Laboratory measured behavioral impulsivity relates to suicide attempt history

Effect of group sand play therapy on psychopathologies of adolescents with delinquent behaviors

Prior research has established adolescent vulnerability to delinquent behavior. This single-arm, noninterventional, observational study investigated the effect of sand play therapy on the psychopathologies of adolescents with delinquent behavior. A total of 68 adolescents participated in the study. Participants were treated with 8 weekly sessions of sand play therapy, lasting 50 minutes each and conducted in groups of 3 to 4 members. The psychopathologies of depression, anxiety, self-esteem, impulsiveness, characteristics of attention-deficit hyperactivity disorder (ADHD), and impulsiveness were measured using self-reporting scales. Following therapy, depression (t = 3.28; P = .002; ES = 0.399) and anxiety (t = 4.00; P < .001; ES = 0.485) decreased significantly with moderate effect size. ADHD characteristics (t = 2.73; P = .008) and impulsiveness (t = 2.73; P = .009) also decreased significantly with effect size of 0.330 and 0.327, respectively. Self-esteem (t = -2.06, P = .043; ES = 0.251) was found to have significantly increased. The high-risk group within each psychopathology showed significantly higher improvement than the low-risk group. Results showed that group sand play therapy is effective in improving internalizing problems such as depression and anxiety, as well as externalizing problems of ADHD features and impulsiveness among adolescents with deviant behaviors.

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

Microbial Reprogramming in Obsessive-Compulsive Disorders: A Review of Gut-Brain Communication and Emerging Evidence

Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Dysbiosis, an imbalance in the gut microbial composition, has been associated with various health conditions, including mental health disorders, autism, and inflammatory diseases. While the exact mechanisms underlying OCD remain unclear, this review presents a growing body of evidence suggesting a potential link between dysbiosis and the multifaceted etiology of OCD, interacting with genetic, neurobiological, immunological, and environmental factors. This review highlights the emerging evidence implicating the gut microbiota in the pathophysiology of OCD and its potential as a target for novel therapeutic approaches. We propose a model that positions dysbiosis as the central unifying element in the neurochemical, immunological, genetic, and environmental factors leading to OCD. The potential and challenges of microbial reprogramming strategies, such as probiotics and fecal transplants in OCD therapeutics, are discussed. This review raises awareness of the importance of adopting a holistic approach that considers the interplay between the gut and the brain to develop interventions that account for the multifaceted nature of OCD and contribute to the advancement of more personalized approaches.

Hope As a Buffer to Suicide Attempts Among Adolescents with Depression

BACKGROUND

Suicide among adolescents has long been linked to symptoms of depression. However, limited research has examined the potential buffering effect of hope on the relationship between depression and suicide attempts.

METHODS

To test the effect of hope on the positive relationship between depression and suicide attempts, we used data (N = 502 adolescents) from youth ages 12-18 collected as part of the 2018 Healthy Youth Survey in the State of Washington. Based on hope theory, we hypothesized a "buffering" form of moderation, with the presence of greater hope weakening the positive relationship between depression and suicide attempts. In other words, with higher hope, adolescents reporting depressive symptoms are less inclined to attempt suicide.

RESULTS

Testing the moderating effect of hope via bootstrap resampling (N = 5000), the results indicated adolescents' hope levels indeed buffered the relationship between depressive symptoms and self-reported suicide attempts. To wit, when adolescents' hope was low, there was a significant, robust, and positive relationship between depressive symptoms and suicide attempts (b = 0.2644, 95% CI [0.1604, 0.3683], t = 5.0, p < .001). However, when adolescents' hope was high, there was no longer a significant relationship between depressive symptoms and suicide attempts (b = 0.0304, 95% CI [-0.997, 0.1605], t = 0.4590, p = .65).

CONCLUSION

The buffering effect of hope was validated in a second, larger sample (n = 9308) of adolescents. This result suggests the potential utility of hope theory-based interventions to assist depressed adolescents reduce their likelihood of suicide.

Attentional control deficits and suicidal ideation variability: An ecological momentary assessment study in major depression

Suicidal behavior is associated with deficits in cognitive control; however, suicidal ideation (SI), a key precursor to suicidal behavior, has been less consistently linked to neuropsychological functioning. Additionally, no study to date has examined attentional control capacities in relation to variability in suicidal ideation, defined as fluctuation in SI intensity and duration across short periods of time. Prior research suggests that suicidal individuals with highly variable SI experience greater stress-responsive increases in SI and cortisol, potentially raising risk for suicidal behavior. Here, we examined attentional control capacities associated with SI variability and severity in ninety-five subjects with major depressive disorder. Variability and severity of SI and depressive affect were quantified using Ecological Momentary Assessment (EMA) over a 7-day period. Participants completed the Continuous Performance Task (CPT) and a computerized Stroop task for assessment of attentional control. EMA SI variability was associated with greater attentional interference on the Stroop task, and this was not accounted for by severity of SI, concurrently assessed depressive affect, or baseline depression. CPT performance was not related to SI variability or intensity. Findings highlight the utility of EMA methods in characterizing patterned experiences of SI and suggest that attentional control deficits may contribute to these characteristic patterns.

Impulsivity, suicidal thoughts, psychological distress, and religiosity in adolescents and young adults

Background

Impulsivity is associated with suicidal acts and ideation, whereas higher religious commitment has been identified as a potential protective factor linked to lower suicidal ideation.

Objectives

We examined the extent to which higher religious commitment is associated with lower suicidal ideation and whether religious commitment modifies the relationship between impulsivity and suicidal ideation.

Methods

Adolescent and young adult males, with a prior history of suicidal act and ideations, completed standardized questionnaires [i.e., Beck Scale for Suicidal Ideation (BSS), Barratt Impulsivity Scale-II (BIS-II), Depression Anxiety Stress Scale (DASS), and Religious Commitment Inventory-10 (RCI-10)], to assess impulsivity, suicidal ideation, distress, and religious commitment. Regression and mediation analyses were performed to investigate the relationships among impulsivity, religious commitment, and suicidal ideation.

