Relationship between cognition and suicidal behavior in recent-onset psychosis

Area of Science:

• Psychiatry
• Neuroscience
• Cognitive Science

Background:

• Suicidal behavior (SB) is prevalent in first-episode psychosis (FEP).
• The impact of cognitive functions and insight on SB in FEP is not fully understood.
• Existing research on risk factors for SB in psychosis has not clearly defined the role of cognition.

Purpose of the Study:

• To investigate the association between a history of SB and various cognitive domains in individuals with recent-onset FEP.
• To differentiate the roles of neurocognition, social cognition, and metacognition, including cognitive insight (CI), in relation to SB history.
• To identify specific cognitive patterns associated with suicidal behavior in the early stages of psychosis.

Main Methods:

• A sample of 190 participants with recent-onset FEP was analyzed from two multicentric studies.
• Participants were categorized into two groups: those with and without a history of SB.
• Demographic, clinical, neurocognitive, social cognition, and metacognitive data were compared between groups, with statistical adjustments and effect size calculations.

Main Results:

• No significant differences were observed in demographic, clinical, neurocognitive, or general metacognitive variables between groups.
• Individuals with a history of SB demonstrated significantly higher cognitive insight (CI) (medium effect size).
• Associations were found between prior SB and specific social cognition/metacognition aspects: lower externalizing bias, better theory of mind (ToM), and a tendency towards jumping to conclusions (JTC).

Conclusions:

• Neurocognitive functioning in recent-onset psychosis is not associated with a history of suicidal behavior.
• Cognitive insight (CI) emerges as a novel distinguishing factor, with higher CI observed in individuals with a past history of SB.
• Specific social cognition and metacognitive profiles, including enhanced ToM and altered attributional style, characterize individuals with prior SB in FEP, suggesting potential targets for intervention.