The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder

Background

Impulsivity, a core feature of bipolar disorder (BD), is a multifaceted concept encompassing failure of response inhibition and poor decision-making. Abnormalities in these two cognitive domains have been reported in BD patients but their relationship with impulsivity has not been explored.

Methods

Twenty-five remitted patients with BD completed the Barratt Impulsiveness Scale (BIS) and performed the Hayling Sentence Completion Task (HSCT) and a computerized version of the Iowa Gambling task. The HSCT total errors scaled score was used as a measure of response inhibition while the gabling task score, which reflects participants' ability to make advantageous choices, was used a measure of decision making.

Results

Higher scores on the BIS attentional and non-planning subscales were respectively associated with more errors in the HSCT and less advantageous choices in the gambling task.

Limitations

All patients were medicated. Healthy participants were not included.

Conclusions

Viewed in the context of recent relevant studies our findings suggest that impulsivity, response inhibition and decision-making in BD may represent behavioural manifestations of the same underlying biological mechanism possibly linked to ventral prefrontal cortical function.

Neurocognitive dimensions characterising patients with first-episode psychosis

Background

Assessment of neurocognitive dysfunction in schizophrenia is hampered by the multitude of tests used in the literature.

Aims

We aimed to identify the main dimensions of an assessment battery for patients with first-episode psychosis and to estimate the relationship between dimension scores and gender, age, education, diagnosis and symptoms.

Method

Eight frequently used neuropsychological tests were used. We tested 219 patients 3 months after start of therapy or at remission, whichever occurred first.

Results

We identified five dimensions: working memory (WM); verbal learning (VL); executive function (EF); impulsivity (Im); and motor speed (MS). Significant findings were that the MS score was higher for men, and the WM and VL scores were correlated with years of education.

Conclusions

Neurocognitive function in first-episode psychosis is described by at least five independent dimensions.

The impulse to infidelity and oedipal splitting

Freud suggested that the child perceives parental intercourse as an act of infidelity by the desired but unfaithful parent. Parental sexual infidelity is felt to be a major narcissistic injury that gives rise to fantasies of revenge. A defensive organization arises to manage this trauma and its attendant revenge fantasies. That organization involves splitting of the desired parent into faithful and unfaithful parts, displacement of hostility on to the rival parent, and identification with the desired but unfaithful parent resulting in the impulse to infidelity. Romantic fantasies of escape and rescue from evil rivals provide guilt free ways of satisfying fantasies of oedipal revenge. In those fantasies the evil rival is turned into an injured third party who gets his or her just deserts as the romantic couple gets to live happily ever after. This defensive organization may embroil patients in complicated love triangles as adults for which they may seek treatment. Analyzing the repudiated narcissistic wound of parental infidelity and the disguised revenge fantasies that defend against that wound may provoke narcissistic rage towards the analyst as a moralistic, possessive, controlling, envious, and spoiling oedipal parent.

Impulsivity and the Self-Defeating Behavior of Narcissists

Currently prominent models of narcissism (e.g., Morf & Rhodewalt, 2001) primarily explain narcissists' self-defeating behaviors in terms of conscious cognitive and affective processes. We propose that the disposition of impulsivity may also play an important role. We offer 2 forms of evidence. First, we present a meta-analysis demonstrating a strong positive relationship between narcissism and impulsivity. Second, we review and reinterpret the literature on 3 hallmarks of narcissism: self-enhancement, aggression, and negative long-term outcomes. Our reinterpretation argues that impulsivity provides a more parsimonious explanation for at least some of narcissists' self-defeating behavior than do existing models. These 2 sources of evidence suggest that narcissists' quest for the status and recognition they so intensely desire is thwarted, in part, by their lack of the self-control necessary to achieve those goals.

Depression, Anxiety, and Personal Finance Behavior: Implications for the Classical Economic Conception of Humans as Rational Decision-Makers

In a sample of 138 college students, the personal finance behaviors of impulse control and organization were negatively associated with the use of recreational drugs and with scores on measures of depression, mania, and anxiety.

