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Kim S, Jang KI, Lee HS, Shim SH, Kim JS. Differentiation between suicide attempt and suicidal ideation in patients with major depressive disorder using cortical functional network. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110965. [PMID: 38354896 DOI: 10.1016/j.pnpbp.2024.110965] [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: 11/07/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
Studies exploring the neurophysiology of suicide are scarce and the neuropathology of related disorders is poorly understood. This study investigated source-level cortical functional networks using resting-state electroencephalography (EEG) in drug-naïve depressed patients with suicide attempt (SA) and suicidal ideation (SI). EEG was recorded in 55 patients with SA and in 54 patients with SI. Particularly, all patients with SA were evaluated using EEG immediately after their SA (within 7 days). Graph-theory-based source-level weighted functional networks were assessed using strength, clustering coefficient (CC), and path length (PL) in seven frequency bands. Finally, we applied machine learning to differentiate between the two groups using source-level network features. At the global level, patients with SA showed lower strength and CC and higher PL in the high alpha band than those with SI. At the nodal level, compared with patients with SI, patients with SA showed lower high alpha band nodal CCs in most brain regions. The best classification performances for SA and SI showed an accuracy of 73.39%, a sensitivity of 76.36%, and a specificity of 70.37% based on high alpha band network features. Our findings suggest that abnormal high alpha band functional network may reflect the pathophysiological characteristics of suicide and serve as a clinical biomarker for suicide.
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Affiliation(s)
- Sungkean Kim
- Department of Human-Computer Interaction, Hanyang University, Ansan, Republic of Korea
| | - Kuk-In Jang
- Cognitive Science Research Group, Korea Brain Research Institute (KBRI), Daegu, Republic of Korea
| | - Ho Sung Lee
- Department of Pulmonology and Allergy, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
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Wang Q, Wen M, Fan S, Liu J, Wang X, Guo W, Hu J, Zhang J, Li B, Zhang L, Zhang Y, Li K. Attention-Dominated Cognitive Dysfunction May Be a Biological Marker for Distinguishing SA from SI in Adolescents: A Network Analysis Study Based on Adolescent Depression. Psychol Res Behav Manag 2024; 17:945-956. [PMID: 38464812 PMCID: PMC10924855 DOI: 10.2147/prbm.s448904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Suicidal behavior is strongly correlated with depressive symptoms and the degree of suicidal ideation. Cognitive impairment may have varying degrees of influence on suicidal ideation (SI) and suicidal attempts (SA). The aim of this study was to identify the cognitive biomarkers that distinguish suicidal ideation from suicidal attempts in adolescents. Methods The cross-sectional sample comprised 54 adolescents with major depressive disorder (MDD) and 32 healthy controls (HC). The THINC-it was utilized to assess cognitive function of all the samples. Suicidal ideation was examined by the Positive and Negative Suicide Ideation Scale (PANSI). Based on the type of data, one-way ANOVA or Kruskal-Wallis was performed to investigate group differences. Bonferroni post-hoc analysis was employed for regulating type I error for pairwise comparisons. Network analysis was used to compare the networks associated with suicidal ideation, depression symptoms, and cognitive function between SA and SI. Results The depression symptoms (HAMD-17) (F=72.515, P<0.001) and suicidal ideation (PANSI) (F=267.952, P<0.001) in the SA were higher than those in the SI. Analysis of between-group differences showed SA performed worse in THINC-it, especially in "Spotter (SP)" (P=0.033), "Objective cognition score (OS)" (P=0.027) and "Composite score (CS)" (P=0.017). Compared with SI, network analysis revealed that SA had a unique network of cognitive function, depressive symptoms, and suicidal ideation. Nevertheless, both networks exhibit comparable performance concerning the node strength of cognitive function. Within their separate networks, the aspects of CS, OS, and SP have emerged as the three most crucial elements. Conclusion Adolescents with SI or SA exhibit a broad spectrum of cognitive impairments. Attention impairment can be beneficial in discerning between SI and SA. Future interventions for adolescent suicide can center on attention and the comprehensive cognitive ability that it represents.
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Affiliation(s)
- Qi Wang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Min Wen
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shaohang Fan
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jinning Liu
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Xiaowen Wang
- Psychosomatic Medicine Department, Jiangxi Provincial People's Hospital, Nanchang, People's Republic of China
| | - Wentao Guo
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Jinyun Hu
- Psychiatric Department, The Second People's Hospital of Yuxi, Yunnan, People's Republic of China
| | - Jialan Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Bing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Lili Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Yunshu Zhang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
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Ji Y, Liu X, Zheng S, Zhong Q, Zheng R, Huang J, Yin H. Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder. J Affect Disord 2023; 342:139-147. [PMID: 37714386 DOI: 10.1016/j.jad.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Depression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD). METHODS Data from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed. RESULTS 1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment. LIMITATIONS The analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed. CONCLUSIONS The Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.
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Affiliation(s)
- Yujia Ji
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Xingchang Liu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuqiong Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Quan Zhong
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Rongxin Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Jin Huang
- Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China.
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Kim S, Yoon H, Shin J, Yang CM. Classification of fNIRS signals from adolescents with MDD in suicide high- and low-risk groups using machine learning. J Affect Disord 2023; 340:379-386. [PMID: 37536425 DOI: 10.1016/j.jad.2023.07.118] [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: 02/23/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
Prefrontal cortex activation is attenuated during cognitive tasks in patients with suicidal ideation or major depressive disorder (MDD). However, the apparent relationship between patients with MDD, especially suicide high-risk (SHR) adolescents, and the characteristics of their hemodynamic responses has not yet been elucidated. To investigate this relationship, we recruited 30 patients with MDD aged 13-19. Functional near-infrared spectroscopy (fNIRS) data were collected for all patients during a Stroop test. Through a ten-time iterative leave-one-out cross-validation via 1000 iterative random search-based feature selections, we achieved a generalized classification accuracy of 70.3±5.0 % (from min. 63.3 % to max. 76.7 %). From the results of random search-based feature selection, Ch08oxy and Ch09deoxy were identified as the two most relevant fNIRS channels. This finding implies that these fNIRS channels can be used as neurological biomarkers to distinguish SHR adolescents with MDD from suicide low-risk (SLR) adolescents. In addition, we determined the oxy-Hb channels of the SHR group, except for Ch01oxy, Ch02oxy, Ch11oxy, and Ch14oxy, were hyperactivated compared to the SLR group.
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Affiliation(s)
- Seonghyeon Kim
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Haram Yoon
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Jaeyoung Shin
- Department of Electronic Engineering, Wonkwang University, Iksan 54538, Republic of Korea.
| | - Chan-Mo Yang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea.
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Ling J, Keilp JG, Galfalvy HC, Cardino VN, Ahmed A, Burke AK, Fenton JI, Mann JJ, Sublette ME. Plasma Phospholipid Polyunsaturated Fatty Acid Associations with Neurocognition. Nutrients 2023; 15:4542. [PMID: 37960195 PMCID: PMC10650577 DOI: 10.3390/nu15214542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Neurocognitive deficits are implicated in major depressive disorder (MDD) and suicidal behavior, and cognitive function may be affected by blood levels of polyunsaturated fatty acids (PUFAs). Neuroprotective functions have been described for omega-3 (n-3) PUFAs, while omega-6 (n-6) PUFAs exhibit broadly opposing activities. Both classes of PUFAs are linked to MDD and suicidal behavior. However, few studies have investigated the relationships between PUFAs and neurocognitive function with respect to MDD or suicidal behavior. Among participants with MDD (n = 45) and healthy volunteers (HV, n = 30) we assessed performance on tasks of attentional capacity and executive function and its relationship to plasma phospholipid PUFA levels, expressed as a percentage of total plasma phospholipids, for eicosapentaenoic acid (EPA%), docosahexaenoic acid (DHA%), and arachidonic acid (AA%). Regression models tested the correlations between PUFA levels and task performance in three groups: MDD with a history of suicide attempt (SA, n = 20), MDD with no attempts (NA, n = 25), and HV. Interaction testing indicated a significant positive correlation of EPA% with continuous performance test scores in the NA group (F = 4.883, df = 2,72, p = 0.01), a measure of sustained attention. The AA% correlated negatively with performance on two executive function tasks, object alternation (beta = -3.97, z-score = -2.67, p = 0.008) and the Wisconsin card sort (beta = 0.80, t-score = -2.16, df = 69, p = 0.035), after adjustment for group and age, with no group effects. Our findings suggest a role for PUFA imbalance in attentional functioning and executive performance; however, no MDD-specific effect was observed.
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Affiliation(s)
- Jinjie Ling
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - John G. Keilp
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Hanga C. Galfalvy
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, New York, NY 10032, USA
| | - Vanessa N. Cardino
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (V.N.C.); (J.I.F.)
| | - Alyina Ahmed
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Psychology Department, Barnard College, New York, NY 10027, USA
| | - Ainsley K. Burke
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Jenifer I. Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (V.N.C.); (J.I.F.)
| | - J. John Mann
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
- Department of Radiology, Columbia University, New York, NY 10027, USA
| | - M. Elizabeth Sublette
- Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY 10032, USA; (J.L.); (J.G.K.); (H.C.G.); (A.A.); (A.K.B.); (J.J.M.)
