Predicting suicidal behaviour after first episode of non-affective psychosis: The role of neurocognitive functioning.

BACKGROUND: Suicide has been recognised as one of the major causes of premature death in psychosis. However, predicting suicidal behaviour (SB) is still challenging in the clinical setting and the association of neurocognition with SB in psychosis remains poorly understood. This study aimed to investigate the role of neurocognitive performance as predictor of SB. Also, we sought to explore differences in the evolution of clinical and neurocognitive functioning between participants with/without history of suicide attempts (SA) over follow-up period. METHODS: The sample of the study is composed by 517 patients. Sociodemographic, clinical, functional and neurocognitive measures were evaluated at baseline as well as 1-year and 3 years after first episode of psychosis. Bivariate and multivariate analyses explored the influence of these variables as putative baseline predictors of SB. Repeated measures analyses of variance tested differences in clinical and neurocognitive outcomes at 1- and 3-year follow-up. RESULTS: Global cognitive functioning (GCF) (OR = 1.83, 95% CI = 1.25-2.67) and severe depressive symptoms (OR = 1.17, 95% CI = 1.07-1.28) predicted SB. Longitudinal analyses revealed that patients with SB at follow-up presented with higher levels of remission in terms of positive psychotic symptoms and depression. In addition, those with a history of SB had worse GCF and visual memory than those without such antecedents. CONCLUSIONS: GCF was found to be the most robust predictor of SB along with severe depressive symptomatology. Hence, poorer cognitive performance in FEP appears to emerge as a risk factor for suicidal behaviour from early stages of the illness and a comprehensive neurocognitive assessment may contribute to risk assessment.

The role of premorbid personality and social cognition in suicidal behaviour in first-episode psychosis: A one-year follow-up study.

BACKGROUND: High suicide attempt (SA) rates have been reported in first-episode psychosis (FEP) patients, particularly during the first year after the illness onset. Despite previous studies establishing several risk factors for suicidal behaviour in FEP, premorbid personality and social cognition have not been sufficiently investigated to date. OBJECTIVE: To test whether personality traits and social cognition are associated with SAs in FEP over a 12-month follow-up. METHOD: Sixty-five FEP patients were evaluated at first contact with mental health services. The presence of SAs was recorded at six and twelve months after first presentation. Bivariate and multivariate analyses explored the influence of a range of sociodemographic and clinical variables, including premorbid personality and social cognition-related Theory of Mind (ToM) measures, on SAs. RESULTS: SAs were associated with greater severity of symptoms at first hospitalization with psychotic symptoms (OR = 2.18, 95% CI = 1.25-3.82), schizoid personality traits (OR = 1.62, 95% CI = 1.02-2.57) and impairment in a first-order false belief task (OR = 4.26, 95% CI = 1.05-17.31) in the multivariate models. CONCLUSIONS: Symptom severity at illness onset, premorbid schizoid personality traits and ToM impairment emerged as predictors of SA in this FEP sample, which, if replicated, may be useful in identifying high-risk groups and implementing more targeted suicide prevention programs in FEP.

Enfermedad de Parkinson y espectro obsesivo-compulsivo / Parkinson´s disease and obsessive-compulsive spectrum

Introducción. La descripción de la asociación de síntomas obsesivos con trastornos neurológicos ha sentado las bases de los modelos neuroanatómicos del trastorno obsesivo-compulsivo y ha involucrado a los ganglios basales y lóbulos frontales en su etiopatogenia. En la última década se han comunicado frecuentemente en pacientes con enfermedad de Parkinson fenómenos obsesivo-compulsivos –ya sean rasgos o síntomas– y trastornos del control de impulsos –en el otro extremo del espectro–. Se ha postulado que esta asociación constituiría una prueba más del hipotético papel de los ganglios de la base en los circuitos implicados en la aparición de los fenómenos característicos de los trastornos del espectro obsesivo-compulsivo. Objetivos. Se realiza una revisión en Medline con las expresiones ‘obsessive compulsive Parkinson’ e ‘impulse control Parkinson’, con la finalidad de comprobar las evidencias existentes sobre dichas asociaciones. Desarrollo. Parecen existir suficientes datos como para no considerar casual la aparición de novo de trastornos del control de impulsos en enfermos parkinsonianos. Esto se ha relacionado sobre todo con el tratamiento con agonistas dopaminérgicos. Mayor desacuerdo existe sobre la presentación de síntomas obsesivo-compulsivos en la enfermedad de Parkinson, al encontrarse estudios con resultados dispares y con importantes diferencias metodológicas, incluso en la definición del fenómeno obsesivo. Conclusiones. Actualmente son necesarios más estudios que profundicen en esta cuestión y que sean lo más rigurosos posible, por los avances que podría suponer para el conocimiento de la neurobiología de estas entidades (AU)

Introduction. The description of obsessive symptoms associated with neurological diseases are in the basis of the neuroanatomical models of obsessive-compulsive disorder, with participation of basal ganglia and frontal lobes in its ethiopathogenesis. In the last years, the growth of obsessive-compulsive phenomena –including personality features or symptoms– and impulse control disorders –at the other extreme of the spectrum– in patients with Parkinson’s disease were frequently reported. It was proposed that this association could be other proof of the role of basal ganglia in the characteristic features of the obsessive-compulsive spectrum disorders. Aims. A review in Medline was conduced using the expressions ‘obsessive compulsive Parkinson’ and ‘impulse control Parkinson’. The purpose of this review was to compile the current evidence about these associations. Development. There are sufficient data to support that the growth of impulse control disorders in parkinsonian patients are not produced by chance. It was mainly related with the dopaminergic agonist treatments. More controversial is the growth of obsessive-compulsive symptoms in Parkinson’s disease. The studies found have shown contradictory results and important methodological disparities that included even the definition of obsessive phenomenon. Conclusions. Further and more rigorous studies about these topics are needed, because they could produce and important advance in the knowledge of the neurobiology of these entities (AU)

[Parkinson's disease and obsessive-compulsive spectrum]. / Enfermedad de Parkinson y espectro obsesivo-compulsivo.

INTRODUCTION: The description of obsessive symptoms associated with neurological diseases are in the basis of the neuroanatomical models of obsessive-compulsive disorder, with participation of basal ganglia and frontal lobes in its ethiopathogenesis. In the last years, the growth of obsessive-compulsive phenomena -- including personality features or symptoms -- and impulse control disorders -- at the other extreme of the spectrum -- in patients with Parkinson's disease were frequently reported. It was proposed that this association could be other proof of the role of basal ganglia in the characteristic features of the obsessive-compulsive spectrum disorders. AIMS: A review in Medline was conduced using the expressions 'obsessive compulsive Parkinson' and 'impulse control Parkinson'. The purpose of this review was to compile the current evidence about these associations. DEVELOPMENT: There are sufficient data to support that the growth of impulse control disorders in parkinsonian patients are not produced by chance. It was mainly related with the dopaminergic agonist treatments. More controversial is the growth of obsessive-compulsive symptoms in Parkinson's disease. The studies found have shown contradictory results and important methodological disparities that included even the definition of obsessive phenomenon. CONCLUSIONS: Further and more rigorous studies about these topics are needed, because they could produce and important advance in the knowledge of the neurobiology of these entities.