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

Published online by Cambridge University Press:  10 July 2012

J. G. Keilp ,
M. Gorlyn ,
M. Russell ,
M. A. Oquendo ,
A. K. Burke ,
J. Harkavy-Friedman  and
J. J. Mann
J. G. Keilp*
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
M. Gorlyn
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
M. Russell
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
M. A. Oquendo
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
A. K. Burke
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
J. Harkavy-Friedman
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
J. J. Mann
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY, USA
*
*Address for correspondence: Dr J. G. Keilp, Box 42, New York State Psychiatric Institute (NYSPI), 1051 Riverside Drive, New York, NY 10032, USA. (Email: jgk13@columbia.edu)
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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.

Keywords

Bipolar disordercognitiondepressionneuropsychologysuicidal behavior
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 3 , March 2013 , pp. 539 - 551
Copyright
Copyright © Cambridge University Press 2012

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References

Arie, M, Apter, A, Orbach, I, Yefet, Y, Zalzman, G (2008). Autobiographical memory, interpersonal problem solving, and suicidal behavior in adolescent inpatients. Comprehensive Psychiatry 49, 22–29.CrossRefGoogle ScholarPubMed
Audenaert, K, Goethals, I, Van Laere, K, Lahorte, P, Brans, B, Versijpt, J, Vervaet, M, Beelaert, L, Van Heeringen, K, Dierckx, R (2002). SPECT neuropsychological activation procedure with the Verbal Fluency Test in attempted suicide patients. Nuclear Medicine Communications 23, 907–916.CrossRefGoogle ScholarPubMed
Badre, D, Wagner, AD (2007). Left ventrolateral prefrontal cortex and the cognitive control of memory. Neuropsychologia 45, 2883–2901.CrossRefGoogle ScholarPubMed
Baer, RA (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice 10, 125–143.Google Scholar
Bartfai, A, Winborg, IM, Nordström, P, Asberg, M (1990). Suicidal behavior and cognitive flexibility: design and verbal fluency after attempted suicide. Suicide and Life-Threatening Behavior 20, 254–266.CrossRefGoogle ScholarPubMed
Baune, BT, Miller, R, McAfoose, J, Johnson, M, Quirk, F, Mitchell, D (2010). The role of cognitive impairment in general functioning in major depression. Psychiatry Research 176, 183–189.CrossRefGoogle ScholarPubMed
Beck, AT, Beck, R, Kovacs, M (1975). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry 132, 285–287.Google ScholarPubMed
Becker, ES, Strohbach, D, Rinck, M (1999). A specific attentional bias in suicide attempters. Journal of Nervous and Mental Disease 187, 730–735.CrossRefGoogle ScholarPubMed
Bishop, SR, Lau, M, Shapiro, S, Carlson, L, Anderson, ND, Carmody, J, Segal, ZV, Abbey, S, Speca, M, Velting, D, Devins, G (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice 11, 230–241.Google Scholar
Botvinick, MM, Braver, TS, Barch, DM, Carter, CS, Cohen, JD (2001). Conflict monitoring and cognitive control. Psychological Review 108, 624–652.CrossRefGoogle ScholarPubMed
Broadbent, DE, Cooper, PF, FitzGerald, P, Parkes, KR (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology 21, 1–16.CrossRefGoogle ScholarPubMed
Brower, MC, Price, BH (2001). Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review. Journal of Neurology, Neurosurgery and Psychiatry 71, 720–726.CrossRefGoogle ScholarPubMed
Burton, CZ, Vella, L, Weller, JA, Twamley, EW (2011). Differential effects of executive functioning on suicide attempts. Journal of Neuropsychiatry and Clinical Neurosciences 23, 173–179.CrossRefGoogle ScholarPubMed
Carter, CS, van Veen, V (2007). Anterior cingulate cortex and conflict detection: an update of theory and data. Cognitive, Affective, and Behavioral Neuroscience 7, 367–379.CrossRefGoogle ScholarPubMed
Cha, CB, Najmi, S, Park, JM, Finn, C, Nock, MK (2010). Attentional bias toward suicide related stimuli predicts suicidal behavior. Journal of Abnormal Psychology 119, 616–622.CrossRefGoogle ScholarPubMed
Clark, L, Dombrovski, AY, Siegle, GJ, Butters, MA, Shollenberger, CL, Sahakian, BJ, Szanto, K (2011). Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychology and Aging 26, 321–330.CrossRefGoogle ScholarPubMed