An Examination of the Psychometric Properties of the Chinese Version of the Barratt Impulsiveness Scale, 11th Version in a Sample of Chinese Adolescents

The current study examined the psychometric properties of the Chinese translation of the Barratt Impulsiveness Scale 11th version in a sample of adolescents from Hunan province, mainland China. During an initial assessment, 396 secondary school students (Grades 10-12) completed the scale and self-report measures assessing problem behaviors and alcohol use. The scale was re-administered 1 mo. later. Analysis gave Cronbach alpha of .80 and test-retest reliability of .70. Confirmatory factor analysis indicated a model containing six first-order factors and two second-order factors best fit the data. Girls reported higher Total scores than boys as well as higher scores on the motor impulsiveness, self-control, and cognitive instability sub-scales. Scores were associated in the predicted direction with a wide variety of self-reported problem behaviors including alcohol use, gambling, and academic misconduct. Current findings indicate that the translated scale is a promising tool with some further development for assessing impulsiveness with Chinese adolescents.

Challenges in Assessing Intent to Die: Can Suicide Attempters Be Trusted?

Assessing a person's intent to die in a suicide attempt is crucial for risk assessment and research, yet suicidal intent is notoriously difficult to measure. People who intended to die when they hurt themselves may deny it, and others may feign intent for secondary gain. Additionally, ambivalence, memory gaps, impulsivity, and fluidity of intent can hinder accurate assessment of intent. Circumstantial evidence, such as a suicide note, may illuminate true intentions but also has substantial limitations. This article summarizes disparate challenges to the measurement of suicidal intent; describes strengths and weaknesses of circumstantial indicators; reviews evidence from studies using the Suicide Intent Scale to show that subjective and circumstantial indicators do not strongly correlate with each other; and concludes with a call to place more trust in individuals whose disclosures of suicidal intent are questionable, even if the possibility for manipulation exists.

Motivation, Working Memory, and Decision Making: A Cognitive-Motivational Theory of Personality Vulnerability to Alcoholism

This article presents a cognitive-motivational theory (CMT) of the mechanisms associated with three basic dimensions of personality vulnerability to alcoholism, impulsivity/novelty seeking, harm avoidance, and excitement seeking. CMT describes the interrelationships between activity in basic motivational systems and attentional, decision-making, and working memory processes as the mechanisms associated with variation in each personality trait. Impulsivity/novelty seeking reflects activity in both appetitive and inhibitory motivational systems, greater attention to reward cues, and increased emotional reactivity to reward and frustration. Harm avoidance reflects individual differences in fearfulness and activity in specific inhibitory systems. Excitement seeking reflects the need to engage in appetitive behaviors in less predictable environments to experience positive affect. CMT also describes the impact of working memory and the specific motivational processes underlying each trait dimension on the dynamics ofdecision making from the perspective of decision field theory.

The Endophenotype of Impulsivity: Reaching Consilience Through Behavioral, Genetic, and Neuroimaging Approaches

Impulsivity is a multidimensional construct with implications for understanding the etiology and treatment of multiple forms of psychopathology. As a multidimensional construct, however, the processes underlying impulsivity, particularly behavioral inhibition, must be separated to allow for investigations into its neurogenetic bases. Evidence from both animal and human studies supports the role of dopamine in impulsivity, and neuroimaging research is elucidating brain regions involved in behavioral inhibition. Evidence is now emerging that suggests an interaction between dopamine system genes and frontal brain regions in underlying individual differences in behavioral inhibition. However, to reach a comprehensive understanding of the neurogenetic bases of behavioral inhibition, an appropriate framework is required. Therefore, it is proposed that by identifying intervening variables more sensitive to the effects of genetic variation, known as an endophenotype approach, we will be able to overcome many of the methodological limitations that prevent a better understanding at present.

