Opposite effects of suicidality and lithium on gray matter volumes in bipolar depression

被引:129
作者
Benedetti, Francesco [1 ,3 ,4 ]
Radaelli, Daniele [1 ,3 ,4 ]
Poletti, Sara [1 ,3 ,4 ,5 ]
Locatelli, Clara [1 ,3 ,4 ]
Falini, Andrea [2 ,3 ,4 ]
Colombo, Cristina [1 ,3 ]
Smeraldi, Enrico [1 ,3 ,4 ]
机构
[1] Ist Sci San Raffaele, Dept Clin Neurosci, I-20132 Milan, Italy
[2] Ist Sci San Raffaele, Dept Neuroradiol, I-20132 Milan, Italy
[3] Univ Vita Salute, Milan, Italy
[4] Univ Vita Salute San Raffaele, CERMAC, Milan, Italy
[5] Univ Palermo, Dipartimento Sci Farmacol, I-90133 Palermo, Italy
关键词
Suicide; Bipolar disorder; Gray matter; Lithium; Adverse childhood experiences; ADVERSE CHILDHOOD EXPERIENCES; VENTRAL PREFRONTAL CORTEX; VOXEL-BASED MORPHOMETRY; ORBITOFRONTAL CORTEX; SLEEP-DEPRIVATION; ANTIDEPRESSANT RESPONSE; DISORDER PATIENTS; STRUCTURAL BRAIN; RISK-FACTORS; BEHAVIOR;
D O I
10.1016/j.jad.2011.07.006
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
Background: Mood disorders are associated with the highest increase of attempted and completed suicide. Suicidality in major depressive disorder and in schizophrenia has been associated with reduced gray matter volumes in orbitofrontal cortex. Lithium reduces the suicide risk of patients with bipolar disorder (BD) to the same levels of the general population, and can increase GM volumes. We studied the effect of a positive history of attempted suicide and ongoing lithium treatment on regional GM volumes of patients affected by bipolar depression. Methods: With a correlational design, we studied 57 currently depressed inpatients with bipolar disorder: 19 with and 38 without a positive history of suicide attempts, 39 unmedicated and 18 with ongoing lithium treatment. Total and regional gray matter volumes were assessed using voxel-based morphometry. Results: Total GM volume is inversely correlated with depression severity. A positive history of suicide attempts was associated with higher stress in early life. Suicide attempters showed reduced GM volumes in several brain areas including dorsolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate, superior temporal cortex, parieto-occipital cortex, and basal ganglia. Long term lithium treatment was associated with increased GM volumes in the same areas where suicide was associated with decreased GM. Conclusions: Reduced GM volumes in critical cortical areas of suicidal patients could be a biological correlate of an impaired ability to associate choices and outcomes and to plan goal-directed behaviors based on a lifetime historical perspective, which, coupled with mood-congruent depressive cognitive distortions, could lead to more hopelessness and suicide. Lithium could exert its specific therapeutic effect on suicide by acting in the same areas. (C) 2011 Elsevier B.V. All rights reserved.
引用
收藏
页码:139 / 147
页数:9
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