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Nan J, Grennan G, Ravichandran S, Ramanathan D, Mishra J. Neural activity during inhibitory control predicts suicidal ideation with machine learning. NPP-DIGITAL PSYCHIATRY AND NEUROSCIENCE 2024; 2:10. [PMID: 38988507 PMCID: PMC11230903 DOI: 10.1038/s44277-024-00012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024]
Abstract
Suicide is a leading cause of death in the US and worldwide. Current strategies for preventing suicide are often focused on the identification and treatment of risk factors, especially suicidal ideation (SI). Hence, developing data-driven biomarkers of SI may be key for suicide prevention and intervention. Prior attempts at biomarker-based prediction models for SI have primarily used expensive neuroimaging technologies, yet clinically scalable and affordable biomarkers remain elusive. Here, we investigated the classification of SI using machine learning (ML) on a dataset of 76 subjects with and without SI(+/-) (n = 38 each), who completed a neuro-cognitive assessment session synchronized with electroencephalography (EEG). SI+/- groups were matched for age, sex, and mental health symptoms of depression and anxiety. EEG was recorded at rest and while subjects engaged in four cognitive tasks of inhibitory control, interference processing, working memory, and emotion bias. We parsed EEG signals in physiologically relevant theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) frequencies and performed cortical source imaging on the neural signals. These data served as SI predictors in ML models. The best ML model was obtained for beta band power during the inhibitory control (IC) task, demonstrating high sensitivity (89%), specificity (98%). Shapley explainer plots further showed top neural predictors as feedback-related power in the visual and posterior default mode networks and response-related power in the ventral attention, fronto-parietal, and sensory-motor networks. We further tested the external validity of the model in an independent clinically depressed sample (n = 35, 12 SI+) that engaged in an adaptive test version of the IC task, demonstrating 50% sensitivity and 61% specificity in this sample. Overall, the study suggests a promising, scalable EEG-based biomarker approach to predict SI that may serve as a target for risk identification and intervention.
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Affiliation(s)
- Jason Nan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA USA
| | - Gillian Grennan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
| | - Soumya Ravichandran
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
| | - Dhakshin Ramanathan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, San Diego, CA USA
| | - Jyoti Mishra
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, San Diego, CA USA
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Ruch DA, Bridge JA, Tissue J, Madden SP, Galfavy H, Gorlyn M, Sheftall AH, Szanto K, Keilp JG. Alterations in performance and discriminating power of the death/suicide implicit association test across the lifespan. Psychiatry Res 2024; 335:115840. [PMID: 38492262 DOI: 10.1016/j.psychres.2024.115840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/02/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
The Death/Suicide Implicit Association Test (d/s-IAT) has differentiated individuals with prior and prospective suicide attempts in previous studies, however, age effects on test results remains to be explored. A three-site study compared performance on the d/s-IAT among participants aged 16-80 years with depression and prior suicide attempt (n = 82), with depression and no attempts (n = 80), and healthy controls (n = 86). Outcome measures included the standard difference (D) score, median reaction times, and error rates. Higher D scores represent a stronger association between death/suicide and self, while lower scores represent a stronger association between life and self. The D scores differed significantly among groups overall. Participants with depression exhibited higher scores compared to healthy controls, but there was no difference between participants with and without prior suicide attempts(F[2,242]=8.76, p<.001). Response times for participants with prior attempts differed significantly from other groups, with no significant differences in error rates. The D score was significantly affected by age (β =-0.007, t = 3.65, p<.001), with slowing of response times in older ages. Results suggest reaction time d/s-IAT D scores may not distinguish implicit thinking about suicide as response times slow with age, but slowed response times may be sensitive to suicide risk potentially indicating basic information processing deficits.
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Affiliation(s)
- Donna A Ruch
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States.
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370W. 9th Avenue, Columbus, OH 43210, United States
| | - Jaclyn Tissue
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States
| | - Sean P Madden
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Hanga Galfavy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States; Department of Biostatistics, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, United States
| | - Marianne Gorlyn
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, United States
| | - John G Keilp
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
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Lamontagne SJ, Zabala PK, Zarate CA, Ballard ED. Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks. Neurosci Biobehav Rev 2023; 153:105361. [PMID: 37595649 PMCID: PMC10592047 DOI: 10.1016/j.neubiorev.2023.105361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/22/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023]
Abstract
Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.
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Affiliation(s)
- Steven J Lamontagne
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Paloma K Zabala
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Roberto N, Vazquez M, Radua J, Pariente JC, Muñoz-Moreno E, Laredo C, Bracco L, Fernández T, Martín-Parra S, Martínez-Aran A, Sánchez-Moreno J, Saiz P, Ruiz-Veguilla M, Borras R, Toll A, Elices M, Brambilla P, Courtet P, Perez-Solà V, Vieta E, Grande I. Safety intervention for improving functioning in suicidal attempters (STRONG): A secondary prevention study. Study rationale and research protocol. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00001-7. [PMID: 38591829 DOI: 10.1016/j.sjpmh.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Suicide is one of the most largely preventable causes of death worldwide. The aim of the STRONG study is to assess the effectiveness of a specific intervention (an extended Safety Planning Intervention) called iFightDepression-SURVIVE (iFD-S) in suicidal attempters by changes in psychosocial functioning. As secondary outcomes, quality of life, cognitive performance, clinical state and neuroimaging correlates will be considered. OBJECTIVE To describe the rationale and design of the STRONG study, an extension of the SURVIVE study, a national multicenter cohort about on prevention in suicidal attempters. METHODS The STRONG study is a two-year clinical trial. A total sample of 60 patients will be randomly allocated to two arms: a group will receive a iFD-S and treatment as usual (TAU) (n=30 treatment group), while another group will exclusively receive TAU (n=30 control group). There will be three study points: baseline; 3-month; and 6-month follow-up assessments, all of which will include rater-blinded evaluation of psychosocial functioning, quality of life, clinical state, cognitive performance and neuroimaging acquisition. RESULTS It is expected to obtain data on the efficacy of iFD-S in patients who have committed a suicide attempt. CONCLUSION Results will provide insight into the effectiveness of IFD-S in suicidal attempters with respect to improvements in psychosocial functioning, quality of life, cognition, and neuroimaging correlates. CLINICAL TRIALS ID NCT05655390.
