Impaired Decision Making in Suicide Attempters

• Published in: The American journal of psychiatry Vol. 162; no. 2; pp. 304 - 310
• Main Authors: Jollant, Fabrice, Bellivier, Frank, Leboyer, Marion, Astruc, Bernard, Torres, Stéphane, Verdier, Régis, Castelnau, Didier, Malafosse, Alain, Courtet, Philippe
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.02.2005; American Psychiatric Association
• Subjects: Adult; Adult and adolescent clinical studies; Affective Symptoms - diagnosis; Affective Symptoms - psychology; Aged; Anger; Biological and medical sciences; Cognition Disorders - diagnosis; Cognition Disorders - physiopathology; Cognition Disorders - psychology; Comparative studies; Decision Making; Female; Frontal Lobe - physiopathology; Gambling; Hostility; Humans; Impulsive Behavior - diagnosis; Impulsive Behavior - psychology; Male; Medical sciences; Middle Aged; Mood Disorders - diagnosis; Mood Disorders - psychology; Neuropsychological impairment; Neuropsychological Tests - statistics & numerical data; Parasuicide; Personality Assessment; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk factors; Self destructive behavior; Serotonin - physiology; Suicidal behaviour; Suicide; Suicide, Attempted - psychology; Suicides & suicide attempts; Violence - psychology; France; Europe; Anger; Social environment; Human; Impulsivity; Aggression; Decision making; Mental health; Cognition; Emotion emotionality; Personality; Experimental study; Suicide attempt; Hostility; Predictive factor; Neuropsychologia; Comparative study; Public health
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.162.2.304

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.