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Strasser ES, Haffner P, Fiebig J, Quinlivan E, Adli M, Stamm TJ. Behavioral measures and self-report of impulsivity in bipolar disorder: no association between Stroop test and Barratt Impulsiveness Scale. Int J Bipolar Disord 2016; 4:16. [PMID: 27530736 PMCID: PMC4987743 DOI: 10.1186/s40345-016-0057-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/06/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Impulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder. It can be measured using behavioral tasks and self-report questionnaires. Previous findings revealed patients to show worse performance on at least one behavioral measure of impulsivity. Additionally, self-reported impulsivity seems to be higher among bipolar patients, both parameters being possibly associated with a more severe course of illness. In this study, our primary aim was to investigate the relationship between these two constructs of impulsivity among bipolar patients. METHODS A total of 40 euthymic patients with bipolar disorder (21 female, 22 Bipolar I) and 30 healthy controls were recruited for comprehensive neuropsychological assessment. To assess inhibition control as a behavioral measure of impulsivity, the Stroop Color and Word Test (Stroop) was used. Additionally, both groups completed the Barratt Impulsiveness Scale (BIS) as a self-report of impulsivity. To compare the groups' performance on the Stroop and ratings on the BIS, the non-parametric Mann-Whitney U test was used. Within the bipolar group, we additionally examined the possibility of an association between Stroop performance and BIS total scores using Pearson's Correlation r. RESULTS Patients and controls differed significantly on the Stroop and BIS, with patients performing worse on the Stroop and scoring higher on the BIS. However, there was no association between the Stroop and BIS within the bipolar group. As an exploratory analysis, a positive correlation between Stroop performance and number of episodes was found. Further, we detected a statistical trend in the direction of poorer Stroop performance among patients treated with polypharmacy. CONCLUSIONS Both difficulties with behavioral inhibition and self-reported impulsivity were observed to be higher in bipolar patients than controls in the current study. However, within the patient group we did not observe an association between patients' behavioral performance and self-report. This indicates that the parameters likely constitute distinct, dimensional factors of bipolar disorder. In future research, studies with larger samples should investigate which of the two markers constitutes the better marker for the illness and is more suitable to differentiate the most severe patients.
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Affiliation(s)
- Elisa Sophie Strasser
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Paula Haffner
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jana Fiebig
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Esther Quinlivan
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Mazda Adli
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Fliedner Klinik Berlin, Berlin, Germany
| | - Thomas Josef Stamm
- Dept. of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Peters EM, Balbuena L, Marwaha S, Baetz M, Bowen R. Mood instability and impulsivity as trait predictors of suicidal thoughts. Psychol Psychother 2016; 89:435-444. [PMID: 26718767 DOI: 10.1111/papt.12088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 07/14/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Impulsivity, the tendency to act quickly without adequate planning or concern for consequences, is a commonly cited risk factor for suicidal thoughts and behaviour. There are many definitions of impulsivity and how it relates to suicidality is not well understood. Mood instability, which describes frequent fluctuations of mood over time, is a concept related to impulsivity that may help explain this relationship. The purpose of this study was to determine whether impulsivity could predict suicidal thoughts after controlling for mood instability. METHODS This study utilized longitudinal data from the 2000 Adult Psychiatric Morbidity Survey (N = 2,406). There was a time interval of 18 months between the two waves of the study. Trait impulsivity and mood instability were measured with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Logistic regression analyses were used to evaluate baseline impulsivity and mood instability as predictors of future suicidal thoughts. RESULTS Impulsivity significantly predicted the presence of suicidal thoughts, but this effect became non-significant with mood instability included in the same model. CONCLUSIONS Impulsivity may be a redundant concept when predicting future suicidal thoughts if mood instability is considered. The significance is that research and therapy focusing on mood instability along with impulsivity may be useful in treating the suicidal patient. PRACTITIONER POINTS Mood instability and impulsivity both predict future suicidal thoughts. Impulsivity does not predict suicidal thoughts after controlling for mood instability. Assessing and treating mood instability could be important aspects of suicide prevention and risk management.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
| | - Marilyn Baetz
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rudy Bowen
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Cortical folding patterns are associated with impulsivity in healthy young adults. Brain Imaging Behav 2016; 11:1592-1603. [DOI: 10.1007/s11682-016-9618-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McDonald V, Hauner KK, Chau A, Krueger F, Grafman J. Networks underlying trait impulsivity: Evidence from voxel-based lesion-symptom mapping. Hum Brain Mapp 2016; 38:656-665. [PMID: 27667777 DOI: 10.1002/hbm.23406] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/08/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023] Open
Abstract
Impulsivity is considered a multidimensional construct that encompasses a range of behaviors, including poor impulse control, premature decision-making, and the inability to delay gratification. In order to determine the extent to which impulsivity and its components share a common network, a voxel-based lesion-symptom mapping (VLSM) analysis was performed in a large sample of patients (N = 131) with focal, penetrating traumatic brain injuries (pTBI). Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), a standard self-report measure that allows for unique estimates of global impulsivity and its factor analysis-derived components (e.g., "motor impulsivity"). Heightened global impulsivity was associated with damage to multiple areas in bilateral prefrontal cortex (PFC), left superior, middle and inferior temporal gyrus, and left hippocampus. Moreover, a cluster was identified within the left PFC associated specifically with motor impulsivity (defined as "acting without thinking"). The results were consistent with the existing literature on bilateral prefrontal cortical involvement in behavioral impulsivity, but also provided new evidence for a more complex neuroanatomical representation of this construct, characterized by left-lateralized temporal and hippocampal involvement, as well as a left-lateralized prefrontal network specifically associated with motor impulsivity. Hum Brain Mapp 38:656-665, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Valerie McDonald
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Katherina K Hauner
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Aileen Chau
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, Virginia.,Department of Psychology, George Mason University, Fairfax, Virginia
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Borda JP. Self over time: another difference between borderline personality disorder and bipolar disorder. J Eval Clin Pract 2016; 22:603-7. [PMID: 27144989 DOI: 10.1111/jep.12550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 01/17/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES The nature of the relationship between bipolar disorder and borderline personality disorder has been an intense field of debate in the last two decades. Current diagnostic classifications approach this complex phenomenon using syndromatic definitions based on presence or absence of a restricted set of signs or symptoms that have demonstrated low specificity. One of the several utilities of the phenomenological method in psychiatry is to complement the clinical panorama, helping in the process of identifying potential differences between two separated clinical syndromes. The main objective of this publication is to explore one particular clinical difference between these two conditions - that is, the experience of self-continuity and time perception. METHODS the argument explored in this paper is based on previous second-person or phenomenological accounts of sufferers of both conditions. RESULTS AND CONCLUSIONS Whereas borderline personality disorder patients tend to experience only the present moment, referring frequent difficulties of drawing experiences of the past in order to determine their own future, bipolar disorder patients are constantly worried about the contradictions in their past experiences and the latent risk of losing control of themselves in future episodes of their disease. This contrast should be, however, corroborated in future research comparing directly the two groups in terms of the continuity of the self and their temporal structures.
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Impulsivity in bipolar disorders in a Tunisian sample. Asian J Psychiatr 2016; 22:77-80. [PMID: 27520900 DOI: 10.1016/j.ajp.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/14/2016] [Accepted: 05/14/2016] [Indexed: 12/29/2022]
Abstract
Impulsivity as a trait characteristic is increased in bipolar disorder and may be a core factor of the illness. The objectives of our work are to evaluate the level of impulsivity among patients with bipolar disorder and to study its relation with mood state, alcohol misuse, suicide attempts and other socio-demographic and clinical factors. We measured impulsivity in 60 subjects with bipolar disorder in relationship to socio-demographic and clinical variables. The subjects completed Data included socio-demographic details and clinical variables, the Barratt Impulsiveness Scale (BIS-11) in an Arabic version to assess impulsivity, The Mini International Neuropsychiatric Interview "MINI" version 05 to screen for alcohol abuse or dependence and mood graphic rate scale (MGRS) to evaluate mood state. Our results show that the mean score of BIS-11 was 71.5. Fifty-five per cent of the patients had a high level of impulsiveness. No differences were found relating to mood state. Impulsivity was related to Male gender, lower educational level, early age of onset, smoking, alcohol and drug misuse and prior suicide attempts. The treatment of patients with BD should consider to reduce impulsivity to improve morbidity.
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Commonalities in EEG Spectral Power Abnormalities Between Women With ADHD and Women With Bipolar Disorder During Rest and Cognitive Performance. Brain Topogr 2016; 29:856-866. [PMID: 27464584 PMCID: PMC5054048 DOI: 10.1007/s10548-016-0508-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022]
Abstract
While attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) denote distinct psychiatric conditions, diagnostic delineation is impeded by considerable symptomatic overlap. Direct comparisons across ADHD and BD on neurophysiological measures are limited. They could inform us on impairments that are specific to or shared between the disorders and, therefore, potential biomarkers that may aid in the identification of the diagnostic boundaries. Our aim was to test whether quantitative EEG (QEEG) identifies differences or similarities between women with ADHD and women with BD during resting-state and task conditions. QEEG activity was directly compared between 20 ADHD, 20 BD and 20 control women during an eyes-open resting-state condition (EO) and a cued continuous performance task (CPT-OX). Both ADHD (t38 = 2.50, p = 0.017) and BD (t38 = 2.54, p = 0.018) participants showed higher absolute theta power during EO than controls. No significant differences emerged between the two clinical groups. While control participants showed a task-related increase in absolute theta power from EO to CPT-OX (t19 = −3.77, p = 0.001), no such change in absolute theta power was observed in the ADHD (t19 = −0.605, p = 0.553) or BD (t19 = 1.82, p = 0.084) groups. Our results provide evidence for commonalities in brain dysfunction between ADHD and BD. Absolute theta power may play a role as a marker of neurobiological processes in both disorders.
