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Goldstein KE, Pietrzak RH, Challman KN, Chu KW, Beck KD, Brenner LA, Interian A, Myers CE, Shafritz KM, Szeszko PR, Goodman M, Haznedar MM, Hazlett EA. Multi-modal risk factors differentiate suicide attempters from ideators in military veterans with major depressive disorder. J Affect Disord 2024:S0165-0327(24)01636-7. [PMID: 39341292 DOI: 10.1016/j.jad.2024.09.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/16/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND The suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD. METHODS Sixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior. RESULTS Relative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go. LIMITATIONS Findings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD. CONCLUSIONS This study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.
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Affiliation(s)
- Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert H Pietrzak
- United States Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Katelyn N Challman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Kevin D Beck
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Eastern Colorado Health Care System, Aurora, CO, USA; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Health Care System, Lyons, NJ, USA; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Catherine E Myers
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Keith M Shafritz
- Department of Psychology, Hofstra University, Hempstead, NY, United States of America; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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2
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Pertl SM, Srirangarajan T, Urminsky O. A multinational analysis of how emotions relate to economic decisions regarding time or risk. Nat Hum Behav 2024:10.1038/s41562-024-01927-3. [PMID: 39210027 DOI: 10.1038/s41562-024-01927-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2024] [Indexed: 09/04/2024]
Abstract
Emotions have been theorized to be important drivers of economic choices, such as intertemporal or risky decisions. Our systematic review and meta-analysis of the previous literature (378 results and 50,972 participants) indicates that the empirical basis for these claims is mixed and the cross-cultural generalizability of these claims has yet to be systematically tested. We analysed a dataset with representative samples from 74 countries (n = 77,242), providing a multinational test of theoretical claims that individuals' ongoing emotional states predict their economic preferences regarding time or risk. Overall, more positive self-reported emotions generally predicted a willingness to wait for delayed rewards or to take favourable risks, in line with some existing theories. Contrary to the assumption of a universal relationship between emotions and decision-making, we show that these relationships vary substantially and systematically across countries. Emotions were stronger predictors of economic decisions in more economically developed and individualistic countries.
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Affiliation(s)
- Samuel M Pertl
- Stanford Graduate School of Business, Stanford, CA, USA.
| | | | - Oleg Urminsky
- University of Chicago Booth School of Business, Chicago, IL, USA
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3
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Zhou X, Lin Z, Liu J, Xiang M, Deng X, Zou Z. The relationship between event-related potential components and suicide risk in major depressive disorder. J Psychiatr Res 2024; 175:89-95. [PMID: 38718444 DOI: 10.1016/j.jpsychires.2024.05.014] [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: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Suicide is a serious global issue, with major depressive disorder (MDD) being a significant risk factor for suicidal thoughts and behaviors. There is an urgent need to determine whether event-related potential components (ERPs) could be used as an indicator to assess suicidal risk. METHODS From 2020 to 2023, 258 participants in total were recruited into the study. All participants were divided into four groups: MDD patients at high (n = 66), moderate (n = 66), and low risk (n = 56) of suicide, and healthy controls (HCs)(n = 70). Each participant provided socio-demographic information and underwent evaluations using clinical psychological scales such as 7-item Generalized Anxiety Disorder (GAD-7), Health Questionnaire-9 items (PHQ-9), and Nurses' Global Assessment of Suicide Risk (NGASR). The auditory brainstem response test and ERP examination were performed for all subjects. RESULTS Our study found that the amplitude of P2-P3 and N2-P3 was significantly reduced in MDD patients at moderate and high risk of suicide, and these were negatively correlated with NGASR total score (all P < 0.05). Point B latency was positively correlated with NGASR total score (P < 0.05). Patients with MDD patients at low risk for suicide had a lower A-B amplitude compared to HCs (P < 0.05). No differences were found in MMN or P50 components between the four groups (all P > 0.05). CONCLUSIONS MDD patients at higher risk of suicide exhibited severe impairment of cognitive function. ERP indices, such as the amplitude of P2-P3 and N2-P3, could be associated with the risk of suicide in MDD patients.
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Affiliation(s)
- Xiaobo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China; Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zhonghua Lin
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jingwen Liu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China; Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Minjing Xiang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xia Deng
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China; Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zhili Zou
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China; Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Escobar LE, Liew M, Yirdong F, Mandelos KP, Ferraro-Diglio SR, Abraham BM, Polanco-Roman L, Benau EM. Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis. J Affect Disord 2024; 349:8-20. [PMID: 38169241 DOI: 10.1016/j.jad.2023.12.082] [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: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control. METHODS We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA. RESULTS We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A. LIMITATIONS There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included. CONCLUSIONS Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.
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Affiliation(s)
- Lesly E Escobar
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | - Megan Liew
- Department of Psychology, SUNY Stony Brook, Stony Brook, NY, USA; Department of Psychology, University of Missouri, Columbia, MO, USA
| | - Felix Yirdong
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
| | | | | | - Blessy M Abraham
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Erik M Benau
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA.
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5
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Wang T, Yang L, Yang L, Liu BP, Jia CX. The relationship between psychological pain and suicidality in patients with major depressive disorder: A meta-analysis. J Affect Disord 2024; 346:115-121. [PMID: 37926158 DOI: 10.1016/j.jad.2023.10.160] [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: 04/23/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the association between psychological pain and suicidality in patients with major depressive disorder (MDD). METHOD The databases of PubMed, Web of Science and PsycINFO were used to search and articles were screened for inclusion and exclusion criteria until February 2022. Two researchers independently screened the papers, extracted data, and evaluated the risk of bias of the included studies. Comprehensive Meta-Analysis software (CMA) was used for meta-analysis and the combined OR (95 % CI) values were calculated. RESULTS A total of 7 articles were included, with a sample size of 1364. The present study showed that psychological pain was a risk factor for suicidality in patients with MDD (OR = 1.322, 95 % CI:1.165-1.500). After Duval and Tweedie trim and fill to rectify potential publication bias, psychological pain was still a risk factor for suicidality in patients with MDD [OR = 1.196 (95 % CI: 1.030-1.388), P < 0.001]. Subgroup analyses showed that average age ≥ 40 [r = 0.57 (95 % CI: 0.32-0.81), P < 0.001] was moderating variable for psychological pain and suicidality. CONCLUSIONS Reducing psychological pain in MDD patients is somewhat important for preventing their suicidality, especially for the patients with advancing age.
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Affiliation(s)
- Tao Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lan Yang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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6
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Tanrıverdi D, Bekircan E, Koç Z. The Relationship Between Psychache and Suicide Risk With Spiritual Well-Being Levels of Patients Diagnosed With Depression. J Am Psychiatr Nurses Assoc 2024; 30:132-140. [PMID: 35172647 DOI: 10.1177/10783903221079796] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Depression has long been accepted as a serious disability and burden globally, while suicide is a misunderstood and complex cause of death. Psychache is the psychological variable most strongly associated with suicidality. Spirituality is considered an important buffer against stressful events and may help people overcome distress and difficulties. AIMS: This study aims to determine how psychache and suicide risk are related to levels of spiritual well-being in patients with depression. METHODS: Data were collected using the Suicide Probability Scale, the Psychache Scale, and the Spiritual Well-Being Scale. The sample study consisted of 150 Turkish patients diagnosed with depression and receiving psychiatric care. RESULTS: It was found that higher level of spiritual well-being led to decreased risk of suicide and lower level of psychache. Suicide risk increased in parallel to the increasing levels of psychache (p < .001). CONCLUSIONS: It was observed that higher levels of spiritual well-being may promote a significantly lower risk of suicide and lower levels of psychache. Likewise, increasing levels of psychache may lead to an increase in suicide risk.
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Affiliation(s)
| | - Esra Bekircan
- Esra Bekircan, MSc, Trabzon University, Trabzon, Turkey
| | - Zeynep Koç
- Zeynep Koç, MSc, Gaziantep University, Gaziantep, Turkey
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7
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Olson EA, Ahmad S, Granger SJ, Ashraf A, Pizzagalli DA, Rosso IM. Anhedonia and Delay Discounting: Differing Patterns of Brain-Behavior Relationships in Healthy Control Participants Versus Individuals With Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:80-90. [PMID: 37536568 PMCID: PMC10830883 DOI: 10.1016/j.bpsc.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Anhedonia may contribute to individual differences in delay discounting (DD). In prior work, we found that higher anhedonia was associated with shallower DD in healthy control (HC) participants but steeper DD in individuals with posttraumatic stress disorder (PTSD). In this study, we aimed to directly compare the relationship between anhedonia and DD across groups and to identify functional brain correlates of this interaction. METHODS Participants (HC group: n = 23, DSM-5 PTSD group: n = 23) completed a questionnaire assessing anhedonia (Snaith-Hamilton Pleasure Scale [SHAPS]), task-based functional magnetic resonance imaging of decision making including DD, and resting-state functional magnetic resonance imaging. Task-based activity and resting-state functional connectivity were evaluated in reward-related regions that have also been implicated in PTSD (nucleus accumbens [NAcc], right anterior insula). RESULTS Higher SHAPS scores were associated with steeper DD in PTSD, but there was no relationship between DD and SHAPS in the HC group. There was a significant group-by-SHAPS interaction for NAcc activity, t31 = 2.92, p = .007: Greater NAcc activity when immediate rewards were chosen was associated with higher SHAPS in the PTSD group but lower SHAPS in the HC group. In resting-state functional connectivity, there was a group-by-SHAPS interaction between the NAcc seed and right parietal and frontal pole clusters. CONCLUSIONS These results extend prior findings that anhedonia is associated with steeper DD in PTSD and demonstrate that this behavioral finding occurs in the context of NAcc hyperactivity to immediate rewards and hyperconnectivity in anhedonic individuals with PTSD.
