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首页> 外文期刊>Journal of psychiatric research >Deterministic learning and attempted suicide among older depressed individuals: Cognitive assessment using the Wisconsin Card Sorting Task
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Deterministic learning and attempted suicide among older depressed individuals: Cognitive assessment using the Wisconsin Card Sorting Task

机译：老年抑郁症患者的确定性学习和自杀未遂：使用威斯康星卡片分类任务的认知评估

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Background: Late-life suicide is an under-investigated public health problem. Among the putative vulnerabilities for this complex multifactorial behaviour are deficits in cognitive control, an ability to integrate and prioritize multiple cognitive processes in order to flexibly adapt behaviour and meet situational demands. We investigated cognitive control during rule learning in a complex and changing environment in older individuals with suicide attempts of varying lethality. Method: Ninety-three participants over the age of 60 (30 healthy controls, 29 depressed never suicidal, 20 low-lethality suicide attempters, 14 high-lethality suicide attempters) underwent structured clinical and cognitive assessments. Participants then completed the Wisconsin Card Sorting Test (WCST), a well-studied task of cognitive control during rule learning. Results: High-lethality attempters demonstrated a pattern of deficits involving poor conceptual reasoning, perseverative errors and total errors. Compared to low-lethality attempters and healthy controls, high-lethality attempters demonstrated poor conceptual reasoning, as well as increased rates of perseverative errors and total errors. Compared to non-suicidal depressed participants, high-lethality attempters also made more conceptual errors. Conclusion: High-lethality suicide attempts among older people are associated with impaired cognitive control during rule learning as detected by the WCST. Our data suggest that impairment in cognitive control during rule learning may represent a vulnerability distinct from the impulsive diathesis, typically manifesting in young, low-lethality attempters. This vulnerability may contribute to the high incidence of serious or, often, fatal suicidal acts in old age.
机译：背景：晚期自杀是未充分研究的公共卫生问题。这种复杂的多因素行为的推定漏洞包括认知控制缺陷，整合和优先处理多个认知过程以灵活地适应行为并满足情境需求的能力。我们研究了规则学习过程中在复杂且多变的环境中对年龄较大的个体进行的致命性自杀尝试，研究了认知控制。方法：60名年龄在60岁以上的参与者（30名健康对照者，29名抑郁从未自杀者，20名低致死性自杀未遂者，14名高致死性自杀未遂者）接受了结构化的临床和认知评估。然后，参与者完成了威斯康星卡片分类测试（WCST），这是一项在规则学习过程中经过充分研究的认知控制任务。结果：高致命性尝试者表现出一种缺陷模式，其中涉及不良的概念推理，持久性错误和全部错误。与低致死性尝试者和健康对照相比，高致死性尝试者表现出较差的概念推理，并且持久性错误和完全错误的发生率增加。与非自杀的抑郁参与者相比，高致死性尝试者在概念上也犯了更多错误。结论：WCST检测到，老年人中的高致死率自杀企图与规则学习过程中的认知控制受损有关。我们的数据表明，规则学习过程中认知控制的障碍可能代表了不同于冲动素质的脆弱性，通常表现在年轻，低致死性尝试者中。这种脆弱性可能导致老年时发生严重的或常常是致命的自杀行为的高发生率。

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