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Ng TH, Stange JP, Black CL, Titone MK, Weiss RB, Abramson LY, Alloy LB. Impulsivity predicts the onset of DSM-IV-TR or RDC hypomanic and manic episodes in adolescents and young adults with high or moderate reward sensitivity. J Affect Disord 2016; 198:88-95. [PMID: 27011364 PMCID: PMC4844858 DOI: 10.1016/j.jad.2016.03.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 01/13/2016] [Accepted: 03/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing body of research suggests that bipolar disorders (BD) are associated with high impulsivity. Using a multi-method approach, the current study provided the first examination of the hypothesis that impulsivity would prospectively predict shorter time to onset of DSM-IV-TR or RDC hypomanic or manic episodes in a sample selected based on reward sensitivity, a biobehavioral trait shown to predict onset and course of BD. METHODS 163 participants with high reward sensitivity and 114 participants with moderate reward sensitivity were followed every six months for an average of 2.68 years. Participants completed the Barratt Impulsiveness Scale - Version 11 (BIS-11), Balloon Analog Risk Task (BART), Beck Depression Inventory, Altman Self-Rating Mania Scale, and an expanded Schedule for Affective Disorders and Schizophrenia (exp-SADS) - Lifetime Version at baseline and were followed prospectively with the exp-SADS - Change Version to assess onset of hypomanic or manic episodes and treatment seeking for mood problems. RESULTS Cox proportional hazard regression analyses indicated that impulsivity as measured by a behavioral task (BART; OR=1.04, p=.03) and a self-report measure (BIS-11 Attentional Impulsiveness subscale; OR=1.16, p=.01) predicted shorter time to hypomania/mania onset, after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and reward sensitivity. LIMITATIONS The study was limited by non-comprehensive assessment of impulsivity and unknown generalizability to clinical samples. CONCLUSIONS Impulsivity confers vulnerability to hypomania or mania. Future studies would benefit from considering how impulsivity can be integrated into existing biopsychosocial models of BD.
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Affiliation(s)
- Tommy H Ng
- Department of Psychology, Temple University, United States
| | | | | | | | - Rachel B Weiss
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Unites States
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, Unites States
| | - Lauren B Alloy
- Department of Psychology, Temple University, United States.
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Cheema MK, MacQueen GM, Hassel S. Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition. Cogn Neuropsychiatry 2016; 20:424-37. [PMID: 26436337 DOI: 10.1080/13546805.2015.1076722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Impulsivity and risk-taking behaviours are reported in bipolar disorder (BD). We examined whether financial management skills are related to impulsivity in patients with BD. METHODS We assessed financial management skills using the Executive Personal Finance Scale (EPFS), impulsivity using the Barratt Impulsiveness Scale (BIS) and response inhibition using an emotional go/no-go task in bipolar individuals (N = 21) and healthy controls (HC; N = 23). RESULTS Patients had fewer financial management skills and higher levels of impulsivity than HC. In patients and controls, increased impulsivity was associated with poorer personal financial management. Patients and HC performed equally on the emotional go/no-go task. Higher BIS scores were associated with faster reaction times in HC. In patients, however, higher BIS scores were associated with slower reaction times, possibly indicating compensatory cognitive strategies to counter increased impulsivity. CONCLUSIONS Patients with BD may have reduced abilities to manage personal finances, when compared against healthy participants. Difficulty with personal finance management may arise in part as a result of increased levels of impulsivity. Patients may learn to compensate for increased impulsivity by modulating response times in our experimental situations although whether such compensatory strategies generalize to real-world situations is unknown.
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Affiliation(s)
- Marvi K Cheema
- a Faculty of Medicine and Dentistry , University of Alberta , Edmonton , Alberta , Canada
| | - Glenda M MacQueen
- b Department of Psychiatry & Hotchkiss Brain Institute , University of Calgary , Calgary , Alberta , Canada
| | - Stefanie Hassel
- b Department of Psychiatry & Hotchkiss Brain Institute , University of Calgary , Calgary , Alberta , Canada.,c Department of Psychology , School of Life & Health Sciences, Aston University , Birmingham , UK
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Haltigan JD, Vaillancourt T. The Borderline Personality Features Scale for Children (BPFS-C): Factor Structure and Measurement Invariance across Time and Sex in a Community-Based Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9550-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fortgang RG, Hultman CM, van Erp TG, Cannon TD. Multidimensional assessment of impulsivity in schizophrenia, bipolar disorder, and major depressive disorder: testing for shared endophenotypes. Psychol Med 2016; 46:1497-1507. [PMID: 26899136 PMCID: PMC7039317 DOI: 10.1017/s0033291716000131] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Impulsivity is associated with bipolar disorder as a clinical feature during and between manic episodes and is considered a potential endophenotype for the disorder. Schizophrenia and major depressive disorder share substantial genetic overlap with bipolar disorder, and these two disorders have also been associated with elevations in impulsivity. However, little is known about the degree of overlap among these disorders in discrete subfacets of impulsivity and whether any overlap is purely phenotypic or due to shared genetic diathesis. METHOD We focused on five subfacets of impulsivity: self-reported attentional, motor, and non-planning impulsivity, self-reported sensation seeking, and a behavioral measure of motor inhibition (stop signal reaction time; SSRT). We examined these facets within and across disorder proband and co-twin groups, modeled heritability, and tested for endophenotypic patterning in a sample of twin pairs recruited from the Swedish Twin Registry (N = 420). RESULTS We found evidence of moderate to high levels of heritability for all five subfacets. All three proband groups and their unaffected co-twins showed elevations on attentional, motor, and non-planning impulsivity. Schizophrenia probands (but not their co-twins) showed significantly lower sensation seeking, and schizophrenia and bipolar disorder probands (but not in their co-twins) had significantly longer SSRTs, compared with healthy controls and the other groups. CONCLUSIONS Attentional, motor, and non-planning impulsivity emerged as potential shared endophenotypes for the three disorders, whereas sensation seeking and SSRT were associated with phenotypic affection but not genetic loading for these disorders.
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Affiliation(s)
| | - Christina M. Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Theo G.M. van Erp
- Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, CA, USA
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Haltigan JD, Vaillancourt T. Identifying Trajectories of Borderline Personality Features in Adolescence: Antecedent and Interactive Risk Factors. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:166-75. [PMID: 27254092 PMCID: PMC4813416 DOI: 10.1177/0706743715625953] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine trajectories of adolescent borderline personality (BP) features in a normative-risk cohort (n = 566) of Canadian children assessed at ages 13, 14, 15, and 16 and childhood predictors of trajectory group membership assessed at ages 8, 10, 11, and 12. METHOD Data were drawn from the McMaster Teen Study, an on-going study examining relations among bullying, mental health, and academic achievement. Participants and their parents completed a battery of mental health and peer relations questionnaires at each wave of the study. Academic competence was assessed at age 8 (Grade 3). Latent class growth analysis, analysis of variance, and logistic regression were used to analyze the data. RESULTS Three distinct BP features trajectory groups were identified: elevated or rising, intermediate or stable, and low or stable. Parent- and child-reported mental health symptoms, peer relations risk factors, and intra-individual risk factors were significant predictors of elevated or rising and intermediate or stable trajectory groups. Child-reported attention-deficit hyperactivity disorder (ADHD) and somatization symptoms uniquely predicted elevated or rising trajectory group membership, whereas parent-reported anxiety and child-reported ADHD symptoms uniquely predicted intermediate or stable trajectory group membership. Child-reported somatization symptoms was the only predictor to differentiate the intermediate or stable and elevated or rising trajectory groups (OR 1.15, 95% CI 1.04 to 1.28). Associations between child-reported reactive temperament and elevated BP features trajectory group membership were 10.23 times higher among children who were bullied, supporting a diathesis-stress pathway in the development of BP features for these youth. CONCLUSIONS Findings demonstrate the heterogeneous course of BP features in early adolescence and shed light on the potential prodromal course of later borderline personality disorder.
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Affiliation(s)
- John D Haltigan
- Counselling, Faculty of Education, University of Ottawa, Ottawa, Ontario School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario
| | - Tracy Vaillancourt
- Counselling, Faculty of Education, University of Ottawa, Ottawa, Ontario School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario
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Kitsune GL, Kuntsi J, Costello H, Frangou S, Hosang GM, McLoughlin G, Asherson P. Delineating ADHD and bipolar disorder: A comparison of clinical profiles in adult women. J Affect Disord 2016; 192:125-33. [PMID: 26724691 DOI: 10.1016/j.jad.2015.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/30/2015] [Accepted: 12/20/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Overlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms. METHODS Sixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment. RESULTS ADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted. CONCLUSIONS Using measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.
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Affiliation(s)
- Glenn L Kitsune
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Jonna Kuntsi
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Helen Costello
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Sophia Frangou
- Clinical Neurosciences Studies Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Georgina M Hosang
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Gráinne McLoughlin
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK
| | - Philip Asherson
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), London, UK.