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Affiliation(s)
- Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Subul Ahmad
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Steven J Granger
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Aseelah Ashraf
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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8
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Meerwijk EL. Psychological pain in depressive disorder: A concept analysis. J Clin Nurs 2023; 32:8154. [PMID: 37404006 DOI: 10.1111/jocn.16822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Esther L Meerwijk
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (MPD 152), Menlo Park, California, USA
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9
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Jiang C, Huang Z, Zhou Z, Chen L, Zhou H. Decreased beta 1 (12-15 Hertz) power modulates the transfer of suicidal ideation to suicide in major depressive disorder. Acta Neuropsychiatr 2023; 35:362-371. [PMID: 37605898 DOI: 10.1017/neu.2023.39] [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] [Indexed: 08/23/2023]
Abstract
BACKGROUND Suicide prevention for major depressive disorder (MDD) is a worldwide challenge, especially for suicide attempt (SA). Viewing suicide as a state rather than a lifetime event provided new perspectives on suicide research. OBJECTIVE This study aimed to verify and complement SAs biomarkers of MDD with a recent SA sample. METHODS This study included 189 participants (60 healthy controls; 47 MDD patients with non-suicide (MDD-NSs), 40 MDD patients with suicide ideation (MDD-SIs) and 42 MDD patients with SA (MDD-SAs)). MDD patients with an acute SA time was determined to be within 1 week since the last SA. SUICIDALITY Part in MINI was applied to evaluate suicidality. Absolute powers in 14 frequency bands were extracted from subject's resting-state electroencephalography data and compared within four groups. The relationship among suicidality, the number of SA and powers in significant frequency bands were investigated. RESULTS MDD-SIs had increased powers in delta, theta, alpha and beta band on the right frontocentral channels compared to MDD-NSs, while MDD-SAs had decreased powers in delta, beta and gamma bands on widely the right frontocentral and parietooccipital channels compared to MDD-SIs. Beta 1 power was the lowest in MDD-SAs and was modulated by the number of SA. The correlation between suicidality and beta 1 power was negative in MDD-SAs and positive in MDD-SIs. CONCLUSION Reduced beta 1 (12-15 Hz) power could be essential in promoting suicidal behaviour in MDD. Research on recent SA samples contributes to a better understanding of suicide mechanisms and preventing suicidal behaviour in MDD.
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Affiliation(s)
- Chenguang Jiang
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu Province, China
| | - Zixuan Huang
- Department of Music and Wellbeing, School of Music, University of Leeds, Leeds, UK
| | - Zhenhe Zhou
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu Province, China
| | - Limin Chen
- Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu Province, China
| | - Hongliang Zhou
- Department of Clinical Psychology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
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10
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Riera-Serra P, Gili M, Navarra-Ventura G, Riera-López Del Amo A, Montaño JJ, Coronado-Simsic V, Castro A, Roca M. Longitudinal associations between executive function impairments and suicide risk in patients with major depressive disorder: A 1-year follow-up study. Psychiatry Res 2023; 325:115235. [PMID: 37178501 DOI: 10.1016/j.psychres.2023.115235] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Impaired executive function (EF) is a key feature of patients with major depressive disorder (MDD) that several studies have linked to suicidal ideation and suicide attempts. This is the first longitudinal study to examine the association between impaired EF and suicide risk in adult patients with MDD. Longitudinal prospective study with 3 assessment points: baseline, 6 and 12 months. The Columbia-Suicide Severity Rating Scale (C-SSRS) was used to assess suicidality. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess EF. The association between EF impairments and suicidality was analyzed using mixed-effects models. Out of 167 eligible outpatients, 104 were included in the study. Of these, 72 were re-evaluated at 6 months and 60 at 12 months, obtaining 225 complete observations of the EF. Impaired decision-making and risk-taking behavior were associated with suicidal ideation. Difficulty in impulse control was related to suicidal ideation and to greater severity of suicidal ideation. Impaired spatial planning and working memory was linked to suicide attempts. Our results add to previous literature that the association between EF impairments and suicidality is maintained over the long term, supporting it as a longitudinal risk factor and a possible neurocognitive marker of suicide in patients with MDD.
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Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain.
| | - Antonio Riera-López Del Amo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Juan José Montaño
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
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11
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Valentini E, Bianchi S, Menculini G, Cusenza AS, Balena E, Balducci PM, Amantini K, Moretti P, Tortorella A. Suicidality in a psychiatric inpatient unit: a 2-year retrospective study in Umbria, central Italy. Int Clin Psychopharmacol 2023; 38:154-159. [PMID: 36602882 DOI: 10.1097/yic.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Suicide ranks among the 10 leading causes of death worldwide; in Italy, almost 4000 persons per year die by suicide. Studies focusing on suicidality in Italian inpatient samples before the COVID-19 pandemic are scant. We, thus, aimed to define sociodemographic and clinical variables associated with suicidal ideation (SI) and deliberate self-harm (DSH) in a sample of inpatients admitted to a Psychiatric Inpatient Unit. This retrospective study was conducted in the Psychiatric Inpatient Unit of the Perugia Hospital, from January 2018 to December 2019. Sociodemographic and clinical characteristics, including diagnostic and treatment features, were collected from the medical records of subjects admitted for suicidality-related phenomena, namely DSH and SI. The prevalence of suicidality-related phenomena in the sample ( n = 850) was 14.12% (n=120) and was mainly due to DSH ( n = 84; 70%). Subjects hospitalized due to these conditions were more frequently females, separated, and displayed a higher prevalence of personality disorders, especially borderline personality disorder. People in the suicidality-related phenomena subgroup were more often committed involuntarily and reported multiple hospitalizations less frequently than other inpatients. They were receiving community treatment in a higher percentage of cases, and lithium was prescribed more frequently than among inpatients who were hospitalized for reasons other than suicidality. Our study provides a further characterization of psychiatric inpatients who experience SI or perform DSH. Targeted treatment strategies should be considered for subjects suffering from personality disorders who experience suicidality-related phenomena.
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Affiliation(s)
| | | | | | | | | | | | - Kety Amantini
- Department of Mental Health, AUSL Umbria 1, Perugia, Italy
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12
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Cáceda R, Mirmina J, Kim DJ, Rafiaa M, Carbajal JM, Akram F, Lau J, Chacko M, Tedla A, Teng Y, Perlman G. Low global frontal brain activity is associated with non-planned or impulsive suicide attempts. A preliminary study. J Affect Disord 2023; 326:44-48. [PMID: 36708954 DOI: 10.1016/j.jad.2023.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Suicide prevention is limited by the frequent non-planned or impulsive nature of suicidal behavior. For instance, 25-62 % of suicide attempts, occur within 30 min of the onset of suicidal ideation. We aimed to examine frontal brain activity in depressed patients following a suicide attempt and its relationship with the duration of the suicidal process. METHODS We recruited 35 adult patients within three days of a suicide attempt of at least moderate lethality. Duration of the suicidal process was recorded in a semi-structured interview, including suicide contemplation (time from onset of suicidal ideation to decision to kill oneself) and suicide action intervals (time from the decision to kill oneself to suicide attempt). Resting state EEG data from AF7, AF8, TP9 and TP10 leads was collected with a portable MUSE 2 headband system. The average frequency values throughout a 5-minute portable EEG recording were extracted for delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) waves. RESULTS Delta (r = 0.450, p = 0.021) and theta power (r = 0.395, p = 0.044) were positively correlated with the duration of the suicide action interval. There were no significant correlations of the suicide contemplation interval with clinical or EEG measures. Patients with suicide action interval shorter than 30 min showed lower delta power (U = 113, p = 0.049) compared with those with longer duration. CONCLUSIONS Lower theta and delta activity may reflect hindered cognitive control and inhibition in impulsive suicide attempters. Portable EEG may provide a valuable tool for clinical research and in the management of acutely suicidal patients.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, New York, USA.
