Decision making and vulnerability to suicidal behaviour in elderly

Suicide is a major public health concern, especially for older adults, who have higher rates of completed suicide than any other age group in most countries of the world. However, understanding suicidal behaviour remains a challenging task particularly among the elders who have been poorly studied. Decision making has been recently found to be altered in suicide attempters under 65.To test wether decision making would be a neuropsychological trait of vulnerability to suicidal behaviours, the authors used the Iowa Gambling Task to investigate normothymic non demented elders with a history of suicidal behaviour (N = 35) and compared it to decision making in non suicide attempters with a past history of depression (N = 52) and comparison subjects (N = 43). The data also were compared to those of similar groups of younger normothymic subjects. Moreover, the old suicidal patients were assessed according to the age at the onset of suicidal behaviour (before or after 60).Old suicide attempters did not significantly differ from the other aged groups and according to the age of first suicidal behaviour. Old suicide attempters presented better performances than that of younger suicidal patients.Vulnerability to suicidal behaviour in older people may proceed from cognitive processes which are different from the ones involved in suicidal vulnerability of younger subjects. These results are preliminary and further studies are needed to explore vulnerability cognitive patterns to suicide among elders.

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Prefrontal activation in suicide attempters during decision making with emotional feedback

Translational Psychiatry ◽

10.1038/s41398-020-00995-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Adrián Alacreu-Crespo ◽

Emilie Olié ◽

Emmanuelle Le Bars ◽

Fabienne Cyprien ◽

Jérémy Deverdun ◽

...

Keyword(s):

Decision Making ◽

Iowa Gambling Task ◽

Anterior Cingulate ◽

Suicide Attempters ◽

Risky Choices ◽

Emotional Face Processing ◽

Expected Outcome ◽

History Of ◽

Emotional Face ◽

History Of Depression

Abstract Emotional feedback, such as faces showing emotions, can influence decision making. Decision making and emotional face processing, mainly mediated by the prefrontal and cingulate cortices, are impaired in suicide attempters. Here, we used functional MRI (fMRI) to study prefrontal activation in suicide attempters during a modified version of the Iowa Gambling Task (IGT) that included emotional face feedback. We randomly distributed the 116 euthymic women (n = 45 suicide attempters, n = 41 affective controls with history of depression without suicide attempt, and n = 30 healthy controls) included in the study in three emotional IGT groups: concordant (safe and risky choices followed by happy and angry faces, respectively), discordant (safe and risky choices followed by angry and happy faces, respectively), and neutral condition (safe and risky choices followed by neutral faces). Considering the two IGT phases (ambiguous and risky), we then analyzed five regions of interest during the risky vs. safe choices: orbitofrontal (OFC), anterior cingulate (ACC), ventrolateral (VLPFC), medial (MPFC) and dorsal prefrontal (DPFC) cortices. We found: (1) impaired decision making and increased DPFC and OFC activation in suicide attempters vs. controls in the discordant condition during the risky phase; (2) reduced VLPFC activation in suicide attempters in the concordant condition during the ambiguous phase; and (3) decreased OFC, ACC and DPFC activation in both control groups in the concordant condition during the ambiguous phase. Suicide attempters showed prefrontal alterations during reward-learning decision making with emotional feedback. Suicide attempters may guide their decisions to avoid social negative feedback despite the expected outcome.

