Emotional feedback, such as faces showing emotions, can influence decision making. Decision making and emotional face processing, mainly mediated by the prefrontal and cingulate cortices, are impaired in suicide attempters. Here, we used functional MRI (fMRI) to study prefrontal activation in suicide attempters during a modified version of the Iowa Gambling Task (IGT) that included emotional face feedback. We randomly distributed the 116 euthymic women (n = 45 suicide attempters, n = 41 affective controls with history of depression without suicide attempt, and n = 30 healthy controls) included in the study in three emotional IGT groups: concordant (safe and risky choices followed by happy and angry faces, respectively), discordant (safe and risky choices followed by angry and happy faces, respectively), and neutral condition (safe and risky choices followed by neutral faces). Considering the two IGT phases (ambiguous and risky), we then analyzed five regions of interest during the risky vs. safe choices: orbitofrontal (OFC), anterior cingulate (ACC), ventrolateral (VLPFC), medial (MPFC) and dorsal prefrontal (DPFC) cortices. We found: (1) impaired decision making and increased DPFC and OFC activation in suicide attempters vs. controls in the discordant condition during the risky phase; (2) reduced VLPFC activation in suicide attempters in the concordant condition during the ambiguous phase; and (3) decreased OFC, ACC and DPFC activation in both control groups in the concordant condition during the ambiguous phase. Suicide attempters showed prefrontal alterations during reward-learning decision making with emotional feedback. Suicide attempters may guide their decisions to avoid social negative feedback despite the expected outcome.

情绪反馈，例如面部表情，可以影响决策。决策和情绪面部处理，主要由前额叶和扣带回皮质介导，在自杀未遂者中受损。在这里，我们使用功能性 MRI (fMRI) 来研究修改版爱荷华赌博任务 (IGT) 期间自杀未遂者的前额叶激活，其中包括情绪面部反馈。我们随机分配了 116 名情绪正常的女性（n  = 45 名自杀未遂者，n  = 41 名有抑郁史但没有自杀企图的情感对照者，以及n = 30 个健康对照）包括在三个情绪 IGT 组的研究中：一致（安全和冒险的选择，然后分别是快乐和愤怒的脸），不一致（安全和冒险的选择，然后是愤怒和快乐的脸，分别）和中性状态（安全和冒险的选择，然后是中立的面孔）。考虑到两个 IGT 阶段（模棱两可和有风险），然后我们分析了风险与安全选择期间的五个感兴趣区域：眶额 (OFC)、前扣带回 (ACC)、腹外侧 (VLPFC)、内侧 (MPFC) 和背前额叶 ( DPFC) 皮质。我们发现：（1）在风险阶段，在不和谐的条件下，自杀未遂者与对照组的决策受损和 DPFC 和 OFC 激活增加；(2) 在模糊阶段，在一致条件下，自杀未遂者的 VLPFC 激活减少；(3)在模糊阶段，在一致条件下，两个对照组的OFC、ACC和DPFC活化降低。自杀未遂者在通过情绪反馈做出奖励学习决策时表现出前额叶改变。尽管有预期的结果，但自杀未遂者可能会引导他们的决定以避免社会负面反馈。