Results

Of the 747 study participants (mean age 18.8 years, SD = 4.1), 151 (20.2%) had a history of suicidal acts and 177 (23.7%) had a history of suicidal ideation. Non-planning impulsivity (predictor) was inversely associated with religious commitment (r = -0.33, p < 0.01), and religious commitment (mediator) was inversely related to suicidal ideation (outcome) (r = -0.32, p < 0.01). These findings remained statistically significant when controlling for either religious commitment or non-planning impulsivity, as appropriate. Higher religious commitment reduced the association between non-planning impulsivity and suicidal ideation (p < 0.01).

Conclusion

The findings highlight the potential for cultivating spirituality to buffer against higher suicidal ideation, and thus could be considered as an additional therapeutic strategy for individuals with higher levels of impulsivity and co-morbid suicidal ideation.

Predictors of future suicide attempts in individuals with high suicide risk admitted to an acute psychiatry suicide intervention unit in India. A survival analysis study

OBJECTIVE

Determination of suicide vulnerability remains challenging in mental illness. Variability in risk factors identified compound its poor predictability. Longitudinal studies, offering more reliable indices of risk, from developing countries are conspicuously limited. Furthermore, research advances allude to inherent vulnerability. This study, the first of its kind from India, consequently aimed to delineate factors influencing subsequent attempts in mental illness and acute suicidality.

METHOD

Baseline and follow-up information (up to five years) was obtained from medical records of individuals (n = 130) with acute suicidality [recent attempt (first attempt/ reattempt) and high-risk ideators]. Variables were compared between individuals with, and without subsequent suicide attempts. Time to attempt and factors influencing the same was determined using survival analysis, and Cox proportional hazard for estimating the likelihood of a subsequent suicide attempt.

RESULTS

Median duration of follow up of the sample (n = 130) was 23 months. The sample comprised of individuals with a recent attempt (first-time attempt), recent reattempt and recent high-risk ideators. Subsequent suicide attempts were noted in 30 (23.1 %) patients. Baseline sociodemographic and clinical variables, including suicidality, could not differentiate individuals with a subsequent suicide attempt. Survival analysis indicated that 65 % of subsequent attempts occurred within 9 months of discharge. Family history of suicide and the presence of impulsive-aggressive traits were associated with both, reduced survival time and overall increased risk of a subsequent suicide attempt.

CONCLUSION

This study delineates both, the time frame associated with greatest risk, as well as individuals most likely to reattempt suicide. It thereby offers insights into potential windows of opportunity to mitigate prospective suicide risk. Strategies such as enhanced after-care and integrating specific interventions to attenuate impulsive-aggressive behaviors could be a focus to prevent future attempts, thereby decreasing rates of suicide amongst those with mental illness. Furthermore, the findings of this study reaffirm the role of factors that independently confer vulnerability to suicide. Traversing noted regional variations, the findings importantly reinforce the distinct pathophysiological underpinnings of suicide in mental illness.

The effect of social exclusion on intertemporal choice in suicide attempters: A preliminary experimental study

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.

Cognitive effort avoidance in veterans with suicide attempt histories

Suicide attempts (SA) are increasing in the United States, especially in veterans. Discovering individual cognitive features of the subset of suicide ideators who attempt suicide is critical. Cognitive theories attribute SA to facile schema-based negative interpretations of environmental events. Over-general autobiographical memory and facile solutions in problem solving tasks in SA survivors suggest that aversion to expending cognitive effort may be a neurobehavioral marker of SA risk. In veterans receiving care for mood disorder, we compared cognitive effort discounting and evidence-gathering in a beads task between veterans with (SAHx+; n = 26) versus without (SAHx-; n = 22) a history of SA. Groups did not differ in depressed mood or in a proxy metric of premorbid intelligence. Compared to SAHx- participants, SAHx+ participants self-reported significantly more severe cognitive problems in most domains, and also eschewed choice to earn higher monetary reward if earning it required a slightly increased working memory (WM) demand relative to an easy WM task. There was no group difference, however, in extent of evidence-gathering before declaring a conclusion in a beads task. These preliminary data suggest that aversion to expenditure of cognitive effort, potentially as a component of cognitive difficulties, may be a marker for SA risk.

Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis

Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.

Distinct patterns of altered quantitative T1ρ and functional BOLD response associated with history of suicide attempts in bipolar disorder

Despite the high risk for suicide, relatively few studies have explored the relationship between suicide and brain imaging measures in bipolar disorder. In addition, fewer studies have explored the possibility that altered brain metabolism may be associated with suicide attempt. To begin to fill in these gaps, we evaluated functional (task based fMRI) and metabolic (quantitative T1ρ) differences associated with suicide attempt in participants with bipolar disorder. Thirty-nine participants with bipolar disorder underwent fMRI during a flashing checkerboard task and 27 also underwent quantitative T1ρ. The relationship between neuroimaging and history of suicide attempt was tested using multiple regression while adjusting for age, sex, and current mood state. Differences between two measures of suicide attempt (binary: yes/no and continuous: number of attempts) were quantified using the corrected Akaike Information Criterion. Participants who had attempted suicide had greater fMRI task-related activation in visual areas and the cerebellum. The number of suicide attempts was associated with a difference in BOLD response in the amygdala, prefrontal cortex, and cerebellum. Increased quantitative T1ρ was associated with number of suicide attempts in limbic, basal ganglia, and prefrontal cortex regions. This study is a secondary analysis with a modest sample size. Differences between measures of suicide history may be due to differences in statistical power. History of suicide was associated with limbic, prefrontal, and cerebellar alterations. Results comparing those with and without suicide attempts differed from results using number of suicide attempts, suggesting that these variables have different neurobiological underpinnings.

