Suicide behavior and neuropsychological assessment of type I bipolar patients. J Affect Disord 112(1-3):231-236

Neurosciences And Neuropsychology Research Group, FUMEC University, Brazil.
Journal of Affective Disorders (Impact Factor: 3.38). 06/2008; 112(1-3):231-6. DOI: 10.1016/j.jad.2008.03.019
Source: PubMed


Neuropsychological deficits are often described in patients with bipolar disorder (BD). Some symptoms and/or associated characteristics of BD can be more closely associated to those cognitive impairments. We aimed to explore cognitive neuropsychological characteristics of type I bipolar patients (BPI) in terms of lifetime suicide attempt history.
We studied 39 BPI outpatients compared with 53 healthy controls (HC) matched by age, educational and intellectual level. All subjects were submitted to a neuropsychological assessment of executive functions, decision-making and declarative episodic memory.
When comparing BDI patients, regardless of suicide attempt history or HC, we observed that bipolar patients performed worse than controls on measures of memory, attention, executive functions and decision-making. Patients with a history of suicide attempt performed worse than non-attempters on measures of decision-making and there were a significant negative correlation between the number of suicide attempts and decision-making results (block 3 and net score). We also found significant positive correlation between the number of suicide attempts and amount of errors in Stroop Color Word Test (part 3).
The sample studied can be considered small and a potentially confounding variable - medication status - were not controlled.
Our results show the presence of neuropsychological deficits in memory, executive functions, attention and decision-making in BPI patients. Suicide attempts BPI scored worse than non-suicide attempt BPI on measures of decision-making. More suicide attempts were associated with a worse decision-making process. Future research should explore the relationship between the association between this specific cognitive deficits in BPIs, serotonergic function and suicide behavior in bipolar patients as well other diagnostic groups.

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Available from: Leandro Fernandes Malloy-Diniz
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    • "Full articles were then obtained for final analyses. Of the 1830 originally identified abstracts, 25 studies met the inclusion criteria (Bartfai et al. 1990; Ellis et al. 1992; Becker et al. 1999; King et al. 2000; Keilp et al. 2001, 2013; Audenaert et al. 2002; Jollant et al. 2005, 2010; LeGris et al., 2012; Raust et al. 2007; Westheide et al. 2008; Yen et al. 2008; Malloy-Diniz et al. 2009; Oldershaw et al. 2009; Cha et al. 2010; Martino et al. 2010; Gilbert et al. 2011; Richard-Devantoy et al. 2011, 2012, 2013a; Bridge et al. 2012; McGirr et al. 2012; Miranda et al. 2012; Gorlyn et al. 2013). Although eligible, three studies were not included, or only partially (for instance, some tests but not others), because precise means and standard deviations were not available in papers and could not be obtained after contacting the authors (Williams & Broadbent, 1986; Dombrovski et al. 2008; Gilbert et al. 2011). "
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    ABSTRACT: Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. However, it is not clear which cognitive tests may best reveal this vulnerability. The objective was to identify neuropsychological tests of vulnerability to suicidal acts in patients with mood disorders. A search was made of Medline, EMBASE and PsycINFO databases, and article references. A total of 25 studies (2323 participants) met the selection criteria. A total of seven neuropsychological tests [Iowa gambling task (IGT), Stroop test, trail making test part B, Wisconsin card sorting test, category and semantic verbal fluencies, and continuous performance test] were used in at least three studies to be analysed. IGT and category verbal fluency performances were lower in suicide attempters than in patient controls [respectively, g = -0.47, 95% confidence interval (CI) -0.65 to -0.29 and g = -0.32, 95% CI -0.60 to -0.04] and healthy controls, with no difference between the last two groups. Stroop performance was lower in suicide attempters than in patient controls (g = 0.37, 95% CI 0.10-0.63) and healthy controls, with patient controls scoring lower than healthy controls. The four other tests were altered in both patient groups versus healthy controls but did not differ between patient groups. Deficits in decision-making, category verbal fluency and the Stroop interference test were associated with histories of suicidal behavior in patients with mood disorders. Altered value-based and cognitive control processes may be important factors of suicidal vulnerability. These tests may also have the potential of guiding therapeutic interventions and becoming part of future systematic assessment of suicide risk.
    Full-text · Article · Jun 2014 · Psychological Medicine
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    • "Several studies have previously reported decision-making impairment in patients with a personal history of suicidal act (Jollant et al., 2005; Malloy-Diniz et al., 2009; Bridge et al., 2012). This persistent deficit may represent a neurocognitive factor of vulnerability to suicidal acts in patients with mood disorders. "
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    ABSTRACT: Disadvantageous decision-making has been reported in patients who had attempted suicide and may represent a cognitive risk factor for suicide. Making decisions necessitates both implicit/associative and explicit/analytic processes. Here, we explored explicit mechanisms, and hypothesized that suicide attempters fail to use explicit understanding to make favorable choices. The Iowa Gambling Task (IGT) was used to assess decision-making in 151 non-depressed patients with a history of mood disorder and suicidal act, 81 non-depressed patients with a history of mood disorders but no suicidal act, and 144 healthy individuals. After performing the task, we assessed the explicit understanding of the participants of the contingencies in the task, i.e. which options yielded higher gain or loss. Correct explicit understanding was reported less often in suicide attempters and affective controls than in healthy controls (45.7% and 42.0% vs. 66.0%). Moreover, understanding was associated with better performance in healthy and affective controls, but not in suicide attempters, with no between-group difference among those who did not reach understanding. Patients with histories of suicide attempt, therefore, show a disconnection between what they "know" and what they "do", possibly reflecting underlying impairments in implicit associative processes. These cognitive alterations should be addressed in preventative interventions targeting suicide.
    Full-text · Article · Aug 2013
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    • "These neurocognitive deficits may represent vulnerability factors to suicidal behavior, as they may render these individuals more sensitive to their environment and/or less likely to respond advantageously to changes in this environment. Among these deficits, disadvantageous decision-making has been found in several independent populations (Jollant et al., 2005, 2007, 2010; Malloy-Diniz et al., 2009; Martino et al., 2010; Clark et al., 2011). This was recently confirmed by a meta-analysis of nine positive and negative studies, showing a significant effect size in the comparison between suicide attempters and patient controls (Richard-Devantoy et al., submitted). "
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    ABSTRACT: The literature suggests that many suicide attempters show impairment in both decision-making and cognitive control. However, it is not clear if these deficits are linked to each other, and if they may be related to more basic alterations in attention. This is a relevant question in the perspective of future interventions targeting cognitive deficits to prevent suicidal acts. Two different populations of patients with histories of suicide attempts were assessed (N=142 and 119). The Iowa Gambling Task (IGT) was used to measure decision-making in both populations. We used a D2 cancellation task and a verbal working memory task in population 1; the Stroop test, the N-Back task, the Trail Making Test, and the Hayling Sentence Completion test in population 2. Regarding decision-making, we only found a small negative correlation between the Hayling test error score (r=-0.24; p=0.01), and the net score from the second half of the IGT. In contrast, working memory, cognitive flexibility and cognitive inhibition measures were largely inter-correlated. Most patients were medicated. Only patients with mood disorders. These results add to previous findings suggesting that the neurocognitive vulnerability to suicidal behavior may rely on impairments in two distinct anatomical systems, one processing value-based decision-making (associated with ventral prefrontal cortex, among others) and one underlying cognitive control (associated with more dorsal prefrontal regions). This distinction may result in tailored-made cognitive interventions.
    Full-text · Article · Jul 2013 · Journal of Affective Disorders
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