Cognition As a Therapeutic Target in the Suicidal Patient Approach

Abstract

The current considerations about completed suicides and suicide attempts in different cultures call the attention of professionals to this serious public health problem. Integrative approaches have shown that the confluence of multiple biological and social factors modulate various psychopathologies and dysfunctional behaviors, such as suicidal behavior. Considering the level of intermediate analysis, personality traits and cognitive functioning are also of great importance for understanding the suicide phenomenon. About cognitive factors, we can group them into cognitive schemas of reality interpretation and underlying cognitive processes. On the other hand, different types of primary cognitive alterations are related to suicidal behavior, especially those resulting from changes in frontostriatal circuits. Among such cognitive mechanisms can be highlighted the attentional bias for environmental cues related to suicide, impulsive behavior, verbal fluency deficits, non-adaptive decision-making, and reduced planning skills. Attentional bias consists in the effect of thoughts and emotions, frequently not conscious, about the perception of environmental stimuli. Suicidal ideation and hopelessness can make the patient unable to find alternative solutions to their problems other than suicide, biasing their attention to environmental cues related to such behavior. Recent research efforts are directed to assess the possible use of attention bias as a therapeutic target in patients presenting suicide behavior. The relationship between impulsivity and suicide has been largely investigated over the last decades, and there is still controversy about the theme. Although there is strong evidence linking impulsivity to suicide attempts. Effective interventions address to reduce impulsivity in clinical populations at higher risk for suicide could help in the prevention. Deficits in problem-solving ability also seem to be distorted in patients who attempt suicide. Understanding cognitive changes in patients who attempt suicide open an important perspective in the approach of patients with mental disorders. Identifying cognitive deficits in these patients, along with personality traits, depressive symptoms, and suicidal cognitive schemas may indicate to the psychiatrist the need for emergency care. Behavioral and cognitive interventions have been associated with reductions in suicide ideation, as well as suicide attempts in different populations.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention

“…However, the suicidal phenotype is very heterogeneous, as are different cognitive functioning and personality traits. 29 The inclusion of subjects with low levels of suicide risk may be another reason for the nonsignificant results of these studies. 28 Future studies capable of differentiating homogeneous categories according to predictors of response to psychotherapy are necessary.…”

The Interaction Effects of Suicidal Ideation and Childhood Abuse on Brain Structure and Function in Major Depressive Disorder Patients

“…In other words, cognitive intervention is of great significance toward reducing SI. Specific interventions in cognition such as attention, impulse, problem-solving, and decision-making can maximize the advantages of existing SI-intervention methods [59].…”

Neurocognition and the Suicidal Process

“…In one study, suicidal cognitions (cognitive distortions related to suicide) accounted for almost 40% of the variance in predicting suicidal ideation after discharge (Rufino and Ellis 2017). The major links between suicidal behavior and cognitive deficits seem to include attentional biases, cognitive inflexibility, impulsivity, as well as impairments in problem-solving and decision-making (da Silva et al 2018). Cognitive distortions, such as hopelessness, may have a direct association with suicidality, while neurocognitive deficits (e.g., impaired problem-solving, rigidity) may have an indirect one, through their contribution to the development of cognitive distortions (Fazakas-DeHoog et al 2017).…”