Standardized Suicide Prevention Program for Gatekeeper Intervention of North Korean Defectors in South Korea.

OBJECTIVE: North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs' particular circumstances. METHODS: A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention. RESULTS: We developed a multi-part gatekeeper training program, "Suicide CARE for NKDs." In the "Introduction," trainees learn about the need for the program and its importance. In "Careful observation," trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In "Active listening," trainees learn how to ask about suicidal thoughts and to listen empathetically. In "Risk evaluation and expert referral," trainees learn to evaluate suicide risk and to connect NKDs with institutes or services. CONCLUSION: We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.

Altered subcallosal and posterior cingulate cortex-based functional connectivity during smoking cue and mental simulation processing in smokers.

BACKGROUND: Long-term cigarette smoking induces sensitization of incentive salience and conditioning of contextual cues which involves brain function alteration across multiple regions. Understanding how nicotine affects hub-based functional connectivities involved in affective and cognitive function can help us determine the treatment strategy for nicotine dependence. METHOD: Functional MRI was conducted on 30 smokers and 30 non-smokers while mentally simulating neutral and smoking hand movements. Smoking cue and mental simulation processing-related changes in functional connectivity strengths of the subcallosal and posterior cingulate cortex (SCC and PCC) with major brain network nodes were examined. RESULTS: Compared to non-smokers, smokers showed cue-induced SCC functional connectivities which were enhanced with the intraparietal sulcus and reduced with the medial prefrontal cortex. The PCC activation and functional connectivity enhancements with the anterior insula cortex and rostro-lateral prefrontal cortex was found during smoking mental simulation. The PCC-lateral prefrontal cortex functional connectivity correlated with nicotine dependence severity. CONCLUSION: The present results demonstrate that smokers can be identified by cue-induced SCC functional connectivity strength decline and increment in the default mode and dorsal attention network nodes. However, nicotine dependence was associated with smoking mental simulation-related PCC-lateral prefrontal cortex functional connectivity strength, suggesting that the development of nicotine dependence may depend on the strength of coupling between the default mode network and the central executive network at the cognitive level.

The role of amygdala during auditory verbal imagery of derogatory appraisals by others.

We tend to simulate or recall others' appraisals through auditory verbal imagery (AVI) process to react appropriately. In particular, the ability to imagine derogatory appraisals by others may be critically important for social survival. In this study, we investigated the neural correlates implicated in the processing of unpleasant emotion related to derogatory remark and its self-directedness during AVI process. Twenty-three right-handed healthy human subjects participated in our study. We asked each subject to imagine hearing one's own or another person's voice saying derogatory or non-derogatory neutral remarks during the scanning of functional magnetic imaging. A test of the interaction between derogatory emotion and its self-directedness revealed significant activation of the amygdala. Additionally, we observed decreased neural activity in the anterior cingulate cortex (ACC) during imagery of derogatory remarks compared to neutral remarks. Our findings indicate an important role of the amygdala in the processing of unpleasant emotion or self-relevance of information in the real world may also be expanded to the processing of self-directedness of unpleasant emotion in the imagined world, and thereby contribute to human higher social cognitive process. This study also suggests that deactivation of ACC may enable us to enact vivid affective responses, and thereby contribute to an effective simulation of social interaction.

The neural mechanism of imagining facial affective expression.

To react appropriately in social relationships, we have a tendency to simulate how others think of us through mental imagery. In particular, simulating other people's facial affective expressions through imagery in social situations enables us to enact vivid affective responses, which may be inducible from other people's affective responses that are predicted as results of our mental imagery of future behaviors. Therefore, this ability is an important cognitive feature of diverse advanced social cognition in humans. We used functional magnetic imaging to examine brain activation during the imagery of emotional facial expressions as compared to neutral facial expressions. Twenty-one right-handed subjects participated in this study. We observed the activation of the amygdala during the imagining of emotional facial affect versus the imagining of neutral facial affects. In addition, we also observed the activation of several areas of the brain, including the dorsolateral prefrontal cortex, ventral premotor cortex, superior temporal sulcus, parahippocampal gyrus, lingual gyrus, and the midbrain. Our results suggest that the areas of the brain known to be involved in the actual perception of affective facial expressions are also implicated in the imagery of affective facial expressions. In particular, given that the processing of information concerning the facial patterning of different emotions and the enactment of behavioral responses, such as autonomic arousal, are central components of the imagery of emotional facial expressions, we postulate the central role of the amygdala in the imagery of emotional facial expressions.

Neural mechanism for judging the appropriateness of facial affect.

Questions regarding the appropriateness of facial expressions in particular situations arise ubiquitously in everyday social interactions. To determine the appropriateness of facial affect, first of all, we should represent our own or the other's emotional state as induced by the social situation. Then, based on these representations, we should infer the possible affective response of the other person. In this study, we identified the brain mechanism mediating special types of social evaluative judgments of facial affect in which the internal reference is related to theory of mind (ToM) processing. Many previous ToM studies have used non-emotional stimuli, but, because so much valuable social information is conveyed through nonverbal emotional channels, this investigation used emotionally salient visual materials to tap ToM. Fourteen right-handed healthy subjects volunteered for our study. We used functional magnetic resonance imaging to examine brain activation during the judgmental task for the appropriateness of facial affects as opposed to gender matching tasks. We identified activation of a brain network, which includes both medial frontal cortex, left temporal pole, left inferior frontal gyrus, and left thalamus during the judgmental task for appropriateness of facial affect compared to the gender matching task. The results of this study suggest that the brain system involved in ToM plays a key role in judging the appropriateness of facial affect in an emotionally laden situation. In addition, our result supports that common neural substrates are involved in performing diverse kinds of ToM tasks irrespective of perceptual modalities and the emotional salience of test materials.

Neural Mechanism of Inferring Person's Inner Attitude towards Another Person through Observing the Facial Affect in an Emotional Context.

OBJECTIVE: The goal of the present study was to identify the brain mechanism involved in the attribution of person's attitude toward another person, using facial affective pictures and pictures displaying an affectively-loaded situation. METHODS: Twenty four right-handed healthy subjects volunteered for our study. We used functional magnetic resonance imaging (MRI) to examine brain activation during attitude attribution task as compared to gender matching tasks. RESULTS: We identified activation in the left inferior frontal cortex, left superior temporal sulcus, and left inferior parietal lobule during the attitude attribution task, compared to the gender matching task. CONCLUSION: This study suggests that mirror neuron system and ventrolateral inferior frontal cortex play a critical role in the attribution of a person's inner attitude towards another person in an emotional situation.

Compassionate attitude towards others' suffering activates the mesolimbic neural system.

Compassion is one of the essential components which enable individuals to enter into and maintain relationships of caring. Compassion tends to motivate us to help people who are emotionally suffering. It is also known that a feeling of intrinsic reward may occur as a result of experiencing compassion for others. We conducted this study to understand the neural nature of compassion for other people's emotional state. Twenty-one healthy normal volunteers participated in this study. We used a 2 x 2 factorial design in which each subject was asked to assume a compassionate attitude or passive attitude while viewing the sad or neutral facial affective pictures during functional magnetic imaging. The main effect of a compassionate attitude was observed in the medial frontal cortex, the subgenual frontal cortex, the inferior frontal cortex and the midbrain regions. A test of the interaction between a compassionate attitude and sad facial affect revealed significant activations in the midbrain-ventral striatum/septal network region. The results of this study suggest that taking a compassionate attitude towards other people's sad expressions modulate the activities of the midbrain-ventral striatum/septal region network, which is known to play a role in the prosocial/social approach motivation and its accompanied rewarding feeling.