Principal Investigator
Mani Pavuluri, MD, PhD
Risk for attempting suicide is alarmingly high at 20-47% in adolescent bipolar disorder (ABD) (Bhangoo et al., 2003; Goldstein et al., 2005), placing our efforts to prevent suicide in ABD as the top most priority. Therefore, this study is envisioned to move the field forwards in characterizing the signature of brain dysfunction in suicidal patients with ABD. It is very promising that we may be able to prevent youth suicide by identifying those at high risk for suicide, and finding interventions to address the associated brain abnormalities.
In the current study, we will categorize the ABD patients as “attempters,” and “non-attempters.” The non- attempters include those that fall into the spectrum of considering suicide, wishing they were dead, or having thought of killing themselves, but never attempted suicide. We will compare equal number of 13-18 year old youths across three groups (N=90): suicide attempters with ABD, suicide non attempters with ABD, and HC matched on demographics.
Specific Aim 1: To determine the link between affect dysregulation, impulsivity and suicide attempts in ABD patients relative to healthy controls (HC) using various neurocognitive and behavioral measures.
Hypothesis
Suicide attempters with ABD have poor affect regulation and are highly impulsive when compared to non-attempters with ABD, as shown by neurocognitive and behavioral measures. Healthy controls have greater ability to regulate affect and are less impulsive when compared to ABD patients.
Specific Aim 2: To map the brain circuitry that underlies the affect dysregulation (fronto-limbic circuitry) and response inhibition (fronto-striatal circuitry) in suicide attempters with ABD, non attempters with ABD, and HC.
Hypothesis
Suicide attempters, compared to the other two groups, will show increased amygdala activation, decreased ventrolateral (hierarchical center for emotional control) and dorsolateral (hierarchical center for cognitive control) prefrontal cortex activation, with loss of top-down regulation of emotions. In addition, decreased ventrolateral prefrontal cortex (VLPFC) and compensatory increased caudate activation will be associated with poor response inhibition in the attempters, compared to non attempters and HC.
FUNDING: American Foundation for Suicide Prevention, Marshall Reynolds Foundation