Neuropsychological dysfunction in depressed suicide attempters
Neuropsychological dysfunction in depressed suicide attempters
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DOI：
10.1176/appi.ajp.158.5.735
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发表时间：
2001-05-01
影响因子：
17.7
通讯作者：
Mann, JJ
中科院分区：
文献类型：
--
作者：
Keilp, JG;Sackeim, HA;Mann, JJ
目的：精神疾病背景下的神经心理缺陷可能与自杀风险相关。在这项研究中，神经心理学表现进行了比较，抑郁症患者至少有一个先前的自杀企图的高致死性，抑郁症患者与低致死性先前的企图，抑郁症患者没有先前的自杀企图，和非病人。50名未服药的重度抑郁症患者（21例无自杀企图史，14例和15例分别有低致死率和高致死率自杀企图）和22例非患者进行了评估。各组在年龄、教育、职业水平和估计的病前智力方面具有可比性。神经心理成套测验在五个复合领域内产生分数：一般智力功能（当前）、运动功能、注意力、记忆力和执行功能。先前自杀企图具有高致死性的患者在执行功能测试中的表现明显差于所有组，并且是唯一一组在一般智力功能，注意力，和记忆判别函数分析揭示了数据中两个突出的维度：一个是将高致命性自杀者与所有其他群体区分开来（主要与执行功能测试的表现相关），另一个是将所有抑郁症患者群体与非患者区分开来（与注意力和记忆力测量的表现相关）。对于高致死率的自杀企图的患者，赤字并没有出现反映弥漫性脑损伤从过去的尝试，因为弥漫性损伤的影响，通常的测试结果没有选择性imported.Conclusions：神经心理缺陷的抑郁症患者的高致死率自杀企图表明执行功能的损害超出了典型的重度抑郁症。抑郁症患者更广泛的神经心理损伤可能是严重自杀企图的危险因素。
Objective: Neuropsychological deficits in the context of psychiatric disease may be associated with suicide risk. In this study, neuropsychological performance was compared among depressed patients with at least one prior suicide attempt of high lethality, depressed patients with low-lethality prior attempts, depressed patients with no prior suicide attempts, and nonpatients.Method: Fifty unmedicated patients in a major depressive episode (21 with no history of suicide attempts and 14 and 15 patients with previous attempts of low and high lethality, respectively) and 22 nonpatients were assessed. Groups were comparable in age, education, occupational level, and estimated premorbid intelligence. The neuropsychological battery produced scores within five composite domains: general intellectual functioning (current), motor functioning, attention, memory, and executive functioning.Results: Patients whose prior suicide attempts were of high lethality performed significantly worse than all groups on tests of executive functioning and were the only group to perform significantly worse than nonpatients on tests of general intellectual Functioning, attention, and memory. A discriminant function analysis revealed two prominent dimensions in the data: one that discriminated high-lethality suicide attempters from all other groups (primarily associated with performance on tests of executive functioning) and another that discriminated all depressed patient groups from nonpatients (associated with performance on measures of attention and memory). For the patients with high-lethality prior suicide attempts, deficits did not appear to reflect diffuse brain damage from past attempts, since the results of tests commonly affected by diffuse injury were not selectively impaired.Conclusions: Neuropsychological deficits in depressed patients with high-lethality prior suicide attempts suggest impairment of executive functioning beyond that typically found in major depression. This more extensive neuropsychological jmpairment in the context of depression may be a risk factor for severe suicide attempts.