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Diagnósticos psiquiátricos y rasgos de personalidad asociados con el deterioro de la capacidad de toma de decisiones

Published online by Cambridge University Press:  12 May 2020

F. Jollant ,
S. Guillaume ,
I. Jaussent ,
F. Bellivier ,
M. Leboyer ,
D. Castelnau ,
A. Malafosse  and
Ph. Courtet
F. Jollant
Affiliation:
Universidad de Montpellier I, Facultad de Medicina, Montpellier, F-34000, Francia lnserm, U888, Montpellier, F 34000, Francia CHU Montpellier, Servicio de Urgencias, Montpellier, F 34000, Francia
S. Guillaume
Affiliation:
Universidad de Montpellier I, Facultad de Medicina, Montpellier, F-34000, Francia lnserm, U888, Montpellier, F 34000, Francia CHU Montpellier, Servicio de Urgencias, Montpellier, F 34000, Francia
I. Jaussent
Affiliation:
Universidad de Montpellier I, Facultad de Medicina, Montpellier, F-34000, Francia lnserm, U888, Montpellier, F 34000, Francia
F. Bellivier
Affiliation:
Universidad de París 12, Facultad de Medicina, IFR 10, Créteil, F 94000, Francia Inserm, Unidad 841, Créteil, F 94000, Francia AP-CV, Grupo Henri Mondor-Albert Chenevier, Servicio de Psiquiatría, Créteil, F 94000, Francia
M. Leboyer
Affiliation:
Universidad de París 12, Facultad de Medicina, IFR 10, Créteil, F 94000, Francia Inserm, Unidad 841, Créteil, F 94000, Francia AP-CV, Grupo Henri Mondor-Albert Chenevier, Servicio de Psiquiatría, Créteil, F 94000, Francia
D. Castelnau
Affiliation:
CHU Montpellier, Servicio de Urgencias, Montpellier, F 34000, Francia
A. Malafosse
Affiliation:
lnserm, U888, Montpellier, F 34000, Francia Departamento de Medicina Genética y Desarrollo, Facultad de Medicina, Ginebra, Suiza Departamento de Psiquiatría, Hospitales Universitarios de Ginebra, Hospital Belle-Idée, 2 Chemin du Petit Bel-Air 1225 Chénebourg, Suiza
Ph. Courtet
Affiliation:
Universidad de Montpellier I, Facultad de Medicina, Montpellier, F-34000, Francia lnserm, U888, Montpellier, F 34000, Francia CHU Montpellier, Servicio de Urgencias, Montpellier, F 34000, Francia
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Resumen

Objetivo.

El deterioro de la capacidad de toma de decisiones es un rasgo importante de los trastornos psiquiátricos. En una población numerosa con diversas enfermedades psiquiátricas exploramos la relación entre el deterioro de los procesos de toma de decisiones y las variables clínicas.

Métodos.

Usamos la Tarea de Apuestas de lowa (lowa Gambling Task) para medir la capacidad de toma de decisiones en 317 pacientes. Los diagnósticos psiquiátricos se hicieron siguiendo los criterios del DSM-IV. Se usaron autocuestionarios para evaluar varios rasgos de la personalidad. Se identificaron los últimos intentos suicidas y los más graves.

Resultados.

(1) Después de controlar la edad y la ingesta de medicación, un intento de suicidio anterior (CP = 2 [1,1-3,8]) y los trastornos bipolares normotímicos (CP = 3,4 [1,1-10,5]) se asociaron significativamente y por separado con el deterioro de los procesos de toma de decisiones. (2) La capacidad de toma de decisiones se correlacionó significativamente con la labilidad afectiva. (3) No se encontró ninguna asociación entre las capacidades para la toma de decisiones y las características suicidas.

Discusión.

Una falta de poder estadístico puede haber enmascarado las asociaciones con el trastorno obsesivo compulsivo y la anorexia nerviosa. No controlamos otras funciones cognitivas excepto la atención.

Conclusión.

