51
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Pu S, Setoyama S, Noda T. Association between cognitive deficits and suicidal ideation in patients with major depressive disorder. Sci Rep 2017; 7:11637. [PMID: 28912439 PMCID: PMC5599636 DOI: 10.1038/s41598-017-12142-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/05/2017] [Indexed: 11/12/2022] Open
Abstract
The role of cognitive function in suicidal ideation in patients with major depressive disorder (MDD) has not been adequately explored. This research sought to measure the relationship between suicidal ideation and cognitive function. Therefore, in this study, the association between cognitive function and suicidal ideation in patients with MDD was assessed. Cognitive function was evaluated in 233 patients with MDD using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS). Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale. Approximately 59.2% of the patients (138/233) expressed suicidal ideation. Among the BACS subtests, only the executive function scores were significantly lower in patients with MDD with than in those without (p < 0.005). In addition, the executive function, motor speed function, and composite scores correlated negatively with the severity of suicidal ideation in these patients. These results suggest that executive function, motor speed function, and global neuropsychological function are associated with suicidal ideation in patients with MDD and that the BACS neuropsychological battery is an efficient instrument for monitoring these characteristics. Moreover, specific BACS scores can potentially serve as cognitive biomarkers of suicide risk in patients with MDD.
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Affiliation(s)
- Shenghong Pu
- Integrative Brain Imaging Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Shiori Setoyama
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Takamasa Noda
- Integrative Brain Imaging Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
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52
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Baek K, Kwon J, Chae JH, Chung YA, Kralik JD, Min JA, Huh H, Choi KM, Jang KI, Lee NB, Kim S, Peterson BS, Jeong J. Heightened aversion to risk and loss in depressed patients with a suicide attempt history. Sci Rep 2017; 7:11228. [PMID: 28894106 PMCID: PMC5593974 DOI: 10.1038/s41598-017-10541-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 08/10/2017] [Indexed: 01/19/2023] Open
Abstract
Suicide attempters have been found to be impaired in decision-making; however, their specific biases in evaluating uncertain outcomes remain unclear. Here we tested the hypothesis that suicidal behavior is associated with heightened aversion to risk and loss, which might produce negative predictions about uncertain future events. Forty-five depressed patients with a suicide attempt history, 47 nonsuicidal depressed patients, and 75 healthy controls participated in monetary decision-making tasks assessing risk and loss aversion. Suicide attempters compared with the other groups exhibited greater aversion to both risk and loss during gambles involving potential loss. Risk and loss aversion correlated with each other in the depressed patients, suggesting that a common pathophysiological mechanism underlies these biases. In addition, emotion regulation via suppression, a detrimental emotional control strategy, was positively correlated with loss aversion in the depressed patients, also implicating impairment in regulatory processes. A preliminary fMRI study also found disrupted neural responses to potential gains and losses in the subgenual anterior cingulate cortex, insula cortex, and left amygdala, brain regions involved in valuation, emotion reactivity, and emotion regulation. The findings thus implicate heightened negative valuation in decision-making under risk, and impaired emotion regulation in depressed patients with a history of suicide attempts.
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Affiliation(s)
- Kwangyeol Baek
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea.,Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - JaeHyung Kwon
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Yong An Chung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jerald D Kralik
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jung-Ah Min
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - HyuJung Huh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kyung Mook Choi
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kuk-In Jang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Na-Bin Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sunyoung Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles and the Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, United States
| | - Jaeseung Jeong
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea.
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53
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Gawlowska M, Beldzik E, Domagalik A, Gagol A, Marek T, Mojsa-Kaja J. I Don't Want to Miss a Thing - Learning Dynamics and Effects of Feedback Type and Monetary Incentive in a Paired Associate Deterministic Learning Task. Front Psychol 2017. [PMID: 28642724 PMCID: PMC5462995 DOI: 10.3389/fpsyg.2017.00935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Effective functioning in a complex environment requires adjusting of behavior according to changing situational demands. To do so, organisms must learn new, more adaptive behaviors by extracting the necessary information from externally provided feedback. Not surprisingly, feedback-guided learning has been extensively studied using multiple research paradigms. The purpose of the present study was to test the newly designed Paired Associate Deterministic Learning task (PADL), in which participants were presented with either positive or negative deterministic feedback. Moreover, we manipulated the level of motivation in the learning process by comparing blocks with strictly cognitive, informative feedback to blocks where participants were additionally motivated by anticipated monetary reward or loss. Our results proved the PADL to be a useful tool not only for studying the learning process in a deterministic environment, but also, due to the varying task conditions, for assessing differences in learning patterns. Particularly, we show that the learning process itself is influenced by manipulating both the type of feedback information and the motivational significance associated with the expected monetary reward.
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Affiliation(s)
- Magda Gawlowska
- Department of Forensic Psychology, Institute of Applied Psychology, Jagiellonian UniversityKrakow, Poland
| | - Ewa Beldzik
- Neurobiology Department, Malopolska Centre of Biotechnology, Jagiellonian UniversityKrakow, Poland.,Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian UniversityKrakow, Poland
| | - Aleksandra Domagalik
- Neurobiology Department, Malopolska Centre of Biotechnology, Jagiellonian UniversityKrakow, Poland
| | - Adam Gagol
- Neurocognitive Processing Laboratory, Institute of Philosophy, Jagiellonian UniversityKrakow, Poland
| | - Tadeusz Marek
- Neurobiology Department, Malopolska Centre of Biotechnology, Jagiellonian UniversityKrakow, Poland.,Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian UniversityKrakow, Poland
| | - Justyna Mojsa-Kaja
- Neurobiology Department, Malopolska Centre of Biotechnology, Jagiellonian UniversityKrakow, Poland.,Department of Neurobiology and Neuropsychology, Institute of Applied Psychology, Jagiellonian UniversityKrakow, Poland
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54
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Glenn CR, Cha CB, Kleiman EM, Nock MK. Understanding Suicide Risk within the Research Domain Criteria (RDoC) Framework: Insights, Challenges, and Future Research Considerations. Clin Psychol Sci 2017; 5:568-592. [PMID: 28670505 PMCID: PMC5487002 DOI: 10.1177/2167702616686854] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This paper provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains-highlighting the RDoC construct(s) where research has focused, construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.
