Editors' ChoicePsychiatry

Can imaging predict future suicidal behavior?

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Science Translational Medicine  07 Sep 2016:
Vol. 8, Issue 355, pp. 355ec143
DOI: 10.1126/scitranslmed.aah6433

Suicide rates have increased over the past 10 years in the United States. There is much interest in curbing this troubling outcome by predicting which patients will become suicidal and attempt suicide. In new work, Oquendo and colleagues performed a prospective study using positron emission tomography (PET) imaging to investigate whether serotonin 1A receptor (5HT1AR) and serotonin transporter (5HTT) binding in vivo could predict suicidal behavior.

The authors measured the binding potential of [11C]WAY-100635, a 5HT1AR antagonist, and [11C]DASB, a 5HTT radiotracer, in the brains of 100 adult patients with major depression using PET. About 50% of the participants were attempters of suicide before PET imaging. The authors focused on determining the binding potential in the raphe nuclei (RN), a midbrain structure that has been associated with suicidal ideation, lethality, and suicidal intent before a suicidal attempt. After PET imaging, the participants underwent standard treatments for major depression and were evaluated for their suicidal behavior over the next two years. Among the 100 scanned patients, 15 attempted and two completed suicide. The authors found that higher binding of [11C]WAY-100635 to 5HT1AR in the RN predicted suicidal ideation at 3 and 12 but not 24 months after a major depressive episode. 5HT1AR binding in the RN also correlated positively with lethality of suicidal attempts. In addition to RN, binding to the dorsolateral prefrontal cortex, anterior cingulate gyrus, and insula also predicted suicidal lethality in these suicide attempters. Surprisingly, unlike [11C]WAY-100635 binding to 5HT1AR, [11C]DASB binding to 5HTT did not show association with any measures of suicidal behavior.

This study is one of the largest prospective PET brain imaging studies in patients with mood disorders and shows the potential for PET imaging in predicting which suicidal patients may exhibit more lethal self-harm behaviors. Furthermore, this imaging method has the potential to distinguish subtypes of suicidal attempters based on their serotonergic neurophysiology. This outcome will bring us a step closer to customizing treatment approaches for groups of suicidal patients with similar underlying pathophysiology.

M. A. Oquendo et al., Positron emission tomographic imaging of the serotonergic system and prediction of risk and lethality of future suicidal behavior. JAMA Psychiatry 10.1001/jamapsychiatry.2016.1478 (2016). [Full Text]

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