Lethal Forethought: Delayed Reward Discounting Differentiates High- and Low-Lethality Suicide Attempts in Old Age

Dombrovski, Alexandre Y.; Szántó, Katalin; Siegle, Greg J.; Wallace, Meredith L.; Forman, Steven D.; Sahakian, Barbara J.; Reynolds, Charles F.; Clark, Luke

doi:10.1016/j.biopsych.2010.12.025

Cited by 174 publications

(147 citation statements)

References 43 publications

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“…Our previous study (Takahashi et al, 2008b) demonstrated that depressive patients are more irrational in intertemporal choices for gain and loss than healthy controls. Also, a recent study reported that impulsive suicide attempters discount delayed rewards steeply (Dombrovski et al, 2011). These findings indicate that irrational suicidal behavior may be associated with large k values and smaller q values across gain and loss.…”

Section: Decision Over Time (Intertemporal Choice)mentioning

confidence: 82%

Neuroeconomics of Suicide

Takahashi

2011

SSRN Journal

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Summary:Suicidal behavior is a leading cause of injury and death worldwide. Suicide has been associated with psychiatric illnesses such as depression and schizophrenia, as well as economic uncertainty, and social/cultural factors. This study proposes a neuroeconomic framework of suicide. Neuroeconomic parameters (e.g., risk-attitude, probability weighting, time discounting in intertemporal choice, and loss aversion) are predicted to be related to suicidal behavior. Neurobiological and neuroendocrinological substrates such as serotonin, dopamine, cortisol (HPA axis), nitric oxide, serum cholesterol, epinephrine, norepinephrine, gonadal hormones (e.g., estradiol and progesterone), dehydroepiandrosterone (DHEA) in brain regions such as the orbitofrontal/dorsolateral prefrontal cortex and limbic regions (e.g., the amygdala) may supposedly be related to the neuroeconomic parameters modulating the risk of suicide. The present framework puts foundations for -molecular neuroeconomics‖ of decision-making processes underlying suicidal behavior.

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Section: Decision Over Time (Intertemporal Choice)mentioning

confidence: 82%

Neuroeconomics of Suicide

Takahashi

2011

SSRN Journal

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“…Cognitive control can be thought of as the ability to organize information in a way that helps achieve the best outcome. It underlies certain (but not all) aspects of decision-making, which in turn appears impaired in younger (Jollant et al, 2005) and older (Dombrovski et al, 2010, Dombrovski et al, 2011a suicide attempters. Decisions that involve uncertainty, options with multiple features, and changes over time place particularly high demands on cognitive control (Dombrovski et al, under review).…”

Section: Discussionmentioning

confidence: 99%

Cognitive Inhibition in Elderly High-lethality Suicide Attempters

Richard‐Devantoy

Szántó

Butters

et al. 2015

European Psychiatry

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Background-People who attempt suicide often display cognitive impairments, particularly poor cognitive control. Could poor cognitive control contribute to high suicide rates in old age? A component of cognitive control, cognitive inhibition -active suppression of task-irrelevant processing -is very sensitive to aging and has been linked to attempted suicide. We investigated cognitive inhibition in older high-lethality suicide attempters, closely resembling suicide victims, as well as low-lethality attempters, and control groups with and without depression and suicidal ideation.

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“…Ce résultat a été répliqué depuis chez des adolescents (Dougherty et al, 2009 ;Mathias et al, 2011) Il a aussi été mis en évidence une prise de décision désavantageu-se chez le sujet âgé suicidant (Clark et al, 2011, Dombrovski et al, 2011b, suggérant que les anomalies de prise de décision peuvent être un facteur cognitif de vulnérabilité suicidaire à tout âge.…”

Section: La Prise De Décisionunclassified

Le suicide de la personne âgée : existe-t-il des spécificités liées à l’âge ?

Richard‐Devantoy

Jollant

2013

smq

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Le suicide de la personne âgée pose la question de notre relation à la vieillesse et à la mort. Significativement lié à la dépression, il est relativement élevé dans cette tranche d’âge. Les conduites suicidaires de la personne âgée présentent des particularités cliniques : une intentionnalité et une létalité suicidaire élevées, peu d’antécédents personnels de conduites suicidaires et un faible niveau d’impulsivité et d’agressivité. La vulnérabilité suicidaire pourrait reposer sur des mécanismes étiopathogéniques à la fois communs et différents selon l’âge. Par exemple, il y aurait une prépondérance des facteurs développementaux précoces marqués par de l’impulsivité et de l’agressivité chez l’adolescent et le jeune adulte ; chez l’adulte âgé, il y aurait un vieillissement pathologique. Des déficits neurocognitifs similaires conduisent le sujet à ne pas pouvoir répondre adéquatement à son environnement, différent selon l’âge. La comparaison directe des sujets jeunes et âgés est nécessaire pour comprendre la genèse de la vulnérabilité suicidaire. Nous conclurons cet article avec un résumé des principes de reconnaissance et de prise en charge du risque suicidaire.Suicide in the elderly raises the question of our relationship with aging and death. Suicide rate is relatively high in this group and is significantly related to depression widely under-diagnosed in the elderly. Suicidal behaviour in the elderly has clinical specificities including high intentionality and lethality, usually little personal history of suicidal behaviour and low levels of impulsivity—aggression. Suicidal vulnerability could rely on etiopathogenic mechanisms both common and different according to age; for example, a preponderance of early developmental factors and impulsivity-aggression in adolescents and young adults vs. pathological aging in older adults, but partly similar neurocognitive deficits leading individuals not to respond adequately to their environment (itself different with age). Direct comparisons between elderly and younger subjects would be required. The article concludes with a summary of the principles of recognition and management of suicide risk

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Lethal Forethought: Delayed Reward Discounting Differentiates High- and Low-Lethality Suicide Attempts in Old Age

Cited by 174 publications

References 43 publications

Neuroeconomics of Suicide

Neuroeconomics of Suicide

Cognitive Inhibition in Elderly High-lethality Suicide Attempters

Le suicide de la personne âgée : existe-t-il des spécificités liées à l’âge ?

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