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
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Jordan JT, Chick CF, Rolle CE, Hantke N, Gould CE, Lutz J, Kawai M, Cotto I, Karna R, Pirog S, Berk M, Sudheimer K, O'Hara R, Beaudreau SA. Neurocognitive markers of passive suicidal ideation in late-life depression. Int Psychogeriatr 2023; 35:421-431. [PMID: 33118918 DOI: 10.1017/s1041610220003610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES (1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression. DESIGN Cross-sectional study. SETTING University medical school. PARTICIPANTS Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara). MEASUREMENTS Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains. RESULTS The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume. CONCLUSIONS Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychology, Dominican University of California, San Rafael, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Camarin E Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan Hantke
- Mental Health and Clinical Neuroscience Division, VA Portland Health Care System, Portland, OR, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Geriatric Research, Education, and Clinical Centers (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Julie Lutz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosy Karna
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sophia Pirog
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Berk
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Keith Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
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Rymo I, Fässberg MM, Kern S, Zetterberg H, Skoog I, Waern M, Sacuiu S. Mild cognitive impairment is associated with passive suicidal ideation in older adults: A population-based study. Acta Psychiatr Scand 2023; 148:91-101. [PMID: 36994943 DOI: 10.1111/acps.13549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To investigate the association between MCI and passive/active suicidal ideation in a population-based sample of older adults. METHOD The sample included 916 participants without dementia acquired from the two population-based studies Prospective Population Study of Women (PPSW) and the H70-study. Cognitive status was assessed using a comprehensive neuropsychiatric examination and classified according to the Winblad et al. criteria: 182 participants were classified as cognitively intact, 448 had cognitive impairment but did not fulfill MCI criteria and 286 were diagnosed with MCI. Passive/active suicidal ideation was assessed using the Paykel questions. RESULTS Passive or active suicidal ideation (any level) was reported by 16.0% of those with MCI and 1.1% of those who were cognitively intact. MCI was associated with past year life-weariness (OR 18.32, 95% CI 2.44-137.75) and death wishes (OR 5.30, 95% CI 1.19-23.64) in regression models adjusted for covariates including major depression. Lifetime suicidal ideation was reported more frequently in MCI (35.7%) than in cognitively intact participants (14.8%). MCI was associated with lifetime life-weariness (OR 2.90, 95% CI 1.67-5.05). Among individuals with MCI, impairments in memory and visuospatial ability were associated with both past year and lifetime life-weariness. CONCLUSION Our findings suggest reports of past year as well as lifetime passive suicidal ideation to be more frequent among individuals with MCI compared to those cognitively intact, indicating that individuals with MCI may constitute a high-risk group for suicidal behavior.
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Affiliation(s)
- Irma Rymo
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Addiction Disorders Clinic, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- UCL Institute of Neurology, Department of Neurodegenerative Disease, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychosis Department, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Simona Sacuiu
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health AGECAP at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
- Cognitive Disorders Clinic, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Tubbs AS, Killgore WDS, Karp JF, Fernandez FX, Grandner MA. Insomnia and the Interpersonal Theory of suicide among civilians, service members, and veterans. J Psychiatr Res 2022; 155:534-541. [PMID: 36194991 DOI: 10.1016/j.jpsychires.2022.09.043] [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: 05/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Insomnia is associated with suicide risk in civilian and military populations. Thwarted belongingness is proposed as a mediator of this relationship under the Interpersonal Theory of Suicide (IPTS). The present study explored how insomnia relates to suicidal ideation in conjunction with thwarted belongingness among civilians, Service members, and Veterans. METHODS Data from the Military Suicide Research Consortium for N = 6556 individuals (6316 with non-missing suicidal ideation status) were divided into 4 subgroups: civilians, never deployed Service members, previously deployed Service members, and Veterans. Robust Poisson models evaluated the associations between insomnia severity/subtype and current suicidal ideation, with bootstrap mediation models assessing thwarted belongingness as a mediator. RESULTS A 5-point increase in insomnia severity was associated with a 38% increased risk for current suicidal ideation among civilians, a 56% greater risk among never deployed Service members, an 83% greater risk among previously deployed Service members, and a 37% greater risk among Veterans. Moreover, active Service members showed greater associations between difficulty falling asleep and staying asleep with suicidal ideation than civilians. These associations were independent of covariates and only mediated by thwarted belongingness among Veterans. CONCLUSIONS The relationship between insomnia and suicide is not purely explained by thwarted belongingness except among Veterans. Future research should explore additional psychological and neurobiological mechanisms connecting insomnia and suicidality.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA.
| | - William D S Killgore
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, 85724, USA
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Barker J, Oakes-Rogers S, Leddy A. What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. J Psychiatr Res 2022; 154:91-101. [PMID: 35933859 DOI: 10.1016/j.jpsychires.2022.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.
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Sher L. The pathophysiology of high-lethality suicide attempts: a vital area of suicide research. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:237-238. [PMID: 35239837 PMCID: PMC9169476 DOI: 10.1590/1516-4446-2021-2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Shah J, Kandil OA, Mortagy M, Abdelhameed A, Shah A, Kuron M, Abdellatif YO. Frailty and Suicidality in Older Adults: A Mini-Review and Synthesis. Gerontology 2022; 68:571-577. [PMID: 35417914 DOI: 10.1159/000523789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
The prevalence of frailty, which is significantly associated with late-life suicidality, increases with age in older adults. This review addresses the compiled evidence on the relationship between suicidality and frailty within older populations, explores the latest findings, weighs the effectiveness of various intervention strategies, and outlines potential future investigations in this area. Growing evidence suggests that identifying and addressing risk factors, including mood disorders, prior suicide attempts, poor physical health, and social isolation/problems can decrease the risk of late-in-life suicide. Various studies have shown that interventions such as diet improvements, cognitive training, psychosocial programs, and depression medication could reduce the severity of frailty and suicidality, with physical exercise being the most effective intervention. Combined programs with multiple interventions can have an even greater impact on combating depression, lowering risk of falls, and improving gait speed in older adults.
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Affiliation(s)
- Jaffer Shah
- New York State Department of Health, New York, New York, USA.,Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Omneya A Kandil
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Mortagy
- Department of Internal Medicine, New Giza University School of Medicine, New Giza, Egypt
| | - Aya Abdelhameed
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asghar Shah
- Division of Biology and Medicine, Brown University, Providence, Rhode Island, USA
| | - Michael Kuron
- Department of Biology, University of Virginia, Charlottesville, Virginia, USA
| | - Yasser Omar Abdellatif
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
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12
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Huber RS, Sheth C, Renshaw PF, Yurgelun-Todd DA, McGlade EC. Suicide Ideation and Neurocognition Among 9- and 10-Year Old Children in the Adolescent Brain Cognitive Development (ABCD) Study. Arch Suicide Res 2022; 26:641-655. [PMID: 32985363 PMCID: PMC8004531 DOI: 10.1080/13811118.2020.1818657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE During the past decade, the pediatric suicide rate has nearly tripled. Yet, little is known about suicide behavior (SB) in children. Identification of risk factors associated with SB during childhood may be critical to preventing future attempts. The purpose of this study was to examine the relationship between neurocognitive performance and suicide ideation (SI) in children. METHOD The present study utilized baseline data from 11,875 participants in the Adolescent Brain Cognitive Development (ABCD) study, a longitudinal study that follows 9- and 10-year-old children through late adolescence to examine factors that influence developmental trajectories. Suicidality was assessed by the Kiddie Schedule for Affective Disorder and Schizophrenia (KSADS) suicide module completed by the parent. Neurocognitive ability was assessed using the NIH Toolbox Cognition measures administered to the youth. RESULTS Children with a history of SI reported by their parent or concordant parent and youth report of SI demonstrated lower performance on the NIH Toolbox Picture Sequence Memory Test compared to children without SI. The difference in performance on the memory task remained significant when including demographic characteristics, family history of suicide, and internalizing symptoms in the model as covariates. CONCLUSIONS To our knowledge, this is the first study to identify decreased episodic memory in children with SI. These findings are similar to results from adult and adolescent studies which have reported decreased memory performance among suicide attempters. Deficits in episodic memory may impact a child's ability to problem-solve and generate potential future outcomes, which may increase the risk for SB. Early identification of memory deficits in children may inform suicide prevention and intervention efforts.Highlights6% of parents and children reported a history of active suicide ideation in children.Children with a history of suicide ideation had lower episodic memory performance.Early identification of memory deficits may inform suicide intervention efforts.
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Hong C, Ding C, Zhu Y, Chen S, Zhang Y, Yuan H, Yang D. 正念干预改善抑郁个体执行功能及其神经机制. CHINESE SCIENCE BULLETIN-CHINESE 2022. [DOI: 10.1360/tb-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Barsznica Y, Noiret N, Lambert B, Monnin J, De Pinho C, Hickel J, Masse C, Richard-Devantoy S, Morgny C, Bennabi D, Haffen E, Laurent E, Vandel P, Chopard G. Saccadic Eye Movements in Elderly Depressed Patients With Suicidal Behaviors: An Exploratory Eye-Tracking Study. Front Psychol 2021; 12:712347. [PMID: 34858252 PMCID: PMC8631956 DOI: 10.3389/fpsyg.2021.712347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Suicidal behaviors (SBs) are often associated with impaired performance on neuropsychological executive functioning (EF) measures that encourage the development of more specific and reliable tools. Recent evidence could suggest that saccadic movement using eye tracking can provide reliable information on EF in depressive elderly. The aim of this study was to describe oculomotor performances in elderly depressed patients with SB. To achieve this aim, we compared saccadic eye movement (SEM) performances in elderly depressed patients (N = 24) with SB and with no SB in prosaccade (PS) and antisaccade (AS) tasks under the gap, step, and overlap conditions. All participants also underwent a complete neuropsychological battery. Performances were impaired in patients with SB who exhibited less corrected AS errors and longer time to correct them than patients with no SB. Moreover, both groups had a similar performance for PS latencies and correct AS. These preliminary results suggested higher cognitive inflexibility in suicidal patients compared to non-suicidal. This inflexibility may explain the difficulty of the depressed elderly in generating solutions to the resurgence of suicidal ideation (SI) to respond adequately to stressful environments. The assessment of eye movement parameters in depressed elderly patients may be a first step in identifying high-risk patients for suicide.