| | - Julianne Mirmina
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Diane J Kim
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Marianne Rafiaa
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Jessica M Carbajal
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Faisal Akram
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Jaisy Lau
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Mason Chacko
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Alemante Tedla
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - York Teng
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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Fang Y, Tan X, Du Q, Ren Y, Mai Y, Jiang T, Zhao J. The effect of social exclusion on intertemporal choice in suicide attempters: A preliminary experimental study. J Psychiatr Res 2022; 156:62-68. [PMID: 36242945 DOI: 10.1016/j.jpsychires.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/16/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide-related theories and a growing body of evidence suggest that suicidal patients may have a tendency toward "short-sightedness"-the preference for immediate gratification when making intertemporal choice-and that social exclusion may exacerbate this tendency in suicidal patients. The present study examined the intertemporal choice performance of suicide attempters under conditions of social exclusion in a sample of affective disorder patients. METHODS A total of 64 affective disorder patients (22 non-suicidal patients, 24 single-suicide attempters and 18 multiple-suicide attempters) completed an intertemporal choice task in an exclusion or a non-exclusion condition. Social exclusion was manipulated using the Cyberball paradigm. RESULTS Non-suicidal patients and single-suicide attempters both exhibited an exaggerated preference for immediate rewards in the exclusion condition compared with the non-exclusion condition; in contrast, the multiple-suicide attempters appeared relatively indifferent to the social exclusion, exhibiting virtually identical preferences for immediate rewards in both the exclusion and non-exclusion conditions. In addition, the multiple-suicide attempters exhibited an exaggerated preference for immediate rewards compared with non-suicidal patients and single-suicide attempters in the non-exclusion condition, while the three groups did not differ in the exclusion condition. CONCLUSIONS Affective disorder patients with a single or no suicide attempts are more short-sighted after being excluded, while those with multiple suicide attempts appeared consistent short-sightedness in both exclusion and non-exclusion conditions. The study provides preliminary evidence of the role of disadvantageous intertemporal choice in the suicidal process. Future research replicate and extend these findings could have implications for suicide prevention and intervention.
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Affiliation(s)
- Yuan Fang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Zhongshan Mental Health Center, The Third People's Hospital of Zhongshan, Zhongshan, 528451, China
| | - Xiao Tan
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Qifeng Du
- Zhongshan Mental Health Center, The Third People's Hospital of Zhongshan, Zhongshan, 528451, China
| | - Yanzhen Ren
- Zhongshan Mental Health Center, The Third People's Hospital of Zhongshan, Zhongshan, 528451, China
| | - Yiling Mai
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Tingyun Jiang
- Zhongshan Mental Health Center, The Third People's Hospital of Zhongshan, Zhongshan, 528451, China.
| | - Jiubo Zhao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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14
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Bettis AH, Benningfield MM, Dao A, Dickey L, Pegg S, Venanzi L, Kujawa A. Self-injurious thoughts and behaviors and alterations in positive valence systems: A systematic review of the literature. J Psychiatr Res 2022; 156:579-593. [PMID: 36370537 PMCID: PMC9742322 DOI: 10.1016/j.jpsychires.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/20/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs), which include suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI), are prevalent and associated with impairments in functioning and elevated risk of suicide deaths. Preventing suicide is a complex problem, with numerous systems likely contributing to the onset and maintenance of SITBs, and there is a critical need to identify more precise predictors of risk. Positive valence systems (PVS) are an understudied domain with promise for improving understanding of risk processes underlying SITBs. In this systematic review, we evaluate the evidence for the potential role of altered PVS function in SI, SA, and/or NSSI, including alterations in reward responsiveness, learning, and valuation assessed through behavioral, physiological and circuit measures. Results provide preliminary support for associations between distinct aspects of PVS function and alterations in SITBs. Specifically, SI appears to be characterized by low reward responsiveness, whereas little research has examined reward responsiveness in SA, and NSSI has been characterized by hyper-responsiveness to rewards. Alterations in reward learning and valuation are commonly examined in SA, with some evidence that they may be more strongly associated with attempts than SI or NSSI. At the same time, the literature is limited in that some constructs are commonly examined in one form of SITBs but not others. Further, research is predominantly cross-sectional and focused on adults, raising questions about the role of PVS function in developmental pathways to SITBs. We conclude by integrating the research to date and highlighting promising directions for future research.
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Affiliation(s)
- Alexandra H Bettis
- Vanderbilt University Medical Center, Department of Psychiatry & Behavioral Sciences, USA.
| | | | - Anh Dao
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lindsay Dickey
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Samantha Pegg
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lisa Venanzi
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Autumn Kujawa
- Vanderbilt University, Department of Psychology and Human Development, USA
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15
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Rzeszutek MJ, DeFulio A, Sylvester GE. A Systematic Review of Behavior-Outcome Psychological Assessments as Correlates of Suicidality. Arch Suicide Res 2022; 26:1757-1793. [PMID: 35023805 DOI: 10.1080/13811118.2021.2022049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AIM Identifying correlates of suicidality is an important goal for suicide researchers because these correlates may predict suicidal behaviors. Psychological tasks that assess sensitivity to the outcomes of actions (i.e., consequence-based learning) have been commonly used by researchers seeking to identify correlates of suicidality. This is likely due to the straightforward integration of the tasks within most theoretical frameworks for understanding suicidality. Contextual factors have been shown to have a substantial effect on responding in behavior-outcome tasks. However, the direct relevance of these factors as determinants of behavior in suicide research is not clear. Thus, the purpose of this review was to assess the role of context in tasks involving behavior-outcome relations in suicide research. METHODS Four databases were searched using terms from general learning theory. Articles that featured evaluation of tasks with hypothetical or real outcomes to differentiate suicidality were included. RESULTS Eighty-two studies met inclusion criteria. Across studies there were 27 different tasks. Most instances of tasks across studies involved rewards (76.9%), while others emphasized punishment (15.7%), social (5.6%), or virtual suicide (1.8%) outcomes. Differentiation of suicidality was detected by 43.4%, 64.7%, 83.3%, and 50% of tasks featuring reward, punishment, social contexts, and virtual suicide respectively. All but five studies were retrospective. CONCLUSION Tasks that more closely mimic contexts and outcomes related to suicide appear to produce more pronounced differentiation of people with suicidality from people without suicidality. The lack of prospective designs is an important limitation of the literature.HIGHLIGHTSTasks that involve punishment or social outcomes better discriminate suicidality.Reward-based tasks are overused in suicide research.The conditioning hypothesis of suicidality is closely aligned with the literature.Only 5 of 82 studies incorporated prospective measures.
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16
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Huang S, Lewis MO, Bao Y, Adekkanattu P, Adkins LE, Banerjee S, Bian J, Gellad WF, Goodin AJ, Luo Y, Fairless JA, Walunas TL, Wilson DL, Wu Y, Yin P, Oslin DW, Pathak J, Lo-Ciganic WH. Predictive Modeling for Suicide-Related Outcomes and Risk Factors among Patients with Pain Conditions: A Systematic Review. J Clin Med 2022; 11:4813. [PMID: 36013053 PMCID: PMC9409905 DOI: 10.3390/jcm11164813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Suicide is a leading cause of death in the US. Patients with pain conditions have higher suicidal risks. In a systematic review searching observational studies from multiple sources (e.g., MEDLINE) from 1 January 2000-12 September 2020, we evaluated existing suicide prediction models' (SPMs) performance and identified risk factors and their derived data sources among patients with pain conditions. The suicide-related outcomes included suicidal ideation, suicide attempts, suicide deaths, and suicide behaviors. Among the 87 studies included (with 8 SPM studies), 107 suicide risk factors (grouped into 27 categories) were identified. The most frequently occurring risk factor category was depression and their severity (33%). Approximately 20% of the risk factor categories would require identification from data sources beyond structured data (e.g., clinical notes). For 8 SPM studies (only 2 performing validation), the reported prediction metrics/performance varied: C-statistics (n = 3 studies) ranged 0.67-0.84, overall accuracy(n = 5): 0.78-0.96, sensitivity(n = 2): 0.65-0.91, and positive predictive values(n = 3): 0.01-0.43. Using the modified Quality in Prognosis Studies tool to assess the risk of biases, four SPM studies had moderate-to-high risk of biases. This systematic review identified a comprehensive list of risk factors that may improve predicting suicidal risks for patients with pain conditions. Future studies need to examine reasons for performance variations and SPM's clinical utility.
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Affiliation(s)
- Shu Huang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Motomori O. Lewis
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Prakash Adekkanattu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lauren E. Adkins
- Health Science Center Libraries, University of Florida, Gainesville, FL 32610, USA
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32610, USA
| | - Walid F. Gellad
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Center for Health Equity Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Veterans Health Administration, Pittsburgh, PA 15240, USA
| | - Amie J. Goodin
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Yuan Luo
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jill A. Fairless
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
| | - Theresa L. Walunas
- Department of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Pengfei Yin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - David W. Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 15240, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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17
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Cáceda R, Kim DJ, Carbajal JM, Hou W. The Experience of Pain is Strongly Associated With Poor Sleep Quality and Increased Risk for Suicide. Arch Suicide Res 2022; 26:1572-1586. [PMID: 34126041 DOI: 10.1080/13811118.2021.1939208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide. METHODS Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior. RESULTS Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity. CONCLUSIONS The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk. HIGHLIGHTSWe assessed the association between pain and sleep quality in suicidal patients.Sleep quality, physical and psychological pain were associated with suicide risk.Pain perception may mediate the progression to suicidal behavior.
