Richard-Devantoy S, Berlim M T, Jollant F
McGill University, Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada.
Psychol Med. 2014 Jun;44(8):1663-73. doi: 10.1017/S0033291713002304. Epub 2013 Sep 9.
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.
自杀行为是应激事件与包括认知缺陷在内的易损因素之间复杂相互作用的结果。然而，尚不清楚哪种认知测试最能揭示这种易损性。目的是确定情绪障碍患者自杀行为易损性的神经心理学测试。
检索了Medline、EMBASE和PsycINFO数据库以及文章参考文献。共有25项研究（2323名参与者）符合入选标准。至少三项研究使用了总共七种神经心理学测试[爱荷华赌博任务（IGT）、斯特鲁普测试、连线测验B部分、威斯康星卡片分类测试、类别和语义言语流畅性测试以及连续操作测试]进行分析。
自杀未遂者的IGT和类别言语流畅性表现低于患者对照组[分别为g = -0.47，95%置信区间（CI）-0.65至-0.29和g = -0.32，95%CI -0.60至-0.04]以及健康对照组，后两组之间无差异。自杀未遂者的斯特鲁普测试表现低于患者对照组（g = 0.37，95%CI 0.10 - 0.63）和健康对照组，患者对照组得分低于健康对照组。与健康对照组相比，另外四项测试在两组患者中均有改变，但两组患者之间无差异。
决策、类别言语流畅性和斯特鲁普干扰测试的缺陷与情绪障碍患者的自杀行为史相关。基于价值的和认知控制过程的改变可能是自杀易损性的重要因素。这些测试也可能有指导治疗干预的潜力，并成为未来自杀风险系统评估的一部分。