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Decision Making Under Ambiguity and Under Risk in Depressed Suicide Attempters, Depressed Non-Attempters and Healthy Controls

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.160 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S291-S292

Author(s):

E.A. Deisenhammer ◽

S.K. Schmid ◽

G. Kemmler ◽

B. Moser ◽

M. Delazer

Keyword(s):

Decision Making ◽

Iowa Gambling Task ◽

Suicide Attempts ◽

Control Group ◽

Healthy Controls ◽

Suicide Attempters ◽

Lifetime History ◽

Study Results ◽

History Of ◽

Risky Decisions

IntroductionStudy results on decision-making (DM) abilities in suicidal individuals are conflicting. Most studies have focused on DM under ambiguity and included patients with a lifetime history of suicide attempts.ObjectiveTo assess DM abilities with two different instruments in recent suicide attempters.MethodsThe study sample consisted of three groups. Group 1 (SA) were currently depressed inpatients having attempted suicide within the previous six months. Group 2 (NSA) consisted of depressed inpatients without a lifetime history of suicide attempts. Group 3 (CG) was a healthy control group. Besides depression severity, impulsiveness and suicidal intent (SA group only) DM was assessed using the Iowa gambling task (IGT) for DM under ambiguity and the game of dice task (GDT) for DM under risk.ResultsA total of 78 participants (SA group, n = 21; NSA group, n = 31; CG, n = 26) were included into the study. Significant between group differences were found regarding marital status, current partnership, smoking status, depression score, impulsiveness score and family history of psychiatric disorders (all discriminating controls from patients but not between SA and NSA groups). The three groups did not differ with regard to IGT scores. Concerning GDT, the SA group showed significantly lower scores compared to the two other groups, implying a readiness for more risky decisions in suicide attempters versus non-attempters and controls.ConclusionSuicide attempters appear to make more risky decisions compared to depressed non-attempters as well as healthy controls even if the DM under ambiguity patterns do not differ.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Neuropsychological deficits in past suicide attempters with varying levels of depression severity

Psychological Medicine ◽

10.1017/s0033291714000786 ◽

2014 ◽

Vol 44 (14) ◽

pp. 2965-2974 ◽

Cited By ~ 34

Author(s):

J. G. Keilp ◽

S. R. Beers ◽

A. K. Burke ◽

N. M. Melhem ◽

M. A. Oquendo ◽

...

Keyword(s):

Working Memory ◽

Major Depression ◽

Rating Scale ◽

Suicide Attempts ◽

Past History ◽

Clinical State ◽

Suicide Attempters ◽

History Of ◽

Attention Memory ◽

Interference Processing

BackgroundOur previous work identified deficits in interference processing and learning/memory in past suicide attempters who were currently depressed and medication-free. In this study, we extend this work to an independent sample studied at various stages of illness and treatment (mild symptoms, on average) to determine if these deficits in past suicide attempters are evident during a less severe clinical state.MethodA total of 80 individuals with a past history of major depression and suicide attempt were compared with 81 individuals with a history of major depression and no lifetime suicide attempts on a battery of neurocognitive measures assessing attention, memory, abstract/contingent learning, working memory, language fluency and impulse control.ResultsPast attempters performed more poorly in attention, memory and working memory domains, but also in an estimate of pre-morbid intelligence. After correction for this estimate, tests that had previously distinguished past attempters – a computerized Stroop task and the Buschke Selective Reminding Test – remained significantly worse in attempters. In a secondary analysis, similar differences were found among those with the lowest levels of depression (Hamilton Depression Rating Scale score <10), suggesting that these deficits may be trait markers independent of current symptomatology.ConclusionsDeficits in interference processing and learning/memory constitute an enduring defect in information processing that may contribute to poor adaptation, other higher-order cognitive impairments and risk for suicidal behavior.

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Deficits in Reward Decision-Making on the Iowa Gambling Task in Justice-Involved Adults

10.31234/osf.io/xt59h ◽

2021 ◽

Author(s):

Lana Vedelago ◽

Iris Balodis ◽

Kaitlyn McLachlan ◽

Heather Moulden ◽

Vanessa Morris ◽

...

