Impaired decision making in suicide attempters
Impaired decision making in suicide attempters
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DOI：
10.1176/appi.ajp.162.2.304
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发表时间：
2005-02-01
影响因子：
17.7
通讯作者：
Courtet, P
中科院分区：
文献类型：
--
作者：
Jollant, F;Bellivier, F;Courtet, P
目的：对自杀行为的认识还不够全面。压力素质模型表明，5-羟色胺能投射到眼眶前额叶皮质的缺陷与自杀行为的易感性有关。眼眶前额叶皮质参与了决策，这是一种处理复杂选择的认知功能，可能受到5-羟色胺能调节。在这项初步研究中，作者评估了自杀未遂者的决策。方法：作者使用爱荷华州赌博任务调查了有暴力(N=32)或非暴力(N=37)自杀行为史的患者，患有情感障碍但没有自杀行为史的患者(N=25)，以及健康对照对象(N=82)。当患者没有患上电流轴I障碍时，对他们进行评估。作者还评估了爱荷华州赌博任务绩效与冲动、敌意、愤怒、攻击性和情绪不稳定的心理测量指标的相关性。结果：两组自杀未遂者的得分均显著低于健康对照受试者，其中暴力自杀未遂者的得分显著低于情感性对照受试者。自杀未遂者组之间和两个对照组之间没有显著差异。表现上的差异不能用年龄、智力、教育水平、自杀未遂次数、首次自杀未遂年龄、轴心I障碍病史或药物使用来解释。爱荷华州赌博任务成绩与情绪不稳定、愤怒表达呈正相关，与冲动无关。结论：决策障碍可能是由情绪障碍所致，可能是自杀行为的神经心理危险因素。
Objective: The understanding of suicidal behavior is incomplete. The stress-diathesis model suggests that a deficit in serotonergic projections to the orbitofrontal cortex is involved in susceptibility to suicidal behavior. The orbitofrontal cortex has been implicated in decision making, a cognitive function dealing with complex choices that may be under serotonergic modulation. In this preliminary study, the authors assessed decision making in suicide attempters.Method: The authors used the Iowa Gambling Task to investigate patients with a history of violent (N= 32) or nonviolent ( N= 37) suicidal behavior, patients suffering from affective disorders with no history of suicidal behavior ( N= 25), and healthy comparison subjects ( N= 82). Patients were assessed when they were not suffering from a current axis I disorder. The authors also assessed the correlation of Iowa Gambling Task performance with psychometric measures of impulsivity, hostility, anger, aggression, and emotional instability.Results: Both groups of suicide attempters scored significantly lower than healthy comparison subjects, and violent suicide attempters performed significantly worse than affective comparison subjects. No significant differences were observed between the groups of suicide attempters or between the two comparison groups. The differences in performance could not be accounted for by age, intellectual ability, educational level, number of suicide attempts, age at first suicide attempt, history of axis I disorder, or medication use. Iowa Gambling Task performances were correlated positively with affective lability and with anger expression but not with impulsivity.Conclusions: Impaired decision making, possibly due to emotional dysfunction, may be a neuropsychological risk factor for suicidal behavior.