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Affiliation(s)
- Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Mireia Vazquez
- Departamento de Psicología Clínica i Psiquiatría, Instituto de Neurociencias, Hospital Clínico de Barcelona, C. Casanova, 140, 08036 Barcelona, Spain
| | - Joaquim Radua
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Carlos Pariente
- Magnetic Resonance Imaging Core Facility, IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Emma Muñoz-Moreno
- Magnetic Resonance Imaging Core Facility, IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Carlos Laredo
- Magnetic Resonance Imaging Core Facility, IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Lorenzo Bracco
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tábatha Fernández
- Departamento de Psicología Clínica i Psiquiatría, Instituto de Neurociencias, Hospital Clínico de Barcelona, C. Casanova, 140, 08036 Barcelona, Spain
| | - Sara Martín-Parra
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Departament de Psicologia Clínica i Psicobiologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain
| | - Anabel Martínez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Departament de Psicologia Clínica i Psicobiologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Saiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Miguel Ruiz-Veguilla
- Virgen del Rocio University Hospital, University of Sevilla/IBiS/CIBERSAM, Seville, Spain
| | - Roger Borras
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain
| | - Alba Toll
- Institute Mar of Medical Research, IMIM, Barcelona, Spain
| | - Matilde Elices
- Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Víctor Perez-Solà
- Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain; Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
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Wolff B, Franco VR, Magiati I, Pestell CF, Glasson EJ. Psychosocial and neurocognitive correlates of suicidal thoughts and behaviours amongst siblings of persons with and without neurodevelopmental conditions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104566. [PMID: 37441861 DOI: 10.1016/j.ridd.2023.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of neuropsychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis (WHO, 2014) and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap. METHOD The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviours amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14-27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests. RESULTS NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = -0.32), suicidal ideation (25.76% versus 8.89%, δ = -0.40) and history of suicide attempts (18.18% versus 4.44%, δ = -0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86-0.91, negative predictive value 0.81-0.90, false negative rates 0.11-0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality. CONCLUSIONS Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.
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Affiliation(s)
- Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Australia; Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
| | | | - Iliana Magiati
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Australia; Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia
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McCall WV, Ribbens LT, Looney SW. Relationships among insomnia, executive function, and suicidal ideation in depressed outpatients: A mediation analysis. Scand J Psychol 2023; 64:105-112. [PMID: 36214265 DOI: 10.1111/sjop.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022]
Abstract
Insomnia is a risk factor for suicide, and both are associated with cognitive problems. However, prior research has not examined insomnia, cognition, and suicidal ideation within one sample. We describe cross-sectional associations among insomnia, psychomotor speed, set shifting, and suicidal ideation in 85 depressed adults. Greater insomnia was associated with slower psychomotor speed, while slower psychomotor speed was associated with a greater level (i.e., elaboration of suicide planning) and intensity of suicidal ideation in the past week. Slower set shifting was associated with a greater level and intensity of suicidal ideation in the past week. Mediation analysis indicated that psychomotor speed and set shifting both had a significant total effect on the intensity of suicidal ideation in the past week; set shifting also had a significant total effect on the sum of intensity and suicidal ideation level in the past week. The level of insomnia explained only small percentages of the total effect of either psychomotor speed or set shifting on the intensity of suicidal ideation and the sum of intensity and suicidal ideation level. The findings in this sample demonstrate significant associations of slower psychomotor speed and set shifting with suicidal ideation, with negligible contribution from insomnia.
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Affiliation(s)
- William V McCall
- Department of Psychiatry and Health Behavior; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Lucas T Ribbens
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Stephen W Looney
- Department of Population Health Sciences; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Ai H, Duan L, Huang L, Luo Y, Aleman A, Xu P. Dissociated deficits of anticipated and experienced regret in at-risk suicidal individuals. Front Psychiatry 2023; 14:1121194. [PMID: 36970290 PMCID: PMC10034165 DOI: 10.3389/fpsyt.2023.1121194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundsDecision-making deficits have been reported as trans-diagnostic characteristics of vulnerability to suicidal behaviors, independent of co-existing psychiatric disorders. Individuals with suicidal behaviors often regret their decision to attempt suicide and may have impairments in future-oriented processing. However, it is not clear how people with suicidal dispositions use future-oriented cognition and past experience of regret to guide decision-making. Here, we examined the processes of regret anticipation and experience in subclinical youth with and without suicidal ideation during value-based decision-making.MethodsIn total, 80 young adults with suicidal ideation and 79 healthy controls completed a computational counterfactual thinking task and self-reported measures of suicidal behaviors, depression, anxiety, impulsivity, rumination, hopelessness, and childhood maltreatment.ResultsIndividuals with suicidal ideation showed a reduced ability to anticipate regret compared to healthy controls. Specifically, suicidal ideators’ experience of regret/relief was significantly different from that of healthy controls upon obtained outcomes, while their disappointment/pleasure experience was not significantly different from healthy controls.ConclusionThese findings suggest that young adults with suicidal ideation have difficulty predicting the consequences or the future value of their behavior. Individuals with suicidal ideation showed impairments in value comparison and flat affect to retrospective rewards, whereas individuals with high suicidality showed blunted affect to immediate rewards. Identifying the counterfactual decision-making characteristics of at-risk suicidal individuals may help to elucidate measurable markers of suicidal vulnerability and identify future intervention targets.
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Affiliation(s)
- Hui Ai
- Institute of Applied Psychology, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Lian Duan
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- *Correspondence: Lian Duan, ; Pengfei Xu,
| | - Lin Huang
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
| | - Yuejia Luo
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
- Center for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
| | - André Aleman
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- Section Cognitive Neuroscience, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
- Center for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
- *Correspondence: Lian Duan, ; Pengfei Xu,
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Zhou Y, Wang C, Lan X, Li W, Chao Z, Wu K, McIntyre RS, Ning Y. Cognitive Function Mediates the Anti-suicide Effect of Repeated Intravenous Ketamine in Adult Patients With Suicidal Ideation. Front Psychiatry 2022; 13:779326. [PMID: 35586411 PMCID: PMC9108147 DOI: 10.3389/fpsyt.2022.779326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Prior research has shown that ketamine has anti-suicide effects. Additional evidence also suggests that ketamine may offer pro-cognitive effects. Herein, we propose that the anti-suicide effects of ketamine are partially mediated via pro-cognitive effects. We aimed to determine whether improvement in cognitive function mediated change in suicidal ideation was associated with ketamine treatment. METHODS Unipolar or bipolar depressive patients (n = 86) with suicidal ideation received six infusions of ketamine (0.5 mg/kg) over 2 weeks. The current severity of suicidal ideation and depression symptoms were assessed with the Beck Scale for Suicide Ideation (SSI) and the Montgomery-Asberg Depression Rating Scale (MADRS), respectively, at baseline, days 13 and 26. Cognitive domains, including processing speed, working memory, visual learning, and verbal learning were measured with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery at the same time points. RESULTS Mediation analysis showed a significant total effect of ketamine treatment on SSI score (coef = -1.853, 95%CI [-2.2, -1.5]). The direct and total indirect (MADRS total score and any of cognitive domains) effects of ketamine on suicidal ideation both were statistically significant (direct: coef = -1.064 to -1.352; total indirect: coef = -0.501 to -0.788). MADRS total score and processing speed (but not other cognitive domains) were significant partial mediators of the association between ketamine treatment and improvements in suicidal ideation. CONCLUSION Depressive symptoms severity and processing speed performance partially mediated improvements in suicidal ideation after repeated ketamine infusions in persons with unipolar or bipolar depressive disorder.
