Lifetime suicide intent, executive function and insight in schizophrenia and schizoaffective disorders

Abstract

Objectives Lack of insight and neurocognitive deficits are often seen in schizophrenia patients. While there are several studies investigating the relationship between suicidal ideation, executive function and insight, there are relatively fewer investigating the triangular relationship between suicide intent, insight and cognitive competence in schizophrenia. The aim of our study was to address this issue. Methods One hundred seventy five subjects with DSM-IV TR diagnoses of schizophrenia or schizoaffective disorder were enrolled and the diagnosis was established using the Hindi version of the Diagnostic Interview for Genetic Studies and other available information in consultation with a Board certified senior Psychiatrist. All the subjects were interviewed on Beck’s cognitive insight scale and tested on the Trail Making Test. All the subjects who had lifetime history of suicide attempt were interviewed on Pierce’s suicide intent scale. Results Ever attempters scored significantly higher on Beck’s cognitive insight scale (p = 0.012) and outperformed non-attempters on Trail Making Test A and B (p = 0.026 and p = 0.012 respectively), indicating better executive functions in the former. However among ever attempters, significant relationship was not found between executive functions, insight and severity of suicide intent. Conclusion Our study suggests that good insight and better executive functioning may be significantly correlated with suicide attempts at some time during the course of illness. Patients with schizophrenia should be evaluated for potential suicidality once denial, neurocognitive deficits and other factors associated with poor insight abate.

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

“…It has been suggested that other contributing factors, such as neurocognitive functioning, may be more sensitive in the prediction of SB [7] than the classic risk factors. Indeed, some previous studies suggested that the presence of SB was associated with better neurocognitive performance in domains such as executive functioning [8][9][10]. In keeping with this, the aforementioned study we found significant differences in processing speed functioning at baseline between patients with SB and those without SB prior to first contact with services [5].…”

Suicide attempts in Chinese Han patients with schizophrenia: cognitive, demographic, and clinical variables

“…None of these studies found a difference in cognitive performance between SCZ patients with or without a history of suicide attempts. However, studies have found both negative and positive relationships between cognitive performance and suicide risk, 8,36 which could be due to several reasons. Suicide attempters may have different neurocognitive characteristics than non-attempters, which suggests that comprehensive neurocognitive assessments are needed to investigate their relationship.…”

Suicide in Schizophrenia: An Educational Overview

“…Studies and observations suggest that the following demographic and psychosocial factors increase the risk of suicide in individuals with schizophrenia [10,29,33,34,35,36]:Younger ageBeing maleBeing unmarriedLiving aloneBeing unemployedBeing intelligentBeing well-educatedGood premorbid adjustment or functioningHaving high personal expectations and hopesHaving an understanding that life’s expectations and hopes are not likely to be metHaving had recent (i.e., within past 3 months) life eventsHaving poor work functioningHaving access to lethal means, such as firearms…”