm, such as self-cutting, self-poisoning or jumping from height, regardless of intentions, is common among people with schizophrenia. We wished to investigate brain activations relating to self-harm, in order to test whether these activations could differentiate between schizophrenia patients with self-harm and those without. We used event-related functional MRI with a go/no-go response inhibition paradigm. Fourteen schizophrenia patients with a history of self-harm were compared with 14 schizophrenia patients without a history of self-harm and 17 healthy control participants. In addition, we used standard clinical measures and neuropsychological tests to assess risk factors associated with self-harm. The right dorsolateral prefrontal cortex (DLPFC) and the left posterior cingulate cortex differentiated all three groups; brain activation in these regions being greatest in the control group, and the self-harm patient group being greater than in the non-self-harm patient group. In the self-harm patient group, right DLPFC activity was positively correlated with severity of suicidal thinking. In addition, both patient groups showed less activation in the right orbitofrontal cortex, left ventral anterior cingulate cortex and right thalamus. This is the first study to report right DLPFC activation in association with self-harm and suicidal thinking in patients with schizophrenia. This area could be a target for future neuromodulation studies to treat suicidal thinking and self-harm behaviors in patients with schizophrenia.
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK; Department of Psychology, University of Sheffield, UK. Electronic address: k.h.lee@sheffield.ac.uk.
authors.forename: Kwang-Hyuk
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Pluck
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Lekka
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Horton
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK; Academic Unit of Radiology, School of Medicine, University of Sheffield, UK.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.affiliation: Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK.
authors.forename: Peter W R
authors.initials: PW
authors.lastname: Woodruff
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006179:Gyrus Cinguli / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D017397:Prefrontal Cortex / Q000098:blood supply / Q000473:pathology*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000473:pathology*; D012565:Schizophrenic Psychology; D016728:Self-Injurious Behavior / Q000209:etiology*
chemical_list: D010100:Oxygen
keywords: Dorsolateral prefrontal cortex; Response inhibition; Schizophrenia; Self-harm; Suicidal thinking; go/no-go task