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Affiliation(s)
- Catherine R. Glenn
- Department of Clinical and Social Sciences in Psychology, University of Rochester
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55
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Chase HW, Segreti AM, Keller TA, Cherkassky VL, Just MA, Pan LA, Brent DA. Alterations of functional connectivity and intrinsic activity within the cingulate cortex of suicidal ideators. J Affect Disord 2017; 212:78-85. [PMID: 28157550 PMCID: PMC5358995 DOI: 10.1016/j.jad.2017.01.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/27/2016] [Accepted: 01/14/2017] [Indexed: 01/21/2023]
Abstract
The 'default mode network' (DMN), a collection of brain regions including the posterior cingulate cortex (PCC), shows reliable inter-regional functional connectivity at rest. It has been implicated in rumination and other negative affective states, but its role in suicidal ideation is not well understood. We employed seed based functional connectivity methods to analyze resting state fMRI data in 34 suicidal ideators and 40 healthy control participants. Whole-brain connectivity with dorsal PCC or ventral PCC was broadly intact between the two groups, but while the control participants showed greater coupling between the dorsal anterior cingulate cortex (dACC) and dorsal PCC, compared to the dACC and ventral PCC, this difference was reversed in the ideators. Furthermore, ongoing low frequency BOLD signal in these three regions (dorsal, ventral PCC, dACC) was reduced in the ideators. The structural integrity of the cingulum bundle, as measured using diffusion tensor imaging (DTI), also explained variation in the functional connectivity measures but did not abolish the group differences. Together, these findings provide evidence of abnormalities in the DMN underlying the tendency towards suicidal ideation.
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Affiliation(s)
- Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Anna Maria Segreti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Timothy A Keller
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | | | - Marcel A Just
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Lisa A Pan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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56
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Huh HJ, Baek K, Kwon JH, Jeong J, Chae JH. Impact of childhood trauma and cognitive emotion regulation strategies on risk-aversive and loss-aversive patterns of decision-making in patients with depression. Cogn Neuropsychiatry 2016; 21:447-461. [PMID: 28042929 DOI: 10.1080/13546805.2016.1230053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although poor decision-making ultimately impairs quality of life in depression, few studies describe the clinical characteristics of patients suffering from dysfunctional decision-making. This study aims to delineate the effect of childhood trauma and other personality factors on risk-aversive and loss-aversive patterns of decision-making in patients with depression. METHODS A total of 50 depressive patients completed surveys for the measurement of sociodemographic factors, trauma loads and other clinical characteristics, including depression, anxiety, and strategies for emotion regulation. Risk aversion and loss aversion were quantified using probability discounting task and a 50:50 gamble on monetary decision-making task under specified risks. Stepwise multiple regression analysis was performed to determine the factors, predicting risk aversion or loss aversion in depression. RESULTS Childhood trauma was the most prominent factor predicting loss aversion in patients with depressive disorders. Overall maladaptive emotion regulation strategies were associated with risk aversion. CONCLUSION Childhood trauma and specific strategies of emotion regulation contribute to risk or loss aversion in patients with depression. These findings may provide useful insight into elaborative evaluation and interventions to improve decision-making and quality of life in patients with depression.
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Affiliation(s)
- Hyu Jung Huh
- a Department of Psychiatry , Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine , Seoul , Republic of Korea
| | - Kwangyeol Baek
- b Department of Bio and Brain Engineering , Korea Advanced Institute of Science and Technology (KAIST) , Daejeon , Republic of Korea.,c Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK
| | - Jae-Hyung Kwon
- b Department of Bio and Brain Engineering , Korea Advanced Institute of Science and Technology (KAIST) , Daejeon , Republic of Korea
| | - Jaeseung Jeong
- b Department of Bio and Brain Engineering , Korea Advanced Institute of Science and Technology (KAIST) , Daejeon , Republic of Korea
| | - Jeong-Ho Chae
- a Department of Psychiatry , Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine , Seoul , Republic of Korea
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57
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Abstract
Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.
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58
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Richard-Devantoy S, Berlim MT, Jollant F. Suicidal behaviour and memory: A systematic review and meta-analysis. World J Biol Psychiatry 2016; 16:544-66. [PMID: 25112792 DOI: 10.3109/15622975.2014.925584] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Suicidal behaviour results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. It is not yet clear if memory impairment is part of this specific vulnerability. Therefore, the objective of this study was to examine the association between memory deficits and vulnerability to suicidal acts. METHODS A literature review was performed using Medline, Embase, and PsycInfo databases. Twenty-four studies (including 2,595 participants) met the selection criteria. Four different types of memory (i.e., working memory, short- and long-term memory, and autobiographical memory) were assessed in at least three different studies. RESULTS Autobiographical memory was significantly less specific and more general in patients with a history of suicide attempt relative to those without such a history (Hedges' g = 0.8 and 0.9, respectively). Long-term memory and working memory were both more impaired in suicide attempters than in patient and healthy controls. Only short-term memory did not differentiate suicide attempters from patient controls. CONCLUSIONS Memory may play a significant role in the risk of suicidal acts, perhaps by preventing these individuals from using past experiences to solve current problems and to envision the future, and by altering inhibitory processes. More studies are necessary to better clarify these relationships.