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18
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Baryshnikov I, Isometsä E. Psychological pain and suicidal behavior: A review. Front Psychiatry 2022; 13:981353. [PMID: 36203837 PMCID: PMC9531162 DOI: 10.3389/fpsyt.2022.981353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Despite accumulation of clinical research on risk factors for suicidal process, understanding of the mechanisms and pathways underlying the emergence of suicidal thoughts and their progression to acts is insufficient. The suicidal process has been conceptualized in multiple psychological theories that have aimed to shed light on the interplay of contributing factors. One of the central concepts included in both the cubic model of suicide and the three-step theory of suicide is psychological pain (mental pain or psychache). Over the two last decades, interest in psychological pain has increased considerably, particularly since the discovery of the complex link between the pain processing system and the neurobiology of suicide, and the putative antisuicidal effect of buprenorphine. Growing evidence supports the association between experiencing psychological pain and suicidal ideation and acts in both clinical and non-clinical samples. However, many questions related to the concept of psychological pain and its role in prediction of suicidal behavior remain to be answered in future research. In this narrative review, we have outlined the history of the concept, the definition of psychological pain, and the tools developed for its measurement, summarized the empirical research on psychological pain in relation to suicidal behavior, and suggested future directions for clinical research on psychological pain and suicidal behavior.
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Affiliation(s)
- Ilya Baryshnikov
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
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19
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Lalovic A, Wang S, Keilp JG, Bowie CR, Kennedy SH, Rizvi SJ. A qualitative systematic review of neurocognition in suicide ideators and attempters: Implications for cognitive-based psychotherapeutic interventions. Neurosci Biobehav Rev 2021; 132:92-109. [PMID: 34774586 DOI: 10.1016/j.neubiorev.2021.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Growing evidence suggests cognitive deficits may represent neurocognitive markers with predictive utility in identifying those at risk for suicide. Characterizing these deficits may offer the opportunity to develop targeted interventions. AIM The aim of this systematic qualitative review is to provide a synthesis of the published data on neurocognition in suicide ideators and attempters in order to clarify which neurocognitive targets may be most relevant to address using cognitive-based psychotherapeutic strategies in patients at risk for suicide. RESULTS A total of 63 studies met criteria for inclusion. The most consistent findings were in depressed suicide attempters, where deficits in executive subdomains of inhibition, selective attention and decision-making, as well as in working memory, were identified. In contrast, no clear pattern of neurocognitive deficits emerged from studies in suicide ideators across diagnoses. CONCLUSIONS More studies are needed to clarify the role of cognitive deficits in specific subtypes of individuals at risk for suicide. The findings are discussed in the context of promising research on cognitive remediation and other psychological interventions.
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Affiliation(s)
- Aleksandra Lalovic
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shijing Wang
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - John G Keilp
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Sakina J Rizvi
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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20
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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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21
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Sastre-Buades A, Ochoa S, Lorente-Rovira E, Barajas A, Grasa E, López-Carrilero R, Luengo A, Ruiz-Delgado I, Cid J, González-Higueras F, Sánchez-Alonso S, Baca-García E, Barrigón ML. Jumping to conclusions and suicidal behavior in depression and psychosis. J Psychiatr Res 2021; 137:514-520. [PMID: 33812324 DOI: 10.1016/j.jpsychires.2021.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99-4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.
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Affiliation(s)
- Aina Sastre-Buades
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Ana Barajas
- Centre D'Higiene Mental Les Corts, Barcelona, Spain; Departament de Psicologia Clínica I de La Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Eva Grasa
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Luengo
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Psychiatry Service, Hospital Clínico Universitario de Valencia, Spain
| | - Isabel Ruiz-Delgado
- Unidad de Salud Mental Comunitaria Málaga Norte, UGC Salud Mental Carlos Haya, Servicio Andaluz de Salud, Málaga, Spain
| | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi. Institut D'Assistència Sanitària, Girona, Spain
| | | | | | - Enrique Baca-García
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain; Department of Psychiatry, Madrid Autonomous University, Madrid, Spain; Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain; Universidad Católica Del Maule, Talca, Chile
| | - Maria L Barrigón
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain; Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain; Department of Psychiatry, Madrid Autonomous University, Madrid, Spain; Department of Psychiatry. Centre Hospitalier Universitaire de Nîmes, France.
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22
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Olié E, Husky M, Bars EL, Deverdun J, de Champfleur NM, Crespo AA, Swendsen J, Courtet P. Prefrontal activity during experimental ostracism and daily psychache in suicide attempters. J Affect Disord 2021; 285:63-68. [PMID: 33636672 DOI: 10.1016/j.jad.2021.01.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Suicidal behaviors can result from a complex interaction between social stressors and individual vulnerability. Evidence suggests a specific neural processing of social cues in suicide attempters without knowledge of how it relates to real-world experiences. OBJECTIVE To investigate the association between brain activity during experimental social exclusion (measured by functional MRI) and psychological pain in daily life (assessed by Ecological Momentary Assessment) in patients with a lifetime history of suicide attempt. METHODS Thirty-three euthymic females with a history of a major depressive episode were recruited: 13 suicide attempters and 20 affective controls (no history of suicide attempt). Functional MRI scans were acquired while participants played the Cyberball game, a validated social exclusion paradigm. After fMRI, participants completed EMA for a one-week period. Five times per day, they were asked to rate their psychological pain, hopelessness and the negativity of daily events. EMA indices (psychological pain, hopelessness and their interaction with negative events) were correlated with cerebral activations using a ROI approach (orbitofrontal, dorsal and ventrolateral prefrontal cortices, anterior cingulate cortex and insula) in each group. RESULTS We found a negative correlation between daily ratings of psychological pain and orbitofrontal activation for exclusion versus inclusion during the Cyberball game in suicide attempters but not in affective controls. We did not find correlations between cerebral activation and daily hopelessness ratings. LIMITATIONS Small sample size CONCLUSION: Scanner-based orbitofrontal activity during social exclusion relates to psychological pain in daily life which participates in suicide risk among vulnerable individuals.
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Affiliation(s)
- Emilie Olié
- IGF, Univ Montpellier, CNRS-INSERM, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
| | - Mathilde Husky
- Laboratoire de psychologie, EA4139, UNiversité de Bordeaux, Bordeaux, France
| | - Emmanuelle Le Bars
- Department 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
| | - Jeremy Deverdun
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Department 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
| | - Adrian Alacreu Crespo
- IGF, Univ Montpellier, CNRS-INSERM, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Joel Swendsen
- EPHE PSL Research University, University of Bordeaux CNRS 5287, Institut Universitaire de France
| | - Philippe Courtet
- IGF, Univ Montpellier, CNRS-INSERM, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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23
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Gilroy SP, Tucker RP, Bauer BW, Patros CHG. Contemporary methods in delayed discounting: Applications for suicidology with simulation. Suicide Life Threat Behav 2021; 51:19-26. [PMID: 33624869 DOI: 10.1111/sltb.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present an approach for integrating recently developed methods in behavioral economics into suicidology research. At present, existing applications of delay discounting in suicidology have focused predominantly on hypothetical choices related to monetary value as a proxy to "risky" choices linked to unsafe or suicidal behavior. In this report, we outline a more targeted approach that directly indexes choices related to treatment in suicide prevention initiatives and incorporates the strengths afforded by multi-level modeling. This more targeted approach precludes the need for multi-step comparisons (improving power), avoids compressing choice variability across delays into individual values (improving precision), and better accommodates decision-making at the upper and lower extremes (improving reliability). METHOD We present this analytical approach within the context of a Hypothetical Firearm Decision-making Task with simulated participants. A simulated study is provided to illustrate how this approach can be used to evaluate how individuals make temporally delayed decisions related to treatment for suicidal behavior (i.e., temporarily limiting their access to firearms while undergoing treatment). RESULTS AND CONCLUSIONS The results of this simulated study are provided to illustrate how more advanced behavioral decision-making models can be used to supplement existing research methods in suicidology.
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Affiliation(s)
| | | | - Brian W Bauer
- University of Southern Mississippi, Hattiesburg, Mississippi, USA
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24
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Kim DJ, Bartlett EA, DeLorenzo C, Parsey RV, Kilts C, Cáceda R. Examination of structural brain changes in recent suicidal behavior. Psychiatry Res Neuroimaging 2021; 307:111216. [PMID: 33129637 PMCID: PMC9227957 DOI: 10.1016/j.pscychresns.2020.111216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
We aimed to identify brain structural changes in cortical and subcortical regions linked to recent suicidal behavior. We performed secondary analyses of structural MRI data of two independent studies, namely the Establishing Moderators/Biosignatures of Antidepressant Response - Clinical Care (EMBARC) study and a Little Rock study on acute suicidal behavior. Study 1 (EMBARC, N = 187), compared individuals with remote suicide attempts (Remote-SA), individuals with lifetime suicide ideation but no attempts (Lifetime-SI only), and depressed individuals without lifetime suicide ideation or attempts (non-suicidal depressed). Study 2 (Little Rock data, N = 34) included patients recently hospitalized for suicide ideation or attempt constituted by: patients who recently attempted suicide (Recent-SA), individuals with remote suicide attempts (Remote-SA), and Lifetime-SI only. Study 3 combined the EMBARC and Little Rock datasets including Recent-SA, Remote-SA, Lifetime-SI only and non-suicidal depressed individuals. In Study 1 and Study 2, no significant differences were observed between groups. In Study 3, significantly lower middle temporal gyrus thickness, insular surface area, and thalamic volume and higher volume in the nucleus accumbens were observed in Recent-SA. This pattern of structural abnormalities may underlie pain and emotion dysregulation, which have been linked to the transition from suicidal thoughts to action.