Relations between trait impulsivity, behavioral impulsivity, physiological arousal, and risky sexual behavior among young men

The current study examined how impulsivity-related traits (negative urgency, sensation seeking, and positive urgency), behavioral measures of risk taking and reward seeking, and physiological reactivity related to three different risky sexual behaviors in sexually active undergraduate men (N = 135). Regression analyses indicated that sensation seeking and behavioral risk-taking predicted unique variance in number of sexual partners. These findings suggest that, for young men, acquisition of new partners is associated with need for excitement and reward and willingness to take risks to meet those needs. Sensation seeking, behavioral risk-taking, and skin conductance reactivity to arousing stimuli was related to ever having engaged in sex with a stranger, indicating that, for men, willingness to have sex with a stranger is related not only to the need for excitement and risk-taking but also with innate responsiveness to arousing environmental triggers. In contrast, regression analyses indicated that young men who were impulsive in the context of negative emotions were less likely to use condoms, suggesting that emotion-based impulsivity may be an important factor in negligent prophylactic use. This study adds to the current understanding of the divergence between the correlates of risky sexual behaviors and may lend utility to the development of individualized HIV prevention programming.

The impact of long-term health goals on sexual risk decisions in impulsive and reflective cognitive States

In the heat of the moment, people often impulsively take risks. Having unprotected sex, for example, can result in sexually transmitted infections. In three studies, we investigated a possible explanation for the increased sexual risk propensity of people in an impulsive state. In contrast to the intuitively appealing notion that they are less influenced by their long-term goals, we hypothesized and showed that people in both impulsive and reflective states make less risky sexual decisions when health goals are important. We further showed that, when sexual health goals are important, people in a reflective state make riskier sexual decisions as temptations become stronger, while decisions of people in an impulsive state were not influenced by temptation strength. This supports the counterintuitive prediction that people in an impulsive state are better able to cope with strong temptations than people in a reflective state.

Sex differences in dimensions of impulsivity in a non-clinical sample

Impulsivity has been more closely associated with men than with women because men are more often involved in illegal behaviors. The few studies that have investigated sex differences in impulsivity have used self-report questionnaires and have obtained contradictory results. Two computerized behavioral tests were administered to 125 healthy undergraduate students (75 women, M age 23.8 yr.; 50 men, M age 25.0 yr.). Men exhibited higher scores on motor impulsivity, but there were no significant differences between men and women on attentional and non-planning impulsivity scores. These findings are discussed in terms of the relationship between impulsivity and low- and high-order control.

Justification of Violence Beliefs and Social Problem-Solving as Mediators between Maltreatment and Behavior Problems in Adolescents

This study examined whether justification of violence beliefs and social problem solving mediated between maltreatment experiences and aggressive and delinquent behavior in adolescents. Data were collected on 191 maltreated and 546 nonmaltreated adolescents (ages 14 to 17 years), who completed measures of justification of violence beliefs, social problem-solving dimensions (problem orientation, and impulsivity/carelessness style), and psychological problems. Findings indicated that maltreated adolescents' higher levels of delinquent and aggressive behavior were partially accounted for by justification of violence beliefs, and that their higher levels of depressive symptoms were partially mediated by a more negative orientation to social problem-solving. Comparisons between boys and girls indicated that the model linking maltreatment, cognitive variables, and psychological problems was invariant.

Psychopathological Symptoms, Social Skills, and Personality Traits: A Study with Adolescents

