Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt.
BACKGROUND
Executive dysfunction, distinct from other cognitive deficits in depression, has been associated with suicidal behavior. However, this dysfunction is not found consistently across samples.


METHODS
Medication-free subjects with DSM-IV major depressive episode (major depressive disorder and bipolar type I disorder) and a past history of suicidal behavior (n = 72) were compared to medication-free depressed subjects with no history of suicidal behavior (n = 80) and healthy volunteers (n = 56) on a battery of tests assessing neuropsychological functions typically affected by depression (motor and psychomotor speed, attention, memory) and executive functions reportedly impaired in suicide attempters (abstract/contingent learning, working memory, language fluency, impulse control).


RESULTS
All of the depressed subjects performed worse than healthy volunteers on motor, psychomotor and language fluency tasks. Past suicide attempters, in turn, performed worse than depressed non-attempters on attention and memory/working memory tasks [a computerized Stroop task, the Buschke Selective Reminding Task (SRT), the Benton Visual Retention Test (VRT) and an N-back task] but not on other executive function measures, including a task associated with ventral prefrontal function (Object Alternation). Deficits were not accounted for by current suicidal ideation or the lethality of past attempts. A small subsample of those using a violent method in their most lethal attempt showed a pattern of poor executive performance.


CONCLUSIONS
Deficits in specific components of attention control, memory and working memory were associated with suicidal behavior in a sample where non-violent attempt predominated. Broader executive dysfunction in depression may be associated with specific forms of suicidal behavior, rather than suicidal behavior per se.
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, NY, USA. jgk13@columbia.edu
J G
JG
Keilp
M
M
Gorlyn
M
M
Russell
M A
MA
Oquendo
A K
AK
Burke
J
J
Harkavy-Friedman
J J
JJ
Mann
D000328:Adult; D001288:Attention / Q000502:physiology*; D001714:Bipolar Disorder / Q000503:physiopathology / Q000523:psychology; D003072:Cognition Disorders / Q000503:physiopathology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology*; D015233:Models, Statistical; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D014754:Violence / Q000523:psychology; D055815:Young Adult