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近期自杀未遂者的认知:执行功能改变

Cognition in Recent Suicide Attempts: Altered Executive Function.

作者信息

Fernández-Sevillano Jessica, Alberich Susana, Zorrilla Iñaki, González-Ortega Itxaso, López María Purificación, Pérez Víctor, Vieta Eduard, González-Pinto Ana, Saíz Pilar

机构信息

Department of Neuroscience, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bilbao, Spain.

Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain.

出版信息

Front Psychiatry. 2021 Jul 22;12:701140. doi: 10.3389/fpsyt.2021.701140. eCollection 2021.

Abstract

Neuropsychological alterations can lead to inaccurate perception, interpretation, and response to environmental information, which could be a risk factor for suicide. Ninety-six subjects were recruited from the Psychiatry Department of the Araba University Hospital-Santiago, including 20 patients with a recent attempt and diagnosis of major depressive disorder (MDD) according to DSM-V, 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients, and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on the following cognitive domains: working memory, processing speed, decision-making, executive function, and attention. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons, ANOVA and Bonferroni tests were performed with a < 0.05 significance level. The patient groups did not differ regarding severity of depression and stressful events in the last 6 months. In comparison to healthy controls, depressed patients with lifetime suicide attempts had more general trauma ( = 0.003), emotional abuse ( = 0.003), emotional negligence ( = 0.006), and physical negligence ( = 0.009), and depressed patients with recent suicide attempts had experienced more child sexual abuse ( = 0.038). Regarding neuropsychological assessment, all patient groups performed significantly worse than did healthy controls in processing speed, decision-making, and attention. Comparisons between patient groups indicated that recent suicide attempters had poorer performance on executive function in comparison to both depressed lifetime attempters and depressed non-attempters ( = 0.296, = 0.019, and = 0.301, = 0.028, respectively). Besides, women with recent attempts had slightly better scores on executive function than males. Regarding the rest of the cognitive domains, there were no significant differences between groups. Executive function performance is altered in recent suicide attempts. As impaired executive function can be risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.

摘要

神经心理改变可导致对环境信息的感知、解读和反应不准确,这可能是自杀的一个风险因素。从阿瓦拉大学医院 - 圣地亚哥精神病科招募了96名受试者,包括20名近期有自杀未遂且根据《精神疾病诊断与统计手册》第五版(DSM - V)诊断为重度抑郁症(MDD)的患者、33名有自杀未遂史的MDD患者、23名无自杀未遂的MDD患者以及20名健康对照者。所有参与者均接受了临床访谈,并对以下认知领域进行了神经心理评估:工作记忆、处理速度、决策、执行功能和注意力。进行了向后多元回归分析以调整显著的混杂变量。对于组间比较,采用方差分析(ANOVA)和邦费罗尼检验,显著性水平α < 0.05。患者组在过去6个月的抑郁严重程度和应激事件方面没有差异。与健康对照相比,有终身自杀未遂史的抑郁症患者经历了更多的一般性创伤(P = 0.003)、情感虐待(P = 0.003)、情感忽视(P = 0.006)和身体忽视(P = 0.009),近期有自杀未遂的抑郁症患者经历了更多的儿童性虐待(P = 0.038)。关于神经心理评估,所有患者组在处理速度、决策和注意力方面的表现均显著差于健康对照者。患者组之间的比较表明,与有终身自杀未遂史的抑郁症患者和无自杀未遂的抑郁症患者相比,近期有自杀未遂的患者在执行功能方面表现更差(分别为P = 0.296,P = 0.019和P = 0.301,P = 0.028)。此外,近期有自杀未遂的女性在执行功能方面的得分略高于男性。在其余认知领域方面,各组之间没有显著差异。近期自杀未遂者的执行功能表现发生了改变。由于受损的执行功能可能是自杀的风险因素,自杀预防干预应侧重于其评估和康复。

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