Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression

Table 1

Conclusions from studies reviewed.

(i) Abnormalities of self-referential processing are likely a general characteristic of mood disorders
(ii) Increased self-focused thinking may contribute to depressive symptoms
(iii) Analytical self-focused rumination clearly contributes to the manifestation of depression in unipolar illness and possibly in bipolar spectrum depression
(iv) Aspects of aberrant self-focused thinking (particularly rumination) likely contribute to suicide-related behaviors and thoughts in unipolar depression
(v) The cortical midline structures (CMS) play a key role in both self-referential thinking and emotional regulation
(vi) Functional abnormalities of the CMS are likely a characteristic of mood disorders in general
(vii) In unipolar illness, CMS function plays a role in dysregulation of both self-referential thinking and emotion and likely mediates the relationship between the two
(viii) Dysfunction of both the striatum and CMS are likely involved in the neurobiology of suicide-related thoughts and behaviors
(ix) Abnormal functional connectivity between the striatum and CMS may be relevant for both the expression of both depressive symptoms and suicide