The purpose of this study is two-fold: (a) to study the concomitant relationships between psychopathological symptoms, cooperation, social skills, and other personality traits; and (b) to identify the predictive variables of psychopathological symptoms. The sample consists of 322 adolescents aged 14 to 17 years old. This study uses correlational methodology. In order to assess psychopathological symptoms, cooperation, social skills, and personality traits, the following scales are used: the Symptom Checklist (SCL-90-R; Derogatis, 1983), the Cooperativeness Scale (CS; Rigby, Cox, & Black, 1997), the MESSY social skills scale (Matson, Rotatori, & Helsel, 1983), and the TPT Personality Test (Corral, Pamos, Pereña, & Seisdedos, 2002). Pearson coefficients suggest that adolescents with many psychopathological symptoms have low levels of cooperative behaviors and social skills. They also score high in inappropriate assertiveness, impulsiveness, overconfidence, and jealousy-withdrawal and have low levels of emotional stability, sociability, and responsibility. Through multiple regression analyses, the following variables were identified as predictors of psychopathological symptoms: jealousy-withdrawal, low social integration, impulsiveness, and low self-concept. The role played by intervention programs promoting socio-emotional development to prevent psychopathological symptoms and enhance mental health is discussed.

Time horizons and substance use among African American youths living in disadvantaged urban areas

Transitioning from adolescence to full-fledged adulthood is often challenging, and young people who live in disadvantaged urban neighborhoods face additional obstacles and experience disproportionately higher negative outcomes, including substance abuse and related risk behaviors. This study investigated whether substance use among African Americans ages 15 to 25 (M=18.86 years) living in such areas was related to present-dominated time perspectives and higher delay discounting. Participants (N=344, 110 males, 234 females) living in Deep South disadvantaged urban neighborhoods were recruited using Respondent Driven Sampling, an improved peer-referral sampling method suitable for accessing this hard-to-reach target group. Structured field interviews assessed alcohol, tobacco, and illicit drug use and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). As predicted, substance use was positively related to a greater ZTPI orientation toward present pleasure and a lower tendency to plan and achieve future goals. Although the sample as a whole showed high discounting of delayed rewards, discount rates did not predict substance use. The findings suggest that interventions to lengthen time perspectives and promote enriched views of future possible selves may prevent and reduce substance use among disadvantaged youths. Discontinuities among the discounting and time perspective variables in relation to substance use merit further investigation.

Sex differences in response to amphetamine in adult Long-Evans rats performing a delay-discounting task

The use of animal models to investigate experimental questions about impulsive behavior can provide valuable insight into problems that affect human health. The delay-discounting paradigm involves subjects choosing between smaller reinforcers delivered immediately and larger reinforcers that are delivered after a delay. This is an important experimental paradigm for examining impulsive choice in both laboratory species and humans. However, a shortcoming of previously published delay-discounting studies in animals is that typically only males were studied, reducing the applicability of these studies to human populations. In the present study, both female and male adult Long-Evans rats were trained to perform a delay-discounting task, with delays of 0, 5, 10, 20 and 40 s before delivery of the larger reinforcer. Because dopaminergic signaling is important in mediating this task, the effects of d-amphetamine and the dopamine receptor antagonist, cis-flupenthixol, on task performance were then examined. The main experimental measure was percent larger-reinforcer choice, which was defined as the percentage of experimental trials at each delay in which the delayed, larger reinforcer was chosen. There was no sex difference in percent larger-reinforcer choice during baseline performance of the task. However, d-amphetamine administration disrupted choice in females, as evidenced by <80% larger-reinforcer choice in half of the females, but none of the males, at 0.5 mg/kg. D-Amphetamine also differentially altered the latency to choose between immediate versus delayed reinforcers in females compared to males. In contrast, cis-flupenthixol did not have a sex-related effect on percent larger-reinforcer choice. These findings parallel the sex differences in response to amphetamine seen in human delay-discounting studies and underscore the importance of evaluating sex-based differences in baseline performance and in response to pharmacologic agents when utilizing animal models.

