Raust Aurelie, Slama Frédéric, Mathieu Flavie, Roy Isabelle, Chenu Alain, Koncke Diego, Fouques Damien, Jollant Fabrice, Jouvent Eric, Courtet Philippe, Leboyer Marion, Bellivier Frank
Department of Psychiatry, Chenevier-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil cedex, France.
Psychol Med. 2007 Mar;37(3):411-9. doi: 10.1017/S0033291706009111. Epub 2006 Oct 19.
Abnormal serotonergic neurotransmission has long been demonstrated in suicidal behavior. The dorsal and median raphe nuclei housing the main serotonergic cell bodies and the prefrontal cortex (PFC), particularly the ventral part innervated by the serotonergic system, have therefore been studied extensively in suicidal behavior research. However, only a few studies have described neuropsychological function impairment in suicidal patients. We investigated PFC-related neuropsychological function in patients with suicidal behavior, separating dorsolateral PFC (DLPFC)- and orbitofrontal cortex (OFC)-related functions.
We compared 30 euthymic patients with suicidal behavior aged 18-65 years with 39 control subjects, for the following neuropsychological domains: global intellectual functioning, reward sensitivity, initiation, inhibition, and working memory. Patients and controls were compared by means of univariate and multivariate analyses, adjusting for age at interview, level of education and mood state at the time of evaluation. Trait impulsivity, measured with the Barratt Impulsivity Scale version 10 (BIS-10), was also included as a covariate in a subset of analyses.
Multivariate comparisons demonstrated significant executive function deficits in patients with suicidal behavior. In particular, we observed impairment in visuospatial conceptualization (p<0.0001), spatial working memory (p=0.001), inhibition (Hayling B-A, p=0.04; go anticipations, p=0.01) and visual attention (or reading fluency) (p=0.002). Similar results were obtained following adjustment for motor impulsivity as a covariate, except for spatial working memory.
These deficits are consistent with prefrontal dysfunction in patients with suicidal behavior. Differentiation between DLPFC- and OFC-related neuropsychological functions showed no specific dysfunction of the orbitofrontal region in patients with suicidal behavior in our sample.
长期以来，异常的血清素能神经传递已在自杀行为中得到证实。因此，包含主要血清素能细胞体的中缝背核和中缝正中核以及前额叶皮质（PFC），尤其是受血清素能系统支配的腹侧部分，在自杀行为研究中受到了广泛研究。然而，仅有少数研究描述了自杀患者的神经心理功能损害。我们研究了有自杀行为患者中与前额叶皮质相关的神经心理功能，区分了背外侧前额叶皮质（DLPFC）和眶额叶皮质（OFC）相关的功能。
我们将30名年龄在18 - 65岁的有自杀行为的心境正常患者与39名对照受试者在以下神经心理领域进行比较：整体智力功能、奖励敏感性、启动、抑制和工作记忆。通过单变量和多变量分析对患者和对照进行比较，并对访谈时的年龄、教育水平和评估时的情绪状态进行校正。用Barratt冲动性量表第10版（BIS - 10）测量的特质冲动性也作为协变量纳入部分分析。
多变量比较显示有自杀行为的患者存在显著的执行功能缺陷。具体而言，我们观察到视觉空间概念化（p < 0.0001）、空间工作记忆（p = 0.001）、抑制（海林B - A，p = 0.04；去抑制预期，p = 0.01）和视觉注意力（或阅读流畅性）（p = 0.002）受损。将运动冲动性作为协变量进行校正后也得到了类似结果，但空间工作记忆除外。
这些缺陷与有自杀行为患者的前额叶功能障碍一致。在我们的样本中，区分与DLPFC和OFC相关的神经心理功能显示，有自杀行为的患者眶额叶区域没有特定功能障碍。