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Nanda P, Tandon N, Mathew IT, Padmanabhan JL, Clementz BA, Pearlson GD, Sweeney JA, Tamminga CA, Keshavan MS. Impulsivity across the psychosis spectrum: Correlates of cortical volume, suicidal history, and social and global function. Schizophr Res 2016; 170:80-6. [PMID: 26711526 DOI: 10.1016/j.schres.2015.11.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
Patients with psychotic disorders appear to exhibit greater impulsivity-related behaviors relative to healthy controls. However, the neural underpinning of this impulsivity remains uncertain. Furthermore, it remains unclear how impulsivity might differ or be conserved between psychotic disorder diagnoses in mechanism and manifestation. In this study, self-reported impulsivity, measured by Barratt Impulsiveness Scale (BIS), was compared between 305 controls (HC), 139 patients with schizophrenia (SZ), 100 with schizoaffective disorder (SZA), and 125 with psychotic bipolar disorder (PBP). In each proband group, impulsivity was associated with regional cortical volumes (using FreeSurfer analysis of T1 MRI scans), suicide attempt history, Global Assessment of Functioning (GAF), and Social Functioning Scale (SFS). BIS scores were found to differ significantly between participant groups, with SZA and PBP exhibiting significantly higher impulsivity than SZ, which exhibited significantly higher impulsivity than HC. BIS scores were significantly related to suicide attempt history, and they were inversely associated with GAF, SFS, and bilateral orbitofrontal cortex (OFC) volume in both SZA and PBP, but not SZ. These findings indicate that psychotic disorders, particularly those with prominent affective symptoms, are characterized by elevated self-reported impulsivity measures. Impulsivity's correlations with suicide attempt history, GAF, and SFS suggest that impulsivity may be a mediator of clinical outcome. The observed impulsivity-OFC correlations corroborate the importance of OFC deficits in impulsivity. These correlations' presence in SZA and PBP but not in SZ suggests that impulsivity may have different underlying mechanisms in affective and non-affective psychotic disorders.
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Affiliation(s)
- Pranav Nanda
- College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Neeraj Tandon
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Baylor College of Medicine, Texas Medical Center, Houston, TX, USA
| | - Ian T Mathew
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jaya L Padmanabhan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, McLean Hospital, Belmont, MA, USA
| | - Brett A Clementz
- Department of Psychology, BioImaging Research Center, University of Georgia, Athens, GA, USA; Department of Neuroscience, BioImaging Research Center, University of Georgia, Athens, GA, USA
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA; Departments of Psychiatry and Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - John A Sweeney
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Marek GJ, Day M, Hudzik TJ. The Utility of Impulsive Bias and Altered Decision Making as Predictors of Drug Efficacy and Target Selection: Rethinking Behavioral Screening for Antidepressant Drugs. ACTA ACUST UNITED AC 2015; 356:534-48. [DOI: 10.1124/jpet.115.229922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2015] [Indexed: 11/22/2022]
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Rawlings J, Shevlin M, Corcoran R, Morriss R, Taylor PJ. Out of the blue: Untangling the association between impulsivity and planning in self-harm. J Affect Disord 2015; 184:29-35. [PMID: 26070044 DOI: 10.1016/j.jad.2015.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Planned and unplanned acts of self-harm may have distinct clinical and psychological correlates. Trait impulsivity is one factor that might be expected to determine whether self-harm is planned. Research so far has focussed on suicide attempts and little is known about how individuals engaging in planned and unplanned acts of self-harm differ. The aim of the current study was to examine how individuals who report planned self-harm, unplanned self-harm, and no self-harm differ in terms of impulsivity and affective symptoms (depression, anxiety, and activated mood). METHOD An online survey of University students (n = 1350) was undertaken including measures of impulsivity, affective symptoms and self-harm. Analyses made use of a multinomial logistic regression model with affective and cognitive forms of impulsivity estimated as latent variables. RESULTS Trait affective impulsivity, but not cognitive, was a general risk factor for whether self-harm occurred. There was no evidence of differences between planned and unplanned self-harm. Affective symptoms of depression and anxiety mediated the relationship between affective impulsivity and self-harm. LIMITATIONS The study was cross-sectional, relied on a student sample which may not generalise to other populations. CONCLUSIONS Trait affective impulsivity is associated with self-harm but it appears to be mediated by depression and anxiety symptoms. The exact relationships between trait affective impulsivity, depression, anxiety and self-harm require further longitudinal research in clinical populations but might lead to improved risk assessment and new therapeutic approaches to self-harm.
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Affiliation(s)
- Jodie Rawlings
- School of Psychology, University of Exeter, United Kingdom
| | - Mark Shevlin
- School of Psychology, University of Ulster, United Kingdom
| | - Rhiannon Corcoran
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, United Kingdom
| | - Peter James Taylor
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom.
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Lister JJ, Milosevic A, Ledgerwood DM. Psychological Characteristics of Problem Gamblers With and Without Mood Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:369-76. [PMID: 26454559 PMCID: PMC4542517 DOI: 10.1177/070674371506000806] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Problem and pathological gamblers are significantly more likely to experience mood disorders, compared with the general population. Our study examined the relation of psychological characteristics (personality, trait impulsiveness, and gambling motives) to current co-occurring mood disorder (major depression and dysthymia) status among problem and pathological gamblers. METHOD Problem and pathological gamblers (N = 150) underwent a clinical interview to assess current co-occurring mood disorders; participants completed measures of problem gambling severity, personality, impulsiveness, and gambling motives. RESULTS Problem and pathological gamblers with a current co-occurring mood disorder were more likely to be female, older, and to report higher lifetime and past-year gambling severity. A co-occurring mood disorder was associated with higher personality scores for alienation and stress reaction, lower scores for well-being, social closeness, and control, as well as higher impulsiveness scores for urgency and lack of premeditation, and lower sensation seeking scores. Participants with a co-occurring mood disorder also reported higher coping motives for gambling. Multivariate logistic regression analyses demonstrated that personality factors (lower social closeness and higher alienation) contributed to the greatest likelihood of being diagnosed with a co-occurring mood disorder. CONCLUSIONS Mood disorders frequently co-occur with problem and pathological gambling, and they are associated with greater gambling severity. These findings highlight that interpersonal facets of personality contribute substantially to co-occurring mood disorder status. Implications for treatment will be discussed.
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Affiliation(s)
- Jamey J Lister
- Postdoctoral Research Fellow, Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Aleks Milosevic
- Director, Centre for Interpersonal Relationships, Ottawa, Ontario
| | - David M Ledgerwood
- Associate Professor, Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan; Adjunct Assistant Professor, Department of Psychology, University of Windsor, Windsor, Ontario
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Tomko RL, Lane SP, Pronove LM, Treloar HR, Brown WC, Solhan MB, Wood PK, Trull TJ. Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:740-753. [PMID: 26147324 PMCID: PMC4573801 DOI: 10.1037/abn0000064] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with borderline personality disorder (BPD) often report experiencing several negative emotions simultaneously, an indicator of "undifferentiated" negative affect. The current study examined the relationship between undifferentiated negative affect and impulsivity. Participants with a current BPD (n = 67) or depressive disorder (DD; n = 38) diagnosis carried an electronic diary for 28 days, reporting on emotions and impulsivity when randomly prompted (up to 6 times per day). Undifferentiated negative affect was quantified using momentary intraclass correlation coefficients, which indicated how consistently negative emotion items were rated across fear, hostility, and sadness subscales. Undifferentiated negative affect at the occasion-level, day-level, and across 28 days was used to predict occasion-level impulsivity. Multilevel modeling was used to test the hypothesis that undifferentiated negative emotion would be a significant predictor of momentary impulsivity above and beyond levels of overall negative affect. Undifferentiated negative affect at the occasion and day levels were significant predictors of occasion-level impulsivity, but undifferentiated negative affect across the 28-day study period was only marginally significant. Results did not differ depending on BPD or DD status, though individuals with BPD did report significantly greater momentary impulsivity and undifferentiated negative affect. Undifferentiated negative affect may increase risk for impulsivity among individuals with BPD and depressive disorders, and the current data suggest that this process can be relatively immediate as well as cumulative over the course of a day. This research supports the consideration of undifferentiated negative affect as a transdiagnostic construct, but one that may be particularly relevant for those with BPD.
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Affiliation(s)
- Rachel L. Tomko
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Sean P. Lane
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Lisa M. Pronove
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Hayley R. Treloar
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Alpert Medical School of Brown University, Providence, RI
| | - Whitney C. Brown
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
| | - Marika B. Solhan
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
- VA Boston Healthcare System, Boston, MA
| | - Phillip K. Wood
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
| | - Timothy J. Trull
- University of Missouri-Columbia and Midwest Alcoholism Research Center, Columbia, MO
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Peters EM, Balbuena L, Baetz M, Marwaha S, Bowen R. Mood instability underlies the relationship between impulsivity and internalizing psychopathology. Med Hypotheses 2015; 85:447-51. [PMID: 26182976 DOI: 10.1016/j.mehy.2015.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/23/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022]
Abstract
Impulsivity, the tendency to act without adequate forethought, has been associated with various internalizing disorders. Mood instability, the tendency to experience rapid and intense mood swings, relates to both internalizing disorders and impulsivity. We hypothesized that the association between mood instability and impulsivity accounts for the relationship between impulsivity and internalizing psychopathology. We conducted two studies to test our hypothesis. In Study 1 we used data from the 2007 Adult Psychiatric Morbidity Survey to examine mood instability in the relationship between depression and impulsivity. Mood instability and impulsivity were assessed with the Structured Clinical Interview for DSM-IV Axis-II Personality Disorders and depression was assessed with the revised Clinical Interview Schedule. In Study 2 we used data from the 1984 and 1991 British Health and Lifestyle Surveys to examine mood instability in the longitudinal relationship between impulsivity and internalizing symptoms. Mood instability and impulsivity were measured with the Eysenck Personality Inventory and internalizing symptoms were assessed with the General Health Questionnaire. In both studies we used a sequential regression analysis to test our hypothesis. Results from Study 1 showed that participants with depression were more likely to report impulsivity, but this effect became nonsignificant when mood instability was included in the same regression model. In Study 2 impulsivity predicted internalizing symptoms seven years in the future, but this effect became nonsignificant after mood instability was included in the same regression model. We conclude that impulsivity relates to internalizing psychopathology largely by being associated with mood instability. Research and therapy for internalizing conditions might be more productively directed at mood instability rather than impulsivity.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N0W8, Canada.