Este estudio confirma la asociación independiente entre el deterioro de la capacidad de toma de decisiones y la vulnerabilidad a la conducta suicida, pero no con el abuso de sustancias. Los trastornos bipolares normotímicos, pero no los trastornos unipolares también se asociaron con el rendimiento bajo. A nivel dimensional, la impulsividad y las capacidades para la toma de decisiones pueden ser procesos distintos. La capacidad de regulación afectiva parece ejercer una influencia importante sobre el rendimiento en la toma de decisiones y, en consecuencia, es un objetivo terapéutico importante.

Keywords

SuicidioTrastorno bipolarAdicciónTrastornos de la alimentaciónNeurociencia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 15 , Issue 1 , February 2008 , pp. 23 - 30
Copyright
Copyright © European Psychiatric Association 2008

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References

Bibliografía

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.Google Scholar
Bazanis, E, Rogers, RD, Dowson, JH, Taylor, P, Meux, C, Staley, C, et al. Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychol Med 2002;32(8):1395–405.CrossRefGoogle ScholarPubMed
Bechara, A, Damasio, H, Damasio, AR. Emotion, decision making and the orbitofrontal cortex. Cerob Cortex 2000;10(3):295–307.CrossRefGoogle ScholarPubMed
Bechara, A, Damasio, H, Damasio, AR, Lee, GRDifferent contributions of the human amygdala and ventromedial prefrontal cortex to decision making. J Neurosci 1999; 19(13):5473–81.CrossRefGoogle ScholarPubMed
Bechara, A, Damasio, H, Tranel, D, Damasio, AR. Deciding advantageously before knowing the advantageous strategy. Science 1997;275(5304):1293–5.CrossRefGoogle ScholarPubMed
Bechara, A, Dolan, S, Denburg, N, Hindes, A, Anderson, SW, Nathan, PE. Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers. Neuropsychologia 2001;39(4):376–89.CrossRefGoogle ScholarPubMed
Bechara, A, Dolan, S, Hindes, A. Decision-making and addiction (part II): myopia for the future or hypersensitivity to reward?. Neuropsychologia 2002;40(10):1690–705.CrossRefGoogle ScholarPubMed
Beck, RW, Morris, JB, Beck, AT. Cross-validation of the Suicidal Intent Scale. Psychol Rep 1974;34(2):445–6.CrossRefGoogle ScholarPubMed
Beck, AT, Weissman, A, Lester, D, Trexler, L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974;42(6):861–5.CrossRefGoogle ScholarPubMed
Best, M, Williams, JM, Coccaro, EF. Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder. Proc Nati Acad Sci USA 2002;99(12):8448–53.CrossRefGoogle ScholarPubMed
Blumberg, HP, Leung, HC, Skudlarski, P, Lacadie, CM, Fredericks, CA, Harris, BC, et al. A functional magnetic resonance imaging study of bipolar disorder: state- and trait-related dysfunction in ventral prefrontal cortices. Arch Gen Psychiatry 2003;60(6):601–9.CrossRefGoogle ScholarPubMed
Brown, GL, Goodwin, FK, Ballenger, JC, Goyer, PF, Major, LF. Aggression in humans correlates with cerebrospinal fluid amine metabolites. Psychiatry Res 1979;1(2):131–9.CrossRefGoogle ScholarPubMed
Buss, AH, Durkee, A. An inventory for assessing different kinds of hostility. J Consulting Psychol 1957;21:343–9.CrossRefGoogle ScholarPubMed
Cavedini, P, Bassi, T, Ubbiali, A, Casolari, A, Giordani, S, Zorzi, C, et al. Neuropsychological investigation of decision-making in anorexia nervosa. Psychiatry Res 2004;127(3):259–66.CrossRefGoogle ScholarPubMed
