1
|
Zhu Q, Jiang G, Zheng Y, Fu Z, Zhang P, Zhang XY. The effect of cognitive impairment based on Mini-Mental State Examination (MMSE) on suicidal tendency in patients with schizophrenia: A large cross-sectional study. Schizophr Res 2024; 269:48-55. [PMID: 38729085 DOI: 10.1016/j.schres.2024.05.004] [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: 10/15/2023] [Revised: 04/27/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The effect of cognitive function on suicidal tendency in patients with schizophrenia is still inconclusive. This study aimed to explore the effect of cognitive impairment on suicidal tendency in schizophrenia patients and the risk factors of suicidal tendency in schizophrenia patients with cognitive impairment. METHODS A total of 988 subjects were recruited for this study and finally 517 patients were included in the statistical analysis. Sociodemographic information was collected for each subject. Mini-Mental State Examination (MMSE) was used to assess patients' cognitive functioning. In addition, the Positive and Negative Syndrome Scale (PANSS) positive subscale, Insomnia Severity Index (ISI), and Beck Scale for Suicide Ideation (BSI) were used to assess psychotic symptoms, severity of insomnia, and intensity of suicidal ideation, respectively. RESULTS Schizophrenia patients with cognitive dysfunction were significantly less likely to develop suicidal tendencies than those without cognitive dysfunction (P < 0.05, OR = 0.58, 95%CI: 0.39-0.81). In patients with cognitive impairment, those with suicidal tendency had substantially higher scores on BSI, ISI, EC, PD, IRI, F1, and PANSS positive subscale, and took more types of antipsychotic drugs than those without suicidal tendency (all P < 0.05), and the results of binary logistic regression analysis showed that, PANSS positive subscale score (B = 0.06, p = 0.04, OR = 1.07, 95%CI: 1.00-1.13) was a risk factor for suicidal tendencies. CONCLUSIONS Our findings suggest that schizophrenia patients with cognitive dysfunction are significantly less likely to develop suicidal tendencies. Moreover, positive symptom is a risk factor for suicidal tendencies in schizophrenia patients with cognitive dysfunction.
Collapse
Affiliation(s)
- Quanfeng Zhu
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Guojun Jiang
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Yali Zheng
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Zhengchuang Fu
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Peng Zhang
- Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
2
|
Sastre-Buades A, Caro-Cañizares I, Ochoa S, Lorente-Rovira E, Barajas A, Gutiérrez-Zotes A, Sánchez-Alonso S, López-Carrilero R, Grasa E, Pousa E, Pélaez T, Cid J, González-Higueras F, Ruiz-Delgado I, Baca-Garcia E, Barrigon ML. Relationship between cognition and suicidal behavior in recent-onset psychosis. Schizophr Res 2023; 252:172-180. [PMID: 36652834 DOI: 10.1016/j.schres.2022.12.042] [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: 03/29/2022] [Revised: 08/22/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023]
Abstract
Suicidal behavior (SB) is common in first-episode psychosis (FEP), and cognitive impairment has also been described in psychosis. Despite well-established risk factors for SB in psychosis, the role of cognition and insight remains unclear. This study aimed to explore the relationship between history of SB and cognition in recent-onset FEP, distinguishing between neurocognition, social cognition, and metacognition, and including cognitive insight (CI) as a metacognitive variable. The sample consisted of 190 participants with recent-onset FEP recruited from two multicentric studies. Two groups were formed based on presence/absence of a history of SB. Demographic, clinical, and cognitive data were compared by group, including significance level adjustments and size effect calculation. No differences were found regarding demographic, clinical, neurocognitive, social cognition, and metacognitive variables except for CI (18.18 ± 4.87; t = -3.16; p = 0.0020; d = -0.635), which showed a medium effect size. Small to medium effect size were found for attributional style (externalizing bias) (1.15 ± 3.94; t = 2.07; d = 0.482), theory of mind (ToM) (1.73 ± 0.22; t = 2.04; d = -0.403), jumping to conclusions bias (JTC) (23.3 %; X2 = 0.94; V = 0.178). In recent-onset psychosis, neurocognitive functioning was not related to the history of SB. As novelty, individuals with previous SB showed higher CI. Also, regarding social cognition and metacognition, individuals with prior SB tended to present extremely low externalizing bias, better ToM, and presence of JTC.