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N0W8, Canada
| | - Marilyn Baetz
- Department of Psychiatry, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N0W8, Canada
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, University of Warwick, Coventry CV47AL, UK
| | - Rudy Bowen
- Department of Psychiatry, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N0W8, Canada
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Bauer IE, Meyer TD, Sanches M, Zunta-Soares G, Soares JC. Does a history of substance abuse and illness chronicity predict increased impulsivity in bipolar disorder? J Affect Disord 2015; 179:142-7. [PMID: 25863910 DOI: 10.1016/j.jad.2015.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impulsivity is a common feature shared by bipolar disorder (BD) and substance use disorder (SUD). SUD and recurrent mood episodes are considered to be risk factors for poor outcome in BD. However, the association between impulsivity, illness chronicity and SUD in BD remains unexplored. METHODS 103 BD patients with and without a lifetime history of SUD (36.82±11.34 years, 40 males) were recruited. Participants completed the SCID interview and were administered measures of impulsivity including the Barratt Impulsivity Scale (BIS) and selected tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Hierarchical regression analyses explored the relationship between illness chronicity, SUD, and impulsivity. RESULTS Variance in the BIS, number of false alarms on the Rapid Visual Processing task and other impulsivity indicators of the Cambridge Gambling Task (CGT) was not explained by the chosen variables. Only an increased number of commission errors in the negative condition of the Affective Go/No Go task was significantly associated with illness chronicity. Furthermore there was a trend suggesting a relationship between a lifetime history of SUD and increased propensity to risk-taking during the CGT. LIMITATIONS Potential limitations include medication and patients׳ remission status from SUD. CONCLUSIONS Contrary to our expectations impulsivity was generally not predicted by indicators of illness chronicity or SUD. While impulsivity could still be a marker of BD that is present before the onset of the disorder, the link between the number of mood episodes and specific indicators of impulsivity may be related to mechanisms of neuroprogression.
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Affiliation(s)
- Isabelle E Bauer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States.
| | - Thomas D Meyer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States.
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
| | - Jair C Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
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Increased impulsivity as a vulnerability marker for bipolar disorder: evidence from self-report and experimental measures in two high-risk populations. J Affect Disord 2015; 178:18-24. [PMID: 25770479 DOI: 10.1016/j.jad.2015.02.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heightened impulsivity has been suggested as a possible risk factor for bipolar disorder (BD). However, studies on high-risk populations are scarce and have mainly focused on individuals with a genetic risk. The present study investigated two high-risk samples for BD with regard to several aspects of the impulsivity construct. METHODS Unaffected relatives of BD patients (genetically defined high-risk group, N=29) and participants scoring high on the Hypomanic Personality Scale (psychometrically defined high-risk sample, N=25) were being compared to respective control groups (N=27 and N=25) using a multi-method approach. Participants were accessed on the Barratt Impulsiveness Scale-11 (BIS-11, trait impulsivity), the Stop Signal Task (response inhibition), and the Cambridge Gambling Task (impulsive behavior in decision-making processes). RESULTS Both high-risk groups reported heightened impulsivity on the BIS-11, as well as impulsive decision-making, whereas no significant group differences in response inhibition were observed. LIMITATIONS Limitations were the lack in specificity of the results for BD and the cross-sectional study design, which does not allow conclusions about the influence of impulsivity on the development of or resilience for BD in risk groups. CONCLUSIONS Our findings support the assumption that increased trait impulsivity and impulsive decision-making are a vulnerability marker for and an endophenotype of BD.
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72
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Gratz KL, Kiel EJ, Latzman RD, Moore SA, Elkin TD, Megason GC, Tull MT. Complex Interrelations of Trait Vulnerabilities in Mothers and their Infants. INFANCY 2015. [DOI: 10.1111/infa.12075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kim L. Gratz
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | | | | | - Sarah A. Moore
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | - T. David Elkin
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
| | - Gail C. Megason
- Department of Pediatrics; University of Mississippi Medical Center
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior; University of Mississippi Medical Center
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Ozten M, Erol A, Karayilan S, Kapudan H, Orsel ES, Kumsar NA. Impulsivity in bipolar and substance use disorders. Compr Psychiatry 2015; 59:28-32. [PMID: 25749647 DOI: 10.1016/j.comppsych.2015.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is commonly associated with increased impulsivity, particularly during manic and depressed episodes; also impulsivity remains elevated during euthymic phases. Impulsivity is also a factor in the initiation and maintenance of substance use disorders (SUD). Impulsivity can predispose to substance abuse or can result from it. Impulsivity appears to be relatively independent of mood state and is higher in individuals with past substance use. Thus, we wanted to compare the impulsivity of BD and SUD closely associated with impulsivity and identify potential differences. METHODS Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A), in 35 bipolar interepisode disorder male patients without comorbid substance use disorder and 40 substance use disorder male patients. The BIS-11A mean scores for the two groups were compared through one-way between-groups ANOVA. RESULTS There was no difference between the BD and substance use disorder groups on total and subscale attentional, motor impulsivity measures. However, for the male patients there was difference on the nonplanning subscale. The male BD patient group scored higher than the male substance use disorder patient group regarding nonplanning impulsivity. CONCLUSIONS Our results replicate the findings that interepisode BD and substance use disorder patients both have increased total impulsivity; furthermore, the findings also indicate that trait impulsivity is not completely the same in subscales. Both groups were similar on attention and motor impulsivity subscales; however, on the nonplanning subscale, BD patients were more impulsive than the substance use disorder patients.
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Affiliation(s)
- Mustafa Ozten
- Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya, Turkey.
| | - Atila Erol
- Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya, Turkey.
| | - Semra Karayilan
- Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya, Turkey.
| | - Hilal Kapudan
- Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya, Turkey.
| | - Ertac Sertac Orsel
- Sakarya University, Faculty of Medicine, Department of Psychiatry, Sakarya, Turkey.
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Zhang J, Su H, Tao J, Xie Y, Sun Y, Li L, Zhang XY, Hu Z, He J. Relationship of impulsivity and depression during early methamphetamine withdrawal in Han Chinese population. Addict Behav 2015; 43:7-10. [PMID: 25513754 DOI: 10.1016/j.addbeh.2014.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/10/2014] [Accepted: 10/24/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High level of impulsivity as well as depression is thought to be involved in the maintenance and development of methamphetamine (METH) addiction. However, the relationship between impulsivity and depression has not been studied thoroughly in METH dependence subjects, especially in early METH abstinent subjects. In this study, our objective is to explore the interplay between the depressive symptoms and impulsivity in early METH abstinent subjects. METHODS A total of 182 early abstinent METH dependent subjects (abstinence for 1-7 days) were recruited and the level of impulsivity was measured by the Barratt Impulsiveness Scale (BIS-11). Depressive symptoms and anxiety symptoms were assessed by the short 13-item Beck Depression Inventory (BDI-13) and Beck Anxiety Inventory (BAI) respectively. RESULTS Global impulsivity of BIS-11 was significantly correlated with depressive symptoms among early METH abstinent subjects (r=0.283, p=0.001). Moreover, all subscales of BIS-11 were also found to be correlated with depressive symptoms: correlation with attentional impulsivity (r=0.202, p=0.006); correlation with motor impulsivity (r=0.267, p=0.001); and correlation with non-planning impulsivity (r=0.177, p=0.017). CONCLUSIONS This study showed a relationship between impulsivity and depression, which may further the comprehension of motivational elements contributing to the maintenance and development of METH use disorder. Future research would be dedicated to exploring underlying mechanisms of association between impulsivity and depression.
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75
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Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity. Psychiatry Res 2015; 225:425-32. [PMID: 25537486 DOI: 10.1016/j.psychres.2014.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/24/2014] [Accepted: 12/03/2014] [Indexed: 01/10/2023]
Abstract
Current emotion regulation research in BD has tended to focus on the extent to which patients control their emotions using different cognitive strategies. Fewer studies have investigated whether patients with BD have difficulties in regulating other dimensions of emotion that serve a functional purpose and are thereby more amenable to change. To overcome this paucity of research we utilised a multi-dimensional measure of emotion regulation to characterise the emotion regulation profile of BD, and examine its utility in predicting trait mania and depression propensity. Fifty BD patients and 52 healthy controls completed the Difficulties in Emotion Regulation Scale (DERS) and the General Behaviour Inventory (GBI). Results indicated that patients had difficulties in emotion regulation across a range of dimensions. Impulse control difficulties most parsimoniously predicted trait (hypo)mania propensity in BD patients, whilst poor access to mood regulation strategies predicted depressive propensity. Predictors of the propensity to experience these moods differed in the control group. These findings represent an important step toward informing the development of new treatment strategies to remediate emotion regulation difficulties and improve BD symptomatology.
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76
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Bøen E, Hummelen B, Elvsåshagen T, Boye B, Andersson S, Karterud S, Malt UF. Different impulsivity profiles in borderline personality disorder and bipolar II disorder. J Affect Disord 2015; 170:104-11. [PMID: 25237733 DOI: 10.1016/j.jad.2014.08.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored. METHODS Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated. RESULTS BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II. LIMITATIONS Relatively small sample size; cross-sectional assessment of influence of mood state. CONCLUSIONS BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.