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Affiliation(s)
- Yanling Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Chengyu Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaofeng Lan
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ziyuan Chao
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Kai Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Roger S McIntyre
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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9
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Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature. Eur Child Adolesc Psychiatry 2021; 30:1839-1855. [PMID: 32388626 DOI: 10.1007/s00787-020-01550-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Suicide and suicidal behaviors represent a leading cause of morbidity and mortality during adolescence. While several lines of evidence suggest that suicidal behaviors are associated with risky decisions and deficient cognitive control in laboratory tasks in adults, comparatively less is known about adolescents. Here, we systematically reviewed the literature on the association between these neurocognitive variables and adolescent suicidal behaviors. The online search strategy identified 17 neurocognitive studies examining either cognitive control or decision-making processes in adolescents with past suicidal behaviors. Several studies have reported that adolescents with a history of suicidal behaviors present neuropsychological differences in the cognitive control (using Go/NoGo, suicide Stroop Test, continuous performance test, suicide/death Implicit Association Test), and decision-making (Iowa Gambling Task, Cambridge Gambling Task, cost computation, delay discounting, loss aversion tasks) domains. Due to a lack of replication or conflicting findings, our systematic review suggests that no firm conclusion can be drawn as to whether altered decision-making or poor cognitive control contribute to adolescent suicidal behaviors. However, these results collectively suggest that further research is warranted. Limitations included scarcity of longitudinal studies and a lack of homogeneity in study designs, which precluded quantitative analysis. We propose remediating ways to continue neuropsychological investigations of suicide risk in adolescence, which could lead to the identification of novel therapeutic targets and predictive markers, enabling early intervention in suicidal youth.
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10
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Sastre-Buades A, Alacreu-Crespo A, Courtet P, Baca-Garcia E, Barrigon ML. Decision-making in suicidal behavior: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:642-662. [PMID: 34619171 DOI: 10.1016/j.neubiorev.2021.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 01/19/2023]
Abstract
Impaired decision-making (DM) is well-known in suicidal behavior (SB). We aimed to review the evidence on DM and its mediating factors in SB and perform a meta-analysis on DM assessed using the Iowa Gambling Task (IGT). We conducted a search on databases of papers published on DM and SB up to 2020: 46 studies were included in the systematic review, and 18 in the meta-analysis. For meta-analysis, we compared DM performance between suicide attempters (SAs) and patients (PCs) or healthy controls (HCs). The systematic review showed that SAs have greater difficulties in all DM domains. The meta-analysis found worse IGT performance among SAs in comparison with PCs and HCs. A meta-regression did not find differences for age, gender, psychiatric disorder, and clinical status. Our findings indicate that SAs exhibited deficits in DM under conditions of risk though not ambiguity. Worse DM was independent of age, gender, psychiatric disorder, and suggested that DM impairment could be considered a cognitive trait of suicidal vulnerability, a risk factor and an attribute of SAs.
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Affiliation(s)
- Aina Sastre-Buades
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Department of Neurology, Son Llatzer University Hospital, Palma, Spain.
| | - Adrián Alacreu-Crespo
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, University of Zaragoza, Teruel, Spain.
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
| | - Enrique Baca-Garcia
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Autonomous University of Madrid, Spain; Department of Psychiatry, Rey Juan Carlos University Hospital, Móstoles, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, Infanta Elena University Hospital, Valdemoro, Madrid, Spain; Universidad Católica del Maule, Talca, Chile.
| | - Maria Luisa Barrigon
- Department of Psychiatry, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Autonomous University of Madrid, Spain; Department of Psychiatry, Virgen del Rocío University Hospital, Sevilla, Spain.
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11
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Wang L, Li J, Liu H, Wang Z, Yang L, An L. Influence Factors for Decision-Making Performance of Suicide Attempters and Suicide Ideators: The Roles of Somatic Markers and Explicit Knowledge. Front Psychol 2021; 12:693879. [PMID: 34594264 PMCID: PMC8476741 DOI: 10.3389/fpsyg.2021.693879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
Impaired decision-making has been observed in suicide attempters during the Iowa Gambling Task (IGT). Decision-making performance is influenced by somatic markers and explicit knowledge, but it is still unclear of the influencing role on decision-making performance in suicidal individuals. We aimed to investigate whether there is a decision-making deficit in suicide attempters, suicide ideators, as well as the distinct roles of somatic markers and explicit knowledge wherein. Thirteen suicide attempters, 23 suicide ideators, and 19 healthy controls performed the IGT. Both somatic markers (by the skin conductance responses, SCRs) and explicit knowledge (by the subjective experience rating and a list of questions) were recorded. No significant differences were found among the three groups on IGT performance, explicit knowledge, and anticipatory SCRs. IGT Performance of suicide attempters was positively correlated with explicit knowledge index while behavior performance was positively associated with the SCRs in healthy controls. These results indicate that the suicide attempters seem to apply a compensatory strategy by mostly utilizing explicit knowledge to perform normally as healthy controls in the IGT.