Heroin and amphetamine users display opposite relationships between trait and neurobehavioral dimensions of impulsivity

The multidimensional construct of impulsivity is implicated in all phases of the addiction cycle. Substance dependent individuals (SDIs) demonstrate elevated impulsivity on both trait and laboratory tests of neurobehavioral impulsivity; however our understanding of the relationship between these different aspects of impulsivity in users of different classes of drugs remains rudimentary. The goal of this study was to assess for commonalities and differences in the relationships between trait and neurobehavioral impulsivity in heroin and amphetamine addicts. Participants included 58 amphetamine dependent (ADIs) and 74 heroin dependent individuals (HDIs) in protracted abstinence. We conducted Principal Component Analyses (PCA) on two self-report trait and six neurobehavioral measures of impulsivity, which resulted in two trait impulsivity (action, planning) and four neurobehavioral impulsivity composites (discriminability, response inhibition efficiency, decision-making efficiency, quality of decision-making). Multiple regression analyses were used to determine whether neurobehavioral impulsivity is predicted by trait impulsivity and drug type. The analyses revealed a significant interaction between drug type and trait action impulsivity on response inhibition efficiency, which showed opposite relationships for ADIs and HDIs. Specifically, increased trait action impulsivity was associated with worse response inhibition efficiency in ADIs, but with better efficiency in HDIs. These results challenge the unitary account of drug addiction and contribute to a growing body of literature that reveals important behavioral, cognitive, and neurobiological differences between users of different classes of drugs.

Impulsivity and drinking motives predict problem behaviours relating to alcohol use in university students

AIMS

This study used a four-factor model of impulsivity to investigate inter-relationships between alcohol consumption, impulsivity, motives for drinking and the tendency to engage in alcohol-related problem behaviours.

METHODS

400 University students aged 18-25 completed an online survey consisting of the following measures: Urgency, Premeditation, Perseverance and Sensation Seeking Scale (UPPS) to measure impulsivity; Student Alcohol Questionnaire to assess drinking quantity, frequency and rates of problem behaviours; Drinking Motives Questionnaire to assess motives for drinking.

RESULTS

The majority of the sample (94.5%) drank alcohol at least monthly. Path analysis revealed direct effects of urgency, sensation seeking and premeditation, as well as the quantity of alcohol consumed, on the tendency to engage in risky behaviours with negative consequences. The effect of urgency was mediated by drinking for coping motives and by a combined effect of drinking for social motives and consumption of wine or spirits. Conversely the effect of sensation seeking was mediated by the quantity of alcohol consumed, irrespective of drink type, and the effect of premeditation was mediated by the consumption of wine and spirits, in combination with enhancement motives.

CONCLUSIONS

Sensation seeking, urgency and lack of premeditation are related to different motives for drinking and also demonstrate dissociable relationships with the consumption of specific types of alcohol (beer, wine and spirits) and the tendency to engage in risky behaviours associated with alcohol consumption. Screening for high levels of urgency and for severe drinking consequences may be useful predictors of alcohol-related problems in UK University students aged 18 to 25 years.

The effects of situational factors and impulsiveness on drivers' intentions to violate traffic rules: Difference of driving experience

This study aimed to explore the effects of situational variables and impulsiveness on drivers' intentions to violate traffic rules among novice, less experienced and experienced drivers in China. Specifically, eight scenarios with manipulated variables, including time pressures (high and low), descriptive norms (positive and negative) and accident base rates (high and low), were randomly presented to 232 drivers. All independent variables, except the descriptive norm, were between-subjects designs. The results showed that hypothetical high time pressure and unsafe descriptive norm increased drivers' intentions to commit violations, respectively. Moreover, the effects of situational factors and impulsiveness on their intentions to violate traffic rules depended on driving experience. Cognitive impulsiveness predicted the violation intention only of novice drivers, whereas the descriptive norm affected the intention of the remaining two groups. The stated accident base rate moderated the relationship between the descriptive norm and violation intention of experienced drivers, specifically, when the accident base rate was hypothetical high their violation intention relied more on descriptive norms. The results indicated that with increased driving experience, drivers became more sensitive to situational cues, less influenced by individual factors and, correspondingly, more likely to behave in a manner that was congruent with the surrounding situation and individuals. The potential applications for this research are the development of intervention and training programs specifically for drivers with varying levels of driving experience.

