Executive functioning in depressed patients with suicidal ideation
ABSTRACT 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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ABSTRACT: Neuropsychological dysfunction is associated with risk for suicidal behavior, but it is unknown if antidepressant medication treatment is effective in reducing this dysfunction, or if specific medications might be more beneficial. A comprehensive neuropsychological battery was administered at baseline and after 8 weeks of treatment within a randomized, double-blind clinical trial comparing paroxetine and bupropion in patients with DSM-IV Major Depressive Disorder and either past suicide attempt or current suicidal thoughts. Change in neurocognitive performance was compared between assessments and between medication groups. Treatment effects on the Hamilton Depression Rating Scale and Scale for Suicide Ideation were compared with neurocognitive improvement. Neurocognitive functioning improved after treatment in all patients, without clear advantage for either medication. Improvement in memory performance was associated with a reduction in suicidal ideation independent of the improvement of depression severity. Overall, antidepressant medication improved neurocognitive performance in patients with major depression and suicide risk. Reduced suicidal ideation was best predicted by a combination of the independent improvements in both depression symptomatology and verbal memory. Targeted treatment of neurocognitive dysfunction in these patients may augment standard medication treatment for reducing suicidal behavior risk. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.Psychiatry Research 12/2014; 225(3). DOI:10.1016/j.psychres.2014.12.004 · 2.68 Impact Factor
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ABSTRACT: Our goal was to examine the relationship between attention and suicidal ideation in a school-based adolescent population. This cross-sectional study involved 2,462 students from eight high schools in South Korea (1,021 males and 1,441 females, mean age 17.3 ± 0.6 years). The participants completed the Beck Scale for Suicide Ideation (SSI) and the Beck Depression Inventory (BDI) and took part in computerized attention tasks. Participants with high SSI scores (16 or higher) exhibited a higher mean number of omission errors (OEs) and commission errors (CEs) on the visual sustained attention tasks than did participants with low SSI scores (p < 0.001 and p < 0.001, respectively). On the divided attention tasks, the high SSI group exhibited a higher mean number of CEs than the low SSI group did (p < 0.001). In a general linear model adjusting for age, gender, and high BDI (10 or higher), membership in the high OE group in the visual sustained attention tasks was associated with high SSI scores (p = 0.015). Belonging to the high OE or CE group in the divided attention tasks were associated with high SSI scores (p = 0.024 and p = 0.035, respectively). For both the visual sustained and divided attention tasks, interactions between gender and high OE rates were significant (p ≤ 0.001 and p = 0.013, respectively). In the post hoc analysis, membership in the high OE group was associated with high SSI scores for girls. In a multiple linear regression analysis including all participants and controlling for age, gender, and BDI scores, higher numbers of OEs and CEs on the visual sustained attention tasks predicted higher SSI scores (p < 0.001 and p = 0.019, respectively). On the divided attention task, the number of CEs was positively correlated with the SSI score (p = 0.031). The findings of this study indicate an association between attention deficits and increased suicidal ideation in adolescents after controlling for depressed mood. The current results suggest a direct link between attention deficits and increased suicidality independent of depressive symptoms in adolescents.European Child & Adolescent Psychiatry 02/2015; DOI:10.1007/s00787-015-0687-3 · 3.55 Impact Factor
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ABSTRACT: Abstract Objective: Suicide among adolescents is a major public health problem. Decision-making deficits may play an important role in vulnerability to suicidal behavior, but few studies have examined decision-making performance in youth at risk for suicide. In this study, we seek to extend recent findings that adolescent suicide attempters process risk evaluations differently than adolescents who have not attempted suicide. Methods: We assessed decision-making in 14 adolescent suicide attempters and 14 non-attempter comparison subjects, ages 15-19, using the Cambridge Gambling Task (CGT). Each participant was also administered a diagnostic interview (Mini-International Neuropsychiatric Interview [MINI]), structured suicide severity measures, and a brief intelligence quotient (IQ) measure. Results: After controlling for gender and IQ differences, suicide attempters displayed an elevated risk-taking propensity on the CGT relative to comparison subjects, such that they were more willing to take a large risk with their bank of points, a decision-making style that proves disadvantageous over time. No group differences in the latency or accuracy of decision-making were observed. Conclusions: Adolescents with a history of suicide attempt display increased risk-taking and greater difficulty predicting probable outcomes on the CGT. Such deficits have been associated with dysfunction in the orbitofrontal prefrontal cortex, which supports other studies implicating impaired decision-making among individuals with a history of suicide attempt.Journal of Child and Adolescent Psychopharmacology 09/2014; DOI:10.1089/cap.2014.0041 · 3.07 Impact Factor