Using functional neuroimaging, previously depressed male suicide attempters, in comparison with previously depressed male patients with no history of suicide attempts, were found to have higher activation of the right orbitofrontal cortex in response to viewing angry versus neutral faces.59 This activation was not found when happy faces were presented. Of note, all patients were euthymic at the time of scanning. It was hypothesized that patients with a vulnerability to SB may have a particular sensitivity to rejection and disapproval (expressed by angry faces), modified by orbitofrontal cortex dysfunction. Other findings suggest lower activation of the left lateral orbitofrontal cortex in suicide attempters versus non-attempters during risky versus safe choices as measured in the Iowa gambling task.60 Decision-making impairment in suicide attempters is therefore associated with the decreased ability of these patients to correctly learn to recognize long-term risk in uncertain situations.
