Deterministic learning and attempted suicide among older depressed individuals: cognitive assessment using the Wisconsin Card Sorting Task.
Deterministic learning and attempted suicide among older depressed individuals: cognitive assessment using the Wisconsin Card Sorting Task.
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DOI：
10.1016/j.jpsychires.2011.10.001
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发表时间：
2012-02
影响因子：
4.8
通讯作者：
Szanto K
中科院分区：
文献类型：
--
作者：
McGirr A;Dombrovski AY;Butters MA;Clark L;Szanto K
晚年自杀是一个调查不足的公共卫生问题。这种复杂的多因素行为的假定弱点之一是认知控制的缺陷，即整合和优先考虑多种认知过程的能力，以灵活地适应行为并满足情境需求。我们研究了在复杂和不断变化的环境中，老年人在不同致命性的自杀企图的规则学习过程中的认知控制。93名60岁以上的参与者（30名健康对照，29名抑郁症患者从未自杀，20名低致命性自杀未遂者，14名高致命性自杀未遂者）接受了结构化的临床和认知评估。然后，参与者完成了威斯康星州卡片分类测试（WCST），这是一项在规则学习过程中进行认知控制的研究任务。高杀伤力的错误者表现出一种模式的赤字，包括概念推理差，持续性错误和总错误。与低致命性错误者和健康对照组相比，高致命性错误者表现出概念推理能力差，持续错误和总错误率增加。与非自杀抑郁症参与者相比，高致命性自杀者也犯了更多的概念错误。老年人中高致命性自杀企图与WCST检测到的规则学习期间认知控制受损相关。我们的数据表明，在规则学习过程中的认知控制障碍可能代表了一种不同于冲动素质的脆弱性，通常表现在年轻的，低致命性的攻击者。这种脆弱性可能导致老年人严重或往往致命的自杀行为发生率高。
Late-life suicide is an under-investigated public health problem. Among the putative vulnerabilities for this complex multifactorial behaviour are deficits in cognitive control, an ability to integrate and prioritize multiple cognitive processes in order to flexibly adapt behaviour and meet situational demands. We investigated cognitive control during rule learning in a complex and changing environment in older individuals with suicide attempts of varying lethality. Ninety-three participants over the age of 60 (30 healthy controls, 29 depressed never suicidal, 20 low-lethality suicide attempters, 14 high-lethality suicide attempters) underwent structured clinical and cognitive assessments. Participants then completed the Wisconsin Card Sorting Test (WCST), a well-studied task of cognitive control during rule learning. High-lethality attempters demonstrated a pattern of deficits involving poor conceptual reasoning, perseverative errors and total errors. Compared to low-lethality attempters and healthy controls, high-lethality attempters demonstrated poor conceptual reasoning, as well as increased rates of perseverative errors and total errors. Compared to non-suicidal depressed participants, high-lethality attempters also made more conceptual errors. High-lethality suicide attempts among older people are associated with impaired cognitive control during rule learning as detected by the WCST. Our data suggest that impairment in cognitive control during rule learning may represent a vulnerability distinct from the impulsive diathesis, typically manifesting in young, low-lethality attempters. This vulnerability may contribute to the high incidence of serious or, often, fatal suicidal acts in old age.
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影响因子：
17.7
作者：
Jollant, F;Bellivier, F;Courtet, P
通讯作者：
Courtet, P
影响因子：
11.3
作者：
Keilp, John G.;Gorlyn, Marianne;Mann, J. John
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影响因子：
6.9
作者：
McGirr, A.;Renaud, J.;Turecki, G.
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Turecki, G.
影响因子：
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作者：
Dombrovski, Alexandre Y.;Szanto, Katalin;Siegle, Greg J.;Wallace, Meredith L.;Forman, Steven D.;Sahakian, Barbara;Reynolds, Charles F., III;Clark, Luke
通讯作者：
Clark, Luke
影响因子：
6.9
作者：
Austin, MP;Mitchell, P;Hadzi-Pavlovic, D
通讯作者：
Hadzi-Pavlovic, D