Impulsive and compulsive behaviors in Parkinson's disease

Impulsive-compulsive behaviors (ICBs) in Parkinson's disease (PD) are a common and devastating side effect of dopamine replacement therapy. In this review we describe the phenomenology, prevalence, and risk factors of patients with PD. Results of behavioral studies assessing the neuropsychological profile of patients with PD emphasize that the ICBs, which are behavioral addictions, are not hedonically motivated. Rather, other factors such as the inability to cope with uncertainty may be triggering ICBs. New insights from functional imaging studies, strengthening the incentive salience hypothesis, are discussed, and therapeutic guidelines for the management of ICBs in PD are given.

Test-retest reliability of behavioral measures of impulsive choice, impulsive action, and inattention

Behavioral measures of impulsivity are widely used in substance abuse research, yet relatively little attention has been devoted to establishing their psychometric properties, especially their reliability over repeated administration. The current study examined the test-retest reliability of a battery of standardized behavioral impulsivity tasks, including measures of impulsive choice (i.e., delay discounting, probability discounting, and the Balloon Analogue Risk Task), impulsive action (i.e., the stop signal task, the go/no-go task, and commission errors on the continuous performance task), and inattention (i.e., attention lapses on a simple reaction time task and omission errors on the continuous performance task). Healthy adults (n = 128) performed the battery on two separate occasions. Reliability estimates for the individual tasks ranged from moderate to high, with Pearson correlations within the specific impulsivity domains as follows: impulsive choice (r range: .76-.89, ps < .001); impulsive action (r range: .65-.73, ps < .001); and inattention (r range: .38-.42, ps < .001). Additionally, the influence of day-to-day fluctuations in mood, as measured by the Profile of Mood States, was assessed in relation to variability in performance on each of the behavioral tasks. Change in performance on the delay discounting task was significantly associated with change in positive mood and arousal. No other behavioral measures were significantly associated with mood. In sum, the current analysis demonstrates that behavioral measures of impulsivity are reliable measures and thus can be confidently used to assess various facets of impulsivity as intermediate phenotypes for drug abuse.

Impulsivity moderates the association between racial discrimination and alcohol problems

Alcohol use among university students is a serious public health concern, particularly among minority students who may use alcohol to cope with experiences of racial discrimination. Although the impact of racial discrimination on alcohol use has been well-established, individual differences in factors that may act to either attenuate or exacerbate the negative effects of racial discrimination are largely unknown. One potentially fruitful individual differences trait that has repeatedly been found to predict alcohol problems is the multidimensional personality trait of impulsivity. Nonetheless, the ways in which various aspects of impulsivity interact with racial discrimination is yet unknown. The current study, therefore, examined the joint and interactive contribution of racial discrimination and impulsivity in the prediction of alcohol consumption among racial minority university students. Participants included 336 Black/African-American and Asian/Asian-American university students. Results revealed both racial discrimination and impulsivity to be significantly associated with alcohol problems. Further, individuals' responses to racial discrimination were not uniform. Specifically, the association between racial discrimination and alcohol problems was moderated by lack of Premeditation; racial discrimination was most strongly predictive of alcohol problems for those who reported low level of premeditation. Findings from the present study highlight the importance of investigating risk factors for alcohol problems across multiple levels of the ecology as individual personality traits appear to relate to how one might respond to the experience of racial discrimination.

Effects of working memory load, a history of conduct disorder, and sex on decision making in substance dependent individuals

BACKGROUND

Substance dependence and antisocial psychopathology, such as a history of childhood conduct disorder (HCCD), are associated with impulsive or disadvantageous decision making and reduced working memory capacity (WMC). Reducing WMC via a working memory load increases disadvantageous decision making in healthy adults, but no previous studies have examined this effect in young adults with substance dependence and HCCD.

METHOD

Young adults with substance dependence (SubDep; n=158, 71 female), substance dependence and HCCD (SubDep+HCCD; n=72, 24 female), and control participants (n=152, 84 female) completed a test of decision making (the Iowa Gambling Task; IGT) with or without a concurrent working memory load intended to tax WMC. Outcomes were (i) net advantageous decisions on the IGT, and (ii) preferences for infrequent- versus frequent-punishment decks.