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Affiliation(s)
- Yoan Barsznica
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Department of Neurology, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
- Memory Center of Research and Resources (CMRR), Besançon University Hospital, Besançon, France
| | - Nicolas Noiret
- UMR CNRS 7295 “Research Centre on Cognition and Learning,” University of Poitiers, Poitiers, France
| | | | - Julie Monnin
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
- Memory Center of Research and Resources (CMRR), Besançon University Hospital, Besançon, France
| | - Claire De Pinho
- Department of Old Age Psychiatry, Association Hospitalière de Bourgogne Franche-Comté Hospital, Bavilliers, France
| | - Julia Hickel
- Department of Old Age Psychiatry, Association Hospitalière de Bourgogne Franche-Comté Hospital, Bavilliers, France
| | - Caroline Masse
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | - Stephane Richard-Devantoy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Cynthia Morgny
- Regional Health Observatory, Bourgogne-Franche-Comté, France
| | - Djamila Bennabi
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | - Eric Laurent
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | - Pierre Vandel
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
- Memory Center of Research and Resources (CMRR), Besançon University Hospital, Besançon, France
- Regional Health Observatory, Bourgogne-Franche-Comté, France
| | - Gilles Chopard
- Department of Clinical Psychiatry, Besançon University Hospital, Besançon, France
- Department of Neurology, Besançon University Hospital, Besançon, France
- Laboratory of Neurosciences and Cognitive Psychology, University of Bourgogne Franche-Comté, Besançon, France
- Memory Center of Research and Resources (CMRR), Besançon University Hospital, Besançon, France
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15
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Lalovic A, Wang S, Keilp JG, Bowie CR, Kennedy SH, Rizvi SJ. A qualitative systematic review of neurocognition in suicide ideators and attempters: Implications for cognitive-based psychotherapeutic interventions. Neurosci Biobehav Rev 2021; 132:92-109. [PMID: 34774586 DOI: 10.1016/j.neubiorev.2021.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Growing evidence suggests cognitive deficits may represent neurocognitive markers with predictive utility in identifying those at risk for suicide. Characterizing these deficits may offer the opportunity to develop targeted interventions. AIM The aim of this systematic qualitative review is to provide a synthesis of the published data on neurocognition in suicide ideators and attempters in order to clarify which neurocognitive targets may be most relevant to address using cognitive-based psychotherapeutic strategies in patients at risk for suicide. RESULTS A total of 63 studies met criteria for inclusion. The most consistent findings were in depressed suicide attempters, where deficits in executive subdomains of inhibition, selective attention and decision-making, as well as in working memory, were identified. In contrast, no clear pattern of neurocognitive deficits emerged from studies in suicide ideators across diagnoses. CONCLUSIONS More studies are needed to clarify the role of cognitive deficits in specific subtypes of individuals at risk for suicide. The findings are discussed in the context of promising research on cognitive remediation and other psychological interventions.
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Affiliation(s)
- Aleksandra Lalovic
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shijing Wang
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - John G Keilp
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Sakina J Rizvi
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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16
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Roy JC, Houvenaghel JF, Duprez J, Guillery M, Drapier D, Robert G. Dynamics of cognitive action control in late-life depression during action selection. J Psychiatr Res 2021; 143:276-284. [PMID: 34530338 DOI: 10.1016/j.jpsychires.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Late-Life Depression (LLD) is characterized by deficits in cognitive control. We investigated the effect of LLD on a subset of cognitive control functions, the Cognitive Action Control (CAC), distinguishing on-line and adaptive control. METHODS We compared LLD subjects (n = 31) and Healthy Controls (HC, n = 31) on their performance in a Simon task. The online congruency effect and adaptive effect were compared for reaction times (RT) and accuracy rates between the groups using mixed models. We applied distributional analyses of RT to differentiate the strength of impulsive action selection and the proficiency of selective action suppression. Finally, we measured correlations between the performances on the task and clinical scores of the LLD group. RESULTS LLD had increased error rates in congruent trials compared to HC. Conversely, the adaptive CAC was equivalent between the groups. Distributional analyses showed that the fastest actions were less led by pertinent information in LLD. This phenomenon was found exclusively for congruent trials preceded by non-congruent trials. On the other hand, LLD patients, when they take time, were better than HC to suppress selectively non-relevant information. No difference was observed for adaptation to the preceding condition. No association between behavioral measurements and clinical scores were found. CONCLUSION Our results suggest that LLD participants have a specific cognitive disturbance of CAC, showing less facilitation than HC in congruent situations. We propose that this originates in a difficulty in LLD patients in disengaging their attention from conflict situations, which is consistent with a biased CAC to aversive stimuli in depression.
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Affiliation(s)
- Jean-Charles Roy
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France; Université Rennes 1, Campus Santé de Villejean, France.
| | - Jean-François Houvenaghel
- Neurology Department, Rennes University Hospital, Rennes, France; Behavior and Basal Ganglia Research Unit (EA4712), Université Rennes 1, Rennes, France
| | - Joan Duprez
- Univ Rennes, INSERM, LTSI -U1099, F-35000 Rennes, France
| | - Murielle Guillery
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France; Behavior and Basal Ganglia Research Unit (EA4712), Université Rennes 1, Rennes, France
| | - Dominique Drapier
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France; Université Rennes 1, Campus Santé de Villejean, France; Behavior and Basal Ganglia Research Unit (EA4712), Université Rennes 1, Rennes, France
| | - Gabriel Robert
- Academic Psychiatry Department, Centre Hospitalier Guillaume Régnier, Rennes, France; Université Rennes 1, Campus Santé de Villejean, France; Behavior and Basal Ganglia Research Unit (EA4712), Université Rennes 1, Rennes, France
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17
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Richard-Devantoy S, Badillo-Amberg I, Greenway KT, Tomasso MD, Turecki G, Bertrand JA. Low MoCA performances correlate with suicidal ideation in late-life depression. Psychiatry Res 2021; 301:113957. [PMID: 33962353 DOI: 10.1016/j.psychres.2021.113957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Late-life depression remains an underdiagnosed clinical entity, mainly because the presence of cognitive impairment in the elderly leads clinicians to suspect dementia rather than depression. Our objective was to analyze the cognitive abilities of elderly depressed patients using the Montreal Cognitive Assessment (MoCA) in relation to the presence or absence of suicidal ideation. The MoCA, Beck Scale of Suicidal Ideation, Hamilton Anxiety Scale, and Hamilton Depression Scale were administered to 72 patients with a recent history of late life depression: 43 with suicidal ideation and 29 non-suicidal controls. The results show that suicidal patients demonstrated significantly worse performance on the MoCA total score and the delayed recall subtest in comparison to non-suicidal controls. In addition, after adjusting for age and depression, poorer performance on the MoCA total score correlated to the presence of suicidal ideation. We found that the MoCA total score is able to predict the presence of suicidal ideation in depressed elderly patients in a fair-to-good manner. As late-life depression is already established as a potential prodrome of dementia, longitudinal follow-up may determine whether depressed individuals with suicidal ideation are at higher risk of converting to dementia.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada.
| | - Icoquih Badillo-Amberg
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Kyle T Greenway
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Maria Di Tomasso
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - J A Bertrand
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada; Douglas Research Center, Douglas Mental Health Research Institute, Montréal, Québec, Canada; Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
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18
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Dombrovski AY, Hallquist MN. Search for solutions, learning, simulation, and choice processes in suicidal behavior. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 13:e1561. [PMID: 34008338 PMCID: PMC9285563 DOI: 10.1002/wcs.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value‐based choices. Can individual‐level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case–control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision‐making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood‐congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case–control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real‐time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under:Economics > Individual Decision‐Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior
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Affiliation(s)
| | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
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19
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Oh DJ, Han JW, Bae JB, Kim TH, Kwak KP, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Executive dysfunction and risk of suicide in older adults: a population-based prospective cohort study. J Neurol Neurosurg Psychiatry 2021; 92:528-533. [PMID: 33563806 DOI: 10.1136/jnnp-2020-324390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE It is uncertain what factors increases the risk of suicide in older adults without depression, and it is unknown whether executive dysfunction (ED) is one of those factors. We aimed to examine the effect of ED on the risk of suicide in non-demented older adults without depression. METHODS In an ongoing population-based prospective cohort of Korean older adults, we identified suicide using the National Mortality Database and suicidal ideation or attempt (SIA) based on the Korean version of the Mini International Neuropsychiatric Interview. We defined ED as performing below -1.5 SD of age-adjusted, gender-adjusted and education-adjusted norms in any of following tests: Frontal Assessment Battery, Trail Making Test A, Digit Span Test or Verbal Fluency Test. RESULTS The mean age of the 4791 participants at baseline was 69.7 (SD 6.4) years, and 57.1% of them were women (mean follow-up duration=4.9 years). ED at baseline increased the risk of suicide by about seven times (HR 7.20, 95% CI 1.84 to 28.12, p=0.005) but did not change the risk of SIA. However, cognitive impairment without ED did not change the risks of suicide and SIA. In participants with ED, being aged 75 years or above, living alone, and having a low socioeconomic status were associated with the risk of suicide. CONCLUSION ED is a strong risk factor of late life suicide independent from depression, particularly in very old adults living in disadvantaged environments.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea (the Republic of)
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea (the Republic of)
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea (the Republic of)
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea (the Republic of)
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (the Republic of)
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea (the Republic of)
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea (the Republic of)
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea (the Republic of)
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea (the Republic of)
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea (the Republic of)
| | - Dong Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea (the Republic of)
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea (the Republic of)
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea (the Republic of)
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea (the Republic of)
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea (the Republic of) .,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of).,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea (the Republic of)
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20
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Santamarina-Perez P, Mendez I, Eiroa-Orosa FJ, Singh MK, Gorelik A, Picado M, Font E, Moreno E, Martínez E, Morer A, Cordovilla C, Romero S. Visual memory improvement in adolescents at high risk for suicide who are receiving psychotherapy at a community clinic. Psychiatry Res 2021; 298:113796. [PMID: 33609921 DOI: 10.1016/j.psychres.2021.113796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/06/2021] [Indexed: 01/09/2023]
Abstract
The current study aims to: 1) investigate cognitive differences among adolescents at risk for suicide versus healthy controls (HC) and 2) identify cognitive changes associated with response to psychotherapy among adolescents at high risk for suicide. Thirty-five adolescents at high risk for suicide (HR), and 14 HC adolescents were recruited. Clinical and cognitive assessments were conducted in both groups at baseline and 16 weeks later (after the patients completed psychotherapy). HR and HC adolescents were compared at baseline and at completion of the study. We also conducted further analysis by separating into two groups the HR adolescents who responded to psychotherapy (n=17) and those who did not (n=11). At baseline, the HR group had significantly lower performance on verbal memory and processing speed than the HC group. At week 16, HR adolescents performed as well as HC adolescents in all cognitive domains. Among patients, better performance on visual memory was observed in those who responded to psychotherapy compared to those who did not. We concluded that lower performance on verbal memory and processing speed may be associated with a high risk for suicide among adolescents. Improvement in visual memory might be related to a lower risk for suicide in adolescents.