Keyword(s):

Decision Making ◽

Iowa Gambling Task ◽

Comparison Group ◽

Correctional Institutions ◽

Gambling Task ◽

Community Group ◽

Community Based ◽

Switching Patterns ◽

History Of ◽

Shift Strategy

Deficits in reward decision-making are thought to contribute to criminal offending. These impairments have been measured in laboratory studies using the Iowa Gambling Task (IGT) which assesses implicit learning of different reward/punishment contingencies. This study compared IGT performance between a sample of justice-involved individuals and community-based individuals without an offending history. Participants included 100 adults from two Canadian federal correctional institutions (34% female, Mage = 39.14 ± 9.74) and a comparison group of 89 community adults with no history of offending (39% female, Mage = 37.04 ± 10.79). Responses on the IGT were analyzed for overall net score, learning across the task, and deck switching patterns. Associations between IGT performance and sentence characteristics and static factors assessment of recidivism risk were examined for the justice-involved group. The justice-involved group performed significantly worse than community adults in terms of net score. While the community group learned the advantageous strategy across the task, justice-involved participants exhibited minimal learning. This effect was moderated by recidivism risk within the justice-involved group, with individuals at low risk, but not medium/high risk, showing improvement over the blocks of the task. Finally, the justice-involved group also made greater use of an ineffective “win-stay/lose-shift” strategy. These results suggest that, compared with community participants without history of offending, incarcerated adults tend to employ maladaptive decision-making strategies that yield worse overall outcomes and the extent of impairment is associated with recidivism risk.

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Psychiatric diagnoses and personality traits associated with disadvantageous decision-making

European Psychiatry ◽

10.1016/j.eurpsy.2007.06.001 ◽

2007 ◽

Vol 22 (7) ◽

pp. 455-461 ◽

Cited By ~ 58

Author(s):

F. Jollant ◽

S. Guillaume ◽

I. Jaussent ◽

F. Bellivier ◽

M. Leboyer ◽

...

Keyword(s):

Decision Making ◽

Personality Traits ◽

Statistical Power ◽

Iowa Gambling Task ◽

Past History ◽

Bipolar Disorders ◽

Major Influence ◽

Psychiatric Diagnoses ◽

Compulsive Disorder ◽

Low Performance

AbstractObjectiveDecision-making impairment is an important feature of psychiatric disorders. in a large comorbid psychiatric population, we explored the link between decision-making deficit and clinical variables.MethodWe used the Iowa Gambling Task to measure decision-making in 317 patients. Psychiatric diagnoses were made according to the DSM-IV criteria. Self-questionnaires were used to assess several personality traits. The last and most severe suicidal acts were characterized.Results(1) After controlling for age and medication intake, a past history of suicide attempt (OR = 2.0 [1.1–3.8]) and normothymic bipolar disorders (OR = 3.4 [1.1–10.5]) were significantly and independently associated with impaired decision-making. (2) Decision-making performance was significantly correlated with affective lability. (3) No association was found between decision-making skills and suicidal characteristics.DiscussionA lack of statistical power may have masked associations with obsessive-compulsive disorder and anorexia nervosa. We did not control for other cognitive functions except attention.ConclusionThis study supports the independent association of decision-making impairment with vulnerability to suicidal behaviour but not with substance abuse. Normothymic bipolar disorders, but not unipolar disorders, were also linked to low performance. At the dimensional level, impulsivity and decision-making abilities may be distinct processes. Affective regulation skills appear to be a major influence on decision-making performance and following a relevant therapeutic target.

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A Model for the Management of Suicidal Behaviour in Primary Care

European Psychiatry ◽

10.1016/s0924-9338(09)70618-2 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

V. Voros ◽

P. Osvath ◽

S. Fekete

Keyword(s):

Primary Care ◽

Health Care ◽

Suicidal Behaviour ◽

Suicide Risk ◽

Health Care Services ◽

Warning Signs ◽

Health Concern ◽

Care Services ◽

Suicidal Patients ◽

Primary Care Professionals

Introduction:Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.Aims and methods:Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.Results:We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.Conclusion:In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

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Sociodemographic, obstetric and psychological determinants of obesity among women in early to mid-pregnancy in South India

Wellcome Open Research ◽

10.12688/wellcomeopenres.14954.1 ◽

2019 ◽

Vol 4 ◽

pp. 2

Author(s):

Shubhashree Venkatesh ◽

Anita Nath ◽

Sheeba Balan ◽

Vindhya J ◽

Chandra S. Metgud ◽

...