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Affiliation(s)
- Stephane Richard-Devantoy
- a McGill University, Department of Psychiatry & Douglas Mental Health University Institute , McGill Group for Suicide Studies , Montréal , Québec , Canada.,b Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angers , France
| | - Marcelo T Berlim
- a McGill University, Department of Psychiatry & Douglas Mental Health University Institute , McGill Group for Suicide Studies , Montréal , Québec , Canada
| | - Fabrice Jollant
- a McGill University, Department of Psychiatry & Douglas Mental Health University Institute , McGill Group for Suicide Studies , Montréal , Québec , Canada
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59
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Marraccini ME, Weyandt LL, Rossi JS, Gudmundsdottir BG. Neurocognitive enhancement or impairment? A systematic meta-analysis of prescription stimulant effects on processing speed, decision-making, planning, and cognitive perseveration. Exp Clin Psychopharmacol 2016; 24:269-84. [PMID: 27454675 PMCID: PMC4968888 DOI: 10.1037/pha0000079] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Increasing numbers of adults, particularly college students, are misusing prescription stimulants primarily for cognitive/academic enhancement, so it is critical to explore whether empirical findings support neurocognitive benefits of prescription stimulants. Previous meta-analytic studies have supported small benefits from prescription stimulants for the cognitive domains of inhibitory control and memory; however, no meta-analytic studies have examined the effects on processing speed or the potential impairment on other domains of cognition, including planning, decision-making, and cognitive perseveration. Therefore, the present study conducted a meta-analysis of the available literature examining the effects of prescription stimulants on specific measures of processing speed, planning, decision-making, and cognitive perseveration among healthy adult populations. The meta-analysis results indicated a positive influence of prescription stimulant medication on processing speed accuracy, with an overall mean effect size of g = 0.282 (95% CI [0.077, 0.488]; n = 345). Neither improvements nor impairments were revealed for planning time, planning accuracy, advantageous decision-making, or cognitive perseveration; however, findings are limited by the small number of studies examining these outcomes. Findings support that prescription stimulant medication may indeed act as a neurocognitive enhancer for accuracy measures of processing speed without impeding other areas of cognition. Considering that adults are already engaging in illegal use of prescription stimulants for academic enhancement, as well as the potential for stimulant misuse to have serious side effects, the establishment of public policies informed by interdisciplinary research surrounding this issue, whether restrictive or liberal, is of critical importance. (PsycINFO Database Record
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Affiliation(s)
- Marisa E. Marraccini
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, USA,Department of Psychology, The University of Rhode Island, Kingston, RI, USA
| | - Lisa L. Weyandt
- Department of Psychology, The University of Rhode Island, Kingston, RI, USA
| | - Joseph S. Rossi
- Department of Psychology, The University of Rhode Island, Kingston, RI, USA
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60
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Abstract
Suicide in the elderly is an underestimated and complex issue that has mainly been explored in sociological, clinical and psychological perspectives. Suicide in non-elderly adults has been associated with diverse neurobiological alterations that may shed light on future predictive markers and more efficient preventative interventions. The aim of this paper was to review studies specifically investigating the neurobiology of elderly suicidal behaviour. We performed a systematic English and French Medline and EMBASE search until 2013. Contrary to literature about the non-elderly, we found a paucity of studies investigating the biomarkers of suicidal risk in elderly adults. Main findings were found in the neurocognitive domain. Studies generally supported the existence of cognitive deficits, notably decision-making impairment and reduced cognitive inhibition, in patients with a history of suicidal act compared to patients without such history. However, replications are needed to confirm findings. Due to several limitations including the small number of available studies, frequent lack of replication and small sample size, no firm conclusions can be drawn. The authors encourage further investigations in this field as insight in the neurobiology of these complex behaviors may limit clichés about end of life and aging, as well as improve future prevention of suicide in the elderly.
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61
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Gujral S, Ogbagaber S, Dombrovski AY, Butters MA, Karp JF, Szanto K. Course of cognitive impairment following attempted suicide in older adults. Int J Geriatr Psychiatry 2016; 31:592-600. [PMID: 26490955 PMCID: PMC4840049 DOI: 10.1002/gps.4365] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/02/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive impairment has been associated with late-life suicidal behavior. Without longitudinal data it is unclear whether these are transient features of a depressive state or stable impairments. We examined longitudinally the course of cognitive impairment in older adults with depression and a history of suicide attempt. METHODS We investigated the persistence of cognitive impairment over time in 198 depressed older adults (age >60); 91 suicide attempters, 39 depressed individuals with suicidal ideation (ideators), and 68 non-suicidal depressed adults assessed over a 2-year period at four time points. We used linear mixed effects modeling to examine group differences in trajectories of cognitive decline over 2 years, using the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (DRS), and Executive Interview (EXIT). RESULTS Over the 2-year period, suicide attempters performed significantly worse than both suicide ideators and non-suicidal depressed older adults on the MMSE (mean difference: from ideators: -0.88, p = 0.02; from non-suicidal depressed: -1.52, p < 0.01), while on the EXIT and DRS, suicide attempters performed significantly worse than non-suicidal depressed older adults (mean difference: in EXIT: -1.75, p = 0.01; in DRS: 3.04, p < 0.01; in MMSE: 1.15, p < 0.01). Cognitive impairment in suicide attempters partly resolved, as indicated by a group × time interaction on the DRS (p = 0.039), but not the EXIT (p = 0.58) or the MMSE (p = 0.08). CONCLUSIONS Cognitive impairment in late-life suicidal behavior appears to involve both a stable and a state-related component.
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Affiliation(s)
- Swathi Gujral
- University of Pittsburgh, Department of Psychology,Center for Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh
| | | | - Alexandre Y. Dombrovski
- Center for Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh,Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Jordan F. Karp
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
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Richard-Devantoy S, Olié E, Guillaume S, Courtet P. Decision-making in unipolar or bipolar suicide attempters. J Affect Disord 2016; 190:128-136. [PMID: 26496018 DOI: 10.1016/j.jad.2015.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Disadvantageous decision-making (mainly measured by the Iowa Gambling Task) has been demonstrated in patients with suicidal behavior compared to controls. We, therefore, aimed at clarifying the qualitative and quantitative relationship between decision-making and the risk of suicidal behavior in unipolar and bipolar disorders respectively, as well as establishing the strength of this relationship. METHODS (1) We conducted a cross-sectional study comparing IGT performances between 141 unipolar suicide attempters and 57 bipolar suicide attempters. (2) We conducted a systematic review and a meta-analysis of studies comparing IGT performances in patients with vs. without a history of suicidal acts in bipolar and unipolar disorder, together and separately. RESULTS (1) Among suicide attempters, bipolar and unipolar groups performed similarly (t(195)=-0.7; p=0.48). Unipolar non-attempters performed better IGT than unipolar suicide attempters (t(221)=3.1; p=0.002), only in female gender, whereas performances were similar in bipolar patients whatever the history of suicide attempt (t(77)=-0.3; p=0.7). (2) A meta-analysis of 10 studies confirmed significantly impaired decision-making with a moderate effect-size (-0.38 (95% CI[-0.61--0.16]; z=-3.3; p=0.001) in unipolar disorder and (g=-0.4 (95% CI[-0.75 to -0.05]; z=-2.2; p<0.026) in bipolar disorder suicide attempters compared to unipolar and bipolar non-attempters, respectively. LIMITATIONS It was not possible to analyse according to the level of lethality attempt. CONCLUSION Overall, a strong significant association was found between decision-making and the risk of suicidal behavior in unipolar disorder and bipolar disorder. However, further neuropsychological studies need to analyse separately unipolar and bipolar disorder and to study gender differences.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University, Institute McGill Group for Suicide Studies, FBC Building, 3rd floor, 6875 Boulevard Lasalle, Montréal (Québec), & Hôpital Régional de Saint-Jérôme, Saint-Jérôme, Québec, Canada; Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angers, France.
