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Psychiatric diagnoses and personality traits associated with disadvantageous decision-making

Published online by Cambridge University Press:  30 August 2007

F. Jollant ,
S. Guillaume ,
I. Jaussent ,
F. Bellivier ,
M. Leboyer ,
D. Castelnau ,
A. Malafosse  and
Ph. Courtet
F. Jollant*
Affiliation:
Université Montpellier 1, Faculté de médecine, Montpellier, F-34000, France inserm, U888, Montpellier, F-34000, France CHU Montpellier, Pôle Urgences, Montpellier, F-34000, France
S. Guillaume
Affiliation:
Université Montpellier 1, Faculté de médecine, Montpellier, F-34000, France inserm, U888, Montpellier, F-34000, France CHU Montpellier, Pôle Urgences, Montpellier, F-34000, France
I. Jaussent
Affiliation:
Université Montpellier 1, Faculté de médecine, Montpellier, F-34000, France inserm, U888, Montpellier, F-34000, France
F. Bellivier
Affiliation:
Université Paris 12, Faculté de médecine, IFR 10, Créteil, F-94000, France inserm, Unité 841, Créteil, F-94000, France AP-HP, Groupe Henri MondoreAlbert Chenevier, Pôle de Psychiatrie, Créteil, F-94000, France
M. Leboyer
Affiliation:
Université Paris 12, Faculté de médecine, IFR 10, Créteil, F-94000, France inserm, Unité 841, Créteil, F-94000, France AP-HP, Groupe Henri MondoreAlbert Chenevier, Pôle de Psychiatrie, Créteil, F-94000, France
D. Castelnau
Affiliation:
CHU Montpellier, Pôle Urgences, Montpellier, F-34000, France
A. Malafosse
Affiliation:
inserm, U888, Montpellier, F-34000, France Département de médecine génétique et Développement, Faculté de médecine, Geneva, Switzerland Département de Psychiatrie, Hôpitaux Universitaires de Genève, Hôpital Belle-Idée, 2 chemin du petit Bel-Air 1225Chênebourg, Switzerland
Ph. Courtet
Affiliation:
Université Montpellier 1, Faculté de médecine, Montpellier, F-34000, France inserm, U888, Montpellier, F-34000, France CHU Montpellier, Pôle Urgences, Montpellier, F-34000, France
*
∗Corresponding author. Hôpital Lapeyronie, Service de Psychologie Médicale et Psychiatrie, 371 avenue du Doyen G. Giraud, 34295 Montpellier cedex 5, France. Tel.: +33467338581; fax: +33467338988. E-mail addresses:f-jollant@chu-montpellier.fr (F. Jollant), s-guillaume@chu-montpellier.fr (S. Guillaume), jaussent@montp.inserm.fr (I. Jaussent), bellivier@im3.inserm.fr (F. Bellivier), leboyer@im3.inserm.fr (M. Leboyer), d-castelnau@chu-montpellier.fr (D. Castelnau), alain.malafosse@hcuge.ch (A. Malafosse), p-courtet@chu-montpellier.fr (Ph. Courtet).
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Abstract

Objective

Decision-making impairment is an important feature of psychiatric disorders. in a large comorbid psychiatric population, we explored the link between decision-making deficit and clinical variables.

Method

We used the Iowa Gambling Task to measure decision-making in 317 patients. Psychiatric diagnoses were made according to the DSM-IV criteria. Self-questionnaires were used to assess several personality traits. The last and most severe suicidal acts were characterized.

Results

(1) After controlling for age and medication intake, a past history of suicide attempt (OR = 2.0 [1.1–3.8]) and normothymic bipolar disorders (OR = 3.4 [1.1–10.5]) were significantly and independently associated with impaired decision-making. (2) Decision-making performance was significantly correlated with affective lability. (3) No association was found between decision-making skills and suicidal characteristics.

Discussion

A lack of statistical power may have masked associations with obsessive-compulsive disorder and anorexia nervosa. We did not control for other cognitive functions except attention.

Conclusion

This study supports the independent association of decision-making impairment with vulnerability to suicidal behaviour but not with substance abuse. Normothymic bipolar disorders, but not unipolar disorders, were also linked to low performance. At the dimensional level, impulsivity and decision-making abilities may be distinct processes. Affective regulation skills appear to be a major influence on decision-making performance and following a relevant therapeutic target.

Keywords

SuicideBipolar disorderAddictionEating disordersNeuroscience
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 7 , October 2007 , pp. 455 - 461
Copyright
Copyright © Elsevier Masson SAS 2007

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