Dissociation of impulsive traits by subthalamic metabotropic glutamate receptor 4

Behavioral strategies require gating of premature responses to optimize outcomes. Several brain areas control impulsive actions, but the neuronal basis of natural variation in impulsivity between individuals remains largely unknown. Here, by combining a Go/No-Go behavioral assay with resting-state (rs) functional MRI in mice, we identified the subthalamic nucleus (STN), a known gate for motor control in the basal ganglia, as a major hotspot for trait impulsivity. In vivo recorded STN neural activity encoded impulsive action as a separable state from basic motor control, characterized by decoupled STN/substantia nigra pars reticulata (SNr) mesoscale networks. Optogenetic modulation of STN activity bidirectionally controlled impulsive behavior. Pharmacological and genetic manipulations showed that these impulsive actions are modulated by metabotropic glutamate receptor 4 (mGlu4) function in STN and its coupling to SNr in a behavioral trait-dependent manner, and independently of general motor function. In conclusion, STN circuitry multiplexes motor control and trait impulsivity, which are molecularly dissociated by mGlu4. This provides a potential mechanism for the genetic modulation of impulsive behavior, a clinically relevant predictor for developing psychiatric disorders associated with impulsivity.

The Development of Externalizing and Internalizing Behaviors Among Youth With or Without a Family History of Substance Use Disorder: The Indirect Effects of Early-Life Stress and Impulsivity

Youth with a family history of substance use disorder (FH+) are more prone to have externalizing and internalizing problems compared to youth without a family history of substance use disorder (FH-), increasing the likelihood of later maladjustment. However, mechanisms for this association remain understudied. In this longitudinal study, we examined if FH+ youth are more likely to experience early-life stressors (ELS), which in turn would increase impulsivity and the expression of externalizing and internalizing behaviors. Data were collected from youth and a parent (n = 386) during a baseline assessment (age 10-12 years) and every six months when the youth was 13-16 years old. In support of the primary hypothesis, FH+ youth reported higher levels of externalizing and internalizing behaviors through ELS to impulsivity providing a developmental pathway through which FH+ youth are more prone to externalizing and internalizing problems.

Interactions and implications of Fuzzy-Trace theory for risk taking behaviors in bipolar disorder

BACKGROUND

According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, "gist" reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, "verbatim" reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist "values" mediate the role of "categorical gist". Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships.

METHODS

Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception.

RESULTS

Mediational models indicated that (a) Gist Values mediated Categorical Gist's effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not.

LIMITATIONS

Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the inpatient generalizability of the results.

CONCLUSIONS

The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT's functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.

Relationship between impulsivity and suicide among the rural elderly in China: a case-control psychological autopsy study

Background

The relationship between impulsivity and suicide is inconsistent in different populations. Hence, the relationship between impulsivity and suicide still needs to be studied among the elderly population. The present study intends to explore the relationship between impulsivity and suicide among the rural Chinese elderly.

Methods

A case-control psychological autopsy study was conducted from February 1, 2014 to December 18, 2015 among rural residents over the age of 60 who died by suicide. The sample consisted of 242 suicides as the case group and 242 living individuals as the control group. Data on demographic characteristics, impulsivity, previous history of suicide attempts, social support, negative life events, and suicidal behavior were collected.

Results

Our study found that impulsivity increased the risk of suicide. The case group showed a higher Barratt Impulsiveness Scale score compared with the control group (p < 0.001), which indicates that impulsivity was higher among the elderly suicides. In addition, regression analyses show that impulsivity (odds ratio: 1.03, 95% confidence interval: 1.01–1.06) is an independent risk factor of suicide, after controlling for the effects of marital status, education, family annual income, being left behind, social support, and negative life events. Finally, compared with elderly who do not have a history of attempted suicide, elderly with a history of attempted suicide showed higher impulsivity (p = 0.001).

Anticipatory, Relief-Oriented and Permissive Beliefs in Patients with Suicidal Behaviors: An Exploratory Case-Control Study

OBJECTIVE

The objective is to propose a specific understanding of decision-making in suicidal behavior by using a psychometric instrument, namely the Suicidal Ambivalence Scale (SAS). The SAS, initially used in addictive disorders, allows to distinguish 3 types of thoughts: first anticipatory beliefs [A] (positive expectations regarding behavior); second relief-oriented beliefs [R] (aim to reduce the feeling of suffering) and finally, permissive beliefs [P] (authorize the passage to the act). In addictions disorders, these thoughts favor craving and the act of consumption. We make the hypothesis that the processes of suicidal thoughts function similarly to thought processes in addiction and that all thoughts [A, S and P] are significantly more present in suicidal patients.

METHODS

120 suicidal crisis patients and 161 healthy controls were compared on clinical dimensions (levels of depression, hopelessness). Anticipatory, relief-oriented and permissive beliefs were evaluated with the suicidal ambivalence scale.

RESULTS

Patients have statistically more of beliefs in favor of suicidal behavior to compared healthy controls (t = 2.375, p = 0.019, d = 0.57), more particularly, anticipatory and permissive beliefs. Conversely, patients have statistically less of protective thoughts against the suicidal behavior to compared healthy controls (t = 2.195, p = 0.03, d = 0.499).

CONCLUSION

This study showed the role of anticipatory, relief-oriented and permissive beliefs in the suicidal crisis and the need to create a simple and easy to use clinical tool for more accurate assessments of beliefs in patients with the suicidal crisis.

Reasoning, problem solving, attention/vigilance, and working memory are candidate phenotypes of non-suicidal self-injury in Chinese Han nationality

BACKGROUND

Non-suicidal self-injury (NSSI) is an act of deliberately hurting one's body without the purpose of death. Internal phenotypes have been used in numerous studies of mental disorders, suicide, and self-injury. This research aimed to evaluate the cognitive function of patients with NSSI and determine their potential endophenotype.