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Affiliation(s)
- Lingling Wang
- School of Education, Tianjin University, Tianjin, China.,Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Jingmin Li
- Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Tianjin Vocational Institute, Tianjin, China
| | - Hailing Liu
- Tianjin University of Technology, Tianjin, China
| | - Zhongpeng Wang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Li Yang
- School of Education, Tianjin University, Tianjin, China.,Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Li An
- School of Education, Tianjin University, Tianjin, China.,Institute of Applied Psychology, Tianjin University, Tianjin, China
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12
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Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition. Schizophr Res 2021; 228:298-304. [PMID: 33493778 PMCID: PMC7987901 DOI: 10.1016/j.schres.2020.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for individuals with psychosis. Although factors influencing suicide risk have been studied in schizophrenia, far less is known about factors that protect against or trigger increased risk during early-stage and first episode of psychosis. This study examined whether depression, psychotic symptoms, clinical insight, and cognition were associated with suicide ideation among individuals with first-episode psychosis. METHODS Data were obtained from the Recovery After an Initial Schizophrenia Episode (RAISE) project. Participants (n = 404) included adults between ages 15 and 40 in a first episode of psychosis. Measurement included the Positive and Negative Syndrome Scale, Brief Assessment of Cognition in Schizophrenia, and Calgary Depression Scale for Schizophrenia. A logistic regression model evaluated clinical and cognitive variables as predictors of suicidal ideation. RESULTS Greater positive symptoms (OR = 1.085, p < .01) and depression (OR = 1.258, p < .001) were associated with increased likelihood of experiencing suicidal ideation during the RAISE project. Meanwhile, stronger working memory (OR = 0.922, p < .05) and impaired clinical insight (OR = 0.734, p < .05) were associated with a decreased likelihood of experiencing suicidal ideation. CONCLUSION The likelihood of experiencing suicidal ideation was significantly increased when positive and depressive symptoms were present, and significantly decreased when clinical insight was poorer and working memory stronger. These findings have important implications for the role of cognition and insight in risk for suicide ideation in early-stage psychosis, which may aid in improving the prediction of suicide behaviors and inform clinical decision-making over the course of the illness.
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13
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Postolache TT, Wadhawan A, Rujescu D, Hoisington AJ, Dagdag A, Baca-Garcia E, Lowry CA, Okusaga OO, Brenner LA. Toxoplasma gondii, Suicidal Behavior, and Intermediate Phenotypes for Suicidal Behavior. Front Psychiatry 2021; 12:665682. [PMID: 34177652 PMCID: PMC8226025 DOI: 10.3389/fpsyt.2021.665682] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022] Open
Abstract
Within the general literature on infections and suicidal behavior, studies on Toxoplasma gondii (T. gondii) occupy a central position. This is related to the parasite's neurotropism, high prevalence of chronic infection, as well as specific and non-specific behavioral alterations in rodents that lead to increased risk taking, which are recapitulated in humans by T. gondii's associations with suicidal behavior, as well as trait impulsivity and aggression, mental illness and traffic accidents. This paper is a detailed review of the associations between T. gondii serology and suicidal behavior, a field of study that started 15 years ago with our publication of associations between T. gondii IgG serology and suicidal behavior in persons with mood disorders. This "legacy" article presents, chronologically, our primary studies in individuals with mood disorders and schizophrenia in Germany, recent attempters in Sweden, and in a large cohort of mothers in Denmark. Then, it reviews findings from all three meta-analyses published to date, confirming our reported associations and overall consistent in effect size [ranging between 39 and 57% elevation of odds of suicide attempt in T. gondii immunoglobulin (IgG) positives]. Finally, the article introduces certain links between T. gondii and biomarkers previously associated with suicidal behavior (kynurenines, phenylalanine/tyrosine), intermediate phenotypes of suicidal behavior (impulsivity, aggression) and state-dependent suicide risk factors (hopelessness/dysphoria, sleep impairment). In sum, an abundance of evidence supports a positive link between suicide attempts (but not suicidal ideation) and T. gondii IgG (but not IgM) seropositivity and serointensity. Trait impulsivity and aggression, endophenotypes of suicidal behavior have also been positively associated with T. gondii seropositivity in both the psychiatrically healthy as well as in patients with Intermittent Explosive Disorder. Yet, causality has not been demonstrated. Thus, randomized interventional studies are necessary to advance causal inferences and, if causality is confirmed, to provide hope that an etiological treatment for a distinct subgroup of individuals at an increased risk for suicide could emerge.
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Affiliation(s)
- Teodor T Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States.,Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, United States.,Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, United States
| | - Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Psychiatry, Saint Elizabeth's Hospital, Washington, DC, United States
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Halle, Halle, Germany
| | - Andrew J Hoisington
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, United States.,Department of Systems Engineering and Management, Air Force Institute of Technology, Dayton, OH, United States.,Department of Physical Medicine & Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain.,Department of Psychiatry, Madrid Autonomous University, Madrid, Spain.,Department of Psychiatry, Rey Juan Carlos University Hospital, Móstoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, Infanta Elena University Hospital, Valdemoro, Spain.,Universidad Catolica del Maule, Talca, Chile.,Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Christopher A Lowry
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, United States.,Department of Physical Medicine & Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.,Department of Integrative Physiology, Center for Neuroscience, Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO, United States
| | - Olaoluwa O Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Michael E DeBakey VA Medical Center, Houston, TX, United States
| | - Lisa A Brenner
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, United States.,Department of Physical Medicine & Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.,Department of Psychiatry & Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
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14
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Lin L, Wang C, Mo J, Liu Y, Liu T, Jiang Y, Bai X, Wu X. Differences in Behavioral Inhibitory Control in Response to Angry and Happy Emotions Among College Students With and Without Suicidal Ideation: An ERP Study. Front Psychol 2020; 11:2191. [PMID: 32982887 PMCID: PMC7490336 DOI: 10.3389/fpsyg.2020.02191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Suicidal ideation is one of the strongest predictors of suicide. A large number of studies have illustrated the important effect of impulsivity on suicidal ideation, and behavioral inhibitory control (BIC) is a specific manifestation of impulsivity. The goal of the present study is to evaluate the difference in BIC in response to happy and angry emotions between individuals with or without suicidal ideation to reveal the underlying mechanism of the effect of impulsivity on suicidal ideation when accounting for the effect of emotion. Combining the ERP technique and the two-choice oddball paradigm, a total of 70 college students were recruited to participate in this study. The Beck Scale for Suicidal Ideation–Chinese Version was used to identify whether the participants had suicidal ideation. There were 30 participants in the risky-suicidal ideation (SI) group and 19 participants in the non-suicidal ideation (NSI) group. The results showed that the reaction time of the SI group was longer than that of the NSI group for happy emotions. At the electrophysiological level, the P3 amplitude of the NSI group was larger than that of the SI group regardless of the electrode sites and valence, and the P3 component elicited by angry faces was larger than those elicited by happy faces in the SI group. These findings suggest that individuals without suicidal ideation have better BIC, and the SI group has more difficulty controlling their responses to happy emotions than their responses to angry emotions.