Dombrovski, AY, Butters, MA, Reynolds, CF 3rd, Houck, PR, Clark, L, Mazumdar, S, Szanto, K (2008). Cognitive performance in suicidal depressed elderly: preliminary report. American Journal of Geriatric Psychiatry 16, 109–115.CrossRefGoogle ScholarPubMed
Dombrovski, AY, Clark, L, Siegle, GJ, Butters, MA, Ichikawa, N, Sahakian, BJ, Szanto, K (2010). Reward/Punishment reversal learning in older suicide attempters. American Journal of Psychiatry 167, 699–707.CrossRefGoogle ScholarPubMed
Dougherty, DM, Mathias, CW, Marsh-Richard, DM, Prevette, KN, Dawes, MA, Hatzis, ES, Palmes, G, Nouvion, SO (2009). Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide. Psychiatry Research 169, 22–27.CrossRefGoogle ScholarPubMed
Dour, HJ, Cha, CB, Nock, MK (2011). Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behavior Research and Therapy 49, 294–298.CrossRefGoogle ScholarPubMed
Egner, T, Hirsch, J (2005). Cognitive control mechanisms resolve conflict through cortical amplification of task-relevant information. Nature Neuroscience 8, 1784–1790.CrossRefGoogle ScholarPubMed
Fertuck, EA, Marsano-Jozefowicz, S, Stanley, B, Tryon, WW, Oquendo, M, Mann, JJ, Keilp, JG (2006). The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression. Journal of Personality Disorders 20, 55–70.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). New York State Psychiatric Institute: New York, NY.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW, Loma, B (1996). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). New York State Psychiatric Institute, Biometric Research Department: New York, NY.Google Scholar
Freedman, M, Black, S, Ebert, P, Binns, M (1998). Orbitofrontal function, object alternation and perseveration. Cerebral Cortex 8, 18–27.CrossRefGoogle ScholarPubMed
Hanlon, RE, Rubin, LH, Jensen, M, Daoust, S (2010). Neuropsychological features of indigent murder defendants and death row inmates in relation to homicidal aspects of their crimes. Archives of Clinical Neuropsychology 25, 1–13.CrossRefGoogle ScholarPubMed
Harkavy-Friedman, JM, Keilp, JG, Grunebaum, MF, Sher, L, Printz, D, Burke, AK, Mann, JJ, Oquendo, MA (2006). Are BP I and BP II suicide attempters distinct neuropsychologically? Journal of Affective Disorders 94, 255–259.CrossRefGoogle Scholar
Janis, IB, Nock, MK (2009). Are self-injurers impulsive? Results from two behavioral laboratory studies. Psychiatry Research 169, 261–267.CrossRefGoogle ScholarPubMed
Jollant, F, Bellivier, F, Leboyer, M, Astruc, B, Torres, S, Verdier, R, Castelnau, D, Malafosse, A, Courtet, P (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry 162, 304–310.CrossRefGoogle ScholarPubMed
Jollant, F, Guillaume, S, Jaussent, I, Bellivier, F, Leboyer, M, Castelnau, D, Malafosse, A, Courtet, P (2007). Psychiatric diagnoses and personality traits associated with disadvantageous decision-making. European Psychiatry 22, 455–461.CrossRefGoogle ScholarPubMed
Jollant, F, Lawrence, NL, Olié, E, Guillaume, S, Courtet, P (2011). The suicidal mind and brain: a review of neuropsychological and neuroimaging studies. World Journal of Biological Psychiatry 12, 319–339.CrossRefGoogle ScholarPubMed
Jollant, F, Lawrence, NS, Olie, E, O'Daly, O, Malafosse, A, Courtet, P, Phillips, ML (2010). Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. NeuroImage 51, 1275–1281.CrossRefGoogle ScholarPubMed
Keilp, JG, Gorlyn, M, Oquendo, MA, Burke, AK, Mann, JJ (2008). Attention deficit in depressed suicide attempters. Psychiatry Research 159, 7–17.CrossRefGoogle ScholarPubMed
Keilp, JG, Sackeim, HA, Brodsky, BS, Oquendo, MA, Malone, KM, Mann, JJ (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry 158, 735–741.CrossRefGoogle ScholarPubMed
Keilp, JG, Sackeim, HA, Mann, JJ (2005). Correlates of trait impulsiveness in performance measures and neuropsychological tests. Psychiatry Research 135, 191–201.CrossRefGoogle ScholarPubMed
Kuhl, BA, Dudukovic, NM, Kahn, I, Wagner, AD (2007). Decreased demands on cognitive control reveal the neural processing benefits of forgetting. Nature Neuroscience 10, 908–914.CrossRefGoogle ScholarPubMed
Linehan, MM, Dexter-Mazza, ET (2008). Dialectical behavior therapy for borderline personality disorder. In Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, 4th edn (ed. Barlow, D. H.), pp. 365–420. Guilford Press: New York.Google Scholar
Lynch, TR, Trost, WT, Salsman, N, Linehan, MM (2007). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology 3, 181–205.CrossRefGoogle ScholarPubMed