METHODS

This study used a comparative control design and included 61 patients with NSSI, 55 healthy siblings (HS), and 53 healthy controls. Visual learning, reasoning and problem, verbal learning, attention/vigilance, working memory, and speed of processing were used to evaluate the cognitive function of the subjects.

RESULTS

Patients with NSSI and their HS showed cognitive defects in reasoning and problem, attention/vigilance, and working memory. Substantial differences were observed in verbal learning among the three groups, but no significant difference was recorded in the scores in Brief Assessment of Cognition in Schizophrenia.

CONCLUSIONS

The results suggest that reasoning and problem, attention/vigilance, and working memory may be potential endophenotypes in early identification of Chinese Han people with NSSI behavior.

Modeling endophenotypes of suicidal behavior in animals

Suicide is a major public health concern. One of the common contributors to the increased risk for suicide is the genetic constitution of individuals, which determines certain endophenotypic traits used as quantifiable measure of neurobiological functions. Therefore, a logical deconstruction of the originating endophenotypes associated with suicidal risk could provide a better understanding of this complex disorder. In this regard, non-human animals can be a useful resource to test endophenotypes of suicidal behavior and the neurobiology underlying these endophenotypes. In this review, we have focused on the neurobiological abnormalities, primarily genetic and epigenetic abnormalities, associated with suicidal behavior and the scope of their modeling in animals. This can substantially advance the current understanding of suicidal behavior manifested with certain trait-based endophenotypes and may provide an opportunity to test novel hypotheses as well as aid in the development of treatment opportunities and risk assessment.

Disturbing Dreams and Psychosocial Maladjustment in Children: A Prospective Study of the Moderating Role of Early Negative Emotionality

Although frequent disturbing dreams, including bad dreams and nightmares, have been repeatedly associated with poor psychological well-being in adults, considerably less information exists on their psychosocial correlates in children. Recent empirical and theoretical contributions suggest that the association between disturbing dream frequency and psychosocial adaptation in children may differ as a function of children's negative emotionality. The current study assessed the moderating effect of very early negative emotionality (17 months of age) in the relation between disturbing dream frequency and psychosocial maladjustment (i.e., externalizing + internalizing behaviors) in a sample of 173 11-year-old children. Mixed-model analyses revealed that disturbing dream frequency was associated with some internalizing behaviors but that the association between disturbing dream frequency and most externalizing behaviors was moderated by early negative emotionality. The latter result indicates that the relation between disturbing dream frequency and externalizing behaviors was significant in 11-year-old children showing moderate negative emotionality early in life, but particularly strong in those children with high early negative emotionality. Whereas, a moderating effect of early negative emotionality was not found between disturbing dream frequency and internalizing behaviors, the findings highlight the more specific role of early emotional negativity as a developmental moderator for the link between disturbing dreams and externalizing behaviors in children. The results are discussed in light of recent models of disturbed dreaming production.

Impulsivity and Cognitive Flexibility as Neuropsychological Markers for Suicidality: A Multi-Modal Investigation Among Military Veterans with Alcohol Use Disorder and PTSD

To examine relations between self-report and behavioral measures of impulsivity and cognitive flexibility with suicidal ideation and self-harm and suicide attempt history. Methods: Eighty-seven military veterans who met DSM-5 diagnostic criteria for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) were evaluated for current suicidal ideation and self-harm, suicide attempt history, impulsivity, and cognitive flexibility. Results: Higher levels of self-reported impulsivity were associated with greater suicidal ideation and self-harm and lower behavioral inhibition was associated with greater likelihood of endorsing a suicide attempt. Conclusion: Use of multi-modal assessment of impulsivity and cognitive flexibility may aid in suicide screening and intervention among vulnerable and high-risk populations.

The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder

Background

Impulsivity, a core feature of bipolar disorder (BD), is a multifaceted concept encompassing failure of response inhibition and poor decision-making. Abnormalities in these two cognitive domains have been reported in BD patients but their relationship with impulsivity has not been explored.

Methods

Twenty-five remitted patients with BD completed the Barratt Impulsiveness Scale (BIS) and performed the Hayling Sentence Completion Task (HSCT) and a computerized version of the Iowa Gambling task. The HSCT total errors scaled score was used as a measure of response inhibition while the gabling task score, which reflects participants' ability to make advantageous choices, was used a measure of decision making.

Results

Higher scores on the BIS attentional and non-planning subscales were respectively associated with more errors in the HSCT and less advantageous choices in the gambling task.

Limitations

All patients were medicated. Healthy participants were not included.

Conclusions

Viewed in the context of recent relevant studies our findings suggest that impulsivity, response inhibition and decision-making in BD may represent behavioural manifestations of the same underlying biological mechanism possibly linked to ventral prefrontal cortical function.

Prevalence and predictors of suicidal ideation, plan, and attempts, in first-year college students with ADHD

Objective. The present study evaluated the prevalence of past suicidal ideation (SI), plan, and attempt in college students with ADHD (N = 102) compared to a matched control (N = 102). Predictors of SI, plan, and attempts, were examined. Participants. Study participants were first year college students at a large Southeastern university who completed measures during August or September of 2014 or January of 2015. Methods. Measures were completed by first year students via an online survey. Results. Prevalence rates for SI and related behaviors were higher among the ADHD group than the matched control, with suicide attempts rates four times higher in the ADHD group (13.7% vs. 2.9%). Results showed that ADHD predicted rates of SI and suicide attempt accounting for depression and key demographic variables. Conclusions. Findings have implications for suicide risk assessments conducted with college students with ADHD.

Are suicide attempters more impulsive than suicide ideators?

