Frontal Motor Cortex Activity During Reactive Control Is Associated With Past Suicidal Behavior in Recent-Onset Schizophrenia.
BACKGROUND
Suicide is prevalent in schizophrenia (SZ), yet the neural system functions that confer suicide risk remain obscure. Circuits operated by the prefrontal cortex (PFC) are altered in SZ, including those that support reactive control, and PFC changes are observed in postmortem studies of heterogeneous suicide victims.


OBJECTIVE
We tested whether history of suicide attempt is associated with altered frontal motor cortex activity during reactive control processes.


METHODS
We evaluated 17 patients with recent onset of DSM-IV-TR-defined SZ using the Columbia Suicide Severity Rating Scale and functional magnetic resonance imaging during Stroop task performance. Group-level regression models relating past suicidal behavior to frontal activation controlled for depression, psychosis, and impulsivity.


RESULTS
Past suicidal behavior was associated with relatively higher activation in the left-hemisphere supplementary motor area (SMA), pre-SMA, premotor cortex, and dorsolateral PFC, all ipsilateral to the active primary motor cortex.


CONCLUSIONS
This study provides unique evidence that suicidal behavior in patients with recent-onset SZ directly relates to frontal motor cortex activity during reactive control, in a pattern reciprocal to the relationship with proactive control found previously. Further work should address how frontal-based control functions change with risk over time, and their potential utility as a biomarker for interventions to mitigate suicide risk in SZ.
1 Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
Michael J
MJ
Minzenberg
2 Department of Psychiatry, University of California, Davis School of Medicine, Sacramento, CA, USA.
Tyler
T
Lesh
2 Department of Psychiatry, University of California, Davis School of Medicine, Sacramento, CA, USA.
Tara
T
Niendam
4 Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA, USA.
Jong H
JH
Yoon
1 Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
Yaoan
Y
Cheng
4 Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA, USA.
Remy N
RN
Rhoades
2 Department of Psychiatry, University of California, Davis School of Medicine, Sacramento, CA, USA.|3 Center for Neuroscience, University of California, Davis, CA, USA.
Cameron S
CS
Carter
D000328:Adult; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012559:Schizophrenia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017236:Suicide, Assisted; D013647:Task Performance and Analysis; D055815:Young Adult
cognitive control; fMRI; prefrontal cortex; schizophrenia; suicide