| | - Emilie Olié
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
| | - Sébastien Guillaume
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
| | - Philippe Courtet
- Université Montpellier & CHU Montpellier & Inserm, U1061 Montpellier, France
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63
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Szanto K, Bruine de Bruin W, Parker AM, Hallquist MN, Vanyukov PM, Dombrovski AY. Decision-making competence and attempted suicide. J Clin Psychiatry 2015; 76:e1590-7. [PMID: 26717535 PMCID: PMC4697276 DOI: 10.4088/jcp.15m09778] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/29/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The propensity of people vulnerable to suicide to make poor life decisions is increasingly well documented. Do they display an extreme degree of decision biases? The present study used a behavioral-decision approach to examine the susceptibility of low-lethality and high-lethality suicide attempters to common decision biases that may ultimately obscure alternative solutions and deterrents to suicide in a crisis. METHOD We assessed older and middle-aged (42-97 years) individuals who made high-lethality (medically serious) (n = 31) and low-lethality suicide attempts (n = 29). Comparison groups included suicide ideators (n = 30), nonsuicidal depressed participants (n = 53), and psychiatrically healthy participants (n = 28). Attempters, ideators, and nonsuicidal depressed participants had nonpsychotic major depression (DSM-IV criteria). Decision biases included sunk cost (inability to abort an action for which costs are irrecoverable), framing (responding to superficial features of how a problem is presented), underconfidence/overconfidence (appropriateness of confidence in knowledge), and inconsistent risk perception. Data were collected between June 2010 and February 2014. RESULTS Both high- and low-lethality attempters were more susceptible to framing effects as compared to the other groups included in this study (P ≤ .05, ηp2 = 0.06). In contrast, low-lethality attempters were more susceptible to sunk costs than both the comparison groups and high-lethality attempters (P ≤ .01, ηp2 = 0.09). These group differences remained after accounting for age, global cognitive performance, and impulsive traits. Premorbid IQ partially explained group differences in framing effects. CONCLUSIONS Suicide attempters' failure to resist framing may reflect their inability to consider a decision from an objective standpoint in a crisis. Failure of low-lethality attempters to resist sunk cost may reflect their tendency to confuse past and future costs of their behavior, lowering their threshold for acting on suicidal thoughts.
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Affiliation(s)
- Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213
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Vanyukov PM, Szanto K, Siegle GJ, Hallquist MN, Reynolds CF, Aizenstein HJ, Dombrovski AY. Impulsive traits and unplanned suicide attempts predict exaggerated prefrontal response to angry faces in the elderly. Am J Geriatr Psychiatry 2015; 23:829-39. [PMID: 25529800 PMCID: PMC4528975 DOI: 10.1016/j.jagp.2014.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Abnormal responses to social stimuli are seen in people vulnerable to suicidal behavior, indicating possible disruptions in the neural circuitry mediating the interpretation of socioemotional cues. These disruptions have not been empirically related to psychological and cognitive pathways to suicide. In the present study of older suicide attempters, we examined neural responses to emotional faces and their relationship to impulsivity, one of the components of the suicidal diathesis. METHODS Using functional magnetic resonance imaging, we recorded neurohemodynamic responses to angry faces in a carefully characterized sample of 18 depressed elderly with history of suicide attempts, 13 depressed nonsuicidal patients, and 18 healthy individuals, all aged 60+. Impulsivity was assessed with the Social Problem Solving Inventory Impulsivity/Carelessness Style subscale and Barratt Impulsiveness Scale. The Suicide Intent Scale planning subscale was used to describe the degree of planning associated with the most lethal attempt. RESULTS Depression and history of attempted suicide were not associated with neural responses to angry faces, failing to replicate earlier studies. Higher impulsivity, however, predicted exaggerated responses to angry faces in fronto-opercular and dorsomedial prefrontal cortex (pcorr <0.05). Poorly planned suicide attempts also predicted increased fronto-opercular responses. Results were robust to effects of medication exposure, comorbid anxiety and addiction, severity of depression, burden of physical illness, and possible brain injury from suicide attempts. CONCLUSION Impulsive traits and history of unplanned suicide attempts partly explain the heterogeneity in neural responses to angry faces in depressed elderly. Displays of social emotion command excessive cortical processing in impulsive suicide attempters.
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Abstract
OBJECTIVE Late-life suicide is a complex clinical and public health problem. METHOD In this article, some of the key complexities inherent in studying late-life suicide are discussed in the service of promoting high-quality late-life suicide prevention science. RESULTS We discuss the following research issues: the relatively greater lethality of suicidal behavior in later life (compared to younger ages); the lack of data on whether thoughts of death in later life are indicators of suicide risk; the fact that older adults do not tend to seek specialty mental health care, necessitating moving research into primary care clinics and the community; the lack of theory-based research in late-life suicide; the unclear role of cognitive impairment; and the promise of taking a 'patient centered' and 'participatory research' approach to late-life suicide research efforts. CONCLUSION We believe that these perspectives are too often not capitalized upon in research on suicide prevention with older adults and that voice of the older person could contribute much to our understanding of why older adults think about and act on suicidal thoughts, as well as the most acceptable ways to reach and intervene with those at risk.