OBJECTIVE

For over 100 years impulsiveness has been cited as a key factor in why some people that think about killing themselves go on to attempt suicide. Yet prior studies are limited by not using experimental groups that can test this hypothesis and by treating impulsiveness as a unidimensional construct. To overcome these limitations, we compared suicide ideators and suicide attempters on several dimensions of impulsiveness.

METHOD

In Study 1 we compared inpatient suicide attempters who made an attempt within the prior two weeks (n = 30), current inpatient suicide ideators (n = 31), and community controls (n = 34) on several dimensions of impulsiveness using self-report and behavioral measures. In Study 2 (n = 346), we compared three similar groups based on lifetime and past year suicidal behaviors on several of the measures in Study 1.

RESULTS

In Study 1, we found only that negative urgency was clearly elevated among attempters compared with ideators. In Study 2, there were no significant differences on any impulsiveness constructs, including negative urgency.

CONCLUSIONS

Results from the two studies suggest that attempters may not have significantly elevated trait impulsiveness, compared to ideators; however, attempters may have higher impulsiveness when in a negative state.

Impulsivity and Suicidal Behavior

Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10-34 years. While many long-term risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many characteristics of suicidal behavior cut across diagnoses, but suicide is increased in recurrent psychiatric disorders, addictive disorders, and trauma-related disorders. Suicide results from the interaction of short-term and long-term behavioral regulation. The shorter the time-course of the mechanism, the closer it is to actual suicidal behavior, and the harder it is to prevent. We will discuss the manner in which impulsivity, a major determinant of short-term suicide risk, interacts with longer-term risk factors, especially sensitization to addictive or traumatic stimuli. Impulsivity predisposes to sensitization; in turn, impulsivity is a prominent component of sensitized behavior. Impulsivity can be described as a general pattern of behavior ("trait" impulsivity), as responses that are not conformed to their context (action-impulsivity), or as inability to delay reward or to take future consequences into account (choice-impulsivity). Each of these contributes to suicidal behavior. The neural mechanisms of impulsivity and sensitization are analogous, and sensitization can produce rapidly fluctuating patterns of impulsive behavior, arousal, and anhedonia. In order to recognize and prevent suicidal behavior, it is necessary to identify factors associated with susceptibility to bouts of impulsive behavior in people at elevated long-term risk.

Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample

OBJECTIVE

To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel.

METHOD

The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire.

RESULTS

All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest.

CONCLUSIONS

Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.

Risk for suicide nursing diagnosis and its related risk factors, in psychiatric settings: A descriptive study

AIM

To assess the frequency of risk for suicide nursing diagnosis and its related risk factors, in the nursing care provided in psychiatric settings.

DESIGN

This is a descriptive study.

METHODS

The samples were the documented nursing reports. These reports were evaluated and analysed in terms of using the NANDA-I risk for suicide nursing diagnosis and the risk factors related to this diagnosis.

RESULTS

From the 1,440 reports that were reviewed, 10 nursing diagnoses and 478 risk factors, were identified. Based on the results of this study, risk for suicide is used at a very low level in psychiatric settings, while, considerable number of suicide's risk factors are still existing in these settings.

Frontal Alpha Asymmetry Correlates with Suicidal Behavior in Major Depressive Disorder

Objective

Based on the constant associations made between major depressive disorder (MDD) and alpha asymmetry, and MDD and suicide, this study aimed to examine the relationship between frontal alpha asymmetry and suicide in MDD patients.

Methods

Sixty-six MDD patients, of whom fifteen were male and fifty-one were female, were recruited. Independent groups were created based on the median score of frontal alpha asymmetry: the left dominant (LD) group and the right dominant (RD) group. The alpha band (8‒12 Hz) and its sub-bands (i.e., low alpha band: 8‒10 Hz; high alpha band: 10‒12 Hz) were of interest. Source level alpha asymmetry was calculated as well.

Results

Suicidal behavior was positively correlated with the asymmetry indices of the low alpha band and the alpha band in the LD group and that of the high alpha band in the RD group. Source level analysis revealed positive correlations between suicidal behavior and the asymmetry index of the low alpha band in the LD group.

Conclusion

Frontal alpha asymmetry, especially that of the low alpha band, might reflect the cognitive deficits associated with suicidal behaviors in MDD patients.

Volume of motor area predicts motor impulsivity

Impulsivity is a personality trait associated with many maladaptive behaviors. Trait impulsivity is typically divided into three different dimensions, including attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness. In the present study, we examined the neuroanatomical basis of the multidimensional impulsivity trait. Eighty-four healthy participants were studied with structural magnetic resonance imaging. Multiple regression analyses revealed that the score of motor impulsiveness was negatively correlated with gray matter volumes of the right supplementary motor area and paracentral lobule. A machine-learning-based prediction analysis indicated that decreased gray matter volumes of the supplementary motor area and paracentral lobule strongly predicted the decrease in motor impulsiveness control. Our findings provide insights into the predictive role of motor brain structures in motor impulsivity and inhibition control.

Clinical and Psychosocial Characteristics of Young Children With Suicidal Ideation, Behaviors, and Nonsuicidal Self-Injurious Behaviors

OBJECTIVE

Based on previous findings that suicidal ideation (SI) and behavior (SB) arose in depressed preschoolers and showed stability into school age, we sought to investigate whether unique clinical and psychosocial correlates of SI/SB and nonsuicidal self-injurious behaviors (NSSI) could be identified in young children recuited into a depression treatment study and healthy controls.

METHOD

Data from 288 children 3.0 to 6.11 years of age who were recruited for participation in a psychotherapy treatment study of depression and 26 healthy control subjects (total N = 314) were used. At baseline, subjects received a comprehensive assessment of psychopathology and suicidal ideation/suicidal behavior. Multinominal logistic regressions were conducted comparing those with no SI/SB/NSSI to those with SI/SB or NSSI. Those with SI/SB who also had NSSI were placed in the SI/SB group.