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Affiliation(s)
- Pilar Santamarina-Perez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain.
| | - Iria Mendez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Francisco José Eiroa-Orosa
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Aaron Gorelik
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Marisol Picado
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Elena Font
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Elena Moreno
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Esteve Martínez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Cordovilla
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Institute d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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21
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Macintyre VG, Mansell W, Pratt D, Tai SJ. The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness. Front Psychol 2021; 12:588683. [PMID: 33815194 PMCID: PMC8012495 DOI: 10.3389/fpsyg.2021.588683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives This paper aims to identify potential areas for refinement in existing theoretical models of suicide, and introduce a new integrative theoretical framework for understanding suicide, that could inform such refinements. Methods Literature on existing theoretical models of suicide and how they contribute to understanding psychological processes involved in suicide was evaluated in a narrative review. This involved identifying psychological processes associated with suicide. Current understanding of these processes is discussed, and suggestions for integration of the existing literature are offered. Results Existing approaches to understanding suicide have advanced the current knowledge of suicide in various ways. They have guided valuable research in the following areas: motivations for suicide and the psychological distress which influences suicide attempts; ambivalence about suicide; suicidal individuals’ focus of attention; and ways in which individuals who contemplate suicide differ from individuals who attempt suicide. We outline a new theoretical framework as a means to integrating all of these concepts into the three principles of control, conflict, and awareness. Within this framework, suicide is regarded as occurring due to a long standing conflict between an individual’s personal goals, culminating in an episode of acute loss of control. The new framework posits that the individual then strives to regain control through the means of suicide because of a narrowed awareness of consequences of their actions on other valued goals. This psychological mechanism of limited awareness is posited to be the common pathway by which individuals make a suicide attempt, regardless of which risk factors are present. Conclusion This article introduces a theoretical framework that generates several hypotheses for future research, and focuses on psychological processes occurring during immediate crisis. One of the key hypotheses resulting from our predictions on how individuals progress from contemplating to attempting suicide will be tested in an ongoing program of research: Individuals who attempt suicide have a significantly reduced awareness of consequences of suicide, which would negatively impact on their important life goals, values, principles, or ideals, compared to individuals who contemplate suicide. Therapy guided by the new framework may be more flexible, immediate, and client-focused than other therapies for suicidal individuals.
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Affiliation(s)
- Vanessa G Macintyre
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Warren Mansell
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sara J Tai
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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22
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Richard-Devantoy S, Orri M, Bertrand JA, Greenway KT, Turecki G, Gunnell D, Power C, Geoffroy MC. Childhood cognitive skill trajectories and suicide by mid-adulthood: an investigation of the 1958 British Birth Cohort. Psychol Med 2021; 51:400-407. [PMID: 31736461 DOI: 10.1017/s0033291719003143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Poor cognitive abilities and low intellectual quotient (IQ) are associated with an increased risk of suicide attempts and suicide mortality. However, knowledge of how this association develops across the life-course is limited. Our study aims to establish whether individuals who died by suicide by mid-adulthood are distinguishable by their child-to-adolescence cognitive trajectories. METHODS Participants were from the 1958 British Birth Cohort and were assessed for academic performance at ages 7, 11, and 16 and intelligence at 11 years. Suicides occurring by September 2012 were identified from linked national death certificates. We compared mean mathematics and reading abilities and rate of change across 7-16 years for individuals who died by suicide v. those still alive, with and without adjustment for potential early-life confounding factors. Analyses were based on 14 505 participants. RESULTS Fifty-five participants (48 males) had died by suicide by age 54 years. While males who died by suicide did not differ from participants still alive in reading scores at age 7 [effect size (g) = -0.04, p = 0.759], their reading scores had a less steep improvement up to age 16 compared to other participants. Adjustments for early-life confounding factors explained these differences. A similar pattern was observed for mathematics scores. There was no difference between individuals who died by suicide v. participants still alive on intelligence at 11 years. CONCLUSIONS While no differences in tests of academic performance and IQ were observed, individuals who died by suicide had a less steep improvement in reading abilities over time compared to same-age peers.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- CISSS des Laurentides, St-Jerome, Quebec, Canada
| | - Massimiliano Orri
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Josie-Anne Bertrand
- CISSS des Laurentides, St-Jerome, Quebec, Canada
- The Douglas Research Center, Montréal, Québec, Canada
| | - Kyle T Greenway
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Chris Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Marie-Claude Geoffroy
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
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23
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Perrain R, Dardennes R, Jollant F. Risky decision-making in suicide attempters, and the choice of a violent suicidal means: an updated meta-analysis. J Affect Disord 2021; 280:241-249. [PMID: 33220560 DOI: 10.1016/j.jad.2020.11.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/02/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies showed disadvantageous decision-making in suicide attempters. The present meta-analysis aims to examine the stability of these findings and related questions. METHODS EMBASE and Pubmed databases were searched for studies published between 01/01/2000 and 01/01/2020 with an additional search through bibliographical references. English or French articles published in peer-reviewed journals, reporting quantitative task-based measures of decision-making in suicide attempters were included: 3,582 records were identified, 33 full-text articles screened, and 21 articles finally included. RESULTS All studies were conducted in mood disorders; 18 used the Iowa Gambling Task (IGT) and 3 the Cambridge Gamble Task (CGT). With the IGT, suicide attempters showed riskier choices than patient controls (Hedges' g=-0.28 95%CI (-0.44 - -0.12)) and healthy controls (g=-0.54 (-0.83 - -0.25)) with no significant difference between control groups. The difference between suicide attempters and patient controls was not related to age group, mood disorder type, author, or research center while an effect of time of publication was found (p=0.006). Poorer performance was also found in suicide attempters compared to patient controls when using the CGT (g=-0.57 95%CI (-0.82 - -0.31)). Suicide attempters who used a violent means showed poorer IGT performance than those who used a non-violent means (3 studies). LIMITATION Limited number of studies outside mood disorders. No data to calculate a gender effect. CONCLUSION The present meta-analysis confirmed riskier decision-making in suicide attempters. Although group differences appear to be of modest effect size in general, they were particularly marked in the subgroup of those who used a violent suicidal means.
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Affiliation(s)
- Rebecca Perrain
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France
| | - Roland Dardennes
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France
| | - Fabrice Jollant
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France; McGill Group for suicide studies, McGill University, Montréal, Canada; Nîmes academic hospital (CHU), Nîmes, France; Equipe Moods, INSERM UMR-1178, Paris, France.
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24
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Altered GABA-mediated information processing and cognitive dysfunctions in depression and other brain disorders. Mol Psychiatry 2021; 26:151-167. [PMID: 32346158 DOI: 10.1038/s41380-020-0727-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
Abstract
Cognitive dysfunctions, including impaired attention, learning, memory, planning and problem solving, occur in depressive episodes, often persist during remission, predict relapse, worsen with recurrent episodes, and are not treated by current antidepressants or other medications. Cognitive symptoms are also present in other psychiatric disorders, are a hallmark of aging, and define several late-life disorders, including Alzheimer's disease. This pervasive occurrence suggests either a non-specific outcome of a diseased brain, or a shared underlying pathology contributing to this symptom dimension. Recent findings suggest a role for altered GABAergic inhibition in cognitive symptoms. Cellular, molecular and biochemical studies in human subjects report changes affecting the gamma-amino butyric acid (GABA) system, specifically somatostatin-expressing (SST+) GABAergic interneurons, across brain disorders and during aging. SST+ neurons gate excitatory input onto pyramidal neurons within cortical microcircuits. Experimentally reducing the function of these neurons affects excitatory signal-to-noise ratio, reduces synchronized cellular and neural activity, and leads to cognitive dysfunctions. Conversely, augmenting SST+ cell post-synaptic α5-GABA-A receptor activity has pro-cognitive efficacy in stress and aging models. Together, this suggests that reduced signaling of the SST+ neuron/α5-GABA-A receptor pathway contributes to cognitive dysfunctions, and that it represents a novel therapeutic target for remediating mood and cognitive symptoms in depression, other psychiatric disorders and during aging.
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25
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Kułak-Bejda A, Bejda G, Waszkiewicz N. Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults. Front Psychiatry 2021; 12:695286. [PMID: 34512415 PMCID: PMC8423910 DOI: 10.3389/fpsyt.2021.695286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
More than 600 million people are aged 60 years and over are living in the world. The World Health Organization estimates that this number will double by 2025 to 2 billion older people. Suicide among people over the age of 60 is one of the most acute problems. The factors strongly associated with suicide are mentioned: physical illnesses, such as cancer, neurologic disorder, pain, liver disease, genital disorders, or rheumatoid disorders. Moreover, neurologic conditions, especially stroke, may affect decision-making processes, cognitive capacity, and language deficit. In addition to dementia, the most common mental disorders are mood and anxiety disorders. A common symptom of these disorders in the elderly is cognitive impairment. This study aimed to present the relationship between cognitive impairment due to dementia, mood disorders and anxiety, and an increased risk of suicide among older people. Dementia is a disease where the risk of suicide is significant. Many studies demonstrated that older adults with dementia had an increased risk of suicide death than those without dementia. Similar conclusions apply to prodromal dementia Depression is also a disease with a high risk of suicide. Many researchers found that a higher level of depression was associated with suicide attempts and suicide ideation. Bipolar disorder is the second entity in mood disorders with an increased risk of suicide among the elderly. Apart from suicidal thoughts, bipolar disorder is characterized by high mortality. In the group of anxiety disorders, the most significant risk of suicide occurs when depression is present. In turn, suicide thoughts are more common in social phobia than in other anxiety disorders. Suicide among the elderly is a serious public health problem. There is a positive correlation between mental disorders such as dementia, depression, bipolar disorder, or anxiety and the prevalence of suicide in the elderly. Therefore, the elderly should be comprehensively provided with psychiatric and psychological support.