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Affiliation(s)
- Kimberly A Van Orden
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
| | - Yeates Conwell
- a Department of Psychiatry , University of Rochester School of Medicine , Rochester , NY 14642 , USA
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66
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Minayo MCDS, Cavalcante FG. Tentativas de suicídio entre pessoas idosas: revisão de literatura (2002/2013). CIENCIA & SAUDE COLETIVA 2015; 20:1751-62. [DOI: 10.1590/1413-81232015206.10962014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Foi realizada revisão da literatura sobre as principais questões associadas às tentativas de suicídio em pessoas idosas. O estudo abrangeu o período de 2002 a 2013, a partir das bases Medline, Lilacs, PubMed, PsychInfo, SciELO, Biblioteca Virtual em Violência e Saúde da Bireme e Biblioteca Virtual de Saúde Pública (BVS/SP). Foram selecionadas 105 referências e analisadas 75. Os estudos se ampliaram na América do Norte, Europa e Ásia, são raros na América Latina e inexistem na África. Predominam investigações epidemiológicas. Os principais fatores predisponentes são doenças graves e degenerativas, dependência física, distúrbios e sofrimentos mentais e depressão severa. A depressão é o mais relevante fator explicativo associado a sofrimento físico crônico, perdas, abandonos, solidão e conflitos familiares. Diferenças de gênero, etnia, avanço da idade, questões sociais e traços culturais foram encontrados. O tema em pauta é da mais alta relevância para o Sistema Único de Saúde, mas não tem sido abordado no Brasil nem na teoria e nem na prática. Que esta revisão seja base para estudos empíricos que favoreçam o apoio à saúde do idoso e promova um envelhecer saudável.
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67
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Choon MW, Abu Talib M, Yaacob SN, Awang H, Tan JP, Hassan S, Ismail Z. Negative automatic thoughts as a mediator of the relationship between depression and suicidal behaviour in an at-risk sample of Malaysian adolescents. Child Adolesc Ment Health 2015; 20:89-93. [PMID: 32680393 DOI: 10.1111/camh.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examined the mediating role of negative automatic thoughts in the relationship between depression and suicidal behaviour in a sample of at-risk Malaysian adolescents. METHOD A total of 1441 adolescents were initially recruited via multistage cluster sampling. Subsequently, 294 at-risk adolescents were selected for further analyses through a specified cut-off score. RESULTS The results showed significant positive relationships among the study variables. Specifically, negative automatic thoughts emerged as a significant mediator in the relation between depression and suicidal behaviour (z = 7.15, p < .001). CONCLUSIONS The findings suggest that depressed adolescents are at high risk for a host of negative thought processes which in turn lead to suicidal behaviour. The study limitations and recommendations for further research are discussed.
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Affiliation(s)
- Min Wai Choon
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mansor Abu Talib
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nor Yaacob
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hamidin Awang
- Department of Psychiatry, Universiti Putra Malaysia, Serdang, Malaysia
| | - Jo Pei Tan
- Department of Social Work and Social Care, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, United Kingdom
| | - Sallahuddin Hassan
- Department of Economics and Agribusiness, Universiti Utara Malaysia, Sintok, Malaysia
| | - Zanariah Ismail
- Department of Human Development and Family Studies, Universiti Putra Malaysia, Serdang, Malaysia
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68
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Richard-Devantoy S, Szanto K, Butters MA, Kalkus J, Dombrovski AY. Cognitive inhibition in older high-lethality suicide attempters. Int J Geriatr Psychiatry 2015; 30:274-83. [PMID: 24816626 PMCID: PMC4229451 DOI: 10.1002/gps.4138] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND People who attempt suicide often display cognitive impairments, particularly poor cognitive control. Could poor cognitive control contribute to high suicide rates in old age? A component of cognitive control, cognitive inhibition-active suppression of task-irrelevant processing-is very sensitive to aging and has been linked to attempted suicide. We investigated cognitive inhibition in older high-lethality suicide attempters, closely resembling suicide victims, as well as low-lethality attempters, and control groups with and without depression and suicidal ideation. METHODS A total of 102 participants aged 60 years and older (17 psychiatrically healthy control subjects, 38 depressed control subjects, 16 suicide ideators, 14 low-lethality suicide attempters, and 17 high-lethality suicide attempters) underwent comprehensive clinical and cognitive assessments. They completed the Delis-Kaplan Executive Function System Color-Word Interference Test, a validated modification of the Stroop test. RESULTS High-lethality suicide attempters demonstrated a distinct pattern of cognitive inhibition deficits. Compared with psychiatrically healthy control subjects and suicide ideators, high-lethality attempters took longer to complete inhibition trials, even after accounting for potential confounding factors (age, education, Mini mental state examination score, information processing speed, and accuracy). Compared with non-suicidal depressed and healthy control subjects, low-lethality suicide attempters committed more uncorrected errors; however, this difference was not specific to the inhibition condition. CONCLUSIONS Older suicide attempters are a cognitively heterogeneous group. Poor cognitive control in high-lethality attempters may undermine their ability to solve real-life problems, precipitating a catastrophic accumulation of stressors. Meanwhile, low-lethality attempters' poor performance may reflect a careless approach to the task or faulty monitoring.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada,Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angers, France
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, BT 754, Pittsburgh, PA 15217, USA
| | - Meryl A. Butters
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, BT 754, Pittsburgh, PA 15217, USA
| | - Jan Kalkus
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, BT 754, Pittsburgh, PA 15217, USA
| | - Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, School of Medicine, 3811 O'Hara Street, BT 754, Pittsburgh, PA 15217, USA
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69
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Morimoto SS, Kanellopoulos D, Manning KJ, Alexopoulos GS. Diagnosis and treatment of depression and cognitive impairment in late life. Ann N Y Acad Sci 2015; 1345:36-46. [PMID: 25655026 DOI: 10.1111/nyas.12669] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cognitive impairment in late-life depression is prevalent, disabling, and heterogeneous. Although mild cognitive impairment in depression does not usually progress to dementia, accurate assessment of cognition is vital to prognosis and treatment planning. For example, executive dysfunction often accompanies late-life depression, influences performance across cognitive domains, and is associated with poor antidepressant treatment outcomes. Here, we review how assessment can capture dysfunction across cognitive domains and discuss cognitive trajectories frequently observed in late-life depression in the context of the neurobiology of this disorder. We also review the efficacy of a sample of interventions tailored to specific cognitive profiles.