Collapse
Affiliation(s)
- Aina Sastre-Buades
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain
| | - Irene Caro-Cañizares
- Department of Psychology, Universidad a Distancia de Madrid (UDIMA), Collado-Villalba, 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
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Serra Húnter Programme, Goverment of Catalonia, Barcelona, Spain.
| | - Alfonso Gutiérrez-Zotes
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovirai Virgili, Reus, 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.
| | - 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, Barcelona, Spain.
| | - Esther Pousa
- 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, Barcelona, Spain; Salut Mental Parc Taulí. Sabadell (Barcelona), Hospital Universitari - UAB Universitat Autònoma de Barcelona, Barcelona, Spain; Neuropsiquiatria i Addiccions, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut d'Assistencia Sanitària, Girona, Spain
| | | | | | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Madrid Autonomous University, Madrid, Spain; Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain; Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Spain; Department of Psychiatry, Hospital General de Villalba, Madrid, Spain; Carlos III Institute of Health, Madrid, Spain; Universidad Católica del Maule, Talca, Chile; Department of Psychiatry, Nimes University Hospital, Nimes, France.
| | | | - Maria Luisa Barrigon
- Department of Psychiatry, Jimenez Diaz Foundation Hospital, Madrid, Spain; Fundación Jimenez Diaz Health Research Institute, Madrid, Spain; Department of Psychiatry, Madrid Autonomous University, Madrid, Spain; Department of Psychiatry, University Hospital Puerta de Hierro, Majadahonda, Spain.
| |
Collapse
|
3
|
Fernández-Sevillano J, González-Pinto A, Rodríguez-Revuelta J, Alberich S, Gónzalez-Blanco L, Zorrilla I, Velasco Á, López MP, Abad I, Sáiz PA. Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits. J Affect Disord 2021; 278:488-496. [PMID: 33017675 DOI: 10.1016/j.jad.2020.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/20/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide. METHOD A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. RESULTS 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included. In general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters. LIMITATIONS The number of papers included in this review is limited to the few studies using non-attempter clinically-matched control group and therefore results regarding diagnosis, symptomatology and time of the attempt are modest and contradictory. CONCLUSIONS Patients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.
Collapse
Affiliation(s)
- Jessica Fernández-Sevillano
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Ana González-Pinto
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain.
| | - Julia Rodríguez-Revuelta
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Susana Alberich
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Leticia Gónzalez-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Iñaki Zorrilla
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Ángela Velasco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - María Purificación López
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Iciar Abad
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Pilar Alejandra Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Networking Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| |
Collapse
|
4
|
Wang W, Zhou Y, Wang J, Xu H, Wei S, Wang D, Wang L, Zhang XY. Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109863. [PMID: 31931089 DOI: 10.1016/j.pnpbp.2020.109863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Previous studies have shown that cognitive impairment plays a key role in suicide, an important factor leading to premature death in schizophrenia (SCZ) patients. Empathy has received extensive attention recently; however, the relationship of empathy with suicide in schizophrenia is still unknown. The main aim of this study was to investigate the prevalence of suicide attempts and its association with empathy and other characteristics in Chinese chronic SCZ patients. METHODS The suicide attempt data, together with demographic characteristics and clinical variables were collected from 627 chronic inpatients with schizophrenia. We utilized the Positive and Negative Syndrome Scale (PANSS) for the psychopathological symptoms, and the Interpersonal Reactivity Index (IRI) for affective and cognitive empathy in this study. RESULTS We found a suicide attempt rate of 11.3% in chronic SCZ patients. Compared to non-attempters, suicide attempters were more likely to be women, had younger age and higher education levels, as well as higher positive symptoms and depressive factor score, but lower negative symptoms of PANSS (all p < .05). Moreover, after controlling the confounding factors, suicide attempters scored higher in Personal Distress subscale of IRI (F1, 455 = 5.446, p = .020) than non-attempters. CONCLUSIONS The prevalence of suicide attempt is high in chronic SCZ patients. Its risk factors include some demographic and clinical variables. Moreover, suicide attempters experienced stronger personal distress, suggesting that stronger empathy may be a risk factor of suicide.