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Affiliation(s)
- Diane J Kim
- Renaissance School of Medicine at Stony Brook University, Department of Psychiatry and Behavioral Health, Stony Brook, New York, United States.
| | - Elizabeth A Bartlett
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, United States; New York State Psychiatric Institute, Division of Molecular Imaging and Neuropathology, New York, New York, United States
| | - Christine DeLorenzo
- Renaissance School of Medicine at Stony Brook University, Department of Psychiatry and Behavioral Health, Stony Brook, New York, United States; Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Ramin V Parsey
- Renaissance School of Medicine at Stony Brook University, Department of Psychiatry and Behavioral Health, Stony Brook, New York, United States
| | - Clinton Kilts
- University of Arkansas for Medical Sciences, Psychiatric Research Institute, Little Rock, Arkansas, United States
| | - Ricardo Cáceda
- Renaissance School of Medicine at Stony Brook University, Department of Psychiatry and Behavioral Health, Stony Brook, New York, United States
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25
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Morales S, Barros J. Mental Pain Surrounding Suicidal Behaviour: A Review of What Has Been Described and Clinical Recommendations for Help. Front Psychiatry 2021; 12:750651. [PMID: 35153847 PMCID: PMC8828913 DOI: 10.3389/fpsyt.2021.750651] [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: 07/30/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To conduct a comprehensive review of scientific publications related to mental pain and suicide risk in order to deepen relevant aspects to guide clinical interventions. METHOD Using a text analysis tool, we collected the terms most frequently linked with that situation in published results of research using various tools to evaluate mental pain or psychache. DISCUSSION We propose clinical interventions for the clinical conditions most commonly associated with mental pain.
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Affiliation(s)
- Susana Morales
- Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Jorge Barros
- Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
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26
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Steep Discounting of Future Rewards as an Impulsivity Phenotype: A Concise Review. Curr Top Behav Neurosci 2020; 47:113-138. [PMID: 32236897 DOI: 10.1007/7854_2020_128] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This chapter provides an overview over the behavioral economic index of impulsivity known as delay discounting. Specifically, delay discounting refers to an individual's preference for smaller immediate rewards over a larger delayed rewards. The more precipitously an individual discounts future rewards, the more impulsive they are considered to be. First, the chapter reviews the nature of delay discounting as a psychological process and juxtaposes it with nominally similar processes, including other facets of impulsivity. Second, the chapter reviews the links between delay discounting and numerous health behaviors, including addiction, attention deficit/hyperactivity disorder, and obesity. Third, the determinants of individual variation in delay discounting are discussed, including both genetic and environmental contributions. Finally, the chapter evaluates delay discounting as a potentially modifiable risk factor and the status of clinical interventions designed to reduce delay discounting to address deficits in self-control in a variety of maladaptive behaviors.
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27
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Gibbs HM, Price D, Delgado PL, Clothier JL, Cáceda R. Buprenorphine use for pain and suicidal ideation in severely suicidal patients. Int J Psychiatry Med 2020; 55:387-396. [PMID: 32216493 DOI: 10.1177/0091217420913396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Chronic pain is frequently comorbid with opioid abuse and severe depression, a combination that greatly compounds suicide risk. In addition to the therapeutic value of buprenorphine in addiction and analgesia, growing evidence suggests potential use as an antidepressant. Data supporting buprenorphine antisuicidal properties are scarce. We aim to contribute to the discussion of buprenorphine antisuicidal potential in patients with significant psychiatric and medical comorbidity. METHODS We performed a chart review of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine in outpatient and inpatient settings in a university hospital between 2013 and 2016. RESULTS Four of the patients had an early positive response. However, only three continue to adhere to treatment for six months or longer. CONCLUSIONS More severe opioid use disorder seems to more negatively influence clinical outcome, independently of cluster b personality traits. Identification of patients who could benefit from buprenorphine will require further studies.
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Affiliation(s)
- Hunter M Gibbs
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Price
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L Clothier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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28
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Cáceda R, Carbajal JM, Salomon RM, Moore JE, Perlman G, Padala PR, Hasan A, Delgado PL. Slower perception of time in depressed and suicidal patients. Eur Neuropsychopharmacol 2020; 40:4-16. [PMID: 33004229 PMCID: PMC7655720 DOI: 10.1016/j.euroneuro.2020.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
Effective suicide prevention is hindered by a limited understanding of the natural progression and neurobiology of the suicidal process. Our objective was to characterize the duration of the suicidal process and its relation to possible determinants: time judgment and cognitive impulsivity. In four groups of adults of both sexes including recent suicide attempters (n = 57), suicidal ideators (n = 131), non-suicidal depressed controls (n = 51) and healthy controls (n = 48) we examined time estimation and production, impulsivity and other cognitive variables. Duration of the suicidal process was recorded in suicide attempters. The suicide process duration, suicide contemplation and action intervals, had a bimodal distribution, ∼40% of attempters took less than 5 min from decision to attempt. Time slowing correlated negatively with the suicidal action interval (time from the decision to kill oneself to suicide attempt) (p = .003). Individuals with suicide contemplation interval shorter than three hours showed increased time slowing, measured as shorter time production at 35 s (p = .011) and 43 s (p = .036). Delay discounting for rewards correlated with time estimation at 25 min (p = .02) and 90 s (p = .01). Time slowing correlated positively with suicidal ideation severity, independently of depression severity (p < .001). Perception of time slowing may influence both the intensity and the duration of the suicidal process. Time slowing may initially be triggered by intense psychological pain, then worsen the perception of inescapability in suicidal patients.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
| | | | - Ronald M Salomon
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jordan E Moore
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Prasad R Padala
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Geriatric Research Education and Clinical Center, North Little Rock VA Medical Center, USA
| | - Abdullah Hasan
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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29
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Lengvenyte A, Strumila R, Courtet P, Kim SYH, Olié E. "Nothing Hurts Less Than Being Dead": Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu'être mort »: La douleur psychologique dans les descriptions de cas d'euthanasie et de suicide assisté psychiatrique aux Pays-Bas. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:612-620. [PMID: 32501108 PMCID: PMC7485035 DOI: 10.1177/0706743720931237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS. METHODS An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ > 0.8 in all cases). RESULTS The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders. CONCLUSIONS Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Lithuania
| | - Robertas Strumila
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Lithuania
| | - Philippe Courtet
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Lithuania.,PSNREC, University of Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - Scott Y H Kim
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Emilie Olié
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, France.,PSNREC, University of Montpellier, INSERM, CHU de Montpellier, Montpellier, France
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30
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Cáceda R, James GA, Stowe ZN, Delgado PL, Kordsmeier N, Kilts CD. The neural correlates of low social integration as a risk factor for suicide. Eur Arch Psychiatry Clin Neurosci 2020; 270:619-631. [PMID: 30903270 PMCID: PMC6756996 DOI: 10.1007/s00406-019-00990-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022]
Abstract
Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, HSC T-10-040D, Stony Brook, NY, 11794, USA.
| | - G Andrew James
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, Madison, WI, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nolan Kordsmeier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clint D Kilts
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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31
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García-Pérez Á, Weidberg S, González-Roz A, Alonso-Pérez F, Secades-Villa R. Relationship between delay discounting and depression in cigarette smokers and non-smokers. Addict Behav 2020; 103:106251. [PMID: 31874376 DOI: 10.1016/j.addbeh.2019.106251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
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32
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Shamsaei F, Yaghmaei S, Haghighi M. Exploring the lived experiences of the suicide attempt survivors: a phenomenological approach. Int J Qual Stud Health Well-being 2020; 15:1745478. [PMID: 32223374 PMCID: PMC7172699 DOI: 10.1080/17482631.2020.1745478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Suicide is a complex phenomenon that needs to be studied with a variety of approaches. The purpose of this study is to explore the lived experience of attempted suicide with the phenomenology approach. Method: An interpretive phenomenological approach was used to analyse semi-structured, in-depth interviews with 16 participants (ages 19–57) who were recruited by means of purposive sampling from October to November 2017 at the Farshchian Psychiatric Hospital in Hamadan/Iran. Data analysis was conducted according to van Manen’s phenomenological method. Results: Identified three themes and eight subthemes: Mental pain (subthemes: living through grief, internal conflict, the world is better without me), Social challenges (lack of social connection, financial problems, social support services) and Need for love and belonging (feeling understood, need of empathy). Conclusions: Outcomes and key implications of the study related primarily to improving the treatment experiences of suicide attempt survivors and other at-risk population, and also advancing suicide prevention efforts and to provide support for suicide attempt survivors.
