History of Suicide Attempt Is Associated with Reduced Medial Prefrontal Cortex Activity during Emotional Decision-Making among Men with Schizophrenia: An Exploratory fMRI Study.

Despite the high prevalence of suicidal ideas/attempts in schizophrenia, only a handful of neuroimaging studies have examined the neurobiological differences associated with suicide risk in this population. The main objective of the current exploratory study is to examine the neurofunctional correlates associated with a history of suicide attempt in schizophrenia, using a risky decision-making task, in order to show alterations in brain reward regions in this population. Thirty-two male outpatients with schizophrenia were recruited: 13 patients with (SCZ + S) and 19 without a history of suicidal attempt (SCZ - S). Twenty-one healthy men with no history of mental disorders or suicidal attempt/idea were also recruited. Participants were scanned using fMRI while performing the Balloon Analogue Risk Task. A rapid event-related fMRI paradigm was used, separating decision and outcome events, and the explosion probabilities were included as parametric modulators. The most important finding of this study is that SCZ + S patients had reduced activations of the medial prefrontal cortex during the success outcome event (with parametric modulation), relative to both SCZ - S patients and controls, as illustrated by a spatial conjunction analysis. These exploratory results suggest that a history of suicidal attempt in schizophrenia is associated with blunted brain reward activity during emotional decision-making.