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Affiliation(s)
- Lin Lin
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Chenxu Wang
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Juanchan Mo
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Yu Liu
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Ting Liu
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Yunpeng Jiang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Xuejun Bai
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Xia Wu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.,Faculty of Psychology, Tianjin Normal University, Tianjin, China.,Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
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15
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Alacreu-Crespo A, Olié E, Le Bars E, Cyprien F, Deverdun J, Courtet P. Prefrontal activation in suicide attempters during decision making with emotional feedback. Transl Psychiatry 2020; 10:313. [PMID: 32948747 PMCID: PMC7501865 DOI: 10.1038/s41398-020-00995-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Adrián Alacreu-Crespo
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France. .,PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France.
| | - Emilie Olié
- grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France ,PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Emmanuelle Le Bars
- grid.464046.40000 0004 0450 3123Department of Neuroradiology, Academic hospital of Montpellier & U1051, Institut of Neurosciences of Montpellier, Montpellier, France ,I2FH, Institut d’Imagerie Fonctionnelle Humaine, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
| | - Fabienne Cyprien
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Jérémy Deverdun
- I2FH, Institut d’Imagerie Fonctionnelle Humaine, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
| | - Philippe Courtet
- grid.157868.50000 0000 9961 060XDepartment of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France ,PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
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16
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Alacreu-Crespo A, Guillaume S, Sénèque M, Olié E, Courtet P. Cognitive modelling to assess decision-making impairments in patients with current depression and with/without suicide history. Eur Neuropsychopharmacol 2020; 36:50-59. [PMID: 32456851 DOI: 10.1016/j.euroneuro.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 02/01/2023]
Abstract
It has been reported that decision making is impaired in suicide attempters. Decision making is a complex process and little is known about its different components. Yet, this information would help to understand the functioning of suicidal minds. In this study, the Prospect Valence-Learning (PVL) computational model was applied to the Iowa Gambling Task (IGT) to investigate and compare decision-making components in patients with affective disorder and with/without history of suicide attempts and in healthy controls. To this aim, 116 inpatients with current major depressive episode (among whom 62 suicide attempters) and 38 healthy controls were recruited. Decision-making performance was measured using the IGT. The Bayesian computational PVL model was applied to compare the feedback sensitivity, loss aversion, learning/memory, and choice consistency components of decision making in the different groups. Depressive symptomatology was assessed using the Beck Depression Inventory short form (BDI-SF). The total IGT net score and the loss aversion and learning/memory scores were lower in suicide attempters than in healthy controls. The choice consistency score was low in all patients (with/without suicide history) compared with healthy controls. Moreover, patients with high BDI score showed a positive relationship between the choice consistency score and suicide attempt. These findings suggest that decision-making impairment in depressed patients with and without suicidal history might be the result of underlying problems in feedback processing and task learning, which influence the building of long-term strategies. All these impairments should be targeted in therapeutic strategies for suicidal patients.
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Affiliation(s)
- A Alacreu-Crespo
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
| | - S Guillaume
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - M Sénèque
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - E Olié
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - P Courtet
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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17
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McManimen S, Wong MM. Prospective Investigation of the Interaction Between Social Problems and Neuropsychological Characteristics on the Development of Suicide Ideation. Suicide Life Threat Behav 2020; 50:545-557. [PMID: 31799701 PMCID: PMC7426060 DOI: 10.1111/sltb.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Negative social interactions are known to contribute to the development of suicide ideation. However, it is unclear how this risk factor interacts with other predisposing risk factors. The purpose of this study was to determine how social and neuropsychological factors interact as a prospective predictor of the emergence of suicide ideation in adolescents. METHOD Data were collected from adolescents (M age = 13.12, SD = 1.48) over 3 years as part of a larger study. Participants completed the MINI-Kid and Youth Self-Report, which were used to assess for suicidality. Negative social interactions were operationalized as the Social Problems scale of the YSR. Additionally, adolescents completed a neuropsychological battery at each wave of data collection. RESULTS Logistic moderation analyses demonstrated a significant interaction between task switching and endorsement of negative social interactions in the prediction of suicide ideation one year later, Wald χ2 (1) = 4.94, OR = 0.90, p < .05. Distractibility was a significant predictor, Wald χ2 (1) = 5.52, OR = 3.45, p < .05, but it did not demonstrate an interaction effect. Perseveration failed to reach statistical significance independently and in the interaction. CONCLUSIONS The results indicate that certain neuropsychological characteristics can aid in predicting which adolescents will develop suicide ideation in the presence of negative social interactions, which may have significant clinical implications.
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Affiliation(s)
- Stephanie McManimen
- Department of Psychology, Idaho State University, Pocatello, United States of America,Corresponding author: Idaho State University, 921 S 8 Ave, Stop 8112, Pocatello, Idaho 83209,
| | - Maria M. Wong
- Department of Psychology, Idaho State University, Pocatello, United States of America
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18
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Cao J, Ai M, Chen X, Chen J, Wang W, Kuang L. Altered resting-state functional network connectivity is associated with suicide attempt in young depressed patients. Psychiatry Res 2020; 285:112713. [PMID: 31810745 DOI: 10.1016/j.psychres.2019.112713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 01/16/2023]
Abstract
The purpose of this study was to investigate the changes in resting-state brain functional network connectivity (FNC) in young depressed patients with and without suicidal behavior, and the relationship between FNC and suicidal attempts in depressed youths using resting-state fMRI (RS-fMRI). We conducted independent component analysis (ICA) to identify intrinsically connected neural networks and analyze the alterations of intra- and inter-network connectivity using FNC analysis in 35 depressed youth with suicidal attempts (SU group), 18 patients without suicidal attempts (NSU group) and 47 healthy controls (HC), and investigate brain-behavior associations between the FNC coefficients and clinical behavior in the SU group. SU group showed significantly decreased internetwork connectivity between anterior default mode network (aDMN) and salience network (SN), as well as the right frontal-parietal network (rFPN). However, the internetwork connectivity between the SN and rFPN in SU group was higher than that in NSU group. Moreover, decreased aDMN-rFPN connectivity was negatively correlated with BHS scores, and the differences in SN-rFPN and aDMN-pDMN connectivity were negatively associated with the HAMD score in the SU group. Our findings may provide new insights into the patterns of functional organization in the brain of suicidal depressed patients.