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Affiliation(s)
- Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Safura Yaghmaei
- Department of Nursing, School of Nursing & Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Nursing, School of Nursing & Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Haghighi
- Department of Nursing, School of Nursing & Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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33
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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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Projective Technique Testing Approach to the Understanding of Psychological Pain in Suicidal and Non-Suicidal Psychiatric Inpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010284. [PMID: 31906119 PMCID: PMC6982373 DOI: 10.3390/ijerph17010284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 01/05/2023]
Abstract
Psychological pain is a core clinical factor for understanding suicide, independently from depression. The aim of this study is to assess the role of psychological pain on suicide risk and to evaluate the relationship between psychache and different psychiatric disorders. We conducted the present cross-sectional study on 291 inpatients with a diagnosis of major depressive disorder, bipolar disorder, and schizophrenia. We administered Shneidman’s Psychological Pain Assessment Scale (PPAS) for the assessment of mental pain and the Mini International Neuropsychiatric Interview (MINI) for the assessment of suicide risk. There was a significant association between current psychache and worst-ever psychache and suicide risk in inpatients affected by a depressive disorder, bipolar disorder and schizophrenia. Furthermore, we found a significant difference in current psychache between inpatients with major depressive disorder and inpatients with schizophrenia and in worst-ever psychache between inpatients with bipolar disorder and inpatients with schizophrenia, with lower scores in inpatients with schizophrenia. The assessment of psychache appears to be useful for predicting suicidal risk and should be used routinely for identifying and treating suicide risk in clinical practice.
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Kim DJ, Blossom SJ, Delgado PL, Carbajal JM, Cáceda R. Examination of pain threshold and neuropeptides in patients with acute suicide risk. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109705. [PMID: 31326514 PMCID: PMC7309511 DOI: 10.1016/j.pnpbp.2019.109705] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION One of the main challenges in suicide prevention is the limited understanding of the biological mechanisms underlying suicide. Recent findings suggest impairments in pain processing in acutely suicidal patients. However, little is known about the biological factors that may drive these discrete physiological abnormalities. In this study, we examined plasma peptides involved in analgesic and inflammatory responses and physical pain threshold in acutely suicidal patients. METHODS Thirty-seven depressed patients of both sexes hospitalized for severe suicidal ideation or a recent suicide attempt were characterized clinically including history of suicidal ideation and behavior. Psychological and physical pain, and pressure pain threshold was also measured. Plasma levels of β-endorphin, neurotensin, agouti-related protein (AgRP), C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were run in Milliplex multiplex assays. RESULTS The number of lifetime suicide attempts was positively correlated with β-endorphin (r = 0.702; p = 0.007), and neurotensin (r = 0.728, p = 0.007) plasma levels. Higher pain threshold was measured in the suicide attempt group as compared to the suicidal ideation group. Pain threshold was strongly and negatively associated with CRP plasma levels (r = -0.548; p < 0.001). In patients reporting chronic pain, lower AgRP levels and lower pain threshold were observed (t = 4.472; p = 0.001). CONCLUSION Our results suggest that abnormalities in the opioid and neurotensin systems may underlie the increase in pain threshold found in suicide attempters, and possibly risk for suicidal behavior. Targeting pain circuits and systems may provide therapeutic mechanisms for suicide prevention.
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Affiliation(s)
- Diane J. Kim
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA
| | - Sarah J. Blossom
- Department of Pediatrics and Microbiology/Immunology, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Little Rock, Arkansas, USA
| | - Pedro L. Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jessica M. Carbajal
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA.
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Lengvenyte A, Conejero I, Courtet P, Olié E. Biological bases of suicidal behaviours: A narrative review. Eur J Neurosci 2019; 53:330-351. [PMID: 31793103 DOI: 10.1111/ejn.14635] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ismael Conejero
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France.,Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
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Bauer BW, Capron DW. How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 15:44-61. [PMID: 31697611 DOI: 10.1177/1745691619866463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people's awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention-nudges-as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
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38
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Amlung M, Marsden E, Holshausen K, Morris V, Patel H, Vedelago L, Naish KR, Reed DD, McCabe RE. Delay Discounting as a Transdiagnostic Process in Psychiatric Disorders: A Meta-analysis. JAMA Psychiatry 2019; 76:1176-1186. [PMID: 31461131 PMCID: PMC6714026 DOI: 10.1001/jamapsychiatry.2019.2102] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Delay discounting is a behavioral economic index of impulsive preferences for smaller-immediate or larger-delayed rewards that is argued to be a transdiagnostic process across health conditions. Studies suggest some psychiatric disorders are associated with differences in discounting compared with controls, but null findings have also been reported. OBJECTIVE To conduct a meta-analysis of the published literature on delay discounting in people with psychiatric disorders. DATA SOURCES PubMed, MEDLINE, PsycInfo, Embase, and Web of Science databases were searched through December 10, 2018. The psychiatric keywords used were based on DSM-IV or DSM-5 diagnostic categories. Collected data were analyzed from December 10, 2018, through June 1, 2019. STUDY SELECTION Following a preregistered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, 2 independent raters reviewed titles, abstracts, and full-text articles. English-language articles comparing monetary delay discounting between participants with psychiatric disorders and controls were included. DATA EXTRACTION AND SYNTHESIS Hedges g effect sizes were computed and random-effects models were used for all analyses. Heterogeneity statistics, one-study-removed analyses, and publication bias indices were also examined. MAIN OUTCOMES AND MEASURES Categorical comparisons of delay discounting between a psychiatric group and a control group. RESULTS The sample included 57 effect sizes from 43 studies across 8 diagnostic categories. Significantly steeper discounting for individuals with a psychiatric disorder compared with controls was observed for major depressive disorder (Hedges g = 0.37; P = .002; k = 7), schizophrenia (Hedges g = 0.46; P = .004; k = 12), borderline personality disorder (Hedges g = 0.60; P < .001; k = 8), bipolar disorder (Hedges g = 0.68; P < .001; k = 4), bulimia nervosa (Hedges g = 0.41; P = .001; k = 4), and binge-eating disorder (Hedges g = 0.34; P = .001; k = 7). In contrast, anorexia nervosa exhibited statistically significantly shallower discounting (Hedges g = -0.30; P < .001; k = 10). Modest evidence of publication bias was indicated by a statistically significant Egger test for schizophrenia and at the aggregate level across studies. CONCLUSIONS AND RELEVANCE Results of this study appear to provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined; the literature search also revealed limited studies in some disorders, notably posttraumatic stress disorder, which is a priority area for research.
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Affiliation(s)
- Michael Amlung
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Katherine Holshausen
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Morris
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Herry Patel
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Lana Vedelago
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Katherine R. Naish
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Derek D. Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas,Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas
| | - Randi E. McCabe
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Sun X, Li H, Song W, Jiang S, Shen C, Wang X. ROC analysis of three‐dimensional psychological pain in suicide ideation and suicide attempt among patients with major depressive disorder. J Clin Psychol 2019; 76:210-227. [PMID: 31576558 DOI: 10.1002/jclp.22870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Xuemei Sun
- Department of PsychologyRenmin University of ChinaBeijing China
| | - Huanhuan Li
- Department of PsychologyRenmin University of ChinaBeijing China
| | - Wei Song
- Department of PsychologyRenmin University of ChinaBeijing China
| | - Songyuan Jiang
- Department of PsychologyRenmin University of ChinaBeijing China
| | - Chengfeng Shen
- Department of PsychologyRenmin University of ChinaBeijing China
| | - Xiang Wang
- Medical Institute of PsychologySecond Xiangya Hospital of Central South UniversityChangsha China
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Jollant F, Voegeli G, Kordsmeier NC, Carbajal JM, Richard-Devantoy S, Turecki G, Cáceda R. A visual analog scale to measure psychological and physical pain: A preliminary validation of the PPP-VAS in two independent samples of depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:55-61. [PMID: 30391308 PMCID: PMC6463884 DOI: 10.1016/j.pnpbp.2018.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/25/2018] [Accepted: 10/30/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Psychological pain lies at the heart of human experience. However, it may also be abnormally intense and/or prolonged in pathological states, with negative outcomes. A simple and reliable measure of psychological pain for clinical use would be useful. In this study, we present a preliminary validation of a simple visual analog scale jointly measuring psychological and physical pain. METHODS Two samples of adult (non elderly) depressed patients and healthy controls were independently recruited in two locations in Canada and the USA (N = 46/48 and 200/20, respectively). Six dimensions were successively scored on a paper visual analog scale measuring current, mean and worst pain over the last 15 days, for physical then psychological pain. RESULTS All physical and psychological pain dimensions discriminated depressed from non-depressed subjects. Among depressed patients, psychological pain scores were higher than physical pain scores for a given period of assessment. Moreover, correlations between dimensions from the same pain category (physical or psychological) were higher than between different pain categories. Psychological pain was mainly correlated with depression and hopelessness scales while physical pain was mainly correlated with anxiety scales. Secondary analyses showed that psychological (and some physical) pain measures were correlated with suicidal ideas in one location, but no difference in pain scores was found between patients with vs. without a history of suicidal acts in both samples. Childhood trauma positively correlated with several pain dimensions. CONCLUSION The PPP-VAS appears to be a valid tool in terms of discriminative capacities and convergent-divergent validities. Validation in different samples, including adolescents and elderly, and in various psychiatric and medical conditions will have to be conducted, in addition to the assessment of concurrent and predictive validities, and the confirmation of sensitivity to change. The role of psychological pain in the suicidal process needs to be further elucidated.