MacLeod, CM, Dodd, MD, Sheard, ED, Wilson, DE, Bibi, U (2003). In opposition to inhibition. In The Psychology of Learning and Motivation (ed. Ross, B. H.), vol. 43, pp. 163–214. Elsevier Science: New York.Google Scholar
Mann, JJ, Waternaux, C, Haas, GL, Malone, KM (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry 156, 181–189.CrossRefGoogle Scholar
Marzuk, PM, Hartwell, N, Leon, AC, Portera, L (2005). Executive functioning in depressed patients with suicidal ideation. Acta Psychiatrica Scandinavica 112, 294–301.CrossRefGoogle ScholarPubMed
Morgan, AB, Lilienfield, SO (2000). A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function. Clinical Psychology Review 20, 113–136.CrossRefGoogle ScholarPubMed
Nock, MK, Park, JM, Finn, CT, Deliberto, TL, Dour, HJ, Banaji, MR (2010). Measuring the suicidal mind: implicit cognition predicts suicidal behavior. Psychological Science 21, 511–517.CrossRefGoogle ScholarPubMed
Ochsner, KN, Gross, JJ (2008). Cognitive emotion regulation: insights from social cognitive and affective neuroscience. Current Directions in Psychological Science 17, 153–158.CrossRefGoogle ScholarPubMed
Olie, E, Guillaume, S, Jaussent, I, Courtet, P, Jollant, F (2010). Higher psychological pain during major depressive episode may be a factor of vulnerability to suicidal ideation and act. Journal of Affective Disorders 120, 226–230.CrossRefGoogle ScholarPubMed
Oquendo, MA, Halberstam, B, Mann, JJ (2003). Risk factors of suicidal behavior: the utility and limitations of research instruments. In Standardized Evaluation in Clinical Practice: Review of Psychiatry, vol. 22 (ed. First, M.), pp. 103–130. American Psychiatric Publishing: Washington, DC.Google Scholar
Sinclair, JM, Crane, C, Hawton, K, Williams, JM (2007). The role of autobiographical memory specificity in deliberate self-harm: correlates and consequences. Journal of Affective Disorders 102, 11–18.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JBW, Gibbon, M, First, MB (1990). Instruction Manual for the Structured Clinical Interview for the DSM-IV (SCID-P). American Psychiatric Press: Washington, DC.Google Scholar
Spreen, O, Strauss, E (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary, 3rd edn. Oxford University Press: New York, NY.Google Scholar
Stuss, DT, Levine, B, Alexander, MP, Hong, J, Palumbo, C, Hamer, L, Murphy, KJ, Izukawa, D (2000). Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes. Neuropsychologia 38, 388–402.CrossRefGoogle ScholarPubMed
Swann, AC, Dougherty, DM, Pazzaglia, PJ, Pham, M, Steinberg, JL, Moeller, FG (2005). Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. American Journal of Psychiatry 162, 1680–1687.CrossRefGoogle ScholarPubMed
Van Snellenberg, JX, Wager, TD (2009). Cognitive and motivational functions of the human prefrontal cortex. In Luria's Legacy in the 21st Century (ed. Christensen, A. L., Bougakov, D. and Goldberg, E.), pp. 30–61. Oxford University Press: New York, NY.CrossRefGoogle Scholar
Veiel, HO (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology 19, 587–603.CrossRefGoogle ScholarPubMed
Wechsler, D (1997). Wechsler Adult Intelligence Scale – Third Edition. The Psychological Corporation: San Antonio, TX.Google Scholar
Westheide, J, Quednow, BB, Kuhn, KU, Hoppe, C, Cooper-Mahkorn, D, Hawellek, B, Eichler, P, Maier, W, Wagner, M (2008). Executive performance of depressed suicide attempters: the role of suicidal ideation. European Archives of Psychiatry and Clinical Neuroscience 258, 414–421.CrossRefGoogle ScholarPubMed
Williams, JM, Broadbent, K (1986). Distraction by emotional stimuli: use of a Stroop task with suicide attempters. British Journal of Clinical Psychology 25, 101–110.CrossRefGoogle ScholarPubMed
Wu, CS, Liao, SC, Lin, KM, Tseng, MM, Wu, EC, Liu, SK (2009). Multidimensional assessments of impulsivity in subjects with history of suicidal attempts. Comprehensive Psychiatry 50, 315–321.CrossRefGoogle ScholarPubMed
Zakzanis, KK, Leach, L, Kaplan, E (1998). On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 11, 111–119.Google ScholarPubMed
Zald, DH, Andreotti, C (2010). Neuropsychological assessment of the orbital and ventromedial prefrontal cortex. Neuropsychologia 48, 3377–3391.CrossRefGoogle ScholarPubMed
Zald, DH, Curtis, C, Chernitsky, LA, Pardo, JV (2005). Frontal lobe activation during object alternation acquisition. Neuropsychology 19, 97–105.CrossRefGoogle ScholarPubMed