The decision neuroscience perspective on suicidal behavior: evidence and hypotheses.
The decision neuroscience perspective on suicidal behavior: evidence and hypotheses.
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DOI：
10.1097/yco.0000000000000297
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发表时间：
2017-01
影响因子：
6.9
通讯作者：
Hallquist MN
中科院分区：
文献类型：
--
作者：
Dombrovski AY;Hallquist MN
自杀未遂的人通常会后悔。此外，成瘾和赌博在企图自杀或自杀死亡的人中所占比例过高，这就提出了他们的决策是否受损的问题。决策神经科学的进步使我们能够研究自杀者的决策过程，并阐明不利决策的假定神经基质。早期的研究将自杀未遂与赌博任务的表现不佳联系起来。最近，增强了强化学习计算模型的功能性MRI显示，自杀者的决策受损是由腹内侧前额叶皮层中的预期价值（预期奖励）信号中断引起的。行为研究已经将延迟折扣的增加与低致命性/计划不周的尝试，多次尝试以及自杀未遂和成瘾的共同发生联系起来。这种行为倾向可能与基底神经节的完整性改变有关。相比之下，精心策划、严重的自杀企图与完整/减少的延迟折扣相关。一项研究将高致命性自杀企图与社会决策受损联系起来。这些新出现的文献支持这样一种观点，即决策过程中的各种障碍--通常与冲动性广泛相关--可能标志着不同的自杀途径。我们认为，自杀倾向者对社会压力的攻击性和自我毁灭性反应是由于自动的巴甫洛夫过程比目标导向的计算占主导地位。
Suicide attempts are usually regretted by people who survive them. Furthermore, addiction and gambling are over-represented among people who attempt or die by suicide, raising the question whether their decision-making is impaired. Advances in decision neuroscience have enabled us to investigate decision processes in suicidal people and to elucidate putative neural substrates of disadvantageous decision-making. Early studies have linked attempted suicide to poor performance on gambling tasks. More recently, functional MRI augmented with a reinforcement learning computational model revealed that impaired decision-making in suicide attempters is paralleled by disrupted expected value (expected reward) signals in the ventromedial prefrontal cortex. Behavioral studies have linked increased delay discounting to low-lethality/poorly planned attempts, multiple attempts, and the co-occurrence of attempted suicide and addiction. This behavioral tendency may be related to altered integrity of the basal ganglia. By contrast, well-planned, serious suicide attempts were associated with intact/diminished delay discounting. One study has linked high-lethality suicide attempts and impaired social decision-making. This emerging literature supports the notion that various impairments in decision-making – often broadly related to impulsivity – may mark different pathways to suicide. We propose that aggressive and self-destructive responses to social stressors in people prone to suicide result from a predominance of automatic, Pavlovian processes over goal-directed computations.