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Affiliation(s)
- Fabrice Jollant
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France; CH Sainte-Anne, Clinique des Maladies Mentales et de l'Encéphale (CMME), Paris, France,; McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada.
| | - Géraldine Voegeli
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France, & CH Sainte-Anne, Clinique des Maladies Mentales et de l’ Encéphale (CMME), Paris, France
| | | | | | - Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Gustavo Turecki
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada
| | - Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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41
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Lee SM, Lee S, Kang WS, Jahng GH, Park HJ, Kim SK, Park JK. Gray Matter Volume Reductions Were Associated with TPH1 Polymorphisms in Depressive Disorder Patients with Suicidal Attempts. Psychiatry Investig 2018; 15:1174-1180. [PMID: 30602107 PMCID: PMC6318492 DOI: 10.30773/pi.2018.11.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/01/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Structural changes of brain areas have been reported in depressive disorder and suicidal behavior (SB), in which TPH1 also has been known as a promising candidate gene. We investigated gray matter volume (GMV) differences, TPH1 rs1800532 and rs1799913 polymorphisms previously found to be associated with depressive disorder and SB, and the relationship between the two markers. METHODS Thirteen depressive disorder patients with suicidal attempts (SA) and twenty healthy controls were included. We examined GMV differences using a voxel-based morphometry and regions of interest analysis. Direct sequencing was used for genotyping. RESULTS The patients showed significant GMV reduction in left cerebral region including middle frontal gyrus, inferior frontal gyrus, and anterior cingulate cortex; in right middle temporal gyrus; in left cerebellar tonsil; and in right cerebral region including precentral gyrus and postcentral gyrus (corrected p<0.005). The right precentral and postcentral gyri GMV values of AA and CA genotypes patients were significantly decreased compared to those of CC genotype subjects (corrected p=0.040). CONCLUSION These findings show the possibility that both GMV reductions and TPH1 rs1800532/rs1799913 A allele may be involved in the pathogenesis of depressive disorder patients with SA.
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Affiliation(s)
- Sang Min Lee
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Soyoen Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Won Sub Kang
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hae Jeong Park
- Department of Pharmacology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Su Kang Kim
- Department of Biomedical Laboratory Science, Catholic Kwandong University, Gangneung, Republic of Korea
| | - Jin Kyung Park
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Jauregi A, Kessler K, Hassel S. Linking Cognitive Measures of Response Inhibition and Reward Sensitivity to Trait Impulsivity. Front Psychol 2018; 9:2306. [PMID: 30546331 PMCID: PMC6279859 DOI: 10.3389/fpsyg.2018.02306] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/05/2018] [Indexed: 11/23/2022] Open
Abstract
Impulsivity is regarded as a multifaceted construct that comprises two dimensions: rapid-response impulsivity and reward-delay impulsivity. It is unclear, however, which aspects of trait impulsivity, as assessed by self-report measures are related to rapid-response impulsivity and/or to reward-delay impulsivity, as different results have been reported in studies using both self-report and cognitive measures. This study aimed to directly relate self-report measures of impulsivity to cognitive measures of impulsivity in individuals at low- or high-levels on two impulsivity dimensions, specifically rapid-response impulsivity and reward-delay impulsivity. Participants were classified into high- or low-impulsivity groups based on (1) level of rapid-response impulsivity (determined by BIS-11 Motor subscale scores); (2) level of reward-delay impulsivity (determined by BIS/BAS subscale scores); and (3) a combination of rapid-response impulsivity and reward-delay impulsivity levels. Impulsivity was assessed using Go/No-Go, Stop-Signal and Delay-Discounting tasks and self-report measures. The high rapid-response impulsivity group showed significantly higher reward-delay impulsivity on both, the Delay-Discounting tasks and on self-report measures assessing reward-delay impulsivity, than the low-risk group. Based on the level of reward-delay impulsivity, the high reward-delay impulsivity group scored significantly higher on task-based (cognitive) and self-report measures assessing rapid-response inhibition than the low reward-delay impulsivity group. Combining both dimensions of impulsivity showed that the high-impulsivity group performed significantly worse in rapid-response paradigms and temporally discounted significantly more impulsively than the low-impulsivity group. Thus, combined impulsivity factors provide better assessment of impulsivity than each dimension alone. In conclusion, robust differences in impulsivity can be identified in non-clinical young adults.
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Affiliation(s)
- Ainara Jauregi
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Klaus Kessler
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Courtet P, Olié E. [Social pain at the core of suicidal behavior]. Encephale 2018; 45 Suppl 1:S7-S12. [PMID: 30428996 DOI: 10.1016/j.encep.2018.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 08/31/2018] [Accepted: 09/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Intolerable pain is often reported in suicide notes. Moreover, the frequency of life events preceding a suicidal act is high, especially interpersonal difficulties. Such adversity is the source of psychological or social pain. METHODS We propose a narrative review to discuss the role of pain in the suicidal process while having a focus on social ties. RESULTS Using Ecological Momentary Assessment in suicide attempters it has been shown that being alone increased suicidal ideation while being with close others significantly reduced this risk. At a neuroanatomical level, suicidal vulnerability is associated with dysfunctional insula activation during social exclusion, a region involved in social and physical pain processing. Social pain elicited by social exclusion or devaluation shares common neurobiological patterns with physical pain. It is also an exemplar of psychological pain. Despite the complexity of its definition, higher psychological pain levels are associated with suicidal ideation and acts. Finally, intense physical pain or chronic pain are strong risk factors of suicidal ideation and act. Interestingly, suicide notes often report the existence of an intolerable pain. Presence of psychological pain and difficulties in communication predict the lethality and seriousness of suicide attempts. Moreover, presence of psychological pain is associated with more impulsive choices in suicidal patients, suggesting that a suicidal act is a means to escape intolerable suffering despite negative long-term consequences (i.e. death). Analgesics are usually used to get relief from pain but are also frequently involved in suicidal overdoses. It has been shown that opioid analgesics are associated with an increased risk of suicide. Higher consumption of opioid analgesics has been shown in suicidal patients in comparison to patients with history of depression but no suicidal act and healthy controls whereas non-suicidal patients were those reporting higher presence of pain in comparison to healthy controls. It may suggest that opioids are being used by suicidal patients to get relief from psychological/social pain rather than from physical pain. Involvement of opioidergic system in suicidal process opens new therapeutic strategies. Recently, the time-limited, short-term use of very low dosages of sublingual buprenorphine (vs. placebo) was associated with decreased suicidal ideation and mental pain in severely suicidal patients without substance abuse. In 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, ACT has shown its effectiveness in reducing suicidal ideation and psychological pain. Evidence indicates that maintaining contact either via letter, postcard or telephone with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Based on these results, a preventive program of recontact for suicide attempters, VIGILANS, has been developed in France in usual care. CONCLUSION The approach of the suicidal issue by the angle of pain and social disconnection offers new advances to improve clinical assessment, to identify new biological pathways involved in suicidal risk, and to propose innovative therapeutic and preventive actions.
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Affiliation(s)
- P Courtet
- Département d'urgence et post-urgence psychiatrique, université Montpellier, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - E Olié
- Département d'urgence et post-urgence psychiatrique, université Montpellier, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
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Impairment in delay discounting in schizophrenia and schizoaffective disorder but not primary mood disorders. NPJ SCHIZOPHRENIA 2018; 4:9. [PMID: 29808011 PMCID: PMC5972152 DOI: 10.1038/s41537-018-0050-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 12/26/2022]
Abstract
A measure of planning and impulse control, the delay-discounting (DD) task estimates the extent to which an individual decreases the perceived value of a reward as the reward is delayed. We examined cross-disorder performance between healthy controls (n = 88), individuals with bipolar disorder (n = 23), major depressive disorder (n = 43), and primary psychotic disorders (schizophrenia and schizoaffective disorder; n = 51) on the DD task (using a $10 delayed larger reward), as well as the interaction of DD scores with other symptom domains (cognition, psychosis, and affect). We found that individuals with schizophrenia and schizoaffective disorder display significantly greater rates of discounting compared to healthy controls, while individuals with a primary mood disorder do not differ from healthy controls after adjustment for IQ. Further, impairment in working memory is associated with higher discounting rates among individuals with schizophrenia and schizoaffective disorder, but cognitive dysfunction alone does not account for the extent of impairment in DD. Taken together, these results suggest an impaired ability to plan for the future and make adaptive decisions that are specific to individuals with psychotic disorders, and likely related to adverse functional outcomes. More generally, this work demonstrates the presence of variation in impulsivity across major psychiatric illnesses, supporting the use of a trans-diagnostic perspective. Patients with schizophrenia find it harder to delay gratification compared with patients diagnosed with other psychiatric disorders. Hannah Brown and colleagues in Roy Perlis’ lab at the Center for Quantitative Health at Massachusetts General Hospital, Boston, compared the performance of patients with bipolar disorder, major depressive disorder, schizophrenia, and healthy controls on a task that measures impulsivity. The delay discounting (DD) task assesses individuals’ ability to put off immediate pleasures for greater enjoyments later and is indicative of decision-making and planning behaviors. They found that certain aspects of cognitive dysfunction were associated with an increased preference for immediate rewards and that, even after adjusting for IQ, patients with schizophrenia showed significantly greater discounting rates compared with the other study participants. This variation in a specific measure of impulsivity suggests that the DD task could be used to better define aspects of impulsive behaviors across psychiatric disorders.