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Affiliation(s)
- Erlend Bøen
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Benjamin Hummelen
- Department for Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Department for Research and Education, Oslo University Hospital, Norway
| | - Torbjørn Elvsåshagen
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Boye
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway
| | - Stein Andersson
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Sigmund Karterud
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department for Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik F Malt
- Department of Psychosomatic Medicine, Oslo University Hospital, Post Box 4950 Nydalen, Oslo 0424, Norway; Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Dawson EL, Shear PK, Howe SR, Adler CM, DelBello MP, Fleck DE, Strakowski SM. Impulsivity predicts time to reach euthymia in adults with bipolar disorder. Bipolar Disord 2014; 16:846-56. [PMID: 25039396 DOI: 10.1111/bdi.12232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Specific demographic and illness characteristics have been identified as predictors of overall morbidity and treatment course among individuals with bipolar disorder. However, the role of specific cognitive limitations on disease severity and treatment response is unclear. The present study evaluated whether impulsiveness during acute mania was a significant predictor of achieving euthymia within one year following psychiatric hospitalization. METHODS Participants were 94 adult inpatients (60 manic) with bipolar I disorder. Baseline symptom severity was assessed using the Young Mania Rating Scale and the Montgomery-Åsberg Depression Rating Scale. Impulsivity was measured with the Stop Signal Task, Degraded Stimulus Continuous Performance Task, Delayed Response Task, and Barratt Impulsiveness Scale-11. RESULTS Individual predictors of time to reach euthymia included fewer depressive symptoms and better impulse control at baseline, later age at illness onset, shorter illness duration, and the absence of comorbid attention-deficit hyperactivity disorder. Self-reported impulsivity was a significant independent predictor of time to euthymia, even after accounting for relevant clinical variables. CONCLUSIONS Better trait impulse control may be associated with better treatment responsiveness among adults with bipolar disorder.
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Affiliation(s)
- Erica L Dawson
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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Saddichha S, Schuetz C. Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Compr Psychiatry 2014; 55:1479-84. [PMID: 25035161 DOI: 10.1016/j.comppsych.2014.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review scores on measures of impulsivity in remitted bipolar disorder. DATA SOURCE We used keywords "impulsivity and bipolar" and "impulsivity and mania" to narrow down our search on Medline, EMBASE and Psychinfo to include those studies that had reported impulsivity scores using validated and reliable assessment measures in remitted bipolar disorder (both I and II). We searched all English language studies from 1990 to October 2012. STUDY SELECTION Nineteen reports met the inclusion criteria and were reviewed by two abstractors independently. DATA ABSTRACTION We generated weighted mean differences (WMDs) from pooled data using RevManager 5.0 from Cochrane analysis. RESULTS The Barratt Impulsivity Scale (BIS) 11 was the instrument most commonly used. Nineteen studies met the inclusion criteria, of which 2 were excluded due to incomplete data. A WMD of 12.8 was observed for BIS 11 total scores, 4.3 on the motor component, 4.1 on the cognitive and 7.6 on the non-planning components of the BIS 11 respectively. CONCLUSION Impulsivity is significantly higher in remitted bipolar patients than normal controls. Non-planning impulsivity is a key domain affected in bipolar disorder, which may represent a stable trait.
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Affiliation(s)
- Sahoo Saddichha
- North Western Mental Health, Melbourne Health, Melbourne, VIC, Australia.
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Sanches M, Scott-Gurnell K, Patel A, Caetano SC, Zunta-Soares GB, Hatch JP, Olvera R, Swann AC, Soares JC. Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Compr Psychiatry 2014; 55:1337-41. [PMID: 24889339 PMCID: PMC4183750 DOI: 10.1016/j.comppsych.2014.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Increased impulsivity seems to be present across all phases of bipolar disorder (BD). Impulsivity may therefore represent an endophenotype for BD, if it is also found among normal individuals at high genetic risk for mood disorders. In this study, we assessed impulsivity across four different groups of children and adolescents: patients with BD, major depressive disorder (MDD) patients, unaffected offspring of bipolar parents (UO), and healthy controls (HC). SUBJECTS AND METHODS 52 patients with BD, 31 with MDD, 20 UO, and 45 HC completed the Barratt Impulsiveness Scale (BIS-11), an instrument designed to measure trait impulsivity. RESULTS UO displayed significantly higher total BIS-11 impulsivity scores than HC (p=0.02) but lower scores than BD patients (F=27.12, p<0.01). Multiple comparison analysis revealed higher BIS-11 total scores among BD patients when compared to HC (p<0.01) and UO (p<0.01). MDD patients had higher BIS-11 scores when compared to HC (p<0.01). Differences between MDD patients and UO, as well as between MDD and BD patients, were not statistically significant. CONCLUSION Our findings suggest that trait impulsivity is increased among children and adolescents with mood disorders, as well as in unaffected individuals at high genetic risk for BD.
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Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Kathy Scott-Gurnell
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anita Patel
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheila C Caetano
- Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John P Hatch
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rene Olvera
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan C Swann
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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80
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Ghaemi SN, Dalley S, Catania C, Barroilhet S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand 2014; 130:99-108. [PMID: 24571137 DOI: 10.1111/acps.12257] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the empirical literature on diagnostic validators in borderline personality and bipolar illness. METHOD Using principles of evidence-based medicine, the highest levels of evidence were emphasized in interpretation of similarities or differences between bipolar illness and borderline personality on the five standard diagnostic validators in psychiatric nosology: symptoms, course, genetics, treatment response, and neurobiology. RESULTS Bipolar illness and borderline personality were found to be similar in the nosological validator of symptoms of mood lability and impulsivity, but differed notably on all other diagnostic validators, especially the course validator of past sexual abuse and the genetic validator of a bipolar family history. They also differ notably in the symptom validator of parasuicidal self-harm. Treatment response and neurobiological differences were also present and consistent. CONCLUSION This review of the literature indicates that these two conditions, bipolar illness and borderline personality, are different and can be distinguished. The much stronger biological and genetic evidence for bipolar illness in particular suggests that the two conditions can be reasonably seen as different kinds of clinical entities, namely a biological disease versus a psychosocially caused clinical picture. If this interpretation is correct, similarities between the two conditions, such as mood lability and impulsivity, are superficial, while differences are profound. Further, true comorbidity may be much less common than often presumed.
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Affiliation(s)
- S N Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
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81
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Abolghasemi A, Sadeghi H, Kiamarsi A, Abbasi M. Role of behavioral addictions in predicting reactivity in bipolar mood disorder patients. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e13909. [PMID: 24971298 PMCID: PMC4070189 DOI: 10.5812/ijhrba.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 12/03/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Abstract
Background: Behavioral addictions (BAs) can be understood as disorders characterized by repetitive occurrence of reactivity and uncontrolled behaviors. Very few studies have investigated their association with bipolar mood disorders. Objectives: The present study aimed to determine the role of behavioral addictions in predicting interpersonal behavioral addictions in bipolar mood disorder patients. Materials and Methods: This study had a cross-sectional correlation design. The statistical population was composed of all outpatients with bipolar mood disorders referring to clinical centers in Ardabil. The sample included 60 bipolar mood patients selected from patients referring to clinical centers using the available sampling method. A researcher-made behavioral addiction checklist, Interpersonal Behavioral Addictions Index, and exercise, sexual, and work addiction questionnaires, were used for data collection. The data were analyzed with a Pearson’s correlation coefficient and multivariate regression analysis. Results: The results showed a significant negative relationship between behavioral addictions and interpersonal behavioral addictions (P ≥ 0.01). Multivariate regression analysis results also showed that behavioral addictions are significant and can explain 61% of the variance of interpersonal behavioral addictions in bipolar mood patients. Conclusions: These results suggest that addictive behaviors can affect behavioral addictions in bipolar mood patients. Behavioral addictions lead to negative emotional regulation strategies and result in increased behavioral addictions in these patients. People with high levels of arousal or those who cannot control their behavioral addictions are probably more prone to addictive behaviors.
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Affiliation(s)
- Abbas Abolghasemi
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran
- Corresponding authors: Abbas Abolghasemi, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail: ; Hasan Sadeghi, Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail:
| | - Hasan Sadeghi
- Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran
- Corresponding authors: Abbas Abolghasemi, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail: ; Hasan Sadeghi, Young Researchers Club and Elites, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran. Tel/Fax: +98-4515510132, E-mail:
| | - Azar Kiamarsi
- Department of Psychology, Islamic Azad University Branch Science and Research of Ardabil, Ardabil, IR Iran
| | - Moslem Abbasi
- Department of Psychology, Faculty of Literature and Human Sciences, Salman Farsi University of Kazerun, Kazerun, IR Iran
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82
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Sjoerds Z, van den Brink W, Beekman ATF, Penninx BWJH, Veltman DJ. Response inhibition in alcohol-dependent patients and patients with depression/anxiety: a functional magnetic resonance imaging study. Psychol Med 2014; 44:1713-1725. [PMID: 24016382 DOI: 10.1017/s0033291713002274] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The inability to inhibit certain behaviors is a key feature of impulsivity, which is often present in people with a substance use disorder. However, the findings on impulsivity in people with alcohol dependence (AD) are inconsistent, possibly because of the frequent co-occurrence of depression/anxiety (D/A) and its influence on impulsivity. In the current study, we aimed to distinguish response inhibition impairments in AD from possible response inhibition effects associated with D/A. METHOD AD patients (n = 31) with high D/A co-morbidity were compared to patients with D/A only (n = 18) and healthy controls (HCs; n = 16) using the Stop Signal Task (SST) during functional magnetic resonance imaging (fMRI). Correlation analyses were performed between activated brain areas, behavioral data and addiction and D/A characteristics. RESULTS The three groups did not differ on response inhibition performance. However, AD severity, but not D/A severity, was positively associated with decreased response inhibition. During the SST, AD patients showed hyperactivity in the putamen and thalamus compared with D/A patients and HCs. Thalamus activation was negatively associated with AD duration. In addition, AD patients showed hypoactivity in the supplementary motor area (SMA) compared with HCs. SMA activity within HCs was negatively correlated with depressive symptom severity. Discussion In general, AD patients were not more impulsive than D/A patients or HCs but they did reveal inhibition impairments with increasing AD severity. A shift from cortical to subcortical engagement in AD patients during response inhibition may represent an alternative strategy, which decreased with longer drinking history, suggesting the presence of an AD-specific endophenotype.