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Affiliation(s)
| | - Grzegorz Bejda
- The School of Medical Science in Bialystok, Bialystok, Poland
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26
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Rosenthal A, Meyer MS, Mayo D, Tully LM, Patel P, Ashby S, Titone M, Carter CS, Niendam TA. Contributions of childhood trauma and atypical development to increased clinical symptoms and poor functioning in recent onset psychosis. Early Interv Psychiatry 2020; 14:755-761. [PMID: 32043308 PMCID: PMC7415665 DOI: 10.1111/eip.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/15/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
AIM The trauma-psychosis cycle proposes an interactive relationship between impaired developmental and cognitive trajectory, childhood trauma exposure, and increased risk for psychosis. This study explored how childhood trauma (CT) and atypical development (AD) impact clinical course in an early psychosis cohort. METHODS A retrospective chart review of behavioural and clinical research data was conducted with individuals ages 12 to 40 (N = 508; 72.4% males) evaluated by an early psychosis program. RESULTS CT exposure was associated with earlier onset of full threshold psychosis, more hospitalizations, higher ratings of negative symptoms, and increased likelihood of engaging in suicidal behaviour. AD alone was associated with earlier onset of psychosis symptoms, higher ratings of negative symptoms and greater likelihood of engaging in non-suicidal self-injury. The combination of CT and AD was associated with the earliest symptom onset and poorest psychosocial functioning. CONCLUSIONS The findings contribute to our understanding of heterogeneity in the early psychosis population and highlight the specific risk factors that could be targets in treatment.
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Affiliation(s)
- Adi Rosenthal
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Monet S Meyer
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Danessa Mayo
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Laura M Tully
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
| | - Pooja Patel
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, University of California-Los Angeles, Westwood, California
| | - Stefania Ashby
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, University of Oregon, Eugene, Oregon
| | - Madison Titone
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California.,Center for Neuroscience, University of California-Davis, Davis, California
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, California
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27
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Szanto K, Galfalvy H, Kenneally L, Almasi R, Dombrovski AY. Predictors of serious suicidal behavior in late-life depression. Eur Neuropsychopharmacol 2020; 40:85-98. [PMID: 32778367 PMCID: PMC7655527 DOI: 10.1016/j.euroneuro.2020.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
The present study aimed to identify pathways to suicidal behavior in late life that can guide identification of those most at risk and improve treatment. In a longitudinal study of late-life depression, we prospectively assessed risk factors specifically associated with fatal and near-fatal as compared to less lethal suicidal behavior. We enrolled 401 participants (age 66+9.9): 311 with unipolar non-psychotic depression and 90 non-psychiatric controls. The median follow-up was 5.4 years. Results indicated that history of suicide attempt predicted a two-fold increase in the risk of dying from natural causes. In univariate models, male gender, higher income, current depression and current and worst lifetime suicidal ideation severity, cognitive control deficits, and low levels of non-planning impulsivity predicted fatal and near-fatal suicidal behavior. In contrast, incident less lethal suicidal behavior was mostly associated with maladaptive personality traits, impulsivity, and severity of psychiatric illness in univariate models. In multipredictor models, male gender, worst lifetime suicidal ideation, and deficits in cognitive control independently predicted fatal/near-fatal suicidal behavior, while introversion, history of suicide attempt, and earlier age of onset of depression predicted less lethal suicidal behavior. While clinicians may be familiar with suicide risk factors identified in younger samples such as dysfunctional personality, impulsivity, and co-morbid substance use, in late life these characteristics only pertain to lower-lethality suicidal behavior. Cognitive control deficits, which likely play a greater role in old age, predict serious suicidal behavior.
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Affiliation(s)
| | | | - Laura Kenneally
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, 23504, USA
| | - Rebeka Almasi
- Carnegie Mellon University, Pittsburgh, PA, 15213, USA
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28
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McManimen S, Wong MM. Prospective Investigation of the Interaction Between Social Problems and Neuropsychological Characteristics on the Development of Suicide Ideation. Suicide Life Threat Behav 2020; 50:545-557. [PMID: 31799701 PMCID: PMC7426060 DOI: 10.1111/sltb.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Negative social interactions are known to contribute to the development of suicide ideation. However, it is unclear how this risk factor interacts with other predisposing risk factors. The purpose of this study was to determine how social and neuropsychological factors interact as a prospective predictor of the emergence of suicide ideation in adolescents. METHOD Data were collected from adolescents (M age = 13.12, SD = 1.48) over 3 years as part of a larger study. Participants completed the MINI-Kid and Youth Self-Report, which were used to assess for suicidality. Negative social interactions were operationalized as the Social Problems scale of the YSR. Additionally, adolescents completed a neuropsychological battery at each wave of data collection. RESULTS Logistic moderation analyses demonstrated a significant interaction between task switching and endorsement of negative social interactions in the prediction of suicide ideation one year later, Wald χ2 (1) = 4.94, OR = 0.90, p < .05. Distractibility was a significant predictor, Wald χ2 (1) = 5.52, OR = 3.45, p < .05, but it did not demonstrate an interaction effect. Perseveration failed to reach statistical significance independently and in the interaction. CONCLUSIONS The results indicate that certain neuropsychological characteristics can aid in predicting which adolescents will develop suicide ideation in the presence of negative social interactions, which may have significant clinical implications.
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Affiliation(s)
- Stephanie McManimen
- Department of Psychology, Idaho State University, Pocatello, United States of America,Corresponding author: Idaho State University, 921 S 8 Ave, Stop 8112, Pocatello, Idaho 83209,
| | - Maria M. Wong
- Department of Psychology, Idaho State University, Pocatello, United States of America
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29
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Ng KP, Richard-Devantoy S, Bertrand JA, Jiang L, Pascoal TA, Mathotaarachchi S, Therriault J, Yatawara C, Kandiah N, Greenwood CMT, Rosa-Neto P, Gauthier S. Suicidal ideation is common in autosomal dominant Alzheimer's disease at-risk persons. Int J Geriatr Psychiatry 2020; 35:60-68. [PMID: 31642105 PMCID: PMC7232741 DOI: 10.1002/gps.5215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To study the frequency of suicidal ideation and its association with clinical and neurobiological correlates among cognitively intact autosomal dominant Alzheimer's disease (ADAD) at-risk individuals. METHODS/DESIGN In a cross-sectional study of 183 ADAD at-risk individuals (91 mutation carriers and 92 noncarriers), we compared the frequency of suicidal ideation among carriers and noncarriers. Linear mixed-effects models with family-level random effects evaluated the relationships between geriatric depression scale (GDS), neuropsychiatric inventory-questionnaire (NPI-Q), and suicidal ideation scores among all ADAD at-risk individuals. An interaction term was added to the regression models to evaluate the interactions of suicidal ideation and mutation status on neuropsychiatric symptoms. RESULTS Twenty-six (14.20%) ADAD at-risk individuals (13 [14.28%] carriers and 13 [14.13%] noncarriers) had suicidal ideation. The frequency of suicidal ideation did not differ between carriers and noncarriers. Suicidal ideation was associated with higher GDS among all ADAD at-risk individuals. When stratified into mutation carrier status, noncarriers with suicidal ideation had higher GDS than carriers. There was no statistically significant association between suicidal ideation and NPI-Q among ADAD at-risk individuals. Awareness of mutation status, neuropsychological performances, and cerebrospinal fluid AD biomarkers were not associated with suicidal ideation among carriers and noncarriers. CONCLUSIONS Suicidal ideation is common among cognitively intact ADAD at-risk individuals. While ADAD at-risk individuals with suicidal ideation have greater depressive symptoms, noncarriers with suicidal ideation have higher GDS scores than carriers. Interestingly, awareness of the mutation status was not associated with suicidal ideation in our study. Early identification of suicidal thoughts can facilitate timely interventions to prevent suicidal behaviours. Keywords autosomal dominant Alzheimer's diseasedominantly inherited Alzheimer's networkneuropsychiatric symptomssuicidal ideation.
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Affiliation(s)
- Kok Pin Ng
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Department of Neurology, National Neuroscience Institute, Singapore
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
| | - Stéphane Richard-Devantoy
- Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Québec, Montréal, Canada
- CISSS des Laurentides, Quebec, Canada
| | - Josie-Anne Bertrand
- Douglas Research Center, Douglas Mental Health University Institute, Québec, Canada
| | - Lai Jiang
- Lady Davis Institute, McGill University, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada
| | - Tharick A Pascoal
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
| | - Sulantha Mathotaarachchi
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
| | - Joseph Therriault
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
| | | | | | - Celia M T Greenwood
- Lady Davis Institute, McGill University, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada
| | - Pedro Rosa-Neto
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
| | - Serge Gauthier
- Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, McGill University, Québec, Canada
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Québec, Canada
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30
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Huber RS, Hodgson R, Yurgelun-Todd DA. A qualitative systematic review of suicide behavior using the cognitive systems domain of the research domain criteria (RDoC) framework. Psychiatry Res 2019; 282:112589. [PMID: 31703982 DOI: 10.1016/j.psychres.2019.112589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022]
Abstract
Neurocognitive deficits are associated with both suicide behavior (SB) and psychiatric disorders. Application of a transdiagnostic framework to identify neurocognitive commonalities of SB may clarify important risk factors of SB across psychiatric disorders. The aim of this study was to conduct a qualitative systematic literature review of SB using the Research Domain Criteria (RDoC) Cognitive Systems framework to determine if cognitive deficits exist independently of psychiatric disorders in SB. The following six constructs that encompass the Cognitive Systems domain were assessed: 1) Attention, 2) Cognitive Control, 3) Declarative Memory, 4) Language, 5) Perception, and 6) Working Memory. A total of 1386 abstracts were identified and 74 studies met the inclusion criteria for this review. The majority of studies reviewed (65%) had significant differences in cognition between individuals with and without SB. Seventy-nine percent of studies with a patient control group showed significant cognitive deficits in SB groups. Deficits in cognitive control were associated with SB and had the greatest percentage of studies with significant main findings. Use of the RDoC cognitive systems framework to evaluate SB revealed that cognitive deficits may be a transdiagnostic risk factor for SB, especially alterations in cognitive control.