RESULTS

In this sample of young children, the rates of NSSI, SI, and SB were 21.3%, 19.1%, and 3.5% respectively. Children with SI/SB or NSSI experienced a greater frequency of violent life events than children with no SI/SB/NSSI. Children with SI/SB had significantly more preoccupation with death compared to subjects with NSSI and subjects with no SI/SB/NSSI. Children with SI/SB had more vegetative signs of depression and greater depression severity, and those with NSSI were more irritable with higher depression severity than those with no SI/SB/NSSI.

CONCLUSION

Distinct characteristics of SI/SB and NSSI in early childhood were identified, informing high risk subgroups. Findings suggest that clinicians should be aware of the potential for SI/SB and/or NSSI in young children and should directly address these symptoms in clinical interviews.

CLINICAL TRIAL REGISTRATION INFORMATION

A Randomized Controlled Trial of PCIT-ED for Preschool Depression. https://clinicaltrials.gov/; NCT02076425.

The error-related negativity (ERN) is an electrophysiological marker of motor impulsiveness on the Barratt Impulsiveness Scale (BIS-11) during adolescence

Objectives

Previous studies have postulated that the error-related negativity (ERN) may reflect individual differences in impulsivity; however, none have used a longitudinal framework or evaluated impulsivity as a multidimensional construct. The current study evaluated whether ERN amplitude, measured in childhood and adolescence, is predictive of impulsiveness during adolescence.

Methods

Seventy-five children participated in this study, initially at ages 7–9 years and again at 12–18 years. The interval between testing sessions ranged from 5 to 9 years. The ERN was extracted in response to behavioural errors produced during a modified visual flanker task at both time points (i.e. childhood and adolescence). Participants also completed the Barratt Impulsiveness Scale − a measure that considers impulsiveness to comprise three core sub-traits − during adolescence.

Results

At adolescence, the ERN amplitude was significantly larger than during childhood. Additionally, ERN amplitude during adolescence significantly predicted motor impulsiveness at that time point, after controlling for age, gender, and the number of trials included in the ERN. In contrast, ERN amplitude during childhood did not uniquely predict impulsiveness during adolescence.

Conclusions

These findings provide preliminary evidence that ERN amplitude is an electrophysiological marker of self-reported motor impulsiveness (i.e. acting without thinking) during adolescence.

A behavioral and cognitive neuroscience perspective on impulsivity, suicide, and non-suicidal self-injury: Meta-analysis and recommendations for future research

We conducted a meta-analysis of neurobehavioral and neurocognitive indices of impulsivity in relation to suicidal thoughts and behaviors, as well as non-suicidal self-injury (NSSI). In our systematic review, 34 studies were identified and submitted to a random-effects meta-analysis. A small pooled effect size was observed for the association between behavioral impulsivity and NSSI (OR=1.34, p<0.05). A small-to-medium pooled effect size (OR=2.23, p<0.001) was found for the association between behavioral impulsivity and suicide attempts, and a medium-to-large pooled effect size was observed for this outcome in relation to cognitive impulsivity (OR=3.14, p<0.01). Length of time between suicide attempt and impulsivity assessment moderated the strength of the relation between impulsivity and attempts, with a large pooled effect size (OR=5.54, p<0.001) evident when the suicide attempt occurred within a month of behavioral impulsivity assessment. Studies of clinically significant NSSI temporally proximal to impulsivity assessment are needed. Longitudinal research is required to clarify the prognostic value of behavioral and cognitive impulsivity for short-term risk for self-harm.

Psychiatric phenotypes in chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder involving cognitive, motor, and psychiatrically-relevant symptoms resulting from repetitive head impacts. Psychiatric phenotypes of CTE, including depression and suicidality, present particular challenges for CTE research, given that the diagnosis requires postmortem neuropathological examination. The pathognomonic lesion of CTE is the perivascular accumulation of hyperphosphorylated tau (ptau) protein at the depths of cortical sulci. These lesions are found in the earliest disease stages, and with advancing pathological severity, ptau deposition occurs in widespread brain regions in a four-stage scheme of severity. We review the psychiatric phenotypes of individuals neuropathologically diagnosed with CTE, and suggest that earlier CTE stages hold particular interest for psychiatric CTE research. In the early CTE stages, there is ptau pathology in frontal cortex and axonal loss in the frontal white matter, followed by progressive ptau neurofibrillary degeneration in the amygdala and hippocampus. Neuropathological changes in the frontal and medial temporal lobes may underlie psychiatric phenotypes. Additional insight into the association between CTE pathology and psychiatric sequelae may come from advancements in in vivo methods of CTE detection. Further epidemiological, clinical, and postmortem studies are needed to validate the nature of psychiatric sequelae in CTE.

Impulsivity and Suicidality in Adolescent Inpatients

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19 years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

Considerations on nonclinical approaches to modeling risk factors of suicidal ideation and behavior

Given the serious nature of suicidal ideation and behavior (SIB) and the possibility of treatment-emergent SIB, pharmaceutical companies are now applying more proactive approaches in clinical trials and are considering the value of nonclinical models to predict SIB. The current review summarizes nonclinical approaches to modeling three common risk factors associated with SIB: aggression, impulsivity, and anhedonia. For each risk factor, a general description, advantages and disadvantages, species considerations, nonclinical to clinical translation, and pharmacological validation with respect to treatments associated with SIB are summarized. From this review, several gaps were identified that need to be addressed before use of these nonclinical models can be considered a viable option to predict the relative risk for SIB. Other future directions that may compliment these nonclinical approaches, including the use of selectively-bred or genetically-modified rodent models, transgenic models, gene expression profiling, and biomarker analysis, are discussed. This article was developed with the support of the DruSafe Leadership Group of the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ, www.iqconsortium.org).

