What Can We Learn from the Brains of Bipolar Adolescents Who Have Attempted Suicide?

April 20, 2017 |

pan-lisa-2013April 20, 2017

Background
Individuals with bipolar disorder are at increased risk for suicide. It is estimated that around 50 percent of individuals with bipolar disorder attempt suicide in their lifetime and 15-20 percent die by suicide. Despite the prevalence of these issues, few studies examine the brain function and neural circuitry (how different parts of the brain connect with each other) of individuals living with bipolar disorder and suicide attempts, especially among youth.

Previous studies conducted by Dr. Hilary Blumberg with adults indicated that the neural circuits in the brains of people with bipolar disorder and suicidal behavior are different from those with no mental health disorder, and that these differences may be present early in life. This study is one of the first of its kind to use multiple neuroimaging methods to examine the neural circuitry of adolescents and young adults with bipolar disorder who made suicide attempts.

The Question
Among youth with bipolar disorder, are there differences in brain structure and function when the person has a history of a suicide attempt?

The Study
Sample: three groups of individuals with ages ranging from 14 to 25; 42 people with bipolar disorder without a history of suicide attempts; 26 people with bipolar disorder with a history of at least one suicide attempt; and a psychiatrically healthy control group of 45 people participated.

Structured interviews were administered to assess for current and past mental health disorders; past and current suicidal ideation and behavior; and the lethality and intent of previous suicide attempts. Participants completed self-report measures of hopelessness and impulsivity.

Three types of brain scans were administered to all participants: 1) structural magnetic resonance imaging (sMRI) to assess gray matter volume; 2) diffusion tensor imaging (DTI) to assess white matter density; and 3) functional magnetic resonance imaging (fMRI) to assess brain function when presented with happy, neutral, and fearful faces.

The Results
The study found that suicide attempters and nonattempters with bipolar disorder differed significantly from the control group in terms of suicidal ideation severity, but not in impulsivity, hopelessness, medication status, lifetime comorbid substance use or dependence, mood state, psychosis, or rapid cycling. (Rapid cycling refers to rapid shifts in mood during brief periods of time.)

From the brain scans, researchers found significant differences in gray matter volume between the attempter and non-attempter groups. The attempter group had less gray matter in regions related to emotional regulation, emotional responses, and memory. They also had decreased white matter that connects brain areas involved in these functions when compared to the non-attempter group and the healthy control group.

In addition, the attempter group showed significant decreases in the processing of happy and neutral faces, and minimal decrease in the processing of fearful faces. This indicates a decrease in emotional regulation and density of white matter connections when compared to non-attempters and healthy controls. Previously, emotional dysregulation had been linked to increased likelihood of suicide attempts due to intolerable mood states. In this study, white matter was related to lethality of past suicide attempts and current suicidal ideation, suggesting a unique association with suicide risk.

The Takeaway
There are differences in brain structure and functioning in youth with bipolar disorder who have made suicide attempts that relate to the ability to regulate emotion. These findings suggest that someday it may be possible to use brain scans to assess for suicide risk among people with bipolar disorder, which will allow for earlier and targeted intervention.

Grant-related publications

  • Cox Lippard, E.T., Johnston, J.A.Y., Blumberg, H.P. (2014)  Neurobiological Risk Factors for Suicide Insights from Brain Imaging. Am J Prev Med. 2014 September ; 47(3 0 2): S152–S162. doi:10.1016/j.amepre.2014.06.009.
  • Johnston, J.A.Y., Wang, F., Liu, J., Blond, B., Wallace, A., Liu, J., Spencer, L., Lippard, E.T.C., Purves, K.L., Landeros-Weisenberger, A., Hermes, E., Pittman, B., Martin, A., Oquendo, M., & Blumberg, H.P. (2017). Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder. American Journal of Psychiatry.  Jan 31:appiajp201615050652. doi: 10.1176/appi.ajp.2016.15050652. [Epub ahead of print]
  • Najt, P., Wang, F., Spencer, L., Johnston, J.A.Y., Cox Lippard, E.T., Pittman, B.P., Lacadie, C., Staib, L.H., Papademetris, X., Blumberg H.P. (2016) Anterior Cortical Development During Adolescence in Bipolar Disorder. Biological Psychiatry; 79:303–310 http://www.biologicalpsychiatryjournal.com/.

Click here to read about Dr. Blumberg’s Standard Research Grant.

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