Cavedini, P, Riboldi, G, D'Annucci, A, Belotti, P, Cisima, M, Bellodi, L. Decision-making heterogeneity in obsessive-compulsive disorder: ventromedial prefrontal cortex function predicts different treatment outcomes. Neuropsychologia 2002;40(2):205–11.CrossRefGoogle ScholarPubMed
Christodoulou, T, Lewis, M, Ploubidis, GB, Frangou, S. The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder. Eur Psychiatry 2006;21(4):270–3.CrossRefGoogle ScholarPubMed
Clark, L, Cools, R, Robbins, TW. The neuropsychology of ventral prefrontal cortex: decision-making and reversal learning. Brain Cogn 2004;55(1):41–53.CrossRefGoogle ScholarPubMed
Cloninger, CR, Przybock, TR, Svrakic, DM. The tridimensional personality questionnaire US normative data. Psychol Rep 1991;69:1047–57.CrossRefGoogle Scholar
Dunkin, JJ, Leuchter, AF, Cook, IA, Kasl-Godley, JE, Abrams, M, Rosenberg-Thompson, S. Executive dysfunction predicts nonresponse to fluoxetine in major depression. J Affect Disord 2000;60(1):13–23.CrossRefGoogle ScholarPubMed
Dunn, BD, Dalgleish, T, Lawrence, AD. The somatic marker hypothesis: a critical evaluation. Neurosci Biobehav Rev 2006;30:239–71.CrossRefGoogle ScholarPubMed
Ernst, M, Grant, SJ, London, ED, Contoreggi, CS, Kimes, AS, Spurgeon, L. Decision making in adolescents with behavior disorders and adults with substance abuse. Am J Psychiatry 2003;160(1):33–40.CrossRefGoogle ScholarPubMed
Forgays, DG, Forgays, DK, Spielberger, CD. Factor structure of the State- Trait Anger Expression Inventory. J Pers Assess 1997;69(3):497–507.CrossRefGoogle ScholarPubMed
Grant, S, Contoreggi, C, London, ED. Drug abusers show impaired performance in a laboratory test of decision making. Neuropsychologia 2000;38(8):1180–7.CrossRefGoogle Scholar
Halligan, PW, David, AS. Cognitive neuropsychiatry: towards a scientific psychopathology. Nat Rev Neurosci 2001;2(3):209–15.CrossRefGoogle ScholarPubMed
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Harvey, PD, Greenberg, BR, Serper, MR. The affective lability scales: development, reliability, and validity. J Clin Psychol 1989;45(5):786–93.3.0.CO;2-P>CrossRefGoogle Scholar
Jollant, F, Bellivier, F, Leboyer, M, Astruc, B, Torres, S, Verdier, R, et al. Impaired decision making in suicide attempters. Am J Psychiatry 2005; 162(2):304–10.CrossRefGoogle ScholarPubMed
Jollant, F, Guillaume, S, Jaussent, I, Castelnau, D, Malafosse, A, Courtet, P. Impaired decision-making in suicide attempters may increase the risk of problems in affective relationships. J Affect Disord 2007;99(1-3):59–62.CrossRefGoogle ScholarPubMed
Keefe, RS. The contribution of neuropsychology to psychiatry. Am J Psychiatry 1995;152(1):6–15.Google ScholarPubMed
Kringelbach, ML, Rolls, ET. The functional neuroanatomy of the human orbitofrontal cortex: evidence from neuroimaging and neuropsychology. Prog Neurobiol 2004;72(5):341–72.CrossRefGoogle ScholarPubMed
Larsen, RJ, Diener, E. A multitrait-multimethod examination of affect structure: hedonic level and emotional intensity. Pers Individual Differences 1985;6(5):631–6.CrossRefGoogle Scholar
Lawrence, NS, Wooderson, S, Mataix-Cols, D, David, R, Speckens, A, Phillips, ML. Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder. Neuropsychology 2006;20(4):409–19.CrossRefGoogle ScholarPubMed
Mackinnon, A, Ritchie, K, Mulligan, R. The measurement properties of a French language adaptation of the National Adult Reading Test. Int J Methods Psychiatr Res 1999;8(1):27–38.CrossRefGoogle Scholar