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Cáceda R, Kordsmeier NC, Golden E, Gibbs HM, Delgado PL. Differential Processing of Physical and Psychological Pain during Acute Suicidality. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:116-118. [PMID: 28183088 DOI: 10.1159/000450713] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo Cáceda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark., USA
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Xie W, Li H, Zou Y, Sun X, Shi C. A suicidal mind tends to maintain less negative information in visual working memory. Psychiatry Res 2018; 262:549-557. [PMID: 28967442 DOI: 10.1016/j.psychres.2017.09.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/20/2017] [Accepted: 09/17/2017] [Indexed: 12/17/2022]
Abstract
The motivation to avoid psychological pain may characterize a suicidal mindset. This study examines how this motivational manifestation of suicidal ideation modulates the maintenance of affective information in visual working memory (WM). Forty-five outpatients with major depressive disorder (MDD) and twenty-five healthy participants performed visual WM change localization tasks with emotional (e.g., positive or negative schematic facial expressions) and non-emotional (e.g., colors) stimuli. The number of items that participants retained in WM (i.e., capacity) for each of those stimuli was measured. Based on the Beck Scale for Suicide Ideation, MDD patients were categorized into high and low suicidal ideation groups. These two groups had comparable depression levels. In addition to showing a smaller overall WM capacity for emotionally neutral information (colors), MDD patients with high suicidal ideation retained fewer negative schematic facial stimuli in WM. This disproportional reduction in the amount of negative information held in visual WM was correlated with levels of suicidal ideation and psychological pain across participants. Together, these results reveal the impact of pain avoidance motivation on information processing in WM and provide a novel perspective to understand aberrant cognitive patterns that are potentially driven by maladaptive affective processing in individuals with higher suicide risk.
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Affiliation(s)
- Weizhen Xie
- Department of Psychology, University of California, Riverside, CA, USA; Department of Psychology, Renmin University of China, Beijing, China.
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China.
| | - Yingmin Zou
- Department of Psychology, Renmin University of China, Beijing, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xuemei Sun
- Department of Psychology, Renmin University of China, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Beijing, China
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Abstract
BACKGROUND Increased inflammation is linked to suicide risk. However, it is unclear whether increased inflammation drives suicidal crises or is a trait associated with lifetime suicidal behavior. Limited data exist on the sources of increased inflammation observed in suicidal patients and on its downstream effects. AIMS To examine factors associated with inflammation and with suicidal ideation severity in acutely suicidal depressed patients. METHODS Fifty-two adult depressed patients of both sexes hospitalized for severe suicidal ideation were characterized for suicidality, depression, anxiety, medical comorbidity, psychological and physical pain, impulsivity, verbal fluency, C-reactive protein (CRP) and interleukin (IL) 6. Two generalized linear models were performed with either CRP or suicidal ideation severity as dependent variables. RESULTS CRP levels were positively associated with age, body mass index (BMI), IL6, current physical pain and number of lifetime suicide attempts. Suicidal ideation severity was not significantly correlated with either CRP or IL6. Suicidal ideation severity was positively associated with female sex, presence of an anxiety disorder, current physical pain, number of lifetime suicide attempts and with delay discounting for medium and large losses. CONCLUSIONS Increased inflammation is not associated with acute suicidal risk, but seems to represent a trait associated with lifetime suicidal behavior.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, New York, USA
| | - W Sue T Griffin
- Donald W. Reynolds Department of Geriatrics and Institute on Aging, University of Arkansas for Medical Sciences, Geriatric Research, Education and Clinical Center, VAMC/CAVHS, Little Rock, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, USA
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Chang CC, Tzeng NS, Kao YC, Yeh CB, Chang HA. The relationships of current suicidal ideation with inflammatory markers and heart rate variability in unmedicated patients with major depressive disorder. Psychiatry Res 2017; 258:449-456. [PMID: 28886903 DOI: 10.1016/j.psychres.2017.08.076] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 07/11/2017] [Accepted: 08/27/2017] [Indexed: 10/19/2022]
Abstract
Studies investigating inflammatory status and autonomic functioning simultaneously in depressed patients with current suicidal ideation (SI) are lacking. We recruited 58 unmedicated depressed patients with current SI but without lifetime history of suicidal behavior, as well as 61 equally depressed patients without lifetime history of SI or suicidal behavior. We measured serum cortisol, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and autonomic functioning evaluated by frequency-domain measures of heart rate variability (HRV). The intensity of current SI was rated with the Columbia Suicide Severity Rating Scale. Chronic psychological stress was assessed using the Chinese version of the Perceived Stress Scale (PSS). Patients with current SI showed higher hs-CRP and ESR but lower variance (total HRV), low frequency (LF), and high frequency (HF) HRV than those without lifetime history of SI. We found no differences in cortisol levels and PSS scores. The intensity of current SI was negatively correlated with variance, LF, and HF but positively correlated with hs-CRP. Our results help improve the understanding of the relationships among current SI, inflammation, and autonomic functioning in depressed patients. The combined use of inflammatory markers and HRV indices may one day be applied in predicting and monitoring patients' suicide risk.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Carbajal JM, Gamboa JL, Moore J, Smith F, Ann Eads L, Clothier JL, Cáceda R. Response to unfairness across the suicide risk spectrum. Psychiatry Res 2017; 258:365-373. [PMID: 28888697 DOI: 10.1016/j.psychres.2017.08.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
Suicidal behavior is frequently triggered by social crises, such as familial, romantic, social or work-related conflict. A variety of cognitive and social functioning impairments has been associated with suicidal thoughts and acts. One of the precipitating and perpetuating factors of social conflict is the desire for retribution after a perceived offense, even at one's own detriment. We utilized the Ultimatum Game-a behavioral economic task which examines the behavioral response to perceived unfairness-in order to characterize the response to unfairness across the acute suicide risk spectrum. We examined five groups of adult individuals of both genders (n = 204): High- and Low-Lethality recent Suicide Attempters, Suicidal Ideators, Non-Suicidal Depressed Patients; and Healthy Controls. We also measured demographic and clinical variables. Even though all depressed groups showed similar rejection rates in the Ultimatum Game, there was a higher likelihood of rejecting offers in the low stakes condition in all acutely suicidal groups compared with healthy controls. Stake size, offer, education, and gender of the proposer were significantly associated with rejection rates. Acutely suicidal patients may be more vulnerable to adverse interpersonal interactions. Further characterization of social behavior may provide targets for secondary and tertiary prevention for high-risk individuals.
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Affiliation(s)
| | - Jorge L Gamboa
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jordan Moore
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Favrin Smith
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lou Ann Eads
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L Clothier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ricardo Cáceda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Anhedonia in Trauma-Exposed Individuals: Functional Connectivity and Decision-Making Correlates. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:959-967. [PMID: 30409390 DOI: 10.1016/j.bpsc.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reward processing deficits have been increasingly associated with trauma exposure and are a core feature of posttraumatic stress disorder (PTSD). While altered resting-state functional connectivity (rsFC) of ventral striatal regions, including the nucleus accumbens (NAcc), has been associated with anhedonia in some stress-related disorders, relationships between NAcc rsFC and anhedonia have not previously been investigated in trauma-exposed individuals. Additionally, relationships between anhedonia and reward-related decision making remain unexplored in relation to trauma exposure. We hypothesized that elevated anhedonia would be associated with altered rsFC between NAcc and default mode network regions and with increased delay discounting. METHODS The sample included 51 participants exposed to a DSM-IV PTSD Criterion A event related to community trauma. Participants completed the Clinician Administered PTSD Scale, the Snaith-Hamilton Pleasure Scale, the Beck Depression Inventory, a computerized delay discounting paradigm, and resting-state functional magnetic resonance imaging. rsFC data were analyzed in SPM12 and CONN. RESULTS Higher levels of anhedonia were associated with increased rsFC between seed regions of bilateral NAcc and areas of right dorsomedial prefrontal cortex. This relationship remained significant after accounting for Clinician Administered PTSD Scale total scores, Beck Depression Inventory total scores, or diagnostic group in the regression. Additionally, anhedonia was associated with elevated (increased) delay discounting. CONCLUSIONS Greater anhedonia was related to higher positive connectivity between NAcc and right dorsomedial prefrontal cortex and to increased delay discounting, i.e., greater preference for smaller immediate versus larger delayed rewards. These findings contribute to a growing body of literature emphasizing the importance of anhedonia in trauma-exposed individuals.
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