Keyword(s):

Pregnant Women ◽

South India ◽

Maternal Obesity ◽

Past History ◽

Child Outcomes ◽

The Body ◽

Health Concern ◽

Psychological Determinants ◽

Prevalence Of Obesity ◽

History Of

Background: Worldwide, the occurrence of obesity has markedly increased over the past decades with serious public health consequences. Obese pregnant women are more likely to develop hypertension, pre-eclampsia and gestational diabetes, resulting in obstetric complications which in turn may contribute to an increase in adverse child outcomes and maternal mortality. The present study was done to determine the prevalence of obesity and its association with socio-demographic variables, obstetric history and mental health. Methods: This study was nested within an ongoing cohort study, CASCADE, in a public hospital in Bangalore. The study participants comprised of 280 pregnant women who were 18 years of age and above, with a gestational age of less than 24 weeks, enrolled between a period of August 1st, 2017 until April 30th, 2018. Weight and height were measured using calibrated devices to calculate the body mass index. Results: The prevalence of obesity was observed to be 33.9% among the pregnant mothers. Obesity was found to be significantly associated with age, history of abortion, gravidity on multivariate logistic regression. No association was found with depression and anxiety. Conclusions: Obesity is an important health concern among urban pregnant women in the region of South India. The prevalence is much higher than that reported in other studies. Increasing age, multigravidity and past history of abortion were significantly associated with maternal obesity.

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PREVALENCE OF OSTEOPOROSIS IN SUB-URBAN POPULATION OF CHENNAI USING QUS (QUANTITATIVE ULTRASOUND) OF CALCANEUM -A CROSS SECTIONAL STUDY

10.36106/ijsr/1604084 ◽

2021 ◽

pp. 43-44

Author(s):

S. Balameena ◽

R Agavendra ◽

Karthikeyan Karthikeyan ◽

Sujatha Sujatha ◽

Sabarish Sabarish ◽

...

Keyword(s):

Screening Test ◽

Past History ◽

Age Groups ◽

Cost Effective ◽

Cross Sectional Study ◽

Health Concern ◽

Cross Sectional ◽

Study Results ◽

History Of ◽

Ultrasound Score

Background:Burden of Osteoporosis and its related fractures are enormous and growing public health concern. Worldwide, an estimated 200 million adults suffer from osteoporosis. Vertebral and non-vertebral fractures are the most clinically relevant osteoporotic fracture because they are expensive to treat and have severe consequences for middle aged and elderly population.(1 ,2) The purpose of our study was to assess calcaneal ultrasound score as a screening test for osteoporosis. Material and Methods: Fifty patients above the age of 40 years who attended a health checkup camp conducted by our institute in a suburban population base of Chennai,Tamilnadu was subjected for noninvasive QUS of calcaneum bone as a screening test for osteoporosis. They were divided into different age groups ,co-morbid conditions noted and BMD scores from QUS was assessed. Statistical method were used with SPSS Version .It was a cross sectional descriptive study. Results: A total of 50 patients underwent QUS of calcaneum bone in our study , all of them above the age of 40 years. 33(66%) of them were females and 17(34%) were males. Eight patients( 16% ) had T score < -2.5 out of which 1 was male. 26 patients(52%) had T scores in the osteopenic range (-1>Tscore>-2.5).16 patients(32%) had T scores in the normal range. 40 % of patients had associated osteoarthritis and four patients had diabetes. 2 patients who underwent screening had past history of nontraumatic fractures. Conclusion: QUS of calcaneum is a good screening tool for assessing bone density in our country since its cost effective and can be used in various screening camps. The machine is portable and can be used with minimal training making it easier for the primary caregiver. It has reasonably good sensitivity and fair specicity when using Tscore of -2.5 as the cut off point. However DEXAis the gold standard for treatment and followup of patients with osteoporosis.