Morphological connectivity correlates with trait impulsivity in healthy adults

Background

Impulsivity is one crucial personality trait associated with various maladaptive behavior and many mental disorders. In the study reported here, we investigated the relationship between impulsivity and morphological connectivity (MC) between human brain regions, a newly proposed measure for brain coordination through the development and learning.

Method

Twenty-four participants’ T1-weighted magnetic resonance imaging (MRI) images and their self-reported impulsivity scores, measured by the Barratt impulsiveness scale (BIS), were retrieved from the OpenfMRI project. First, we assessed the MC by quantifying the similarity of probability density function of local morphological features between the anterior cingulate cortex (ACC), one of the most crucial hubs in the neural network modulating cognitive control, and other association cortices in each participant. Then, we correlated the MC to impulsivity scores across participants.

Results

The BIS total score was found to correlate with the MCs between the ACC and two other brain regions in the right hemisphere: the inferior frontal gyrus (IFG), a well-established structure for inhibition control; the inferior temporal gyrus (ITG), which has been previously shown to be associated with hyperactive/impulsivity symptoms. Furthermore, the ACC-IFG MC was mainly correlated with motor impulsivity, and the ACC-ITG MC was mainly correlated with attentional impulsivity.

Discussion

Together, these findings provide evidence that the ACC, IFG, and ITG in the right hemisphere are involved neural networks modulating impulsivity. Also, the current findings highlight the utility of MC analyses in facilitating our understanding of neural correlates of behavioral and personality traits.

Motor impulsivity differentiates between psychiatric inpatients with multiple versus single lifetime suicide attempts

A history of multiple suicide attempts conveys greater risk for suicide than a single attempt. Impulsivity may partially explain the association between multiple attempts and increased risk. We examined trait impulsivity, ability to engage in goal-directed behaviors, and impulse control among psychiatrically hospitalized United States military personnel and their dependents. Individuals with a history of multiple versus single attempts had significantly higher motor impulsivity, indicating spur of the moment action. Providers are encouraged to directly assess and treat motor impulsivity among suicidal individuals. Further research should explore whether motor impulsivity is a mechanism of change in psychosocial suicide prevention interventions.

Lipids, aggression, suicidality and impulsivity in drug-naïve/drug-free patients of schizophrenia

AIM

Present study aimed at determining lipid profiles in acutely symptomatic drug-naïve/drug-free patients of schizophrenia, comparing them with healthy controls and exploring relationships between various lipid fractions, aggression, suicidality and impulsivity in this population.

MATERIALS AND METHODS

This was a cross-sectional hospital-based study, comparing patients with schizophrenia (M=46, F=14; mean age 32.40±6.6 years; 48 drug-free for 10.50±9.2 weeks) with 60 age-sex matched healthy controls. Upon recruitment, fasting venous blood samples of all subjects were analysed for total cholesterol, HDL, LDL, VLDL and TG levels, and patients were rated on PANSS for symptom severity, Modified Overt Aggression Scale for aggression, Impulsivity Rating Scale for impulsivity and Scale for Suicide Ideation for suicidality.

RESULTS

The socio-demographic characteristics of the patients were comparable to controls. In patients, total cholesterol, HDL and LDL levels were found to be significantly lower (p<0.01) than the control group. When explored further in patients, lower total cholesterol and LDL levels showed significant negative correlations with scores on impulsivity (p<0.01) and suicidality (p<0.05); and TG level showed a negative correlation with impulsivity (p<0.05).

CONCLUSIONS

This study adds to a growing literature on a complex relationship between lipid fractions and impulsivity, suicidality and aggression in schizophrenia; providing interesting insights into the biochemical basis of human behaviour and confirming these in a developing-world population. The implications are many, including a need to review judiciously the promotion of weight loss and cholesterol reduction programmes in constitutionally vulnerable population, at least during their acutely-symptomatic states.

Animal models to improve our understanding and treatment of suicidal behavior

Worldwide, suicide is a leading cause of death. Although a sizable proportion of deaths by suicide may be preventable, it is well documented that despite major governmental and international investments in research, education and clinical practice suicide rates have not diminished and are even increasing among several at-risk populations. Although nonhuman animals do not engage in suicidal behavior amenable to translational studies, we argue that animal model systems are necessary to investigate candidate endophenotypes of suicidal behavior and the neurobiology underlying these endophenotypes. Animal models are similarly a critical resource to help delineate treatment targets and pharmacological means to improve our ability to manage the risk of suicide. In particular, certain pathophysiological pathways to suicidal behavior, including stress and hypothalamic-pituitary-adrenal axis dysfunction, neurotransmitter system abnormalities, endocrine and neuroimmune changes, aggression, impulsivity and decision-making deficits, as well as the role of critical interactions between genetic and epigenetic factors, development and environmental risk factors can be modeled in laboratory animals. We broadly describe human biological findings, as well as protective effects of medications such as lithium, clozapine, and ketamine associated with modifying risk of engaging in suicidal behavior that are readily translatable to animal models. Endophenotypes of suicidal behavior, studied in animal models, are further useful for moving observed associations with harmful environmental factors (for example, childhood adversity, mechanical trauma aeroallergens, pathogens, inflammation triggers) from association to causation, and developing preventative strategies. Further study in animals will contribute to a more informed, comprehensive, accelerated and ultimately impactful suicide research portfolio.

Differential effects of cannabinoid CB1 inverse agonists and antagonists on impulsivity in male Sprague Dawley rats: identification of a possibly clinically relevant vulnerability involving the serotonin 5HT1A receptor

RATIONALE

Cannabinoid CB1 inverse agonists hold therapeutic promise as appetite suppressants but have produced suicidal behaviors among a small subpopulation in clinical trials. Anatomical and pharmacological evidence implicate the 5HT_1A serotonin receptor in suicide in humans and impulsivity in humans and animals.