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Affiliation(s)
- Sarah Shizuko Morimoto
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Dora Kanellopoulos
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Kevin J Manning
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut
| | - George S Alexopoulos
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
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Olié E, Seyller M, Beziat S, Loftus J, Bellivier F, Bougerol T, Belzeaux R, Azorin JM, Gard S, Kahn JP, Passerieux C, Leboyer M, Etain B, Henry C, Courtet P. Clinical and neuropsychological characteristics of euthymic bipolar patients having a history of severe suicide attempt. Acta Psychiatr Scand 2015; 131:129-38. [PMID: 25131519 DOI: 10.1111/acps.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Identifying bipolar patients at high-suicide risk is a major health issue. To improve their identification, we compared dimensional and neuropsychological profile of bipolar patients with or without history of suicide attempt, taking into account suicidal severity (i.e. admission to intensive ward). METHOD A total of 343 adult euthymic bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into three subgroups: 214 patients without history of suicide attempt, 88 patients with past history of non-severe suicide attempt and 41 patients with past history of severe suicide attempt. General intellectual functioning, speed of information processing, verbal learning and memory, verbal fluency and executive functioning were assessed. RESULTS Severe suicide attempters had lower affective intensity and lability than non-severe attempters. Severe suicide attempters outperformed non-severe attempters for verbal learning and non-attempters for Stroop word reading part after adjustment for study centre, age, gender, educational level, antipsychotics use, depression score, anxious and addictive comorbidities. CONCLUSION Neuropsychological tasks commonly used to assess bipolar patients do not seem accurate to identify suicide attempters in euthymic patients. In the future, decision-making and emotional recognition tasks should be assessed. Moreover, clinical and neuropsychological profiles should be considered together to better define suicidal risk.
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Affiliation(s)
- E Olié
- Department of Emergency Psychiatry, CHRU, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, Foundation of Scientific Cooperation, France
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71
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Abstract
Suicide in older adults is a significant clinical concern. In this review of recent findings, we concentrate on the role of emotions and cognition in suicide risk and behavior in older adults. We discuss the epidemiology of suicide in older adults, integrate recent findings on non-psychotic major depression, schizophrenia and suicidal ideation, explore the relationship of emotion regulation with suicide, present recent advances on suicide in demented patients, and describe the latest developments on cognition and decision processes in suicide.
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Affiliation(s)
- Dimitris N. Kiosses
- Associate Professor of Psychology in Clinical Psychiatry, Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, 21 Blomingdale Rd, White Plains, NY 10605, Phone: 914-997-4381,
| | - Katalin Szanto
- Associate Professor of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213, Phone: 412-586-9601,
| | - George S. Alexopoulos
- Professor of Psychiatry, Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Rd, White Plains, NY 10605, Phone: 914-997-5767,
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72
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Keilp JG, Beers SR, Burke AK, Melhem NM, Oquendo MA, Brent DA, Mann JJ. Neuropsychological deficits in past suicide attempters with varying levels of depression severity. Psychol Med 2014; 44:2965-2974. [PMID: 25066266 PMCID: PMC5724375 DOI: 10.1017/s0033291714000786] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Our previous work identified deficits in interference processing and learning/memory in past suicide attempters who were currently depressed and medication-free. In this study, we extend this work to an independent sample studied at various stages of illness and treatment (mild symptoms, on average) to determine if these deficits in past suicide attempters are evident during a less severe clinical state. METHOD A total of 80 individuals with a past history of major depression and suicide attempt were compared with 81 individuals with a history of major depression and no lifetime suicide attempts on a battery of neurocognitive measures assessing attention, memory, abstract/contingent learning, working memory, language fluency and impulse control. RESULTS Past attempters performed more poorly in attention, memory and working memory domains, but also in an estimate of pre-morbid intelligence. After correction for this estimate, tests that had previously distinguished past attempters - a computerized Stroop task and the Buschke Selective Reminding Test - remained significantly worse in attempters. In a secondary analysis, similar differences were found among those with the lowest levels of depression (Hamilton Depression Rating Scale score <10), suggesting that these deficits may be trait markers independent of current symptomatology. CONCLUSIONS Deficits in interference processing and learning/memory constitute an enduring defect in information processing that may contribute to poor adaptation, other higher-order cognitive impairments and risk for suicidal behavior.
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Affiliation(s)
- J G Keilp
- Department of Molecular Imaging and Neuropathology,New York State Psychiatric Institute,New York, NY,USA
| | - S R Beers
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - A K Burke
- Department of Molecular Imaging and Neuropathology,New York State Psychiatric Institute,New York, NY,USA
| | - N M Melhem
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - M A Oquendo
- Department of Molecular Imaging and Neuropathology,New York State Psychiatric Institute,New York, NY,USA
| | - D A Brent
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - J J Mann
- Department of Molecular Imaging and Neuropathology,New York State Psychiatric Institute,New York, NY,USA
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73
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Intact alternation performance in high lethality suicide attempters. Psychiatry Res 2014; 219:129-36. [PMID: 24878299 PMCID: PMC4410782 DOI: 10.1016/j.psychres.2014.04.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 02/04/2023]
Abstract
Suicide attempters often perform poorly on tasks linked to ventral prefrontal cortical (VPFC) function. Object Alternation (OA) - a VPFC probe - has not been used in these studies. In this study, currently depressed medication-free past suicide attempters whose most severe attempt was of high (n=31) vs. low (n=64) lethality, 114 medication-free depressed non-attempters, and 86 non-patients completed a computerized OA task. Participants also completed comparison tasks assessing the discriminant validity of OA (Wisconsin Card Sort), its concurrent validity relative to tasks associated with past attempt status (computerized Stroop task, Buschke Selective Reminding Test), and its construct validity as a VPFC measure (Go-No Go and Iowa Gambling Task). Against expectations, high lethality suicide attempters - the majority of whom used non-violent methods in their attempts with some planning - outperformed other depressed groups on OA, with no group differences observed on Wisconsin Card Sort. Despite intact performance on OA, past attempters exhibited deficits on the Stroop and Buschke. OA performance was associated with performance on Go-No Go and Iowa Gambling, confirming that OA measures a similar construct. VPFC dysfunction may not be a characteristic of all suicide attempters, especially those who make more carefully planned, non-violent - though potentially lethal - attempts.