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Affiliation(s)
- Jun Cao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Ming Ai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xiaorong Chen
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Jianmei Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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19
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Alacreu-Crespo A, Olié E, Seneque M, Béziat S, Guillaume S, Costa R, Courtet P. Decision-Making Skills Moderate the Relationship between Psychological and Physical Pain with Suicidal Behavior in Depressed Patients. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:190-191. [PMID: 30763941 DOI: 10.1159/000496572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/04/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Adrián Alacreu-Crespo
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France, .,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France,
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Maude Seneque
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Séverine Béziat
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Raquel Costa
- Department of Psychobiology, University of Valencia, Valencia, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.,Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
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20
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Henrion A, Courtet P, Arpon-Brand V, Lafrancesca A, Lacourt L, Jaussent I, Guillaume S, Olié E, Ducasse D. PEPSUI, a Psychoeducational Program for the Management of Suicidal Patients: A Qualitative Study From a Randomized Controlled Trial. Front Psychiatry 2020; 11:500447. [PMID: 33132924 PMCID: PMC7561374 DOI: 10.3389/fpsyt.2020.500447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide prevention after a recent suicide attempt remains a major issue for clinicians. Indeed, these patients are at risk of new attempts and also less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI). METHODS We started a large multicenter randomized controlled trial in outpatients who attempted suicide in the last year (i.e., current suicidal behavior disorder) to assess the feasibility, acceptability, and effectiveness of a 10-week psychoeducational program (PEPSUI group: scientific information on suicidal behavior, and third-wave cognitive behavioral therapies) compared with a 10-week relaxation program (control condition), in a naturalistic setting. Here, we present the qualitative part of this study. Participants in both groups completed a narrative interview with questions on their general impressions about the therapy process and outcomes, specific areas of change in their life since inclusion, and knowledge and perceptions about suicide and mental health services. Interviews were audiotaped, transcribed, and coded using inductive and deductive thematic analysis with a constant comparative approach. Participants were consecutively included until data saturation. RESULTS The interviews of 18 patients (n=10 in the PEPSUI group, and n=8 in the relaxation group) were analyzed. Qualitative analyses revealed some common points, and many differences between groups that are relevant for suicide prevention. Patients in both groups were satisfied with the programs. Group modality and therapeutic alliance with the instructors were considered useful in both groups. Participation was related to improved perception of mental health units (particularly in the PEPSUI group). Both groups reported the acquisition of stress management skills and distress tolerance. Relaxation was an easy way to survive stress. Conversely, the PEPSUI program had deeper implications for daily life through effective positioning towards internal events (thoughts and emotions) as a consequence of mindfulness-derived practices, enhancement of value-based commitments, improvement of the meaning in life and internal locus of control, increased contact with the present moment, use of a matrix (a decision-making tool), and acquisition of scientific knowledge on suicidal behavior. CONCLUSION Through specific processes for targeting suicidal risk and reducing the stigma, the PEPSUI program may represent a promising intervention for suicide prevention.
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Affiliation(s)
- Audrey Henrion
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Philippe Courtet
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Véronique Arpon-Brand
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Audrey Lafrancesca
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Laetitia Lacourt
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Jaussent
- INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Sébastien Guillaume
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Emilie Olié
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Déborah Ducasse
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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21
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Huber RS, Hodgson R, Yurgelun-Todd DA. A qualitative systematic review of suicide behavior using the cognitive systems domain of the research domain criteria (RDoC) framework. Psychiatry Res 2019; 282:112589. [PMID: 31703982 DOI: 10.1016/j.psychres.2019.112589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022]
Abstract
Neurocognitive deficits are associated with both suicide behavior (SB) and psychiatric disorders. Application of a transdiagnostic framework to identify neurocognitive commonalities of SB may clarify important risk factors of SB across psychiatric disorders. The aim of this study was to conduct a qualitative systematic literature review of SB using the Research Domain Criteria (RDoC) Cognitive Systems framework to determine if cognitive deficits exist independently of psychiatric disorders in SB. The following six constructs that encompass the Cognitive Systems domain were assessed: 1) Attention, 2) Cognitive Control, 3) Declarative Memory, 4) Language, 5) Perception, and 6) Working Memory. A total of 1386 abstracts were identified and 74 studies met the inclusion criteria for this review. The majority of studies reviewed (65%) had significant differences in cognition between individuals with and without SB. Seventy-nine percent of studies with a patient control group showed significant cognitive deficits in SB groups. Deficits in cognitive control were associated with SB and had the greatest percentage of studies with significant main findings. Use of the RDoC cognitive systems framework to evaluate SB revealed that cognitive deficits may be a transdiagnostic risk factor for SB, especially alterations in cognitive control.
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Affiliation(s)
- Rebekah S Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States.
| | - Riley Hodgson
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States
| | - Deborah A Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States; U.S. Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, United States
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22
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23
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Barredo J, Aiken E, van 't Wout-Frank M, Greenberg BD, Carpenter LL, Philip NS. Neuroimaging Correlates of Suicidality in Decision-Making Circuits in Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:44. [PMID: 30809160 PMCID: PMC6379274 DOI: 10.3389/fpsyt.2019.00044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/22/2019] [Indexed: 01/24/2023] Open
Abstract
In depression, brain and behavioral correlates of decision-making differ between individuals with and without suicidal thoughts and behaviors. Though promising, it remains unknown if these potential biomarkers of suicidality will generalize to other high-risk clinical populations. To preliminarily assess whether brain structure or function tracked suicidality in individuals with posttraumatic stress disorder (PTSD), we measured resting-state functional connectivity and cortical thickness in two functional networks involved in decision-making, a ventral fronto-striatal reward network and a lateral frontal cognitive control network. Neuroimaging data and self-reported suicidality ratings, and suicide-related hospitalization data were obtained from 50 outpatients with PTSD and also from 15 healthy controls, and all were subjected to seed-based resting-state functional connectivity and cortical thickness analyses using a priori seeds from reward and cognitive control networks. First, general linear models (GLM) were used to evaluate whether ROI-to-ROI functional connectivity was predictive of self-reported suicidality after false discovery rate (FDR)-correction for multiple comparisons and covariance of age and depression symptoms. Next, regional cortical thickness statistics were included as predictors of ROI-to-ROI functional connectivity in follow-up GLMs evaluating structure-function relationships. Functional connectivity between reward regions was positively correlated with suicidality (p-FDR ≤ 0.05). Functional connectivity of the lateral pars orbitalis to anterior cingulate/paracingulate control regions also tracked suicidality (p-FDR ≤ 0.05). Furthermore, cortical thickness in anterior cingulate/paracingulate was associated with functional correlates of suicidality in the control network (p-FDR < 0.05). These results provide a preliminary demonstration that biomarkers of suicidality in decision-making networks observed in depression may generalize to PTSD and highlight the promise of these circuits as transdiagnostic biomarkers of suicidality.
