认知功能与重性抑郁障碍、双相障碍、精神分裂症及相关障碍患者自杀意念和自杀企图的相关性：系统评价和荟萃分析。
Association between cognitive functioning, suicidal ideation and suicide attempts in major depressive disorder, bipolar disorder, schizophrenia and related disorders: A systematic review and meta-analysis.
机构信息
Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada.
出版信息
J Affect Disord. 2024 Nov 15;365:381-399. doi: 10.1016/j.jad.2024.08.057. Epub 2024 Aug 19.
INTRODUCTION
Treatable mental disorders, such as psychotic, major depressive disorder (MDD), and bipolar disorder (BD), contribute to a substantial portion of suicide risk, often accompanied by neurocognitive deficits. We report the association between cognitive function and suicidal ideation/suicide attempts (SI/SA) in individuals with schizoaffective disorder, BD, and MDD.
METHODS
A systematic search was conducted on PubMed, Ovid and Scopus databases for primary studies published from inception to April 2024. Eligible articles that reported on the effect size of association between cognition and SI/SA were pooled using a random effects model.
RESULTS
A total of 41 studies were included for analysis. There was a negative association between executive functioning and SI/SA in schizoaffective disorder (SA: Corr = -0·78, 95 % CI [-1·00, 0·98]; SI: Corr = -0·06, 95 % CI [-0·85, 0·82]) and MDD (SA: Corr = -0·227, 95 % CI [-0·419, -0·017]; SI: Corr = -0·14, 95 % CI [-0·33, 0·06]). Results were mixed for BD, with a significant positive association between SA and global executive functioning (Corr = 0·08, 95 % CI [0·01, 0·15]) and negative association with emotion inhibition. Mixed results were observed for processing speed, attention, and learning and memory, transdiagnostically.
LIMITATIONS
There is heterogeneity across sample compositions and cognitive measures. We did not have detailed information on individuals with respect to demographics and comorbidities.
CONCLUSIONS
We observed a transdiagnostic association between measures of cognitive functions and aspects of suicidality. The interplay of cognitive disturbances, particularly in reward-based functioning, may underlie suicidality in individuals with mental disorders. Disturbances in impulse control, planning, and working memory may contribute to self-injurious behavior and suicide.
介绍
可治疗的精神障碍，如精神病性障碍、重性抑郁障碍（MDD）和双相情感障碍（BD），会导致很大一部分自杀风险，通常伴有神经认知缺陷。我们报告了精神分裂情感障碍、BD 和 MDD 患者的认知功能与自杀意念/自杀企图（SI/SA）之间的关联。
方法
对 PubMed、Ovid 和 Scopus 数据库进行了系统检索，以获取从建库至 2024 年 4 月发表的原始研究。使用随机效应模型对报告认知与 SI/SA 之间关联效应大小的合格文章进行了汇总。
结果
共有 41 项研究被纳入分析。在精神分裂情感障碍（SA：Corr=-0.78，95%CI[-1.00，0.98]；SI：Corr=-0.06，95%CI[-0.85，0.82]）和 MDD（SA：Corr=-0.227，95%CI[-0.419，-0.017]；SI：Corr=-0.14，95%CI[-0.33，0.06]）中，执行功能与 SI/SA 呈负相关。BD 的结果不一，SA 与整体执行功能呈显著正相关（Corr=0.08，95%CI[0.01，0.15]），与情绪抑制呈负相关。在处理速度、注意力、学习和记忆方面，也观察到了跨诊断的混合结果。
局限性
样本组成和认知测量存在异质性。我们没有关于个体人口统计学和合并症的详细信息。
结论
我们观察到认知功能测量与自杀意念的各个方面之间存在跨诊断关联。认知障碍的相互作用，特别是在基于奖励的功能中，可能是精神障碍患者自杀的基础。冲动控制、计划和工作记忆的障碍可能导致自我伤害行为和自杀。
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