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P01-51-Impulsivity and decision making measured in cocaine addicts in France

European Psychiatry ◽

10.1016/s0924-9338(11)71762-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 51-51

Author(s):

X. He ◽

V. Bloch ◽

G. Brousse ◽

F. Vorspan ◽

J.-P. Lépine

Keyword(s):

Decision Making ◽

Iowa Gambling Task ◽

Gambling Task ◽

Clinical Factors ◽

Chi Square ◽

Cocaine Use ◽

Cocaine Craving ◽

The Usa ◽

History Of ◽

The Mean

IntroductionImpulsivity and decision making are impaired in cocaine addicts. However, most studies were performed in the USA.ObjectivesTo assess impulsivity and decision making in a sample of French cocaine addicts.MethodsSubjects40 current cocaine addicts and 21 control subjects with no history of drug abuse were compared using the Barratt Impulsiveness Scale (BIS) and Iowa Gambling Task (IGT). Subjects from the cocaine addicted group were evaluated for cocaine craving with the Obessive Compulsive Cocaine Scale (OCCS), and for their pattern of use. Statistical analysis: The mean scores of impulsivity and decision making were compared in the two groups (Mann-Whitney U test). In the group of 40 cocaine addicts, clinical factors that could be associated with high impulsivity and poor decision making scores were tested (Spearman’ s rho, Chi-square and Mann-Whitney U tests).ResultCompared to controls, cocaine addicts had a higher impulsivity score (BIS: 72 ± 11 vs 57 ± 8, U = 138, p < .001) and had more disadvantageous choices on the decision making test (IGT) (advantageous minus disadvantageous choices -4 ± 19 vs 24 ± 35, U = 234, p = .005). There was a significant correlation between high impulsivity scores on the BIS and high cocaine craving as well as heavy cocaine use (more than 4 times a week). No correlation was found between poor decision making and high craving or frequent cocaine use.DiscussionThe discrepancy between impulsivity and poor decision making in cocaine addicts is discussed.

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Influence Factors for Decision-Making Performance of Suicide Attempters and Suicide Ideators: The Roles of Somatic Markers and Explicit Knowledge

Frontiers in Psychology ◽

10.3389/fpsyg.2021.693879 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lingling Wang ◽

Jingmin Li ◽

Hailing Liu ◽

Zhongpeng Wang ◽

Li Yang ◽

...

Keyword(s):

Decision Making ◽

Subjective Experience ◽

Explicit Knowledge ◽

Iowa Gambling Task ◽

Influence Factors ◽

Healthy Controls ◽

Gambling Task ◽

Suicide Attempters ◽

Somatic Markers ◽

Skin Conductance Responses

Impaired decision-making has been observed in suicide attempters during the Iowa Gambling Task (IGT). Decision-making performance is influenced by somatic markers and explicit knowledge, but it is still unclear of the influencing role on decision-making performance in suicidal individuals. We aimed to investigate whether there is a decision-making deficit in suicide attempters, suicide ideators, as well as the distinct roles of somatic markers and explicit knowledge wherein. Thirteen suicide attempters, 23 suicide ideators, and 19 healthy controls performed the IGT. Both somatic markers (by the skin conductance responses, SCRs) and explicit knowledge (by the subjective experience rating and a list of questions) were recorded. No significant differences were found among the three groups on IGT performance, explicit knowledge, and anticipatory SCRs. IGT Performance of suicide attempters was positively correlated with explicit knowledge index while behavior performance was positively associated with the SCRs in healthy controls. These results indicate that the suicide attempters seem to apply a compensatory strategy by mostly utilizing explicit knowledge to perform normally as healthy controls in the IGT.

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