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Affiliation(s)
- Z Sjoerds
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - W van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D J Veltman
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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83
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Berutti M, Nery FG, Sato R, Scippa A, Kapczinski F, Lafer B. Association between family history of mood disorders and clinical characteristics of bipolar disorder: results from the Brazilian bipolar research network. J Affect Disord 2014; 161:104-8. [PMID: 24751316 DOI: 10.1016/j.jad.2014.02.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare clinical characteristics of bipolar disorder (BD) in patients with and without a family history of mood disorders (FHMD) in a large sample from the Brazilian Research Network of Bipolar Disorders. METHODS Four-hundred eighty-eight DSM-IV BD patients participating in the Brazilian Research Network of Bipolar Disorders were included. Participants were divided between those with FHMD (n=230) and without FHMD (n=258). We compared these two groups on demographic and clinical variables and performed a logistic regression to identify which variables were most strongly associated with positive family history of mood disorders. RESULTS BD patients with FHMD presented with significantly higher lifetime prevalence of any anxiety disorder, obsessive-compulsive disorder, social phobia, substance abuse, and were more likely to present history of suicide attempts, family history of suicide attempts and suicide, and more psychiatric hospitalizations than BD patients without FHMD. Logistic regression showed that the variables most strongly associated with a positive FHMD were any comorbid anxiety disorder, comorbid substance abuse, and family history of suicide. LIMITATIONS Cross-sectional study and verification of FHMD by indirect information. CONCLUSION BD patients with FHMD differ from BD patients without FHMD in rates of comorbid anxiety disorder and substance abuse, number of hospitalizations and suicide attempts. As FHMD is routinely assessed in clinical practice, these findings may help to identify patients at risk for particular manifestations of BD and may point to a common, genetically determined neurobiological substrate that increases the risk of conditions such as comorbidities and suicidality in BD patients.
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Affiliation(s)
- Mariangeles Berutti
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Fabiano G Nery
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Rodrigo Sato
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Angela Scippa
- Center for Treatment of Affective Disorders (CETHA), Department of Psychiatry, Federal University of Bahia, Salvador, Brazil
| | - Flavio Kapczinski
- Bipolar Disorder Program (PROTAHBI), Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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84
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Saddichha S, Schuetz C. Impulsivity in remitted depression: a meta-analytical review. Asian J Psychiatr 2014; 9:13-6. [PMID: 24813029 DOI: 10.1016/j.ajp.2014.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/26/2022]
Abstract
AIM Depressive disorder and suicide have been associated with impulsivity in several studies. This paper aimed to review measures of trait impulsivity in remitted depressive disorder. METHODS We used keywords "impulsivity and depression"; "impulsivity and depressive disorder" to narrow down our search on Medline, EMBASE and Psychinfo to include those studies that had reported impulsivity scores using validated and reliable assessment measures in remitted depressive disorder. We searched all English language studies from 1990 to December 2012 with 9 reports meeting the inclusion criteria for depression, which were then reviewed by the two reviewers independently. We generated weighted mean differences (WMDs) for depression from the pooled data using RevManager 5.1 from Cochrane analysis. RESULTS The Barratt Impulsivity Scale (BIS) 11 was the instrument commonly used in depression. 9 studies met inclusion criteria in depression, which yielded a WMD of 10.12 on BIS 11 total scores. CONCLUSION There is a strong association of impulsivity and depression, which persists even in remission.
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Affiliation(s)
- Sahoo Saddichha
- Senior Registrar, NWMH, Melbourne Health, Victoria, Australia.
| | - Christian Schuetz
- Department of Psychiatry & Psychiatrist, Burnaby Centre for Addiction & Mental Health, University of British Columbia, Vancouver, Canada
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85
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Newman AL, Meyer TD. Impulsivity: present during euthymia in bipolar disorder? - a systematic review. Int J Bipolar Disord 2014; 2:2. [PMID: 25960939 PMCID: PMC4424222 DOI: 10.1186/2194-7511-2-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/27/2014] [Indexed: 12/04/2022] Open
Abstract
Because impulsivity is part of the presentation of bipolar disorder (BD) and is associated with its course, this systematic review presents the evidence whether increased impulsivity is present in a stable, euthymic mood and therefore potentially a vulnerability marker for BD. A multi-faceted model of impulsivity was adopted to explore how different facets may relate differently to BD. The evidence was explored in relation to studies employing measures of trait impulsivity (in self-report format) and studies exploring impulsivity with behavioural paradigms. Behavioural paradigms were separated into studies measuring response inhibition and those measuring the ability to delay gratification. Twenty-three papers met the inclusion criteria. Most studies using self-report measures found significant differences between euthymic BD patients and healthy controls. There was little evidence of increased impulsivity as measured by behavioural paradigms. Most studies found no significant difference in response inhibition between groups, though it is possible that much of the literature in this area was underpowered to detect an effect. Only five studies explored delay of gratification, of which the two methodologically strongest studies found no group differences. In conclusion, there is evidence that euthymic patients with BD report increased impulsivity when using self-ratings. However, there is currently limited evidence of impulsivity on behavioural measures assessing response inhibition, and this might be restricted to more severe cases. More research is needed on the ability to delay gratification before drawing any conclusions. However, to establish facets of impulsivity as vulnerability markers, future studies should include at-risk individuals to evaluate whether self-rated or behavioural impulsivity precedes the onset of BD.
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Affiliation(s)
- Antonia L Newman
- Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Gosforth, Newcastle upon Tyne, NE3 3XT UK
| | - Thomas D Meyer
- Institute of Neuroscience, Newcastle University, Ridley Building, Newcastle upon Tyne, NE1 7RU UK
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86
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Abstract
PURPOSE OF REVIEW Differentiating bipolar II disorder (BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. The purpose of this review is to focus on recent studies that have considered clinical differences between the conditions including family history, phenomenology, longitudinal course, comorbidity and treatment response, and which might advance their clinical distinction. RECENT FINDINGS Findings suggest key differentiating parameters to include family history, onset pattern, clinical course, phenomenological profile of depressive and elevated mood states, and symptoms of emotional dysregulation. Less specific differentiation is provided by childhood trauma history, deliberate self-harm, comorbidity rates, neurocognitive features, treatment response and impulsivity parameters. SUMMARY This review refines candidate variables for differentiating BP II from BPD, and should assist the design of studies seeking to advance their phenomenological and clinical distinction.
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87
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Impulsivity and risk taking in bipolar disorder and schizophrenia. Neuropsychopharmacology 2014; 39:456-63. [PMID: 23963117 PMCID: PMC3870783 DOI: 10.1038/npp.2013.218] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 12/19/2022]
Abstract
Impulsive risk taking contributes to deleterious outcomes among clinical populations. Indeed, pathological impulsivity and risk taking are common in patients with serious mental illness, and have severe clinical repercussions including novelty seeking, response disinhibition, aggression, and substance abuse. Thus, the current study seeks to examine self-reported impulsivity (Barratt Impulsivity Scale) and performance-based behavioral risk taking (Balloon Analogue Risk Task) in bipolar disorder and schizophrenia. Participants included 68 individuals with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Self-reported impulsivity was elevated in the bipolar group compared with schizophrenia patients and healthy controls, who did not differ from each other. On the risk-taking task, schizophrenia patients were significantly more risk averse than the bipolar patients and controls. Aside from the diagnostic group differences, there was a significant effect of antipsychotic (AP) medication within the bipolar group: bipolar patients taking AP medications were more risk averse than those not taking AP medications. This difference in risk taking because of AP medications was not explained by history of psychosis. Similarly, the differences in risk taking between schizophrenia and bipolar disorder were not fully explained by AP effects. Implications for clinical practice and future research are discussed.
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88
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Carli V, Mandelli L, Zaninotto L, Alberti S, Roy A, Serretti A, Sarchiapone M. Trait-aggressiveness and impulsivity: role of psychological resilience and childhood trauma in a sample of male prisoners. Nord J Psychiatry 2014; 68:8-17. [PMID: 23795860 DOI: 10.3109/08039488.2012.756061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One of the major challenges for research in the field of human aggression is the need to define the role of personality and trait-like dimensions, such as impulsivity and aggressiveness, in predisposing to violent behavior. AIMS 1) To determine whether trait- aggressiveness and impulsivity may be associated with socio-demographic, clinical and crime history variables in a sample of male prisoners; 2) to detect any association of those traits with measures of early traumatic experiences and current resilience traits. METHODS A sample of male prisoners (n = 1356) underwent the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Barratt Impulsivity Scale (BIS). Axis I psychiatric disorders were also assessed. Early traumatic experiences and psychological resilience were detected respectively by the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Two non-linear logistic regression models were performed to test for the best predictors of trait-aggressiveness and impulsivity. RESULTS Subjects with a history of substance use disorders and self-mutilation reported both higher BGLHA and BIS scores. Axis I disorders and suicide attempts were associated with aggressiveness, but not to impulsivity. A consistent correlation was found between BGLHA scores and early traumatic experiences. Resilience was positively correlated to impulsivity but not to aggressiveness scores. CONCLUSIONS Our results support the view that aggressiveness and impulsivity are two different, albeit related trait-like dimensions of personality, having a different relationship with resilience, and, inferentially, a different impact over the development of psychiatric disorders.