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Affiliation(s)
- Jennifer Barredo
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Emily Aiken
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
| | - Mascha van 't Wout-Frank
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Benjamin D Greenberg
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,Neuromodulation Research Facility, Butler Hospital Providence, Providence, RI, United States
| | - Linda L Carpenter
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,Neuromodulation Research Facility, Butler Hospital Providence, Providence, RI, United States
| | - Noah S Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States.,Neuromodulation Research Facility, Butler Hospital Providence, Providence, RI, United States
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24
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Ducasse D, Jaussent I, Arpon-Brand V, Vienot M, Laglaoui C, Béziat S, Calati R, Carrière I, Guillaume S, Courtet P, Olié E. Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:211-222. [PMID: 29874680 DOI: 10.1159/000488715] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. METHODS We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. RESULTS Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = -1.88 [0.34] vs. -0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. CONCLUSIONS Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Jaussent
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Véronique Arpon-Brand
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Marina Vienot
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Camelia Laglaoui
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Séverine Béziat
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Raffaella Calati
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Carrière
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
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25
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Hegedűs KM, Szkaliczki A, Gál BI, Andó B, Janka Z, Álmos PZ. Decision-making performance of depressed patients within 72 h following a suicide attempt. J Affect Disord 2018; 235:583-588. [PMID: 29702452 DOI: 10.1016/j.jad.2018.04.082] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/05/2018] [Accepted: 04/14/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The significance of decision-making in suicidal behaviour is often highlighted; however, the performance of persons in suicide crisis is unknown. This study aimed to explore the comprehensive decision-making profile of depressed patients following a suicide attempt. METHODS Decision-making was measured by reward- ("ABCD") and punishment- ("EFGH") sensitive versions of the Iowa Gambling Task (IGT) in 59 medication-free depressed patients within 72 h after a suicide attempt and in 46 healthy control subjects. Severity of depressive symptoms was assessed in the patient group by the Hamilton Depression Rating Scale. RESULTS Performance of the two groups differed significantly on the IGT ABCD, while a trend towards significant differences was seen on the IGT EFGH. Severity of depressive symptoms did not affect the depressed participants' decision-making performance. LIMITATIONS Subjects were not matched for years of education. Administration of the IGT ABCD and IGT EFGH was not counterbalanced. Methods of suicide attempts and history of previous attempts were not collected. CONCLUSIONS Individuals with a recent suicide attempt showed decision-making dysfunction on both IGT versions. However, on the EFGH, the overall difference between groups was not significant, depressed participants' performance remained poor during all blocks. Their behaviour reflected a focus on best immediate possible outcomes, not regarding future adverse consequences. This could be a result of psychological and cognitive alterations which modulate suicidal behaviour independent from mood. Further longitudinal studies should verify this possibility. Investigation of state-dependent neuropsychological characteristics of suicidal behaviour might be essential for detecting acute suicidal crisis.
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Affiliation(s)
- Klára M Hegedűs
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary.
| | - Andrea Szkaliczki
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary
| | - Bernadett I Gál
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary
| | - Bálint Andó
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary
| | - Zoltán Janka
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary
| | - Péter Z Álmos
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave 57., Szeged H-6725, Hungary
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26
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Kim K, Jeon HJ. Frontal Lobe Dysfunction in a Depressed Patient Who Survived a Suicide Attempt by Jumping from the Bridge on the Han River. Psychiatry Investig 2017; 14:904-908. [PMID: 29209400 PMCID: PMC5714738 DOI: 10.4306/pi.2017.14.6.904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
Suicide attempts at the Han river are rapidly increasing, which are 4.11 times from 2005 to 2015, whereas the rate of completed suicide in South Korea increased 1.07 times during the same period. However, few studies have been conducted on the issue because many suicide attempters were seriously injured after a fall in the Han river. We present a case of a patient with major depressive disorder (MDD) who attempted suicide and minimally injured after jumping from the bridge at the Han river. We could assess his psychological and neurocognitive functions before and immediately after his attempt. From this case, we can identify that higher cognitive aspect of executive dysfunction, especially in the frontal domain of selective attention and inhibition, may be associated with his suicide attempt. In conclusion, we suggest psychiatric treatments for cognitive impulsiveness and safety barriers at the bridge to prevent suicide attempts of patients with MDD.
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Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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27
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de Cates AN, Rees K, Jollant F, Perry B, Bennett K, Joyce K, Leyden E, Harmer C, Hawton K, van Heeringen K, Broome MR. Are neurocognitive factors associated with repetition of self-harm? A systematic review. Neurosci Biobehav Rev 2016; 72:261-277. [PMID: 27923730 DOI: 10.1016/j.neubiorev.2016.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/13/2016] [Accepted: 10/27/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established AIMS: Identify neurocognitive factors that may predict repetition of self-harm. METHODS Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed. RESULTS 7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions. CONCLUSIONS Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.
