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Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide.
136 Veterans at high-risk for suicide previously completed a computer-based GNG task requiring rapid responding (Go) to target stimuli, while withholding responses (No-go) to infrequent foil stimuli; behavioral variables included false alarms to foils (failure to inhibit) and missed responses to targets. We conducted a secondary analysis of these data, with outcomes defined as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as interrupted/aborted attempt or preparatory behavior, or neither (noSE), within 90-days after GNG testing, to examine whether GNG variables could improve ASA prediction over standard clinical variables. A computational model (linear ballistic accumulator, LBA) was also applied, to elucidate cognitive mechanisms underlying group differences.
On GNG, increased miss rate selectively predicted ASA, while increased false alarm rate predicted OtherSE (without ASA) within the 90-day follow-up window. In LBA modeling, ASA (but not OtherSE) was associated with decreases in decisional efficiency to targets, suggesting differences in the evidence accumulation process were specifically associated with upcoming ASA.
These findings suggest that GNG may improve prediction of near-term suicide risk, with distinct behavioral patterns in those who will attempt suicide within the next 90 days. Computational modeling suggests qualitative differences in cognition in individuals at near-term risk of suicide attempt.
This chapter reviews the diagnostic features of pediatric bipolar disorder (BPD) patients, co-morbidity, and the evidence for various medications, including complementary treatments, and offers a treatment algorithm. Co-morbid disorders are the rule rather than the exception among children and adolescents with BPD. Lithium is the only mood stabilizer approved by the United States Food and Drug Administration (FDA) for use in the treatment of mania in adolescents. Valproic acid (VPA) is a chemical compound that has found clinical use as an anticonvulsant and mood stabilizer. Treatment of bipolar depression (BD) can be complicated because of the often necessary use of combinations of medications, including antidepressants, that may induce mania, hypomania, or rapid cycling. It is important for clinicians to be familiar with complementary and alternative medicine (CAM) and integrative therapies for bipolar disorder, as parents may well be using them for their affected children, with or without informing the clinician.
Pathologic rejection sensitivity is the most common feature of depression with atypical features. While monoamine oxidase inhibitors (MAOI) studies suggested that MAOIs might be useful first-line agents in treatment of depression with atypical features, dietary restrictions, high rates of side effects, such as weight gain and sexual dysfunction, and significant drug-drug interactions make MAOIs less attractive in practice. Hence, the advent of the more user-friendly selective serotonin reuptake inhibitors (SSRIs) had significant appeal. The literature is clear that phenelzine is a superior choice over imipramine for the treatment of depression with atypical features, particularly if onset is early and the course is very chronic. Prior to starting an MAOI, the patient must be educated about the content of and rationale for the tyramine-free diet and dangerous medications, such as SRIs and meperidine. The selegiline patch has the side effects of other MAOIs.