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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    • "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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    • "However, this study did not take into account the heterogeneity of suicidal behavior, nor investigated whether those who contemplated suicide but did not exhibit suicidal behavior differ in cognitive control. It is unclear whether cognitive control deficits specifically characterize only those who carry out serious attempts (those with high medical lethality attempts) and whether they are also present in those who currently contemplate suicide (Marzuk et al., 2005) or carry out low lethality attempts. Depression is the most common mental disorder in those who die by suicide or attempt suicide (Conwell et al., 1996; Szanto et al., 2001; Waern et al., 2003). "
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    ABSTRACT: Background: People who attempt suicide often display cognitive impairments, particularly poor cognitive control. Could poor cognitive control contribute to high suicide rates in old age? A component of cognitive control, cognitive inhibition-active suppression of task-irrelevant processing-is very sensitive to aging and has been linked to attempted suicide. We investigated cognitive inhibition in older high-lethality suicide attempters, closely resembling suicide victims, as well as low-lethality attempters, and control groups with and without depression and suicidal ideation. Methods: A total of 102 participants aged 60 years and older (17 psychiatrically healthy control subjects, 38 depressed control subjects, 16 suicide ideators, 14 low-lethality suicide attempters, and 17 high-lethality suicide attempters) underwent comprehensive clinical and cognitive assessments. They completed the Delis-Kaplan Executive Function System Color-Word Interference Test, a validated modification of the Stroop test. Results: High-lethality suicide attempters demonstrated a distinct pattern of cognitive inhibition deficits. Compared with psychiatrically healthy control subjects and suicide ideators, high-lethality attempters took longer to complete inhibition trials, even after accounting for potential confounding factors (age, education, Mini mental state examination score, information processing speed, and accuracy). Compared with non-suicidal depressed and healthy control subjects, low-lethality suicide attempters committed more uncorrected errors; however, this difference was not specific to the inhibition condition. Conclusions: Older suicide attempters are a cognitively heterogeneous group. Poor cognitive control in high-lethality attempters may undermine their ability to solve real-life problems, precipitating a catastrophic accumulation of stressors. Meanwhile, low-lethality attempters' poor performance may reflect a careless approach to the task or faulty monitoring.
    International Journal of Geriatric Psychiatry 05/2014; 30(3). DOI:10.1002/gps.4138 · 2.87 Impact Factor
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