Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt

Abstract

Background Executive dysfunction, distinct from other cognitive deficits in depression, has been associated with suicidal behavior. However, this dysfunction is not found consistently across samples. Method Medication-free subjects with DSM-IV major depressive episode (major depressive disorder and bipolar type I disorder) and a past history of suicidal behavior (n=72) were compared to medication-free depressed subjects with no history of suicidal behavior (n=80) and healthy volunteers (n=56) on a battery of tests assessing neuropsychological functions typically affected by depression (motor and psychomotor speed, attention, memory) and executive functions reportedly impaired in suicide attempters (abstract/contingent learning, working memory, language fluency, impulse control). Results All of the depressed subjects performed worse than healthy volunteers on motor, psychomotor and language fluency tasks. Past suicide attempters, in turn, performed worse than depressed non-attempters on attention and memory/working memory tasks [a computerized Stroop task, the Buschke Selective Reminding Task (SRT), the Benton Visual Retention Test (VRT) and an N-back task] but not on other executive function measures, including a task associated with ventral prefrontal function (Object Alternation). Deficits were not accounted for by current suicidal ideation or the lethality of past attempts. A small subsample of those using a violent method in their most lethal attempt showed a pattern of poor executive performance. Conclusions Deficits in specific components of attention control, memory and working memory were associated with suicidal behavior in a sample where non-violent attempt predominated. Broader executive dysfunction in depression may be associated with specific forms of suicidal behavior, rather than suicidal behavior per se.

The Utility of Impulsive Bias and Altered Decision Making as Predictors of Drug Efficacy and Target Selection: Rethinking Behavioral Screening for Antidepressant Drugs

“…Thus, antidepressant drugs have an overwhelming beneficial effect on suicidality from a population perspective. This conclusion is consistent with a web of overlapping relationships between major depression, impulsivity, and other executive dysfunctions, hopelessness, and suicidality (Westheide et al, 2008;Clark et al, 2011;Carver et al, 2013;Keilp et al, 2013;Joormann and Quinn, 2014).…”

Risk-Sensitive Decision-Making Deficit in Adolescent Suicide Attempters

“…Prior studies using adult samples have linked suicidal behavior to specific neurocognitive factors including executive dysfunction and decision-making deficits ( Jollant et al 2005;Dour et al 2011;Chamberlain et al 2013;Keilp et al 2013) in the context of relatively unimpaired global brain functioning (Marzuk et al 2005). Behavioral and neuroimaging data have increasingly implicated prefrontal cortex (PFC) deficits, and associated reward-sensitive pathways in the expression of suicidal behavior among at-risk individuals (Mann 2003;Oquendo et al 2003;Monkul et al 2007;Jollant et al 2010;Dombrovski et al 2013).…”

Cognitive Inhibition in Elderly High-lethality Suicide Attempters

“…We have previously reported that, in an overlapping sample of older people with depression, a history of high-lethality attempts predicted poor performance on the Wisconsin Card Sort (McGirr et al, 2012). In a US study of younger adults, Keilp and colleagues (Keilp et al, 2013) found an impairment in Stroop performance in suicide attempters compared to both patient and healthy control subjects. Our finding of a high uncorrected error rate in low-lethality attempters parallels that of Brazilian study by Malloy-Diniz and colleagues (Malloy-Diniz et al, 2009) who reported a positive correlation between the number of suicide attempts and the number of errors on the Stroop test in younger bipolar I patients.…”

“…Our finding of a high uncorrected error rate in low-lethality attempters parallels that of Brazilian study by Malloy-Diniz and colleagues (Malloy-Diniz et al, 2009) who reported a positive correlation between the number of suicide attempts and the number of errors on the Stroop test in younger bipolar I patients. Findings, however, are mixed with respect to the motor component of cognitive inhibition, captured by the Go/No-Go test (Keilp et al, 2013, Raust et al, 2007, Richard-Devantoy et al, 2012. The only previous study of cognitive inhibition in elderly suicide attempters (Richard-Devantoy et al, 2012) had found significant impairments in access to relevant information and deletion of irrelevant information in comparison to both depressed and healthy control groups.…”

“…In addition to impulsive aggression (McGirr and Turecki, 2007) and persistent hopelessness (Beck et al, 1985, Szanto et al, 1998, several studies have now reported impairments in cognitive domains such as attentional/cognitive control, episodic memory, working memory, and language fluency (Keilp et al, 2013, Keilp et al, 2001, Raust et al, 2007, Richard-Devantoy et al, 2012 as well as in decision-making (Clark et al, 2011, Dombrovski et al, 2010, Jollant et al, 2005. Cognitive impairments may be particularly prominent in elderly suicide attempters (Dombrovski et al, 2008a, Dombrovski et al, 2010, Erlangsen et al, 2008, Gujral et al, 2012, McGirr et al, 2012.…”