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Affiliation(s)
- Angharad N de Cates
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, UK
| | - Fabrice Jollant
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; Academic Hospital (CHU) of Nîmes, France
| | - Benjamin Perry
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Katie Joyce
- Warwick Medical School, University of Warwick, UK
| | - Eimear Leyden
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | | | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Matthew R Broome
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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28
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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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29
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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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Kim SJ, Kang SG, Cho IH, Lee YJG, Hong JP, Park J, Lee YJ. The relationship between poor performance on attention tasks and increased suicidal ideation in adolescents. Eur Child Adolesc Psychiatry 2015; 24:1361-8. [PMID: 25663429 DOI: 10.1007/s00787-015-0687-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 01/28/2015] [Indexed: 11/24/2022]
Abstract
Our goal was to examine the relationship between attention and suicidal ideation in a school-based adolescent population. This cross-sectional study involved 2,462 students from eight high schools in South Korea (1,021 males and 1,441 females, mean age 17.3 ± 0.6 years). The participants completed the Beck Scale for Suicide Ideation (SSI) and the Beck Depression Inventory (BDI) and took part in computerized attention tasks. Participants with high SSI scores (16 or higher) exhibited a higher mean number of omission errors (OEs) and commission errors (CEs) on the visual sustained attention tasks than did participants with low SSI scores (p < 0.001 and p < 0.001, respectively). On the divided attention tasks, the high SSI group exhibited a higher mean number of CEs than the low SSI group did (p < 0.001). In a general linear model adjusting for age, gender, and high BDI (10 or higher), membership in the high OE group in the visual sustained attention tasks was associated with high SSI scores (p = 0.015). Belonging to the high OE or CE group in the divided attention tasks were associated with high SSI scores (p = 0.024 and p = 0.035, respectively). For both the visual sustained and divided attention tasks, interactions between gender and high OE rates were significant (p ≤ 0.001 and p = 0.013, respectively). In the post hoc analysis, membership in the high OE group was associated with high SSI scores for girls. In a multiple linear regression analysis including all participants and controlling for age, gender, and BDI scores, higher numbers of OEs and CEs on the visual sustained attention tasks predicted higher SSI scores (p < 0.001 and p = 0.019, respectively). On the divided attention task, the number of CEs was positively correlated with the SSI score (p = 0.031). The findings of this study indicate an association between attention deficits and increased suicidal ideation in adolescents after controlling for depressed mood. The current results suggest a direct link between attention deficits and increased suicidality independent of depressive symptoms in adolescents.
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Affiliation(s)
- Seog Ju Kim
- Department of Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, School of Medicine, Gachon University, Incheon, Republic of Korea
| | - In Hee Cho
- Dr. Cho Psychiatric Clinic, Seoul, Republic of Korea
| | - Yu-Jin G Lee
- Department of Psychiatry, Seoul National University, College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University, College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea.
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Hoehne A, Richard-Devantoy S, Ding Y, Turecki G, Jollant F. First-degree relatives of suicide completers may have impaired decision-making but functional cognitive control. J Psychiatr Res 2015; 68:192-7. [PMID: 26228419 DOI: 10.1016/j.jpsychires.2015.07.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The heritability of suicide is well established. Transmission of risk appears to follow traits more than disorders like depression. In the present project, we aimed at investigating the potential for transmission of cognitive deficits previously observed in suicide attempters, specifically impaired decision-making and cognitive control. METHODS Seventeen healthy first-degree relatives of suicide completers with no personal history of suicidal act were compared to 18 first-degree relatives of individuals with major depressive disorder but no family history of suicidal act, and 19 healthy controls. Decision-making was assessed with the Iowa Gambling Task, and cognitive control with the Stroop Task, the Hayling Sentence Completion Test, and the Trail-Making Test. RESULTS Both suicide and depressed relatives showed lower gambling task net scores than healthy controls. However, there were trends toward lower learning abilities in suicide than depressed relatives (interaction: p = 0.07), with more risky choices at the end of the test. Suicide relatives also showed a higher number of self-corrected errors relative to the total number of errors in the Stroop colour test compared to both control groups, with no difference in interference scores. There was no group-difference for any other cognitive tests. CONCLUSION Our findings suggest that decision-making impairment may be found in healthy relatives of suicides and represent a cognitive endophenotype of suicidal behaviour. Normal cognitive control (or self-corrected deficits) may protect relatives against suicidal acts. Impairments in value-based and control processes may, therefore, be part of the suicide vulnerability and represent potential targets of preventative interventions.
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Affiliation(s)
- A Hoehne
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - S 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, UPRES EA 4638, Université d'Angers, Angers, France
| | - Y Ding
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - G Turecki
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - F Jollant
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; Department of Psychiatry, CHU de Nîmes, France.
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Bredemeier K, Miller IW. Executive function and suicidality: A systematic qualitative review. Clin Psychol Rev 2015; 40:170-83. [PMID: 26135816 DOI: 10.1016/j.cpr.2015.06.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
Deficits in executive function (EF) have been proposed as a possible explanation for the "cognitive rigidity" often observed in suicidal individuals. This article provides a systematic review of the existing literature testing the relations between EF and suicidality, across various diagnostic and demographic populations, using the influential multidimensional model of EF proposed by Miyake and colleagues (2000) as an organizing framework. Forty-three journal articles on this topic published before January of 2014 were reviewed. Collectively, results from these studies provide tentative support for an association between EF deficits and suicidality. However, there is some evidence that this association is moderated by other factors (e.g., suicide attempt lethality). Importantly, this relationship may vary across diagnostic groups. Specifically, more studies that used depressive disorder samples reported some positive findings (75%), followed by mixed diagnostic samples (54%). In contrast, fewer positive findings have emerged from studies with bipolar or psychotic disorder samples (29% and 33% respectively), and some even found that suicidality is associated with better EF in individuals with psychotic disorders. Firm conclusions about relationships between specific dimensions of EF and/or aspects of suicidality are difficult to draw this time. Limitations of the existing literature and corresponding directions for future research are discussed.
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Affiliation(s)
- Keith Bredemeier
- Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, United States.
| | - Ivan W Miller
- Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, United States
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Abstract
Gambling Disorder is associated with elevated rates of suicidal thoughts and acts. However, virtually nothing is known about suicidality in people with subsyndromal forms of gambling disorder. A total of 174 non-treatment seeking subjects were recruited for a study of impulsivity and met criteria for a subsyndromal form of DSM-5 gambling disorder (31.0 % females; mean age = 21.7 ± 3.61 years). Subjects were categorized as being 'at risk of suicide' or 'no suicide risk' based on the Mini-International Neuropsychiatric Interview (MINI). Those with and without suicidality were compared on clinical and cognitive measures. 32 (18.4 %) met MINI criteria for suicidality. Suicidality was significantly associated with mood and anxiety disorders, greater rates of nicotine consumption, and relative impairments in decision-making and cognitive flexibility. These findings suggest that decision-making impairments may be implicated in the development of both gambling problems and suicidality. Future work should address causality, neural correlates, and tailored suicide prevention strategies for people with, or at risk for, disordered forms of gambling.
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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: 201] [Impact Index Per Article: 20.1] [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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