(PS3-B47) Examining Emotional Regulation Through Imaging: A Cognitive and Behavioral Analysis of Suicidality in Schizophrenia

Background: Suicidal ideation and behavior (SIB) in schizophrenia is a significant public health problem. Forty percent of people with schizophrenia make at least one lifetime suicide attempt. In healthy controls, SIB can be linked to emotion regulation (ER), which is associated with activation in the posterior parietal cortex and the dorsomedial and ventrolateral PFC. Few studies have examined neural correlates of ER in schizophrenia. In the current study, brain activation was examined during an ER task in patients with schizophrenia with low vs. high SIB.  We hypothesized that participants with higher levels of SIB would have lower levels of activation while performing the ER task compared to participants with low SIB. 





Methods: Participants were assigned to SIB groups with the Columbia-Suicide Severity Rating Scale. Subjects in the high SIB group (n=10) had scores of ≥ 3 on ideation over the past 12 months and/or >2 lifetime attempts; those in the low SIB group (n=8) had scores of ≤2 on ideation (lifetime) and no attempts. In an fMRI task, participants heard negatively or neutrally valanced sentences followed by negative or neutral pictures; neutral pictures were always preceded by neutral statements, whereas negative pictures were preceded by either negative (NegNeg) or neutral (NeutNeg) statements. A comparison of NeutNeg vs. NegNeg indexed the effect of ER. We did not correct for multiple comparisons in this preliminary study but set the clusterwise p-value at 0.01 and the cluster size at 40 voxels. Participants then rated the unpleasantness of each picture. 

Results: Participants generally rated NegNeg pictures as more unpleasant than NeutNeg pictures, demonstrating an effect of ER. In the low SIB group only, the task activated typical emotion regulation circuitry. Compared to the high SIB group, the low SIB subjects had higher activation in the right rostral anterior cingulate cortex (rACC), the right dorsal anterior cingulate cortex (dACC), the right inferior frontal gyrus (rIFG), and the posterior cingulate cortex (PCC). Activation in the group contrast (NeutNeg – NegNeg) could be explained by lower activation in the high SIB vs. the low SIB in the NeutNeg condition.

Discussion: In this preliminary study, patients with low SIB showed higher activation in areas associated with ER compared to those with high SIB, indicating that the high SIB group had activation deficits in those areas on the ER task. The lower activation in the high SIB group was attributable to lower activation in the ER condition rather than the control (NegNeg) condition. This supports dysfunctional ER circuitry as a neural mechanism for SIB in schizophrenia. A better understanding of the neural basis of SIB and behavioral outcomes of emotional regulation in schizophrenia may prompt focused treatment modalities, including CBT, to address this substantial public health emergency.