Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task.

BACKGROUND: Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide. METHOD: 136 Veterans at high-risk for suicide previously completed a computer-based GNG task requiring rapid responding (Go) to target stimuli, while withholding responses (No-go) to infrequent foil stimuli; behavioral variables included false alarms to foils (failure to inhibit) and missed responses to targets. We conducted a secondary analysis of these data, with outcomes defined as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as interrupted/aborted attempt or preparatory behavior, or neither (noSE), within 90-days after GNG testing, to examine whether GNG variables could improve ASA prediction over standard clinical variables. A computational model (linear ballistic accumulator, LBA) was also applied, to elucidate cognitive mechanisms underlying group differences. RESULTS: On GNG, increased miss rate selectively predicted ASA, while increased false alarm rate predicted OtherSE (without ASA) within the 90-day follow-up window. In LBA modeling, ASA (but not OtherSE) was associated with decreases in decisional efficiency to targets, suggesting differences in the evidence accumulation process were specifically associated with upcoming ASA. CONCLUSIONS: These findings suggest that GNG may improve prediction of near-term suicide risk, with distinct behavioral patterns in those who will attempt suicide within the next 90 days. Computational modeling suggests qualitative differences in cognition in individuals at near-term risk of suicide attempt.

Using the Internet to assess perceptions of patients with borderline personality disorder: what do patients want in the DSM-V?

OBJECTIVES: This study was an anonymous Internet survey of individuals currently diagnosed with borderline personality disorder (BPD), where participants gave opinions about BPD criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR), and suggested modifications for BPD criteria to appear in the DSM-V (5th edition). METHODS: Survey links were posted on 24 websites/Internet blogs that offered advice, education, or treatment of BPD. Demographic and clinical data pertaining to each participant were collected. Free-text responses were analyzed by frequencies of keywords and key phrases. RESULTS: A total of 1,832 responses were downloaded between March 7 and June 6, 2009, and 646 responses were analyzable. Results indicated that the majority of the DSM-IV-TR criteria appeared to capture what participants were experiencing, even though a significant percentage of participants felt that something was missing from the current criteria. A significant percentage of participants felt that BPD should be renamed in the DSM-V; some combination of "emotion(al)" and "(dys)regulation" was most commonly suggested to include in an alternative name. CONCLUSIONS: This Internet study highlighted the enthusiasm of individuals diagnosed with BPD to share their opinions on the DSM criteria with mental-health professionals. A significant percentage of participants in this study felt that BPD should be renamed in the DSM-V. Patient involvement during the DSM-V revision process remains controversial.