Executive Functioning in Men with Schizophrenia and Substance Use Disorders. Influence of Lifetime Suicide Attempts

• Published in: PloS one 2017-01, Vol.12 (1), p.e0169943-e0169943
• Main Authors: Adan, Ana, Capella, Maria Del Mar, Prat, Gemma, Forero, Diego A, López-Vera, Silvia, Navarro, José Francisco
• Format: Article
• Language: English
• Subjects: Adult; Alcohol; Alcohol use; Alcoholic beverages; Alcoholism; Analysis; Behavior disorders; Biology and Life Sciences; Clinical decision making; Clinical psychology; Cognition & reasoning; Cognitive ability; Cognitive tasks; Comorbidity; Decision Making; Diagnosis; Disorders; Drug dependence; Drug use; Emotional behavior; Executive Function; Humans; Intelligence; Male; Mathematical analysis; Medicine and Health Sciences; Mental disorders; Neuropsychological Tests; Patients; Physiological aspects; Problem Solving; Prognosis; Psychobiology; Psychosis; Remission; Schizophrenia; Schizophrenia - epidemiology; Schizophrenic Psychology; Service life assessment; Social Sciences; Studies; Substance abuse; Substance abuse treatment; Substance use; Substance use disorder; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Suicidal behavior; Suicide; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; Young adults
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0169943

Lifetime suicide attempts in patients with comorbidity between psychotic disorders and Substance Use Disorder (SUD), known as dual diagnosis, was associated with a worse clinical and cognitive state, poor prognosis and premature death. However, to date no previous study has examined the cognitive performance of these patients considering as independent the presence or absence of lifetime suicide attempts. We explore executive functioning differences between suicide attempters and non-attempters in dual schizophrenia (DS) patients and the possible related factors for both executive performance and current suicide risk. Fifty DS male patients in remission of SUD and clinically stables, 24 with and 26 without lifetime suicide attempts, were evaluated. We considered Z scores for all neuropsychological tests and a composite summary score for both premorbid IQ and executive functioning. DS patients showed low performance in set-shifting, planning and problem solving tasks. Those with suicide attempts presented lower composite summary scores, together with worse problem solving skills and decision-making, compared with non-attempters. However, after controlling for alcohol dependence, only differences in decision-making remained. Executive functioning was related to the premorbid intelligence quotient, and several clinical variables (duration, severity, months of abstinence and relapses of SUD, global functioning and negative symptoms). A relationship between current suicide risk, and first-degree relatives with SUD, insight and positive symptoms was also found. Our results suggest that problem solving and, especially, decision-making tasks might be sensitive to cognitive impairment of DS patients related to presence of lifetime suicide attempts. The assessment of these executive functions and cognitive remediation therapy when necessary could be beneficial for the effectiveness of treatment in patients with DS. However, further research is needed to expand our findings and overcome some limitations of this study.