Impulsivity and Suicidal Behavior
Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10–34 years. While many long-term risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many chara
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ntents 1 Introduction 2 Time Structure of Suicidal Behavior: “A Fit of Melancholy” 2.1 Suicide Risk Characteristics 2.2 High-Risk Behavior Combines Activation and Depression Across Diagnoses 3 Short-Term Indices of Behavioral and Affective Regulation: Endogenous or Exogenous Stressors Increase Risk for Activation and Suicidal Behavior 3.1 Impulsivity Encompasses Distinct Behavioral Models and Adaptations 3.2 Endogenous or Exogenous Stressors Can Increase NE and Risk for Activation and Suicidality 4 In Susceptible Individuals, Stressful or Rewarding Stimuli Produce Sensitization with Increased Susceptibility to Unstable, Impulsive Behavior and Negative Urgency 4.1 Action-Impulsivity as a Latent Trait Predisposing to Suicidality 4.2 Suicide and Near-Instantaneous Behavior Regulation 5 Summary: Determinants of Impulsivity Expression and Targets for Treatment 6 Conclusions References
A. C. Swann (*) and S. J. Mathew Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA e-mail: [email protected] M. Lijffijt Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Research Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA B. O’Brien Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020 Curr Topics Behav Neurosci https://doi.org/10.1007/7854_2020_144
A. C. Swann et al.
Abstract Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10–34 years. While many longterm risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many characteristics of suicidal behavior cut across diagnoses, but suicide is increased in recurrent psychiatric disorders, addictive disorders, and trauma-related disorders. Suicide results from the interaction of short-term and long-term behavioral regulation. The shorter the time-course of the mechanism, the closer it is to actual suicidal behavior, and the harder it is to prevent. We will discuss the manner in which impulsivity, a major determinant of short-term suicide risk, interacts with longer-term risk factors, especially sensitization to addictive or traumatic stimuli. Impulsivity predisposes to sensitization; in turn, impulsivity is a prominent component of sensitized behavior. Impulsivity can be described as a general pattern of behavior (“trait” impulsivity), as responses that are not conformed to their context (action-impulsivity), or as inability to delay reward or to take future consequences into account (choice-impulsivity). Each of these contributes to suicidal behavior. The neural mechanisms of impulsivity and sensitization are analogous, and sensitization can produce rapidly fluctuating patterns of impulsive behavior, arousal
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