Brain mechanisms of vulnerability to suicide in old age remain unclear, and very few researchers study the neurobiology of late-life'suicide. In particular, the field of suicide research lacks an understanding of how psychoiogicai and cognitive markers of suicidal risk (hopelessness, executive dyscontrol) relate to brain markers identified in post-mortem and imaging studies. The applicant - a geriatric psychiatrist with a clinical background in late-life suicide and in the treatment of late-life depression - views suicide as an outcome of an altered decision process, a view supported by preliminary behavioral and imaging data. Thus, the applicant's career goals are to apply advances in the basic neuroscience of decision-making to investigate the brain mechanisms of late-life suicide and, in the future, to identify intervention targets. This approach aims to bridge existing cognitive research on suicidal diathesis with basic and clinical neuroscience. This will be achieved through training in functional magnetic resonance imaging (fMRI;including computational model-based fMRI), in neurobiology of decision-making, and in using neuroscience models to identify intervention targets. An fMRI study of decision-making in elderly depressed suicide attempters focused on disruptions in the processing of value signals in the ventromedial and ventrolateral prefrontal cortex will serve as a vehicle for proposed training. Proposed training and research will be supported by the Advanced Center for Interventions and Services Research for Late-Life Mood Disorders directed by CF. Reynolds (mentor), G.J. Siegle's fMRI lab (co-mentor), and L. Clark's imaging lab (Cambridge, UK). Taking advantage of the neuroimaging resources at the University of Pittsburgh, H.J. Aizenstein will help the applicant to overcome challenges in MR imaging of the aging brain and M.L. Phillips will aid in refining the neural model and developing a life-span perspective on decision-making in suicide. K. Szanto will help the applicant sharpen clinical characterization and manage suicidal risk. An ROl geared towards identifying intervention targets should result from this work.

Public Health Relevance

Worldwide and in the US, the elderly have the highest suicide rate of all age groups - a public burden likely to increase as US population ages and access to firearms is legally upheld. Current prevention approaches are not selective, targeting mainly depression. Insight into brain mechanisms will help identify elderly at risk for suicide and develop neuroscience-based interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23MH086620-01
Application #
7707369
Study Section
Neural Basis of Psychopathology, Addictions and Sleep Disorders Study Section (NPAS)
Program Officer
Wynne, Debra K
Project Start
2009-08-01
Project End
2014-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
1
Fiscal Year
2009
Total Cost
$171,515
Indirect Cost
Name
University of Pittsburgh
Department
Psychiatry
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Dombrovski, Alexandre Y; Hallquist, Michael N (2017) The decision neuroscience perspective on suicidal behavior: evidence and hypotheses. Curr Opin Psychiatry 30:7-14
Vanyukov, Polina M; Szanto, Katalin; Hallquist, Michael et al. (2017) Perceived burdensomeness is associated with low-lethality suicide attempts, dysfunctional interpersonal style, and younger rather than older age. Int J Geriatr Psychiatry 32:788-797
de Bruin, Wändi Bruine; Dombrovski, Alexandre Y; Parker, Andrew M et al. (2016) Late-life Depression, Suicidal Ideation, and Attempted Suicide: The Role of Individual Differences in Maximizing, Regret, and Negative Decision Outcomes. J Behav Decis Mak 29:363-371
Kay, Daniel B; Dombrovski, Alexandre Y; Buysse, Daniel J et al. (2016) Insomnia is associated with suicide attempt in middle-aged and older adults with depression. Int Psychogeriatr 28:613-9
Gujral, Swathi; Ogbagaber, Semhar; Dombrovski, Alexandre Y et al. (2016) Course of cognitive impairment following attempted suicide in older adults. Int J Geriatr Psychiatry 31:592-600
Vanyukov, P M; Szanto, K; Hallquist, M N et al. (2016) Paralimbic and lateral prefrontal encoding of reward value during intertemporal choice in attempted suicide. Psychol Med 46:381-91
Vanyukov, Polina M; Szanto, Katalin; Siegle, Greg J et al. (2015) Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly. Am J Geriatr Psychiatry 23:829-39
Szanto, Katalin; Bruine de Bruin, Wändi; Parker, Andrew M et al. (2015) Decision-making competence and attempted suicide. J Clin Psychiatry 76:e1590-7
Dombrovski, A Y; Szanto, K; Clark, L et al. (2015) Corticostriatothalamic reward prediction error signals and executive control in late-life depression. Psychol Med 45:1413-24
Richard-Devantoy, Stéphane; Szanto, Katalin; Butters, Meryl A et al. (2015) Cognitive inhibition in older high-lethality suicide attempters. Int J Geriatr Psychiatry 30:274-83

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