How do you decide?

Prof Jollent opened the session with a discussion of neurocognitive risk markers, essentially modes of thinking that put people at greater risk of suicide attempts.

Spin the wheel

The first neurocognitive risk marker that Prof Jollent touched on was decision-making ability, which is assessed using the Iowa Gambling Task, a psychological task that is thought to best replicate real-life decision-making capability.

Through a meta-analysis of previous studies, Prof Jollent found that decision-making capability was impaired in patients who had previously attempted suicide. But more specifically, imaging in these studies showed that these patients’ prefrontal cortexes show less differentiation in response to risky versus non-risky behaviour, compared to controls. Essentially patients’ brains can’t tell the difference between high and low risk behaviours.

Risk is relative

This was interesting enough, but Prof Jollent expanded on this hypothesis by showing that first-degree relatives of patients who had attempted suicide (but who had not attempted suicide themselves) are also less discriminating between risky and less-risky behaviour.

If the patient and the relative both had the same tendencies, then why had one of them attempted suicide and one had not? It might be to do with another area of the brain, the cerebellum.

Prof Jollent showed us data that indicated that the cerebellums of the relatives had lower responses to wins and losses than the patients who had attempted suicide. So while they may undertake similarly risky behaviour, they don’t take it so badly when the risk doesn’t pay off.

Take it to heart

This sensitivity to negative outcomes was the focus of the second part of Prof Jollent’s talk, as he presented data showing that patients who had attempted suicide were far more likely to respond negatively to perceived unfairness and showed a far stronger cerebellar response to negative emotional signals.

As before, in the relatives who had not attempted suicide there was a far lower cerebellar response to these signals, which may therefore be a protective affect (against suicide attempts).

The hope for the future

By identifying the cognitive defects that are associated with attempted suicide, and the regions of the brain that may be dysfunctional in these patients, Prof Jollent hoped that valuable therapeutic targets could be identified.

Once again, EPA has provided a fascinating insight into the interaction between our brains and our behaviour.

Continue the conversation on Twitter at #epa2015vienna