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Affiliation(s)
- Rebekah S Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States.
| | - Riley Hodgson
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States
| | - Deborah A Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, United States; U.S. Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, United States
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31
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Arslanoglou E, Banerjee S, Pantelides J, Evans L, Kiosses DN. Negative Emotions and the Course of Depression During Psychotherapy in Suicidal Older Adults With Depression and Cognitive Impairment. Am J Geriatr Psychiatry 2019; 27:1287-1295. [PMID: 31582195 PMCID: PMC6985925 DOI: 10.1016/j.jagp.2019.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The study examines the relationship of negative emotions with: 1) non-emotional symptoms (e.g., vegetative and physical symptoms) and 2) the course of depression in suicidal older adults with Major Depressive Disorder (MDD) and cognitive impairment treated with psychotherapy. DESIGN The authors identified a subgroup of participants (N = 26) who expressed suicidal ideation at Baseline or Week 12 from a randomized controlled trial (RCT) of two psychosocial interventions, Problem Adaptation Therapy (PATH) and Supportive Therapy for Cognitively Impaired. The authors assessed negative emotions, non-emotional symptoms of depression, depression severity, and suicidal ideation at entry, week 4, week 8, and week 12. PARTICIPANTS Participants were 65 years and older and had a diagnosis of unipolar depression, varying degrees of cognitive impairment (up to moderate dementia) and suicidal ideation. SETTING The study was conducted in the Outpatient Department of New York Presbyterian/Weill Cornell Medicine in Westchester, NY. MEASUREMENTS Negative emotions and non-emotional items were identified with the 24-item Hamilton Depression Rating Scale (Ham-D). RESULTS Among participants with suicidal ideation, the reduction in negative emotions from baseline to week 4, week 4 to week 8, and week 8 to week 12 was significantly associated with the reduction in non-emotional symptoms of depression at weeks 4, 8, and 12 (F(1, 35) = 6.20, p = 0.02) and with the reduction in overall depression severity at weeks 4, 8, and 12 (F(1, 35) = 26.63, p <0.0001) after controlling for depression severity at baseline (HAM-D total score) and time trends. CONCLUSION Our findings may guide the treatment of older patients with depression and suicidal ideation to help reduce depression and suicide risk.
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Affiliation(s)
- Elizabeth Arslanoglou
- Weill-Cornell Institute of Geriatric Psychiatry (EA, SB, JP, LE, DNK), Weill Cornell Medicine, White Plains, NY
| | - Samprit Banerjee
- Weill-Cornell Institute of Geriatric Psychiatry (EA, SB, JP, LE, DNK), Weill Cornell Medicine, White Plains, NY
| | - Joanna Pantelides
- Weill-Cornell Institute of Geriatric Psychiatry (EA, SB, JP, LE, DNK), Weill Cornell Medicine, White Plains, NY
| | - Laurie Evans
- Weill-Cornell Institute of Geriatric Psychiatry (EA, SB, JP, LE, DNK), Weill Cornell Medicine, White Plains, NY
| | - Dimitris N Kiosses
- Weill-Cornell Institute of Geriatric Psychiatry (EA, SB, JP, LE, DNK), Weill Cornell Medicine, White Plains, NY.
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Calati R, Nemeroff CB, Lopez-Castroman J, Cohen LJ, Galynker I. Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper. Int J Neuropsychopharmacol 2019; 23:192-205. [PMID: 31781761 PMCID: PMC7171927 DOI: 10.1093/ijnp/pyz063] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There has been increasing interest in both suicide-specific diagnoses within the psychiatric nomenclature and related biomarkers. Because the Suicide Crisis Syndrome-an emotional crescendo of several interrelated symptoms-seems to be promising for the identification of individuals at risk of suicide, the aim of the present paper is to review the putative biological underpinnings of the Suicide Crisis Syndrome symptoms (entrapment, affective disturbance, loss of cognitive control, hyperarousal, social withdrawal). METHODS A PubMed literature search was performed to identify studies reporting a link between each of the 5 Suicide Crisis Syndrome symptoms and biomarkers previously reported to be associated with suicidal outcomes. RESULTS Disturbances in the hypothalamic-pituitary-adrenal axis, with dysregulated corticotropin-releasing hormone and cortisol levels, may be linked to a sense of entrapment. Affective disturbance is likely mediated by alterations in dopaminergic circuits involved in reward and antireward systems as well as endogenous opioids. Loss of cognitive control is linked to altered neurocognitive function in the areas of executive function, attention, and decision-making. Hyperarousal is linked to autonomic dysregulation, which may be characterized by a reduction in both heart rate variability and electrodermal activity. Social withdrawal has been associated with oxytocin availability. There is also evidence that inflammatory processes may contribute to individual Suicide Crisis Syndrome symptoms. CONCLUSION The Suicide Crisis Syndrome is a complex syndrome that is likely the consequence of distinct changes in interconnected neural, neuroendocrine, and autonomic systems. Available clinical and research data allow for development of empirically testable hypotheses and experimental paradigms to scrutinize the biological substrates of the Suicide Crisis Syndrome.
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Affiliation(s)
- Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychology, University of Milan-Bicocca, Milan, Italy,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,Correspondence: Raffaella Calati, PsyD, PhD, Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, Italy ()
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas Dell Medical School, Austin, Texas
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
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Harfmann EJ, Rhyner KT, Ingram RE. Cognitive inhibition and attentional biases in the affective go/no-go performance of depressed, suicidal populations. J Affect Disord 2019; 256:228-233. [PMID: 31200162 DOI: 10.1016/j.jad.2019.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although cognitive inhibition deficits and attentional biases have been associated with suicidality, these findings have not been consistently reported across samples. The aim of the current study was to further investigate these variables among participants with differing suicidal risk. METHODS We compared affective go/no-go performance in 100 depressed individuals with both current suicidal ideation and a prior history of attempted suicide, 100 depressed individuals with current suicidal ideation, but no history of attempted suicide, 100 suicide attempters without current depression or suicidal ideation, and 100 healthy controls. RESULTS Suicide ideators with a history of attempted suicide committed more commission errors during negative word trials than any other group. Additionally, suicide ideators with no attempt history made more commission errors than did controls and previous attempters. An interaction for group status and emotional word valence revealed that suicide ideators with a history of attempted suicide responded fastest to negative words and slowest to positive words. Suicide ideators without an attempt history displayed a similar, but less pronounced pattern. Whereas, controls and previous attempters responded more quickly to positively valenced words. LIMITATIONS The use of cross-sectional self-report data and inclusion of only female participants limits generalizability. CONCLUSIONS Cognitive dysfunctions were apparent in all suicide vulnerable subjects, but significantly greater in suicide ideators with a history of attempted suicide. Suicidal ideation may be associated with a processing bias and inhibitory deficit for negative, mood-congruent information. These findings increase our knowledge of cognitive impairment in suicidality and may potentially help improve intervention strategies.
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Affiliation(s)
- Elisabeth J Harfmann
- Mental Health Department, Clement J. Zablocki Veterans Affairs Medical Center, 5000 W. National Ave, Milwaukee, WI, United States.
| | - Kathleen T Rhyner
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, United States
| | - Rick E Ingram
- Department of Psychology, University of Kansas, Lawrence, KS, United States
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Dombrovski AY, Hallquist MN, Brown VM, Wilson J, Szanto K. Value-Based Choice, Contingency Learning, and Suicidal Behavior in Mid- and Late-Life Depression. Biol Psychiatry 2019; 85:506-516. [PMID: 30502081 PMCID: PMC6380943 DOI: 10.1016/j.biopsych.2018.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/10/2018] [Accepted: 10/07/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Suicidal behavior is associated with impaired decision making in contexts of uncertainty. Existing studies, however, do not definitively address whether suidice attempers have 1) impairment in learning from experience or 2) impairment in choice based on comparison of estimated option values. Our reinforcement learning model-based behavioral study tested these hypotheses directly in middle-aged and older suicide attempters representative of those who die by suicide. METHODS Two samples (sample 1, n = 135; sample 2, n = 125) of suicide attempters with depression (nattempters = 54 and 39, respectively), suicide ideators, nonsuicidal patients with depression, and healthy control participants completed a probabilistic three-choice decision-making task. A second experiment in sample 2 experimentally dissociated long-term learned value from reward magnitude. Analyses combined computational reinforcement learning and mixed-effects models of decision times and choices. RESULTS With regard to learning, suicide attempters (vs. all comparison groups) were less sensitive to one-back reinforcement, as indicated by a reduced effect on both choices and decision times. Learning deficits scaled with attempt lethality and were partially explained by poor cognitive control. With regard to value-based choice, suicide attempters (vs. all comparison groups) displayed abnormally long decision times when choosing between similarly valued options and were less able to distinguish between the best and second-best options. Group differences in value-based choice were robust to controlling for cognitive performance, comorbidities, impulsivity, psychotropic exposure, and possible brain damage from attempts. CONCLUSIONS Serious suicidal behavior is associated with impaired reward learning, likely undermining the search for alternative solutions. Attempted suicide is associated with impaired value comparison during the choice process, potentially interfering with the consideration of deterrents and alternatives in a crisis.
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Affiliation(s)
- Alexandre Y. Dombrovski
- Department of Psychiatry, University of Pittsburgh,Address correspondence to Alexandre Y. Dombrovski, 3811 O’Hara St., BT 742, Pittsburgh, PA 15213,
| | | | - Vanessa M. Brown
- Department of Psychiatry, University of Pittsburgh,Virginia Tech-Carilion Research Institute,Department of Psychology, Virginia Tech
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35
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Conell J, Lewitzka U. Adapted psychotherapy for suicidal geriatric patients with depression. BMC Psychiatry 2018; 18:203. [PMID: 29914407 PMCID: PMC6006781 DOI: 10.1186/s12888-018-1775-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED This debate article aims to evaluate whether current diagnostic and therapeutic options for suicidal geriatric patients with depression suffice, and which adapted strategies might be helpful. We hope to encourage clinicians to consider special approaches when treating the elderly. BACKGROUND Suicide in old age is a major public health problem, as the suicide rates are highest among those aged 60 years and older in most European countries. Although pharmacological treatment options are relatively easy for older patients to obtain, their access to standard psychotherapy is limited. The reasons for this are i) the widely shared attitude about the effectiveness of psychotherapy for older people and ii) the limited access to standard psychotherapy due to their immobility. CONCLUSION New psychotherapeutic methods need to be developed. Psychotherapy at the patient's home seems to be a new approach to accommodate that individual's personal circumstances and make effective therapy possible.
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Affiliation(s)
- Jörn Conell
- AMEOS Klinika Neustadt, Lübeck und Eutin, Kliniken für Psychiatrie und Psychotherapie, 23730, Neustadt i.H, Germany
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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36
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Kiosses DN, Alexopoulos GS, Hajcak G, Apfeldorf W, Duberstein PR, Putrino D, Gross JJ. Cognitive Reappraisal Intervention for Suicide Prevention (CRISP) for Middle-Aged and Older Adults Hospitalized for Suicidality. Am J Geriatr Psychiatry 2018; 26:494-503. [PMID: 29395858 PMCID: PMC5860974 DOI: 10.1016/j.jagp.2017.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022]
Abstract
Middle-aged and older adults constitute a high suicide-risk group. Among adults aged 50 years old and older, suicide rates increased and suicide deaths almost doubled during the period from 2000 to 2015. Suicide rates are elevated for patients hospitalized for suicidality (i.e., active suicidal ideation or suicide attempt) and the 3 months post-hospitalization is the time of the highest suicide risk. Psychosocial interventions for middle-aged and older adults hospitalized for suicidality are sparse. In this article, we present the main aspects, stages, techniques and a clinical case study of Cognitive Reappraisal Intervention for Suicide Prevention (CRISP), a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults who have been recently hospitalized for suicidal ideation or a suicide attempt. CRISP is based on the theory that hospitalization for suicidality is preceded by an emotional crisis ("perfect storm"); this emotional crisis is related to personalized (patient- and situation-specific) triggers; and identifying these personalized triggers and the associated negative emotions and providing strategies for an adaptive response to these triggers and negative emotions will reduce suicidal ideation and improve suicide prevention. CRISP therapists identify these triggers of negative emotions and use cognitive reappraisal techniques to reduce these negative emotions. The cognitive reappraisal techniques have been selected from different psychosocial interventions and the affective neuroscience literature and have been simplified for use with middle-aged and older adults. CRISP may fill a treatment need for the post-discharge high-risk period for middle-aged and older adults hospitalized for suicidality.
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Affiliation(s)
- Dimitris N. Kiosses
- Psychology in Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College
| | | | - Greg Hajcak
- Biomedical Sciences and Psychology, Florida State University
| | - William Apfeldorf
- Clinical Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine
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37
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Saffer BY, Klonsky ED. Do neurocognitive abilities distinguish suicide attempters from suicide ideators? A systematic review of an emerging research area. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12227] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Boaz Y. Saffer
- Department of Psychology; The University of British Columbia; Vancouver BC Canada
| | - E. David Klonsky
- Department of Psychology; The University of British Columbia; Vancouver BC Canada
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38
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Hartzell JW, Geary R, Gyure K, Chivukula VR, Haut MW. Completed suicide in an autopsy-confirmed case of early onset Alzheimer's disease. Neurodegener Dis Manag 2018; 8:81-88. [PMID: 29319406 PMCID: PMC6367712 DOI: 10.2217/nmt-2017-0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 57-year-old male with clinically diagnosed and autopsy-confirmed early onset Alzheimer's disease who completed suicide by gunshot wound to the chest. This case has several unique aspects that have not been discussed in previous case reports of completed suicide in Alzheimer's disease. In particular, our patient's death was highly planned with successful compensation for his cognitive deficits. After all firearms had been removed from the home as a safety precaution, he obtained a new weapon, hid it and left himself cues to find and use it. The case is discussed in the context of literature differentiating the neural circuitry propagating impulsive versus planned suicidal acts.
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Affiliation(s)
- Jennifer Wiener Hartzell
- Department of Supportive Oncology, Levine Cancer Institute, Carolinas HealthCare System, NC 28202, USA.,Department of Neuropsychology & Psychology, Carolinas Rehabilitation, Carolinas HealthCare System, NC 28203, USA
| | - Richard Geary
- Department of Psychiatry, Overlake Medical Center, WA 98004, USA
| | - Kymberly Gyure
- Department of Pathology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Neurosurgery, West Virginia University School of Medicine, WV 26506, USA
| | - Venkata Ravi Chivukula
- Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA
| | - Marc W Haut
- Department of Neurology, West Virginia University School of Medicine, WV 26506, USA.,Department of Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, WV 26505, USA.,Department of Radiology, West Virginia University School of Medicine, WV 26506, USA
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39
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Szanto K, Galfavy H, Vanyukov PM, Keilp JG, Dombrovski AY. Pathways to Late-Life Suicidal Behavior: Cluster Analysis and Predictive Validation of Suicidal Behavior in a Sample of Older Adults With Major Depression. J Clin Psychiatry 2018; 79:17m11611. [PMID: 29489076 PMCID: PMC5932247 DOI: 10.4088/jcp.17m11611] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. METHODS Data were collected from June 2010 to September 2015. In this longitudinal study we examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+ years) nondemented, depressed patients; 57 nonpsychiatric healthy controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors, defining clusters based on personality traits, perceived social support, cognitive performance, and decision-making in an analysis blinded to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. RESULTS Of 5 clusters identified, 3 were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, and overrepresentation of high-lethality attempters; (2) high-personality pathology (ie, low self-esteem), minimal or no cognitive deficits, and overrepresentation of low-lethality attempters and ideators; (3) cognitive deficits, inability to delay future rewards, and similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (P < .001) and lethality (P = .002) of past suicide attempts and in the likelihood of future suicide attempts (P = .010, 30 attempts by 22 patients, 2 fatal) and emergency psychiatric hospitalizations to prevent suicide (P = .005, 31 participants). CONCLUSIONS Three pathways to suicidal behavior in older patients were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits.
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Affiliation(s)
- Katalin Szanto
- Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213. .,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hanga Galfavy
- Columbia University, Department of Psychiatry, New York, NY, USA
| | - Polina M. Vanyukov
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - John G. Keilp
- Columbia University, Department of Psychiatry, New York, NY, USA
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Thompson C, Ong ELC. The Association Between Suicidal Behavior, Attentional Control, and Frontal Asymmetry. Front Psychiatry 2018; 9:79. [PMID: 29593586 PMCID: PMC5861137 DOI: 10.3389/fpsyt.2018.00079] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/26/2018] [Indexed: 12/18/2022] Open
Abstract
It can be difficult to identify those at risk of suicide because suicidal thoughts are often internalized and not shared with others. Yet to prevent suicide attempts it is crucial to identify suicidal thoughts and actions at an early stage. Past studies have suggested that deficits in attentional control are associated with suicide, with the argument that individuals are unable to inhibit negative thoughts and direct resources away from negative information. The current study aimed to investigate the association of suicidal behavior with neurological and behavioral markers, measuring attentional bias and inhibition in two Stroop tasks. Fifty-four participants responded to the color of color words in a standard Stroop task and the color of positive, negative, and neutral words in an emotional Stroop task. Electroencephalographic (EEG) activity was recorded from frontal areas during each task and at resting. Participants were separated into a low-risk and high-risk group according to their self-reported suicidal behavior. Participants in the high-risk group showed slower response times in the color Stroop and reduced accuracy to incongruent trials, but faster response times in the emotional Stroop task. Response times to the word "suicide" were significantly slower for the high-risk group. This indicates an attentional bias toward specific negative stimuli and difficulties inhibiting information for those with high levels of suicidal behavior. In the emotional Stroop task the high-risk group showed reduced activity in leftward frontal areas, suggesting limitations in the ability to regulate emotional processing via the left frontal regions. The findings support the argument that deficits in attentional control are related to suicidal behavior. The research also suggests that under certain conditions frontal asymmetry may be associated with suicidal behavior.
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Affiliation(s)
- Catherine Thompson
- School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Elsie Li Chen Ong
- School of Health Sciences, University of Salford, Salford, United Kingdom.,Division of Information and Technology Studies, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
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Rizk MM, Rubin-Falcone H, Keilp J, Miller JM, Sublette ME, Burke A, Oquendo MA, Kamal AM, Abdelhameed MA, Mann JJ. White matter correlates of impaired attention control in major depressive disorder and healthy volunteers. J Affect Disord 2017; 222:103-111. [PMID: 28688263 PMCID: PMC5659839 DOI: 10.1016/j.jad.2017.06.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with impaired attention control and alterations in frontal-subcortical connectivity. We hypothesized that attention control as assessed by Stroop task interference depends on white matter integrity in fronto-cingulate regions and assessed this relationship using diffusion tensor imaging (DTI) in MDD and healthy volunteers (HV). METHODS DTI images and Stroop task were acquired in 29 unmedicated MDD patients and 16 HVs, aged 18-65 years. The relationship between Stroop interference and fractional anisotropy (FA) was examined using region-of-interest (ROI) and tract-based spatial statistics (TBSS) analyses. RESULTS ROI analysis revealed that Stroop interference correlated positively with FA in left caudal anterior cingulate cortex (cACC) in HVs (r = 0.62, p = 0.01), but not in MDD (r = -0.05, p= 0.79) even after controlling for depression severity. The left cACC was among 4 ROIs in fronto-cingulate network where FA was lower in MDD relative to HVs (F(1,41) = 8.87, p = 0.005). Additionally, TBSS showed the same group interaction of differences and correlations, although only at a statistical trend level. LIMITATIONS The modest sample size limits the generalizability of the findings. CONCLUSIONS Structural connectivity of white matter network of cACC correlated with magnitude of Stroop interference in HVs, but not MDD. The cACC-frontal network, sub-serving attention control, may be disrupted in MDD. Less cognitive control may include enhanced effects of salience in HVs, or less effective response inhibition in MDD. Further studies of salience and inhibition components of executive function may better elucidate the relationship between brain white matter changes and executive dysfunction in MDD.
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Affiliation(s)
- Mina M Rizk
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States; Department of Psychiatry, Faculty of Medicine, Minia University, Egypt.
| | - Harry Rubin-Falcone
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States
| | - John Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Ahmed M Kamal
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt
| | | | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University, New York, NY, United States; Department of Radiology, Columbia University, New York, NY, United States
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Pu S, Setoyama S, Noda T. Association between cognitive deficits and suicidal ideation in patients with major depressive disorder. Sci Rep 2017; 7:11637. [PMID: 28912439 PMCID: PMC5599636 DOI: 10.1038/s41598-017-12142-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/05/2017] [Indexed: 11/12/2022] Open
Abstract
The role of cognitive function in suicidal ideation in patients with major depressive disorder (MDD) has not been adequately explored. This research sought to measure the relationship between suicidal ideation and cognitive function. Therefore, in this study, the association between cognitive function and suicidal ideation in patients with MDD was assessed. Cognitive function was evaluated in 233 patients with MDD using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS). Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale. Approximately 59.2% of the patients (138/233) expressed suicidal ideation. Among the BACS subtests, only the executive function scores were significantly lower in patients with MDD with than in those without (p < 0.005). In addition, the executive function, motor speed function, and composite scores correlated negatively with the severity of suicidal ideation in these patients. These results suggest that executive function, motor speed function, and global neuropsychological function are associated with suicidal ideation in patients with MDD and that the BACS neuropsychological battery is an efficient instrument for monitoring these characteristics. Moreover, specific BACS scores can potentially serve as cognitive biomarkers of suicide risk in patients with MDD.
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Affiliation(s)
- Shenghong Pu
- Integrative Brain Imaging Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Shiori Setoyama
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Takamasa Noda
- Integrative Brain Imaging Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
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Szanto K. Cognitive Deficits: Underappreciated Contributors to Suicide. Am J Geriatr Psychiatry 2017; 25:630-632. [PMID: 28302439 PMCID: PMC5442878 DOI: 10.1016/j.jagp.2017.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Katalin Szanto
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
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Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment. Am J Geriatr Psychiatry 2017; 25:620-629. [PMID: 28223082 PMCID: PMC5429870 DOI: 10.1016/j.jagp.2017.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 12/31/2016] [Accepted: 01/12/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the relationship of negative emotions with suicidal ideation during 12 weeks of Problem Adaptation Therapy (PATH) versus Supportive Therapy of Cognitively Impaired Older Adults (ST-CI), hypothesizing that improved negative emotions are associated with reduced suicidal ideation, PATH improves negative emotions more than ST-CI, and improved negative emotions, rather than other depression symptoms, predict reduction in suicidal ideation. METHODS In a randomized controlled trial of two home-delivered psychosocial interventions, 74 older participants (65-95 years old) with major depressive disorder and cognitive impairment were recruited in collaboration with community agencies. The sample reported less intense feelings than suicidal intention. Interventions and assessments were conducted in participants' homes. PATH focuses on improving emotion regulation, whereas ST-CI focuses on nonspecific therapeutic factors, such as understanding and empathy. Improved negative emotions were measured as improvement in Montgomery Asberg's Depression Rating Scales' (MADRS) observer ratings of sadness, anxiety, guilt, hopelessness, and anhedonia. Suicidal ideation was assessed with the MADRS Suicide Item. RESULTS MADRS Negative Emotions scores were significantly associated with suicidal ideation during the course of treatment (F[1,165] = 12.73, p = 0.0005). PATH participants had significantly greater improvement in MADRS emotions than ST-CI participants (treatment group by time: F[1,63.2] = 7.02, p = 0.0102). Finally, improved negative emotions, between lagged and follow-up interview, significantly predicted reduction in suicidal ideation at follow-up interview (F[1, 96] = 9.95, p = 0.0022). CONCLUSION Findings thatimprovement in negative emotions mediates reduction in suicidal ideation may guide the development of psychosocial interventions for reduction of suicidal ideation (clinicaltrials.gov; NCT00368940).
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Fazakas-DeHoog LL, Rnic K, Dozois DJA. A Cognitive Distortions and Deficits Model of Suicide Ideation. EUROPES JOURNAL OF PSYCHOLOGY 2017; 13:178-193. [PMID: 28580021 PMCID: PMC5450979 DOI: 10.5964/ejop.v13i2.1238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/21/2017] [Indexed: 12/22/2022]
Abstract
Although cognitive distortions and deficits are known risk factors for the development and escalation of suicide ideation and behaviour, no empirical work has examined how these variables interact to predict suicide ideation. The current study proposes an integrative model of cognitive distortions (hopelessness and negative evaluations of self and future) and deficits (problem solving deficits, problem solving avoidance, and cognitive rigidity). To test the integrity of this model, a sample of 397 undergraduate students completed measures of deficits, distortions, and current suicide ideation. A structural equation model demonstrated excellent fit, and findings indicated that only distortions have a direct effect on suicidal thinking, whereas cognitive deficits may exert their effects on suicide ideation via their reciprocal relation with distortions. Findings underscore the importance of both cognitive distortions and deficits for understanding suicidality, which may have implications for preventative efforts and treatment.
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Affiliation(s)
- Laura L Fazakas-DeHoog
- St. Joseph's Health Care - Regional Mental Health Care St. Thomas, St. Thomas, Ontario, Canada.,Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - Katerina Rnic
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - David J A Dozois
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
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History of Bipolar Disorder and the Risk of Dementia: A Systematic Review and Meta-Analysis. Am J Geriatr Psychiatry 2017; 25:357-362. [PMID: 28161155 PMCID: PMC5365367 DOI: 10.1016/j.jagp.2016.11.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We carried out a systematic review and meta-analysis to evaluate whether history of bipolar disorder (BD) increases the risk of dementia. METHODS We searched PubMed and Scopus to identify studies that evaluated the risk of dementia in individuals with a history of BD. A total of 6 studies including 3,026 individuals with history of BD and 191,029 non-BD individuals were included in the meta-analysis. RESULTS History of BD significantly increased the risk of diagnosis of dementia (pooled odds ratio: 2.36; 95% confidence interval: 1.36-4.09; z = 3.07, p < 0.001). Evidence of heterogeneity and of publication bias in the analysis was found. CONCLUSION History of BD is associated with significantly higher risk of dementia in older adults. Future studies are necessary to evaluate the potential mediators of this association and to evaluate interventions that may reduce the risk of dementia in this population.
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Antidepressant pharmacotherapy in old-age depression—a review and clinical approach. Eur J Clin Pharmacol 2017; 73:661-667. [DOI: 10.1007/s00228-017-2219-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 12/21/2022]
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Tu YA, Chen MH, Tsai CF, Su TP, Bai YM, Li CT, Lin WC, Liu ME, Pan TL, Chen TJ, Tsai SJ. Geriatric Suicide Attempt and Risk of Subsequent Dementia: A Nationwide Longitudinal Follow-up Study in Taiwan. Am J Geriatr Psychiatry 2016; 24:1211-1218. [PMID: 27745821 DOI: 10.1016/j.jagp.2016.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It was unclear whether older people without dementia who attempted suicide were at increased risk of subsequently developing dementia. METHODS Using the Taiwan National Health Insurance Research Database, 1,189 patients aged ≥ 65 years who attempted suicide and 4,756 age- and sex-matched control subjects were enrolled in our study and followed to the end of 2011. Those who developed dementia during the follow-up were identified. RESULTS Cox regression analysis, after adjusting for demographic data and medical comorbidities, found that geriatric suicide attempt was associated with an increased risk of subsequent dementia (HR: 7.40; 95% CI: 6.11-8.97; Wald χ2 = 414.87, df = 1, p < 0.001). Both patients aged between 65 and 79 years (HR: 7.74; 95% CI: 6.17-9.71; Wald χ2 = 312.62, df = 1, p < 0.001) and patients aged ≥ 80 years (HR: 6.94; 95% CI: 4.73-10.17; Wald χ2 = 97.78, df = 1, p < 0.001) who attempted suicide had an increased risk of developing dementia in later life. CONCLUSION The elderly who attempted suicide were prone to developing dementia in later life, independent of depression and medical comorbidities. Further studies are necessary to clarify the underlying mechanisms between geriatric suicide and dementia and whether the prompt intervention for geriatric suicide may reduce this risk.
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Affiliation(s)
- Yi-An Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Long Pan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan; Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuang, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Abstract
Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.
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Olsson P, Wiktorsson S, Sacuiu S, Marlow T, Östling S, Fässberg MM, Skoog I, Waern M. Cognitive Function in Older Suicide Attempters and a Population-Based Comparison Group. J Geriatr Psychiatry Neurol 2016; 29:133-41. [PMID: 26810564 DOI: 10.1177/0891988715627015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/04/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim was to compare cognitive function in older suicide attempters with a population-based comparison group. METHODS Hospitalized suicide attempters aged 70 years and older were assessed cognitively at baseline (n = 99) and 1-year follow-up (n = 59). Depression symptoms were rated with the Montgomery-Åsberg Depression Rating Scale (MADRS). Results of cognitive assessments in attempters were compared with results in nonattempter comparison subjects (n = 115) selected among participants in our population-based health studies to yield a similar distribution of MADRS scores. RESULTS Suicide attempters scored lower on Mini-Mental State Examination (MMSE) than comparison persons. Among attempters, the mean MMSE score was lower in those with medically serious attempts. Attempters displayed poorer performance on tests of pentagon drawing and abstract thinking compared to comparison persons, and the results remained also after exclusion of those with medically serious attempts. At 1-year follow-up, significant improvement in MADRS scores was observed in the attempters. No evidence of improvement could be shown regarding cognitive deficits. CONCLUSION Older suicide attempters may have cognitive deficits, which may in part be related to the attempt itself. This needs to be taken into account when designing intervention strategies.
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Affiliation(s)
- Petter Olsson
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Wiktorsson
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Simona Sacuiu
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Marlow
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Section of Psychiatry and Neurochemistry, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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