At the neuroanatomical level, postmortem studies have implicated involvement of the prefrontal cortex, particularly the most ventral regions including the orbitofrontal cortex.52 These regions have been reported to be different from controls in structural neuroimaging studies of different populations of suicide attempters.53, 54, 55 Pharmacological neuroimaging studies have highlighted the particular importance of the prefrontal cortex. Two studies showed reduced prefrontal 5HT2A receptor binding in SB.54, 56 Cannon et al.57 found increased binding of the serotonin transporter in the anterior cingulate gyrus of bipolar patients with a history of suicide attempts compared with those without a past history of attempts. Finally, Leyton et al.58 reported reduced levels of α-[11C]methyl--tryptophan in the ventral and lateral prefrontal cortex of high-lethality suicide attempters compared with healthy controls. These findings support the idea that altered serotonergic modulation may modulate prefrontal cortex dysfunctions, though their genetic basis is unclear.