Collapse
Affiliation(s)
- Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
5
|
Liu D, Zhou Y, Li G, He Y. The factors associated with depression in schizophrenia patients: the role of self-efficacy, self-esteem, hope and resilience. PSYCHOL HEALTH MED 2019; 25:457-469. [PMID: 31762299 DOI: 10.1080/13548506.2019.1695862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Previous studies have shown a significant correlation between depression, resilience, self-efficacy, self-esteem and hope among schizophrenia patients, but few studies have examined the mechanisms among these factors. This study aimed to analyse the relationships among resilience, self-efficacy, self-esteem and hope as influencing factors of depression in schizophrenia patients. A cross-sectional study was conducted, and 361 schizophrenia patients were recruited. They were interviewed about their self-efficacy, self-esteem, hope, resilience and depressive symptoms. A structural equation model was used to examine the direct and indirect associations between them. The global model showed good model fit and the structural equation model revealed that the direct pathway of resilience on depression was significant, and the indirect pathway of self-efficacy, self-esteem and hope on depression via resilience was also significant. Notably, self-efficacy, self-esteem and hope did not directly affect depressive symptoms. These findings support the mediating model of self-efficacy, self-esteem and hope relevant to the depressive symptoms of schizophrenia patients in China, in which resilience plays a pivotal role. These findings elucidate the factors which may be associated with depressive symptoms and imply that enhancing resilience in people with schizophrenia could be beneficial. Moreover, studies with detailed longitudinal assessments are necessary to confirm these findings.
Collapse
Affiliation(s)
- Dongwei Liu
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, Heilongjiang province, China
| | - Yuqiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, Heilongjiang province, China
| | - Guohua Li
- Judicial Expertise Center, Chifeng Anding Hospital, Chifeng, China
| | - Yudi He
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, Heilongjiang province, China
| |
Collapse
|
6
|
Aydın M, Ilhan BC, Tekdemir R, Çokünlü Y, Erbasan V, Altınbaş K. Suicide attempts and related factors in schizophrenia patients. Saudi Med J 2019; 40:475-482. [PMID: 31056625 PMCID: PMC6535170 DOI: 10.15537/smj.2019.5.24153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: To investigate the relationship between suicide attempts and demographic-clinical variables and to assess the methods used in suicide attempts by comparing schizophrenia patients with and without suicide attempts. Methods: A retrospective study with a total of 223 schizophrenia patients aged 18-65 years that were admitted to the Department of Psychiatry, Selcuk University and the Beyhekim Psychiatric Clinic Konya Training and Research Hospital, Konya, Turkey, between January 2014 and January 2018 The data collection forms created by researchers were completed using hospital medical records. Results: It was determined that 40.8% of schizophrenia patients attempted suicide at least once and that 39.6% of schizophrenia patients who attempted suicide had recurrent suicide attempts. Those with suicide attempts had a significantly longer mean duration of untreated psychosis and a higher total number of hospitalizations compared to those without suicide attempts. In addition, the use of depot antipsychotic drugs was significantly lower in those with suicide attempts. There was a statistically significant difference in the presence of traumatic life events between those with and without suicide attempts. Conclusion: Suicidal behavior is an important problem in schizophrenia. Identifying risk factors and high-risk individuals will guide us in the development of preventive interventions.
Collapse
Affiliation(s)
- Memduha Aydın
- Department of Psychiatry, Faculty of Medicine, Selçuk University, Konya, Turkey. E-mail.
| | | | | | | | | | | |
Collapse
|