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Topic: Neurovascular and neuroinflammation mechanisms

associated with bipolar disorder

Microstructural brain abnormalities, affective

temperaments, and suicidal behavior in patients

with major depression

1
1
Gianluca Serafini , Mario Amore , Zoltan Rihmer 2
1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry,
University of Genoa, 16132 Genoa, Italy.
2 Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary and National Institute of
Psychiatry and Addictions, H‑1085 Budapest, Hungary.

ABSTRA CT
According to magnetic resonance imaging (MRI) studies, brain white matter (WM) abnormalities have been suggested to play a
critical role in the pathogenesis of major depressive disorder (MDD) and related suicidal behavior. However, MRI findings may
be limited by low spatial resolution; therefore, an important contribution to the understanding of the role and significance of WM
alterations derived by the development of the most recent magnetic resonance techniques, such as diffusion tensor imaging (DTI).
Several DTI studies reported an association between altered WM integrity and MDD/suicidal behavior. Microstructural WM
abnormalities may be located in neural circuits critically implicated in emotional processes and mood regulation resulting in
enhanced vulnerability to psychiatric morbidity. WM abnormalities detected using DTI may contribute to functional deficits and
help to clarify the pathophysiological mechanisms underlying MDD as well as suicidal behavior. By a clinical point of view,
research also suggested that affective temperaments may play a relevant role in the psychopathological characteristics of
mood disorders, clinical trajectory of episodes and polarity, long‑term outcome and suicidality. Unfortunately, only few studies
investigated the association between affective temperaments and WM abnormalities and discussed their possible implications
in patients with MDD and suicidal behavior. Using a comprehensive search of Medline database, the aim of the present study
was to critically review the current literature on the association between WM alterations as assessed by MRI and DTI techniques,
affective temperaments, MDD and suicidal behavior.
Key words: Affective temperaments, major depression, microstructural white matter lesions, neuroimaging techniques, suicidal behavior

INTRODUCTION Suicidal behavior is a complex and multidimensional
condition aimed at self‑destruction determining a
Major depressive disorder (MDD) is a widespread serious distress in the community and among all those
condition associated with functional impairment who are near the victim; however, as suicide may be
and significant disability. Patients with MDD considered a rare social event, its prediction at the
usually experience frequent recurrences, incomplete individual level is very difficult. Untreated unipolar
recovery between episodes, residual symptoms, poor MDD is one of the most relevant risk factors related to
psychosocial adjustment and high risk of suicide. [1,2] completed suicide accounting for 56‑87% of the cases.
[2]
Importantly, suicide may be considered a state‑ and
Corresponding Author: Dr. Gianluca Serafini, severity‑dependent phenomenon, and this is also
Department of Neuroscience, Rehabilitation, Ophthalmology, demonstrated by the fact that suicidality significantly
Genetics, Maternal and Child Health, Section of Psychiatry, decreases after clinical recovery. Although identifying
[2]
University of Genoa, IRCCS San Martino, Largo Rosanna some clinical, psychological and psychosocial risk
Benzi 10, 16132 Genoa, Italy.
E‑mail: gianluca.serafini@unige.it
This is an open access article distributed under the terms of the Creative
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Cite this article as: Serafini G, Amore M, Rihmer Z. Microstructural brain
abnormalities, affective temperaments, and suicidal behavior in patients with
DOI:
10.4103/2347-8659.167301 major depression. Neuroimmunol Neuroinflammation 2015;2:200-14.
Received: 13-08-2015; Accepted: 06-04-2015

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