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认知建模评估当前患有抑郁症和/或有自杀史的患者的决策障碍。

Cognitive modelling to assess decision-making impairments in patients with current depression and with/without suicide history.

机构信息

PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.

PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.

出版信息

Eur Neuropsychopharmacol. 2020 Jul;36:50-59. doi: 10.1016/j.euroneuro.2020.04.006. Epub 2020 May 23.

Abstract

It has been reported that decision making is impaired in suicide attempters. Decision making is a complex process and little is known about its different components. Yet, this information would help to understand the functioning of suicidal minds. In this study, the Prospect Valence-Learning (PVL) computational model was applied to the Iowa Gambling Task (IGT) to investigate and compare decision-making components in patients with affective disorder and with/without history of suicide attempts and in healthy controls. To this aim, 116 inpatients with current major depressive episode (among whom 62 suicide attempters) and 38 healthy controls were recruited. Decision-making performance was measured using the IGT. The Bayesian computational PVL model was applied to compare the feedback sensitivity, loss aversion, learning/memory, and choice consistency components of decision making in the different groups. Depressive symptomatology was assessed using the Beck Depression Inventory short form (BDI-SF). The total IGT net score and the loss aversion and learning/memory scores were lower in suicide attempters than in healthy controls. The choice consistency score was low in all patients (with/without suicide history) compared with healthy controls. Moreover, patients with high BDI score showed a positive relationship between the choice consistency score and suicide attempt. These findings suggest that decision-making impairment in depressed patients with and without suicidal history might be the result of underlying problems in feedback processing and task learning, which influence the building of long-term strategies. All these impairments should be targeted in therapeutic strategies for suicidal patients.

摘要

据报道,自杀未遂者的决策能力受损。决策是一个复杂的过程,其不同组成部分知之甚少。然而,这些信息将有助于了解自杀者的思维运作。在这项研究中,应用预期价值学习(PVL)计算模型对爱荷华赌博任务(IGT)进行了分析,以研究和比较有/无自杀未遂史的情感障碍患者和健康对照组的决策成分。为此,招募了 116 名患有当前重度抑郁症发作的住院患者(其中 62 名自杀未遂者)和 38 名健康对照组。使用 IGT 测量决策表现。应用贝叶斯计算 PVL 模型比较不同组的反馈敏感性、损失厌恶、学习/记忆和选择一致性的决策成分。使用贝克抑郁量表短表(BDI-SF)评估抑郁症状。与健康对照组相比,自杀未遂者的总 IGT 净得分、损失厌恶和学习/记忆得分较低。所有患者(有/无自杀史)的选择一致性得分均低于健康对照组。此外,BDI 得分较高的患者的选择一致性得分与自杀企图呈正相关。这些发现表明,有或无自杀史的抑郁患者的决策能力受损可能是反馈处理和任务学习中潜在问题的结果,这些问题影响长期策略的建立。所有这些损伤都应成为自杀患者治疗策略的目标。

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