OBJECTIVE

The objective of the study is to assess whether 5HT_1A blockade is necessary for CB1 ligands to produce impulsivity.

METHODS

Sprague Dawley rats were administered the CB1 inverse agonist AM 251, the CB1 antagonist AM 6527, or the peripherally restricted antagonist AM 6545, with or without pretreatment with the 5HT_1A antagonist WAY 100,635 (WAY) on the paced fixed consecutive number (FCN) task, which measures choice to terminate a chain of responses prematurely. As FCN is sensitive to changes in time perception, which have been demonstrated with CB1 blockade, a novel variable consecutive number task with discriminative stimulus (VCN-S _D ) was also performed and proposed to be less sensitive to changes in timing.

RESULTS

Pretreatment with WAY enabled mild but significant reductions in FCN accuracy for AM 251 and AM 6527. No effects were found for AM 6545. On the VCN-S _D task, substantial impairments were found for the combination of WAY and AM 251.

CONCLUSIONS

AM 251, but not the antagonists AM 6527 or AM 6545, produced impulsivity only following systemic 5HT_1A blockade. Although preliminary, the results may indicate that disrupted serotonin signaling produces a vulnerability to undesirable effects of CB1 inverse agonists, which is not evident in the general population. Furthermore, neutral CB1 antagonists do not produce this effect and therefore may have greater safety.

Personality disorder: still the patients psychiatrists dislike?

Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ). Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards personality disorder than depression, with no significant patient ethnic group effects, and the APDQ also showed a (weak) trend towards more negative attitudes to personality disorder. In subgroup analysis, only in the White British patient group were there significantly more negative attitudes to personality disorder. Factor analysis showed significantly less sense of purpose when working with personality disorder. Clinical implications The perceived greater lack of purpose in working with personality disorder should be the target of clinical training and intervention. Targeted interventions that include training in managing personality disorder, supervision and practice in non-specialist, general psychiatry settings are important.

Laboratory impulsivity and depression in blast-exposed military personnel with post-concussion syndrome

In military populations, traumatic brain injury (TBI) also holds potential to increase impulsivity and impair mood regulation due to blast injury effects on ventral frontal cortex - to put military personnel at risk for suicide or substance abuse. We assessed a linkage between depression and impaired behavioral inhibition in 117 blast-exposed service members (SM) and veterans with post-concussion syndrome (PCS), where PCS was defined using a Rivermead Postconcussive Symptom Questionnaire (RPQ) modified to clarify whether each symptom worsened compared to pre-blast. Center for Epidemiological Studies-Depression Scale (CES-D) scores, PTSD Checklist 5 (PCL-5) scores, and RPQ raw subscale scores correlated positively with commission and perseverative errors on the continuous performance test II (CPT-II). In contrast, the number of RPQ symptoms ostensibly worsened post-blast did not correlate with impulsive errors on the CPT-II. These data replicate earlier findings that link increased affective symptomatology to impaired behavior inhibition in military TBI populations, but where additional effects on impulsivity from the blast itself remain equivocal.

Are neurocognitive factors associated with repetition of self-harm? A systematic review

BACKGROUND

Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established AIMS: Identify neurocognitive factors that may predict repetition of self-harm.

METHODS

Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed.

RESULTS

7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions.

CONCLUSIONS

Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

SUBSTANCE USE AND SUICIDALITY: SPECIFICITY OF SUBSTANCE USE BY INJECTION TO SUICIDE ATTEMPTS IN A NATIONALLY REPRESENTATIVE SAMPLE OF ADULTS WITH MAJOR DEPRESSION

BACKGROUND

Although several risk factors for suicidal ideation (SI) have been identified in the research literature, there is a pressing need for studies evaluating markers of risk differentiating ideators from people who have attempted. According to the interpersonal theory of suicide, habituation to painful or provocative experiences increases one's acquired capability for suicide, a necessary component for the transition from SI to attempts. This theory further posits that the acquired capability for suicide should be unrelated to risk for SI. This study tested this theory by examining injection drug use, relative to less painful means of drug use, in relation to SI, suicide plans, and suicide attempts.

METHODS

Data were drawn from the National Survey on Drug Use and Health (NSDUH), a nationally representative survey conducted annually. Participants included 10,203 adults with a history of injectable drug use and major depression.

RESULTS

Injection drug use was positively associated with suicide attempts (Odds Ratio [OR] = 1.66, 95% confidence interval [CI] = 1.18-2.34), but not SI or suicide plans in the full sample. Injection drug use was also associated with suicide attempts (OR = 1.64, 95% CI = 1.14-2.35), but not plans, among ideators. Lastly, injection drug use was associated with the suicide attempts among suicide planners (OR = 1.76, 95% CI = 1.01-3.06). All analyses included sex, age, race/ethnicity, family income, substance use disorder symptom severity for injectable drugs, and depressive symptom severity as covariates.

CONCLUSIONS

Consistent with the interpersonal theory of suicide, injection drug use was associated with specific risk for suicide attempts but not SI or suicide plans.

Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood

OBJECTIVE

Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories.

METHOD

A total of 180 adolescents (ages 12-18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations).

RESULTS

Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes.

CONCLUSION

Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.

Predicting suicide attempts in depressed adolescents: Clarifying the role of disinhibition and childhood sexual abuse

BACKGROUND

Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality - childhood sexual abuse (CSA) and disinhibition - in predicting suicide attempts among depressed adolescents.

METHOD

Participants were 163 adolescents (125 females) aged 13-18 (M=15.60, SD=1.27) diagnosed with Major Depressive Disorder (n=95, 58.3%) and/or Dysthymia (n=69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task.

RESULTS

Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents' report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency.

LIMITATIONS

Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted.

CONCLUSIONS

Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide.