Executive functioning in depressed patients with suicidal ideation

Department of Psychiatry, Weill Medical College, Cornell University, New York, NY 10021, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 11/2005; 112(4):294-301. DOI: 10.1111/j.1600-0447.2005.00585.x
Source: PubMed


Suicidal thinking has been associated with cognitive rigidity, however, not all depressed patients contemplate suicide. Therefore, we hypothesized that compared with depressed subjects without suicidal ideation, depressed individuals with suicidal ideation would display poorer performance on measures of executive functioning that involve mental flexibility.
In-patients with a current major depressive episode who had no current suicidal ideation (n=28) were compared with those who had current suicidal ideation (n=5) on measures of executive functioning and two neurocognitive tests that predominantly assess non-frontal regions.
Compared with non-suicidal depressed patients, depressed suicidal patients performed significantly worse on several measures of executive functioning after controlling for age, IQ, severity of depression and prior suicide attempts. The two groups performed similarly on tests that predominantly assess non-frontal regions.
Depressed individuals contemplating suicide have cognitive rigidity, which does not appear to be a global brain dysfunction. Suicidal mental states may result from dysfunctional executive decision-making that is associated with the frontal lobe.

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    • "assessments , including the PCET . Broadly , the PCET is a measure of executive functions , which are thought to play important roles in the diagnosis and treatment of many neuropsychiatric disorders ( Bondi et al . , 2009 ; Testa & Pantelis , 2009 ) and may help distinguish between suicidal and nonsuicidal indi - viduals ( Burton et al . , 2011 ; Marzuk et al . , 2005 ; Westheide et al . , 2008 ) . Army STARRS research - ers hope to use PCET measurements , among other predictors , to develop models of risk and resilience that can reduce suicidal behavior and other stress - related disorders among Army soldiers . Modeling results from the current study can be used as part of these predictive models in"
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    ABSTRACT: We used cognitive and psychometric modeling techniques to evaluate the construct validity and measurement precision of latent cognitive abilities measured by a test of concept identification learning: the Penn Conditional Exclusion Test (PCET). Item response theory parameters were embedded within classic associative- and hypothesis-based Markov learning models and were fitted to 35,553 Army soldiers' PCET data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Data were consistent with a hypothesis-testing model with multiple latent abilities-abstraction and set shifting. Latent abstraction ability was positively correlated with number of concepts learned, and latent set-shifting ability was negatively correlated with number of perseverative errors, supporting the construct validity of the two parameters. Abstraction was most precisely assessed for participants with abilities ranging from 1.5 standard deviations below the mean to the mean itself. Measurement of set shifting was acceptably precise only for participants making a high number of perseverative errors. The PCET precisely measures latent abstraction ability in the Army STARRS sample, especially within the range of mildly impaired to average ability. This precision pattern is ideal for a test developed to measure cognitive impairment as opposed to cognitive strength. The PCET also measures latent set-shifting ability, but reliable assessment is limited to the impaired range of ability, reflecting that perseverative errors are rare among cognitively healthy adults. Integrating cognitive and psychometric models can provide information about construct validity and measurement precision within a single analytical framework.
    Journal of Clinical and Experimental Neuropsychology 07/2015; 37(6):653-669. DOI:10.1080/13803395.2015.1042358 · 2.08 Impact Factor
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    • "These rates appear to be further affected by factors such as psychosis , depression, substance abuse, and weaker cognitive functioning (Simpson and Tate 2007). Suicidal ideations are frequently reported to relate to cognitive factors including problem solving (Marzuk et al. 2005), impulsivity (Horesh et al. 1999; Hull-Blanks et al. 2004), and overall IQ (Alati et al. 2009). Additionally, girls report higher levels of suicidal intentions and behaviours than boys, but boys display higher rates of suicide completion (Evans et al. 2005); furthermore, the rates of suicidal intentions and behaviours increase as children advance into adolescence (Beautrais 2002; Brent et al. 1999; Groholt et al. 1998; Klonsky and May 2010; Shaffer et al. 1996). "
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    ABSTRACT: Background and Objectives The Children’s Depression Inventory (CDI) is frequently used to screen for the symptoms of depression and suicidal thinking during psychological or neuropsychological evaluations. This includes assessment of children with neurological conditions who are at risk of experiencing suicidal thoughts due to general cognitive, psychiatric, and neurological deficits. The purpose of this study was to examine the prevalence and correlates of suicidal thinking and symptoms of depression in youth with neurological disorders, as measured by the CDI. We expected that reporting suicidal ideations would most often occur in children with epilepsy and individuals with low IQ, and positively correlate with impulsivity. Methods Participants included 313 paediatric neurology patients (mean age = 13.1 years, SD = 3.1, range = 7-17) who underwent neuropsychological assessments, including completion of the CDI. Results Clinically elevated levels of symptoms of depression were found in 10 % of children, with 18.8 % of the total sample endorsing suicidal ideation on the CDI. Suicidal ideation was most commonly endorsed by youth with epilepsy (22.8 %), children between ages 7 and 10 years (25.8 %), youth with intellectual disabilities (40 % for IQ below the 2nd and 70 % for IQ below 0.2nd percentiles), and girls with attention problems (67 %). Depressive symptoms were significantly correlated with IQ, processing speed, executive functions, attention, parent-reported internalizing behaviours, and gender. Suicidal ideations were best predicted by low verbal intelligence, executive dysfunction, being female, and problems with inattention. Conclusions Assessments of youth with neurological issues should include a psychological measure, particularly for patients with epilepsy and cognitive disabilities, even at a relatively early age.
    01/2015; DOI:10.1007/s40817-015-0002-8
    • "In a population-based study carried out in Israel with older adults, suicide ideation was found to be associated with several cognitive processes (Ayalon and Litwin, 2009). This relationship has also been reported by Marzuk et al. (2005) in depressed individuals. They found that individuals with suicidal ideation performed significantly worse than depressed patients without suicidal thinking on various executive tasks. "
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    ABSTRACT: Suicide is one of the main causes of mortality in young people and in individuals with depression. The impact of impaired cognitive function on suicidal ideation is largely unknown. The aim of this study was to examine how cognitive functioning may influence suicidal thoughts, both in the general population and in a subgroup of individuals with depression. A total of 4583 participants (aged 18 years and older) were interviewed in a cross-sectional study of a representative sample of the non-institutionalized Spanish population. Cognitive functioning was evaluated using five cognitive tests. Participants were also asked to provide information about mental health symptoms and conditions through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). Logistic regression analysis was performed overall and by age group. Lifetime prevalence of suicidal ideation was 3.7%, whereas prevalence of suicidal ideation in the previous 12 months was 0.9%. Depression was the strongest risk factor for suicidal ideation. Compared with people without suicidal ideation, people with suicidal ideas performed significantly worse on cognitive functioning after adjusting for age, years of education, gender, and the presence of depression. In the age-subgroup analyses, only the youngest group (18–49 years) showed a significant association between cognitive functioning and suicidal ideation. Worse cognitive functioning was also associated with more frequent suicidal ideas in those individuals with depression even when depression severity was taken into account. In conclusion, both cognitive functioning and diagnosis of depression are associated with higher risk of suicide in the Spanish general population, especially in young individuals.
    European Neuropsychopharmacology 08/2014; 25(2). DOI:10.1016/j.euroneuro.2014.08.010 · 4.37 Impact Factor
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