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74
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Gujral S, Dombrovski AY, Butters M, Clark L, Reynolds CF, Szanto K. Impaired Executive Function in Contemplated and Attempted Suicide in Late Life. Am J Geriatr Psychiatry 2014; 22:811-819. [PMID: 23567385 PMCID: PMC3516623 DOI: 10.1016/j.jagp.2013.01.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/22/2012] [Accepted: 04/23/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE: Executive deficits may play an important role in late-life suicide. Yet, current evidence in this area is inconclusive and does not indicate whether these deficits are broadly associated with suicidal ideation or are specific to suicidal behavior. This study examined global cognition and specifically executive function impairments as correlates of suicidal ideation and suicidal behavior in depressed older adults, with the goal of extending an earlier preliminary study. DESIGN: Case-control study. SETTING: University-affiliated psychiatric hospital. PARTICIPANTS: All participants were age 60+: 83 depressed suicide attempters, 43 depressed individuals having suicidal ideation with a specific plan, 54 nonsuicidal depressed participants, and 48 older adults with no history of psychiatric disorders. MEASUREMENTS: Global cognitive function was assessed with Dementia Rating Scale (DRS) and executive function with Executive Interview (EXIT). RESULTS: Both suicide attempters and suicide ideators performed worse than the two comparison groups on the EXIT, with no difference between suicide attempters and suicide ideators. On the DRS total score, as well as on Memory and Attention subscales, suicide attempters and ideators and nonsuicidal depressed subjects performed similarly and were impaired relative to nonpsychiatric control subjects. Controlling for education, substance use disorders, and medication exposure did not affect group differences in performance on either the EXIT or the DRS. CONCLUSIONS: Executive deficits, captured with a brief instrument, are associated broadly with suicidal ideation in older depressed adults but do not appear to directly facilitate suicidal behavior. Our data are consistent with the idea that different vulnerabilities may operate at different stages in the suicidal process.
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Affiliation(s)
- Swathi Gujral
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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75
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Abstract
For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment-resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper was to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT-associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the use of this important and widely used intervention tool for neuropsychiatric diseases.
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76
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Richard-Devantoy S, Berlim MT, Jollant F. A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychol Med 2014; 44:1663-1673. [PMID: 24016405 DOI: 10.1017/s0033291713002304] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. However, it is not clear which cognitive tests may best reveal this vulnerability. The objective was to identify neuropsychological tests of vulnerability to suicidal acts in patients with mood disorders. METHOD A search was made of Medline, EMBASE and PsycINFO databases, and article references. A total of 25 studies (2323 participants) met the selection criteria. A total of seven neuropsychological tests [Iowa gambling task (IGT), Stroop test, trail making test part B, Wisconsin card sorting test, category and semantic verbal fluencies, and continuous performance test] were used in at least three studies to be analysed. RESULTS IGT and category verbal fluency performances were lower in suicide attempters than in patient controls [respectively, g = -0.47, 95% confidence interval (CI) -0.65 to -0.29 and g = -0.32, 95% CI -0.60 to -0.04] and healthy controls, with no difference between the last two groups. Stroop performance was lower in suicide attempters than in patient controls (g = 0.37, 95% CI 0.10-0.63) and healthy controls, with patient controls scoring lower than healthy controls. The four other tests were altered in both patient groups versus healthy controls but did not differ between patient groups. CONCLUSIONS Deficits in decision-making, category verbal fluency and the Stroop interference test were associated with histories of suicidal behavior in patients with mood disorders. Altered value-based and cognitive control processes may be important factors of suicidal vulnerability. These tests may also have the potential of guiding therapeutic interventions and becoming part of future systematic assessment of suicide risk.
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Affiliation(s)
- S Richard-Devantoy
- McGill University, Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - M T Berlim
- McGill University, Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - F Jollant
- McGill University, Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
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Szanto K, Clark L, Hallquist M, Vanyukov P, Crockett M, Dombrovski AY. The cost of social punishment and high-lethality suicide attempts in the second half of life. Psychol Aging 2014; 29:84-94. [PMID: 24660798 PMCID: PMC4051315 DOI: 10.1037/a0035339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age-related cognitive changes may contribute to impairments in making complex social decisions. Interpersonal conflict is a key factor behind suicidal behavior in old age, with suicidal motivations ranging from escape to revenge. Such conflicts may prove catastrophic for people prone to suicide, in part because of their tendency to make disadvantageous decisions. Yet, little is known about social decision making in older suicidal individuals. We assessed economic bargaining behavior using the Ultimatum Game, where players decide whether to accept or punish (reject) unfair monetary offers from another player. Our sample included depressed older adults with a history of high-medical-lethality suicide attempts, low-medical-lethality suicide attempts, nonsuicidal depressed older adults, and those with no psychiatric history who served as control groups. Participants in all groups punished their counterparts in response to unfair offers. However, low-lethality attempters, nonsuicidal depressed, and nonpsychiatric controls punished less as the cost of punishment increased, accepting more unfair offers as the stakes grew large. High-lethality attempters did not adjust their choices based on stake magnitude, punishing unfair offers without regard to the cost. Two thirds of the difference between the high-lethality attempters and nonpsychiatric controls was explained by individual differences in fairness judgments: the comparison group judged offer fairness as a joint function of inequality and magnitude, whereas the high-lethality attempter participants judged offer fairness on the basis of inequality. In real life, high-lethality attempters' relative insensitivity to the cost of retaliation may lead to uncompromising, catastrophic responses to conflict.
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Affiliation(s)
| | - Luke Clark
- Department of Psychology, University of Cambridge
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78
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Miranda R, Valderrama J, Tsypes A, Gadol E, Gallagher M. Cognitive inflexibility and suicidal ideation: mediating role of brooding and hopelessness. Psychiatry Res 2013; 210:174-81. [PMID: 23528518 PMCID: PMC6003697 DOI: 10.1016/j.psychres.2013.02.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 11/26/2022]
Abstract
Previous research suggests that cognitive inflexibility prospectively increases vulnerability to suicidal ideation, but the specific cognitive factors that may explain the relation have not been examined empirically. The present study examined the brooding subtype of rumination and hopelessness as potential mediators of the prospective relation between cognitive inflexibility and suicidal ideation. Fifty-six young adults who completed a measure of cognitive inflexibility and suicidal ideation at baseline were followed up 2-3 years later and completed measures of brooding, hopelessness, and suicidal ideation. Cognitive inflexibility at baseline predicted suicidal ideation at follow up, adjusting for baseline ideation. This relation was mediated by brooding but not by hopelessness. However, there was an indirect relation between perseverative errors and suicidal ideation through brooding, followed by hopelessness, such that brooding was associated with greater hopelessness and hopelessness, in turn, was associated with greater suicidal ideation. Cognitive inflexibility may increase vulnerability to suicidal thinking because it is associated with greater brooding rumination, while brooding, in turn, is associated with hopelessness.
