Suicidal Behaviour Prior to First Episode Psychosis: Wider and More Widespread Grey-Matter Alterations.

Introduction: The prodromal phase preceding the onset of First Episode Psychosis (FEP) is associated with an increased risk of Suicidal Behaviors (SBs). The aim of this study was to identify specific structural brain abnormalities linked to SBs that occur prior to the onset of FEP.

Methods: Voxel-based morphometry analyses were used to investigate differences in brain Grey Matter (GM) volume using the CAT12 toolbox within SPM12. Covariates, including gender, age, handedness, intracranial volume, depression severity, and global cognitive functioning, were controlled for as confounding factors.

Results: Significant reductions in GM were observed in the left superior temporal gyrus, dorsal posterior cingulate cortex, precuneus, cuneus, anterior cerebellum (p-FWE corrected < 0.05, k > 50) as well as in the right amygdala (0.96 ± 0.06 vs. 1.01 ± 0.05; F = 4.78; p < 0.05) and left amygdala (0.97 ± 0.06 vs. 1.02 ± 0.05; F = 8.97; p = 0.01).

Conclusions: History of SB prior to the onset of the psychotic disorder was related to wider and more widespread brain GM alterations. The regions identified are involved in cognitive and emotional processes such as emotional regulation, social cognition, perseverative thinking, and pain tolerance. These findings suggest that structural brain abnormalities related to SB occurring before FEP onset may serve as early biomarkers for identifying individuals at increased risk of suicide.