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Affiliation(s)
- Vladimir Carli
- Vladimir Carli, Department of Health Sciences, University of Molise , via F. De Sanctis, 86100, Campobasso , Italy , and Department of Public Health Sciences, Karolinska Institutet, National Prevention of Suicide and Mental Ill-Health (NASP) , 17177, Stockholm , Sweden
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89
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Johnson SL, Carver CS, Mulé S, Joormann J. Impulsivity and risk for mania: towards greater specificity. Psychol Psychother 2013; 86:401-12. [PMID: 24217865 DOI: 10.1111/j.2044-8341.2012.02078.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 06/06/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Impulsivity is elevated among people diagnosed with bipolar disorder, and recent evidence suggests that impulsivity can predict onset among those at risk for the disorder. Impulsivity, though, is a broad construct. OBJECTIVE The goal of this study was to examine whether some aspects of impulsivity are more correlated with risk for mania than others. We hypothesized that risk for mania would be related specifically to difficulties controlling impulsive responses to emotions. DESIGN AND METHODS Undergraduates (N = 257) completed a large battery of measures of emotion-relevant and non-emotional forms of impulsivity, along with a well-validated measure of risk for mania, the Hypomanic Personality Scale (HPS). RESULTS Analyses examined correlations of impulsivity scales with the HPS, and partial correlations controlling for lifetime tendencies towards depressive symptoms and current symptoms of alcohol abuse, both of which relate to impulsivity and often co-occur with mania. After controlling for these measures, risk for mania remained correlated with measures of impulsive responses to positive emotions, but not with difficulties in following through or with impulsivity in the context of general distress emotions. CONCLUSIONS Although impulsivity is a major concern among those at risk for mania and those diagnosed with mania, difficulties may be especially evident during positive affective states, and other forms of impulsivity may be less related to mania risk. Discussion focuses on limitations and future directions. PRACTITIONER POINTS Impulsivity is correlated with risk for mania. Mania risk appears tied to tendencies towards impulsive action, particularly during positive affective states. Mania risk was not significantly correlated with other non-emotional forms of impulsivity. A better understanding of what aspects of impulsivity are problematic in bipolar disorder could guide more refined interventions.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California, Berkeley, USA
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90
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Mathias de Almeida K, Nery FG, Moreno RA, Gorenstein C, Lafer B. A sib-pair analysis of impulsivity in bipolar disorder type I. Compr Psychiatry 2013; 54:1148-52. [PMID: 23890763 DOI: 10.1016/j.comppsych.2013.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare impulsivity among patients with bipolar disorder, their siblings, and healthy controls in order to examine whether impulsivity in bipolar disorder is related to genetic liability for the illness. METHODS Using the Barratt Impulsiveness Scale, we assessed 204 subjects: 67 euthymic outpatients with bipolar disorder type I, 67 siblings without bipolar disorder, and 70 healthy controls. RESULTS Impulsivity scores were higher among patients with bipolar disorder than among healthy controls. Siblings showed higher motor impulsivity scores than did healthy controls. CONCLUSIONS Our results suggest that motor impulsivity may be a vulnerability marker for bipolar disorder. Our data may contribute to further improve preventive strategies in subjects at high risk for bipolar disorder.
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Affiliation(s)
- Karla Mathias de Almeida
- Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
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91
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El Kissi Y, Krir MW, Ben Nasr S, Hamadou R, El Hedda R, Bannour S, Ben Hadj Ali B. Life events in bipolar patients: a comparative study with siblings and healthy controls. J Affect Disord 2013; 151:378-83. [PMID: 23830000 DOI: 10.1016/j.jad.2013.05.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/09/2013] [Accepted: 05/31/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND While many studies have focused on life events in depressive disorders, data regarding them in bipolar disorder are scant. The aim of this work was to explore the characteristics of life events in bipolar patients. METHODS Sixty bipolar patients have been included in our study. The evaluation focused on the sociodemographic and clinical characteristics with a standardized measurement of life events using Paykel's interview. The results were compared with those of siblings and healthy controls groups. The three groups were matched for age and sex. RESULTS Compared to the controls, bipolar patients and their siblings had a higher global score of life events and more events in the fields of work, socio-family events and health. Bipolar patients reported more desirable events compared with their siblings and controls. The siblings reported higher scores of uncontrollable and undesirable events than patients and controls, and a higher score of controllable events than patients. LIMITATIONS The Paykel's interview has no validated Tunisian version, which could be a methodological bias in the assessment of life events. Moreover, the assessment of the life events was made during the euthymic phase of the bipolar disorder; however, there was no standardized measure of mood symptoms, to confirm this euthymia. CONCLUSION Our findings could help in the identification of the etiopathogeny of bipolar disorder and would contribute to improve the understanding and management of these patients focusing on the psychosocial aspect which is often overlooked.
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Affiliation(s)
- Yousri El Kissi
- Department of Psychiatry, Farhat Hached Hospital, Ibn Jazzar Street, Sousse 4000, Tunisia.
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92
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Carver CS, Johnson SL, Joormann J. Major depressive disorder and impulsive reactivity to emotion: toward a dual-process view of depression. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:285-99. [PMID: 23865405 PMCID: PMC3721423 DOI: 10.1111/bjc.12014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 11/05/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Dual-process theories of behaviour have been used to suggest that vulnerability to depression involves elevated reactivity to emotions. This study tests that idea, examining self-reported reactivity. DESIGN Comparison between persons with at least one lifetime episode of major depressive disorder (lifetime MDD) and those without this diagnosis, controlling for symptoms of alcohol use (a potential externalizing confound) and current symptoms of depression (a potential state-dependent confound). METHODS Undergraduates (N = 120) completed a clinical interview to diagnose lifetime MDD and a series of self-reports bearing on diverse aspects of self-control, including reactivity to emotion. Thirty-four people were diagnosed with lifetime MDD; 86 did not meet criteria for MDD. The groups were then compared on three factors underlying the scales assessing self-control. RESULTS The MDD group had higher scores than controls on the two factors that reflect impulsive reactivity to diverse emotions, including emotions that are positive in valence. These effects were not explained by associations with either externalizing symptoms or current depressive symptoms. CONCLUSIONS Reflexive reactivity to emotions characterizes depression, in addition to some externalizing problems, and it may deserve study as a potential trans-diagnostic feature. PRACTITIONER POINTS Reflexive reactivity to emotions characterizes persons diagnosed with major depressive disorder. Findings suggest desirability of focusing treatment partly on management of reflexive reactions to emotions. LIMITATION Measures were self-reports, rather than behavioural responses to emotions.
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Affiliation(s)
- Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA.
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93
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Kim YS, Cha B, Lee D, Kim SM, Moon E, Park CS, Kim BJ, Lee CS, Lee S. The Relationship between Impulsivity and Quality of Life in Euthymic Patients with Bipolar Disorder. Psychiatry Investig 2013; 10:246-52. [PMID: 24302947 PMCID: PMC3843016 DOI: 10.4306/pi.2013.10.3.246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/15/2013] [Accepted: 03/27/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients. METHODS A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed. RESULTS The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (β=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale. CONCLUSION Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD.
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Affiliation(s)
- Yoon-Seok Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Dongyun Lee
- Medical Unit of 9th Division, Korea Army, Goyang, Republic of Korea
| | - Sun-Mi Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea
| | - Chul-Soo Park
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Sojin Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
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94
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Halcomb ME, Gould TD, Grahame NJ. Lithium, but not valproate, reduces impulsive choice in the delay-discounting task in mice. Neuropsychopharmacology 2013; 38:1937-44. [PMID: 23584261 PMCID: PMC3746699 DOI: 10.1038/npp.2013.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 12/14/2022]
Abstract
Both lithium and valproate are well-established treatments for bipolar disorder. Studies have also found that lithium is effective at reducing suicidal behaviors in patients with mood disorders. Impulsivity is a validated endophenotype of both bipolar disorder and suicidal behavior. We assessed effects of treatment with lithium or valproate on cognitive impulsivity in selectively bred mice previously shown to manifest relatively high levels of cognitive impulsivity. Mice were trained in the delay-discounting paradigm, a measure of cognitive impulsivity reflecting a behavioral bias towards immediacy, and then treated with lithium, valproate, or control chow. After 3 weeks of drug treatment, mice were tested at various delays to a large, delayed reward. Drug treatment continued during this time. Lithium reduced impulsivity, whereas valproate had no effect on choice behavior. Both drugs increased the number of choice trials and reinforcer intake, but effects on choice behavior did not depend on these motivational changes. To our knowledge, this is the first study demonstrating lithium's effects to reduce cognitive impulsivity. Future studies may focus on the ability of putative pharmacotherapies for patients at risk for bipolar disorder or suicide to modify the impulsive choice dimension of this diseases.
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Affiliation(s)
- Meredith E Halcomb
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Todd D Gould
- Departments of Psychiatry, Pharmacology, Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas J Grahame
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA,Department of Psychology, Indiana University Purdue University, 402 N. Blackford St, LD120F, Indianapolis, IN 46205, USA, Tel: +1 317 274 0194, Fax: +1 317 274 6756, E-mail:
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95
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Watkins HB, Meyer TD. Is there an empirical link between impulsivity and suicidality in bipolar disorders? A review of the current literature and the potential psychological implications of the relationship. Bipolar Disord 2013; 15:542-58. [PMID: 23822918 DOI: 10.1111/bdi.12090] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 08/28/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Suicide is highly prevalent among individuals with bipolar disorder and understanding the factors that increase risk for suicide may help to develop targeted interventions to prevent attempts. Impulsivity is thought to be an influential factor associated with suicidality and is also discussed as a key construct of bipolar disorder. The aim of this paper was to systematically review the current evidence to examine the association between impulsivity and suicidality in bipolar disorder. METHODS PsycInfo, Medline, and Web of Knowledge databases were searched for articles published up until March 2012. Papers were included if they assessed an adult sample of individuals with bipolar disorders, focused on suicidality (ideation with intent to die, suicide attempts, or completion), and used a validated measure to determine impulsivity. RESULT Sixteen papers were identified. Contrary to widespread belief, we found (i) a very inconsistent picture of results including positive, negative, and insignificant associations between impulsivity and suicidality; and (ii) some studies do not take into account important aspects such as state-trait or measurement issues. CONCLUSIONS The link between suicidality and impulsivity is less straightforward than often assumed. Drawing clear conclusions about the association is hampered by factors such as inconsistencies in defining suicidality, measuring impulsivity, and differentiating between impulsivity as a personality trait and impulsivity as a state (e.g., a consequence of substance use or premeditation of the attempt). We suggest that the association is less direct and that psychological models (e.g., Joiner's theory of suicidality) can help foster a more in-depth understanding regarding the relationship.
