Adan Ana, Capella Maria Del Mar, Prat Gemma, Forero Diego A, López-Vera Silvia, Navarro José Francisco
Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
Institute of Neurosciences, University of Barcelona, Barcelona, Spain.
PLoS One. 2017 Jan 18;12(1):e0169943. doi: 10.1371/journal.pone.0169943. eCollection 2017.
Lifetime suicide attempts in patients with comorbidity between psychotic disorders and Substance Use Disorder (SUD), known as dual diagnosis, was associated with a worse clinical and cognitive state, poor prognosis and premature death. However, to date no previous study has examined the cognitive performance of these patients considering as independent the presence or absence of lifetime suicide attempts.
We explore executive functioning differences between suicide attempters and non-attempters in dual schizophrenia (DS) patients and the possible related factors for both executive performance and current suicide risk. Fifty DS male patients in remission of SUD and clinically stables, 24 with and 26 without lifetime suicide attempts, were evaluated. We considered Z scores for all neuropsychological tests and a composite summary score for both premorbid IQ and executive functioning.
DS patients showed low performance in set-shifting, planning and problem solving tasks. Those with suicide attempts presented lower composite summary scores, together with worse problem solving skills and decision-making, compared with non-attempters. However, after controlling for alcohol dependence, only differences in decision-making remained. Executive functioning was related to the premorbid intelligence quotient, and several clinical variables (duration, severity, months of abstinence and relapses of SUD, global functioning and negative symptoms). A relationship between current suicide risk, and first-degree relatives with SUD, insight and positive symptoms was also found.
Our results suggest that problem solving and, especially, decision-making tasks might be sensitive to cognitive impairment of DS patients related to presence of lifetime suicide attempts. The assessment of these executive functions and cognitive remediation therapy when necessary could be beneficial for the effectiveness of treatment in patients with DS. However, further research is needed to expand our findings and overcome some limitations of this study.
精神障碍与物质使用障碍（SUD）共病的患者，即所谓的双重诊断，其终身自杀未遂与更差的临床和认知状态、不良预后及过早死亡相关。然而，迄今为止，尚无研究在将终身自杀未遂的存在与否视为独立因素的情况下，考察这些患者的认知表现。
我们探讨了双相精神分裂症（DS）患者中自杀未遂者与未自杀未遂者在执行功能方面的差异，以及执行功能表现和当前自杀风险的可能相关因素。对50名已戒除SUD且临床稳定的男性DS患者进行了评估，其中24名有终身自杀未遂史，26名无终身自杀未遂史。我们考虑了所有神经心理学测试的Z分数以及病前智商和执行功能的综合汇总分数。
DS患者在任务转换、计划和问题解决任务中表现较差。与未自杀未遂者相比，有自杀未遂史的患者综合汇总分数更低，问题解决能力和决策能力也更差。然而，在控制酒精依赖后，仅决策方面的差异仍然存在。执行功能与病前智商以及几个临床变量（SUD的病程、严重程度、戒断月数和复发情况、整体功能和阴性症状）相关。还发现了当前自杀风险与有SUD的一级亲属、自知力和阳性症状之间的关系。
我们的结果表明，问题解决，尤其是决策任务，可能对与终身自杀未遂相关的DS患者的认知损害敏感。评估这些执行功能并在必要时进行认知康复治疗，可能有助于提高DS患者的治疗效果。然而，需要进一步的研究来扩展我们的发现并克服本研究的一些局限性。
