Department of Psychiatry and Trinity Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
Schizophr Res. 2012 Sep;140(1-3):232-6. doi: 10.1016/j.schres.2012.06.017. Epub 2012 Jul 15.
OBJECTIVE: Suicide is the leading cause of death in schizophrenia. An association between suicidal behavior and both higher and lower cognitive ability in schizophrenia has been reported. To clarify this relationship, we investigated whether the relationship between suicidality and neurocognition varied according to differences in suicidal ideation and behavior. METHODS: Three hundred and ten patients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder were categorized based on patient and staff interviews as either non-suicide attempters, non-attempters expressing suicidal ideation, single suicide attempters, or multiple suicide attempters. These groups were compared on a neuropsychological battery examining current general cognitive ability, episodic and working memory, and attentional control. RESULTS: Neuropsychological performance in those with a history of suicidal ideation (n=63), and those who had made one suicide attempt (n=48) was comparable. Together, these groups outperformed patients with no history of either suicidal behavior or ideation (n=172) on measures of IQ, episodic memory and working memory. Only differences in global cognition remained significant after controlling for between-group differences in depressive symptoms. Those who had either expressed suicidal ideation and/or made a single suicide attempt demonstrated trend level advantages in neuropsychological tests over those that had made multiple suicide attempts. DISCUSSION: These findings support earlier evidence of an association between suicidality and neurocognitive ability in schizophrenia. Specifically, these data suggest that patients who have contemplated suicide or made a single suicide attempt have better cognitive functioning than those who have not. Suicidality in multiple attempters, who do not perform better in neurocognitive tests than those who have neither contemplated nor attempted suicide, is likely to be influenced by factors other than neurocognitive ability.
目的:自杀是精神分裂症患者的主要死亡原因。有报道称,自杀行为与精神分裂症患者较高和较低的认知能力之间存在关联。为了阐明这种关系,我们调查了自杀意念和行为的差异是否会影响自杀行为与神经认知之间的关系。
方法:根据患者和工作人员的访谈,将 310 名符合 DSM-IV 精神分裂症或分裂情感障碍诊断标准的患者分为非自杀企图者、非自杀企图但有自杀意念者、单次自杀企图者和多次自杀企图者。对这些组进行比较,评估当前的一般认知能力、情景记忆和工作记忆以及注意力控制的神经心理学测试。
结果:有自杀意念史(n=63)和有自杀企图史(n=48)的患者的神经心理学表现相当。这两组患者的 IQ、情景记忆和工作记忆测试得分均高于无自杀行为或自杀意念史的患者(n=172)。在控制了抑郁症状的组间差异后,只有整体认知的差异仍然显著。那些有自杀意念和/或单次自杀企图的患者在神经心理学测试中比有多次自杀企图的患者表现出明显的优势。
讨论:这些发现支持了先前有关精神分裂症患者自杀行为与神经认知能力之间关联的证据。具体而言,这些数据表明,有自杀意念或单次自杀企图的患者的认知功能比没有自杀意念或自杀企图的患者更好。多次自杀企图者的自杀行为不太可能受神经认知能力等因素的影响,他们在神经认知测试中的表现并不优于既没有自杀意念也没有自杀企图的患者。
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