Evidence of an association between a vulnerability to suicidal behaviour and neurobiological abnormalities is accumulating. Post-mortem studies have demonstrated structural and biochemical changes in the brains of suicide victims. More recently, imaging techniques have become available to study changes in the brain in vivo. This systematic review of comparative imaging studies of suicidal brains shows that changes in the structure and functions of the brain in association with suicidal behaviour are mainly found in the orbitofrontal and dorsolateral parts of the prefrontal cortex. Correlational studies suggest that these changes relate to neuropsychological disturbances in decision-making, problem solving and fluency, respectively. As a consequence, the findings from these studies suggest that suicidal behaviour is associated with (1) a particular sensitivity to social disapproval (2) choosing options with high immediate reward and (3) a reduced ability to generate positive future events. Further study is needed to elaborate these findings and to investigate to what extent changes in the structure and function of suicidal brains are amenable to psychological and/or biological interventions.
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