The relationship between cognitive dysfunction and suicide crisis syndrome symptoms

Suicide Crisis Syndrome (SCS), a proposed diagnostic construct for the Diagnostic and Statistical Manual of Mental Disorders (DSM), represents an acute suicidal mental state. Because DSM inclusion requires evidence of functional impairment, this study tested the hypothesis that SCS is associated with deficits in executive function (EF).

Eighty-five psychiatric inpatients were assessed at intake and 64 at discharge. The 15-item SCS checklist (SCS-C) evaluated symptoms across five domains: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. EF was measured using a composite score derived from the Trail Making Test (A and B), Stroop Color and Word Test, and Digits Forward and Digits Sequencing tasks. Data were analyzed using Spearman rho correlations, repeated-measures ANOVA, and general linear models (GLM).

SCS-C total score and all domain scores decreased from intake to discharge with small to medium effects. Only Trails A reduced similarly with a small effect size. At intake, there was a negative relationship between SCS Affective Disturbance and EF which was no longer present at discharge. By GLM, there was a significant interaction effect by time, showing that this change in association over time was significant, even when controlling for age.

SCS symptoms, particularly affective disturbance, may be associated with executive dysfunction. This impairment is clinically significant, as it may compromise judgment and increase impulsivity. That the linkage between SCS affective symptoms and reduced cognitive function attenuated by discharge provides preliminary support for the notion that SCS is associated with state-dependent cognitive impairment.