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Affiliation(s)
- Regina Miranda
- Department of Psychology, Hunter College, City University of New York, NY, USA; Department of Psychology, The Graduate Center, City University of New York, NY, USA.
| | - Jorge Valderrama
- Department of Psychology, Hunter College, City University of New
York,Department of Psychology, The Graduate Center, City University of
New York
| | - Aliona Tsypes
- Department of Psychology, Hunter College, City University of New
York
| | - Erin Gadol
- Department of Psychology, Hunter College, City University of New
York
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Dombrovski AY, Szanto K, Clark L, Reynolds CF, Siegle GJ. Reward signals, attempted suicide, and impulsivity in late-life depression. JAMA Psychiatry 2013; 70:1. [PMID: 23925710 PMCID: PMC3859132 DOI: 10.1001/jamapsychiatry.2013.75] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE—Suicide can be viewed as an escape from unendurable punishment at the cost of any future rewards. Could faulty estimation of these outcomes predispose to suicidal behavior? In behavioral studies, many of those who have attempted suicide misestimate expected rewards on gambling and probabilistic learning tasks.OBJECTIVES—To describe the neural circuit abnormalities that underlie disadvantageous choices in people at risk for suicide and to relate these abnormalities to impulsivity, which is one of the components of vulnerability to suicide.DESIGN—Case-control functional magnetic resonance imaging study of reward learning using are inforcement learning model.SETTING—University hospital and outpatient clinic.PATIENTS—Fifty-three participants 60 years or older, including 15 depressed patients who had attempted suicide, 18 depressed patients who had never attempted suicide (depressed control subjects), and 20 psychiatrically healthy controls.MAIN OUTCOMES AND MEASURES—Components of the cortical blood oxygenation level–dependent response tracking expected and unpredicted rewards.RESULTS—Depressed elderly participants displayed 2 distinct disruptions of control over reward-guided behavior. First, impulsivity and a history of suicide attempts (particularly poorly planned ones) were associated with a weakened expected reward signal in the paralimbic cortex,which in turn predicted the behavioral insensitivity to contingency change. Second, depression was associated with disrupted corticostriatothalamic encoding of unpredicted rewards, which in turn predicted the behavioral over sensitivity to punishment. These results were robust to the effects of possible brain damage from suicide attempts, depressive severity, co-occurring substance use and anxiety disorders, antidepressant and anticholinergic exposure, lifetime exposure to electroconvulsive therapy, vascular illness, and incipient dementia.CONCLUSIONS AND RELEVANCE—Altered paralimbic reward signals and impulsivity and/or carelessness may facilitate unplanned suicidal acts. This pattern, also seen in gambling and cocaine use, may reflect a primary deficit in the paralimbic cortex or in its mesolimbic input. The over reactivity to punishment in depression may be caused in part by a disruption of appetitive learning in the corticostriatothalamic circuits.
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Affiliation(s)
- Alexandre Y Dombrovski
- MD, Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA.
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80
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McGirr A, Jollant F, Turecki G. Neurocognitive alterations in first degree relatives of suicide completers. J Affect Disord 2013; 145:264-9. [PMID: 22840615 DOI: 10.1016/j.jad.2012.05.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/08/2012] [Accepted: 05/30/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide aggregates within families and the relatives of suicide completers are at an increased risk for suicide. Though neurocognitive changes are gaining increasing attention as part of the vulnerability for suicide, the literature on neurocognitive alterations among suicide relatives as possible endophenotypes of suicide is sparse. METHOD Normothymic first-degree relatives (n=14) of suicide completers without personal histories of suicide attempts were compared to individuals without family histories of suicide (n=14) matched for age-, sex- and education. Participants completed the Wisconsin card sorting test, a well validated test of cognitive control in a changing environment. RESULTS First-degree relatives of suicide completers made significantly more perseverative errors and have a lower level of conceptual responses than comparison subjects. CONCLUSION Alterations found in first-degree relatives of suicide completers suggest a decreased responsiveness to changing, yet unambiguous, conditions. These neurocognitive impairments are similar to deficits observed among individuals engaging in suicide attempts. Neurocognitive impairments revealed by the Wisconsin card sorting test may represent a neurocognitive endophenotype of suicide.
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Affiliation(s)
- Alexander McGirr
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Blvd., Montreal, QC, Canada H4H 1R3.
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81
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Richard-Devantoy S, Jollant F, Kefi Z, Turecki G, Olié JP, Annweiler C, Beauchet O, Le Gall D. Deficit of cognitive inhibition in depressed elderly: a neurocognitive marker of suicidal risk. J Affect Disord 2012; 140:193-9. [PMID: 22464009 DOI: 10.1016/j.jad.2012.03.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/09/2012] [Accepted: 03/03/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive deficits, in relation to ventral and dorsal prefrontal cortex dysfunctions, have been associated with a higher risk of suicidal acts in young adult patients. Although a public health concern, much less is known about the neurocognitive basis of suicidal behavior in elderly. Here, we aimed at assessing alterations in cognitive inhibition, a suspected major mechanism of the suicidal vulnerability, in suicidal depressed elderly. METHODS We compared 20 currently depressed patients, aged 65 and older who recently attempted suicide to 20 elderly subjects with a current depression but no personal history of suicide attempt and 20 elderly controls. Using an extensive neuropsychological battery, we particularly examined different aspects of cognitive inhibition: access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). RESULTS After adjustment for age, intensity of depression, Mini-Mental State Examination score and speed of information processing, suicidal depressed elderly showed significant impairments in all 3 domains of cognitive inhibition in comparison to both control groups. LIMITATIONS Our results need replication in a larger sample size. CONCLUSIONS Our study suggests that the inability to inhibit neutral information access to working memory, restrain and delete irrelevant information may impair the patient's capacity to respond adequately to stressful situations subsequently leading to an increased risk of suicidal behavior during late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of suicide in depressed elderly.
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Affiliation(s)
- S Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute McGill Group for Suicide Studies Montréal, Québec, Canada.
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