Malhi, GS, Lagopoulos, J, Owen, AM, Ivanovski, B, Shnier, R, Sachdev, P. Reduced activation to implicit affect induction in euthymic bipolar patients: an fMRI study. J Affect Disord 2007;97(1-3): 109-22 .CrossRefGoogle Scholar
Mann, JJ. The neurobiology of suicide. Nat Med 1998;4(1):25–30.CrossRefGoogle ScholarPubMed
Mann, JJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003;4(10):819–28.CrossRefGoogle ScholarPubMed
Martinez-Aran, A, Vieta, E, Reinares, M, Colom, F, Torrent, C, Sanchez Moreno, J, et al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004; 161 (2):262–70.CrossRefGoogle ScholarPubMed
Mitchell, DG, Colledge, E, Leonard, A, Blair, RJ. Risky decisions and response reversal: is there evidence o f orbitofrontal cortex dysfunction in psychopathic individuais?. Neuropsychologia 2002;40(12):2013–22.CrossRefGoogle Scholar
Murphy, FC, Rubinsztein, JS, Michael, A, Rogers, RD, Robbins, TW, Paykel, ES, et al. Decision-making cognition in mania and depression. Psychol Med 2001;31(4):679–93.CrossRefGoogle ScholarPubMed
Must, A, Szabo, Z, Bodi, N, Szasz, A, Janka, Z, Keri, S. Sensitivity to reward and punishment and the prefrontal cortex in major depression. J Affect Disord 2006;90(2-3):209–15.CrossRefGoogle ScholarPubMed
OUey, A, Malhi, GS, Mitchell, PB, Batchelor, J, Lagopoulos, J, Austin, MP. When euthymia is just not good enough: the neuropsychology of bipolar disorder. J Nerv Ment Dis 2005;193(5):323–30.Google Scholar
Oquendo, MA, Placidi, GP, Malone, KM, Campbell, C, Keilp, J, Brodsky, B, et al. Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression. Arch Gen Psychiatry 2003;60(1):14–22.CrossRefGoogle ScholarPubMed
Patton, JH, Stanford, MS, Barratt, ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol 1995;51(6):768–74.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Potter, GG, Kittinger, JD, Ryan Wagner, H, Steffens, DC, Ranga Rama Krishnan, K. Prefrontal neuropsychological predictors of treatment remission in late-life depression. Neuropsychopharmacology 2004;29:2266–71.CrossRefGoogle ScholarPubMed
Robinson, LJ, Thompson, JM, Gallagher, P, Goswami, U, Young, AH, Ferrier, IN, et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006;93(1-3):105–15.CrossRefGoogle ScholarPubMed
Rogers, RD, Everitt, BJ, Baldacchino, A, Blackshaw, AJ, Swainson, R, Wynne, K, et al. Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology 1999;20(4):322–39.CrossRefGoogle ScholarPubMed
Rubinsztein, JS, Michael, A, Paykel, ES, Sahakian, BJ. Cognitive impairment in remission in bipolar affective disorder. Psychol Med 2000;30(5): 1025–36.CrossRefGoogle ScholarPubMed
Sheenan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-Inte rnational Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22–33. quiz 34-57.Google Scholar
Spielberger, CD. Manual for the state-trait anxiety inventory (form Y). Palo Alto, CA: Consulting Psychologists Press; 1983.Google Scholar
Uttl, B, Pilkenton-Taylor, C. Letter cancellation performance across the adult life span. Clin Neuropsychol 2001; 15(4):521–30.CrossRefGoogle ScholarPubMed
Weisman, AD, Worden, JW. Risk-rescue rating in suicide assessment. Arch Gen Psychiatry 1972;26(6):553–60.CrossRefGoogle ScholarPubMed
Zermatten, A, Van, der Linden M, d’Acremont, M, Jermann, F, Bechara, A.Impulsivity anvvd decision making. J Nerv Ment Dis 2005;193(10):647–50.CrossRefGoogle ScholarPubMed