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Affiliation(s)
- Hannah B Watkins
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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96
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Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder. J Affect Disord 2013; 148:384-90. [PMID: 22835849 PMCID: PMC3484175 DOI: 10.1016/j.jad.2012.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/08/2011] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Interactions between characteristics of bipolar and Axis II cluster B disorders are clinically and diagnostically challenging. Characteristics associated with personality disorders may be dimensional aspects of bipolar disorder. We investigated relationships among antisocial personality disorder (ASPD) or borderline personality disorder symptoms, impulsivity, and course of illness in bipolar disorder. METHODS Subjects with bipolar disorder were recruited from the community. Diagnosis was by structured clinical interview for DSM-IV (SCID-I and -II), psychiatric symptom assessment by the change version of the schedule for affective disorders and schizophrenia (SADS-C), severity of Axis II symptoms by ASPD and borderline personality disorder SCID-II symptoms, and impulsivity by the Barratt impulsiveness scale (BIS-11). RESULTS ASPD and borderline symptoms were not related to clinical state or affective symptoms. Borderline symptoms correlated with BIS-11 impulsivity scores, and predicted history of suicide attempts independently of the relationship to impulsivity. ASPD symptoms were more strongly related to course of illness, including early onset, frequent episodes, and substance-related disorders. These effects persisted after allowance for gender and substance-use disorder history. CONCLUSIONS Personality disorder symptoms appear to be dimensional, trait-like characteristics of bipolar disorder. ASPD and Borderline symptoms are differentially related to impulsivity and course of illness.
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Affiliation(s)
- Alan C Swann
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
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97
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Can risk-taking be an endophenotype for bipolar disorder? A study on patients with bipolar disorder type I and their first-degree relatives. J Int Neuropsychol Soc 2013; 19:474-82. [PMID: 23410848 PMCID: PMC4180758 DOI: 10.1017/s1355617713000015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Risk-taking behavior and impulsivity are core features of bipolar disorder. Whether they are part of the inherited aspect of the illness is not clear. We aimed to evaluate risk-taking behavior as a potential endophenotype for bipolar disorders, and its relationship with impulsivity and illness features. The Balloon Analogue Risk Task (BART) and Barratt Impulsiveness Scale-11 (BIS-11) were used to assess risk-taking behavior and impulsivity respectively in 30 euthymic bipolar I patients (BD), their 25 asymptomatic first-degree relatives (BD-R), and 30 healthy controls (HC). The primary BART outcome measure was the behavioral adjustment score (number of pumps after trials where the balloon did not pop minus the number of pumps after trials where the balloon popped). BD (p < .001) and BD-R (p = .001) had similar and significantly lower adjustment scores than HC. Only BD scored significantly higher on BIS-11 total (p = .01) and motor (p = .04) subscales than HC. Neither the BART, nor impulsivity scores associated with illness features. A limitation of this study is medicated patients and a heterogeneous BD-R were included. Riskiness may be a candidate endophenotype for bipolar disorder as it appears independently from illness features, presents similarly in BD and BD-R groups and differs from impulsivity.
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98
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Costa A, la Fougère C, Pogarell O, Möller HJ, Riedel M, Ettinger U. Impulsivity is related to striatal dopamine transporter availability in healthy males. Psychiatry Res 2013; 211:251-6. [PMID: 23158972 DOI: 10.1016/j.pscychresns.2012.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 07/16/2012] [Accepted: 07/26/2012] [Indexed: 01/28/2023]
Abstract
Impulsivity characterises various psychiatric disorders, particularly attention-deficit/hyperactivity disorder (ADHD). Evidence shows that ADHD symptoms are associated with dopamine dysfunction and alleviated with methylphenidate, a drug that reduces dopamine transporter availability. ADHD-like symptoms and impulsive traits are continuously distributed across the general population. Here, we aimed to investigate the dopaminergic basis of impulsivity and other ADHD-related traits in healthy individuals by studying the association of these traits with striatal dopamine transporter availability. Single-photon emission computed tomography with [(123)I] FP-CIT was performed on 38 healthy males. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and hyperactivity-impulsivity and inattention using the Adult ADHD Self-Report Scale (ASRS). We found that greater dopamine transporter availability was associated with higher BIS impulsivity but not with ADHD-related traits. The association with BIS was significant after accounting for individual differences in age and neuroticism. These results suggest that individual differences in the dopamine system may be a neural correlate of trait impulsivity in healthy individuals.
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Affiliation(s)
- Anna Costa
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
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99
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Henna E, Hatch JP, Nicoletti M, Swann AC, Zunta-Soares G, Soares JC. Is impulsivity a common trait in bipolar and unipolar disorders? Bipolar Disord 2013; 15:223-7. [PMID: 23286455 PMCID: PMC3582804 DOI: 10.1111/bdi.12034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Impulsivity is increased in bipolar and unipolar disorders during episodes and is associated with substance abuse disorders and suicide risk. Impulsivity between episodes predisposes to relapses and poor therapeutic compliance. However, there is little information about impulsivity during euthymia in mood disorders. We sought to investigate trait impulsivity in euthymic bipolar and unipolar disorder patients, comparing them to healthy individuals and unaffected relatives of bipolar disorder patients. METHODS Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A) in 54 bipolar disorder patients, 25 unipolar disorder patients, 136 healthy volunteers, and 14 unaffected relatives. The BIS-11A mean scores for all four groups were compared through the Games-Howell test for all possible pairwise combinations. Additionally, we compared impulsivity in bipolar and unipolar disorder patients with and without a history of suicide attempt and substance abuse disorder. RESULTS Bipolar and unipolar disorder patients scored significantly higher than the healthy controls and unaffected relatives on all measures of the BIS-11A except for attentional impulsivity. On the attentional impulsivity measures there were no differences among the unaffected relatives and the bipolar and unipolar disorder groups, but all three of these groups scored higher than the healthy participant group. There was no difference in impulsivity between bipolar and unipolar disorder subjects with and without suicide attempt. However, impulsivity was higher among bipolar and unipolar disorder subjects with past substance use disorder compared to patients without such a history. CONCLUSIONS Questionnaire-measured impulsivity appears to be relatively independent of mood state in bipolar and unipolar disorder patients; it remains elevated in euthymia and is higher in individuals with past substance abuse. Elevated attentional and lower non-planning impulsivity in unaffected relatives of bipolar disorder patients distinguished them from healthy participants, suggesting that increased attentional impulsivity may predispose to development of affective disorders, while reduced attentional impulsivity may be protective.
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Affiliation(s)
- Elaine Henna
- Department of Psychiatry and Behavioral Sciences, University of Texas Center of Excellence on Mood Disorders, University of Texas-Houston Medical School, Houston, TX 77054, USA.
| | - John P Hatch
- Department of Developmental Dentistry and Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mark Nicoletti
- University of Texas Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas–Houston Medical School, Houston
| | - Alan C Swann
- University of Texas Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas–Houston Medical School, Houston
| | - Giovana Zunta-Soares
- University of Texas Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas–Houston Medical School, Houston
| | - Jair C Soares
- University of Texas Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas–Houston Medical School, Houston
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100
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Etain B, Mathieu F, Liquet S, Raust A, Cochet B, Richard JR, Gard S, Zanouy L, Kahn JP, Cohen RF, Bougerol T, Henry C, Leboyer M, Bellivier F. Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients. J Affect Disord 2013; 144:240-7. [PMID: 22901401 DOI: 10.1016/j.jad.2012.07.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/30/2012] [Accepted: 07/01/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND A strong association has been reported between trait-impulsiveness and bipolar disorder (BD). Much attention has been focused on this association, but subgroup analysis has generated conflicting results, raising questions about the role of trait-impulsiveness in suicidal behavior and substance misuse in bipolar patients. METHOD We compared Barratt Impulsiveness Scale-10 scores between 385 euthymic bipolar patients and 185 healthy controls. We then investigated possible association between impulsiveness scores and the following clinical characteristics: suicide attempt (SA), lifetime alcohol/cannabis misuse, rapid cycling and mixed episodes. RESULTS Bipolar patients and healthy controls had significantly different BIS-10 total score and subscores (motor, attentional and nonplanning impulsiveness) (all p values <0.0001). No association was observed between BIS-10 total score, personal history of SA, number of SA, age at first SA and history of violent SA. Higher BIS-10 total scores were associated with alcohol misuse (p=0.005), cannabis misuse (p<0.0001), with an additive effect for these two substances (p=0.005). Higher BIS-10 total scores were also associated with rapid cycling (p=0.006) and history of mixed episodes (p=0.002), with an additive effect of these two variables (p=0.0006). LIMITATIONS We used only one clinical measurement of impulsiveness and did not carry out cognitive assessment. CONCLUSION This study demonstrates that trait-impulsiveness may be considered as a dimensional feature associated with BD and with a more severe clinical expression of the disease, characterized by a history of substance misuse, rapid cycling and mixed episodes. We found no association between impulsiveness and SA characteristics in bipolar patients, confirming some previous negative results.
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Affiliation(s)
- B Etain
- Inserm, U955, Créteil 94000, France.
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