RESULTS

SubDep+HCCD men made fewer advantageous decisions on the IGT than control men without a load, but there were no group differences among women in that condition. Load was associated with fewer advantageous decisions for SubDep+HCCD women and control men, but not for men or women in the other groups. Participants showed greater preference for infrequent-punishment, advantageous decks under load as well.

CONCLUSIONS

There are gender differences in the effects of substance dependence, HCCD, and working memory load on decision making on the IGT. Decision making by control men and SubDep+HCCD women suffered the most under load. Load increases preferences for less-frequent punishments, similar to a delay discounting effect. Future research should clarify the cognitive and neural mechanisms underlying these effects.

Personality, cognition and hazardous drinking: Support for the 2-Component Approach to Reinforcing Substances Model

Personality and cognitive processes are both related to alcohol use and misuse. A recent model of hazardous drinking referred, the 2-CARS model, postulates two major pathways to hazardous drinking. One pathway primarily involves the association between Reward Drive and Positive Outcome Expectancies, the second involves the association between Rash Impulsiveness and Drinking Refusal Self-Efficacy. In previous tests of the model, Drinking Refusal Self-Efficacy was found to have the most proximal impact on drinking, being directly influenced by Rash Impulsiveness, and indirectly influenced by Reward Drive through Positive Outcome Expectancies. The aim of the current study was to test the 2-CARS model in a larger independent sample. Results found that individuals with a strong Reward Drive showed higher Positive Outcome Expectancies, while individuals high in Rash Impulsiveness were more likely to report reduced Drinking Refusal Self-Efficacy. The present results also showed a theoretically unexpected pathway with a direct association between Rash Impulsiveness and Positive Outcome Expectancies. However, overall the results support the view that a greater understanding of hazardous drinking can be achieved by investigating the relationship between these personality and cognitive variables.

Single doses of THC and cocaine decrease proficiency of impulse control in heavy cannabis users

BACKGROUND AND PURPOSE

Cannabis is the most popular drug used in the European Union, closely followed by cocaine. Whereas cannabis impairs neurocognitive function in occasional cannabis users, such impairments appear less prominent in heavy users, possibly as a result of tolerance. The present study was designed to assess whether the impairing effects of Δ(9) -tetrahydrocannabinol (THC) in heavy cannabis users would present in a wide range of neuropsychological functions or selectively affect specific performance domains. We also assessed the acute effects of cocaine on neurocognitive functions of heavy cannabis users.

EXPERIMENTAL APPROACH

Heavy cannabis users, who had a history of cocaine use (n = 61), participated in a double-blind, placebo-controlled, three-way crossover study. Subjects received single doses of cocaine HCl (300 mg), cannabis (THC μg·kg(-1) ) and placebo, and completed a number of tests measuring impulse control and psychomotor function.

KEY RESULTS

Single doses of cannabis impaired psychomotor function and increased response errors during impulsivity tasks. Single doses of cocaine improved psychomotor function and decreased response time in impulsivity tasks, but increased errors.

CONCLUSIONS AND IMPLICATIONS

Heavy cannabis users display impairments in a broad range of neuropsychological domains during THC intoxication. Impairments observed in psychomotor tasks, but not in impulsivity tasks, appeared smaller in magnitude as compared with those previously reported in occasional cannabis users. Heavy cannabis users were sensitive to the stimulating and inhibitory effects of cocaine on psychomotor function and impulsivity respectively. The reduction in proficiency in impulse control may put drug users at increased risk of repeated drug use and addiction.

Interactive effects of drinking history and impulsivity on college drinking

The transition from adolescence into emerging adulthood is a critical developmental period for changes in alcohol use and drinking related problems. Prior research has identified a number of distinct developmental alcohol use trajectories, which appear to be differentially related to young adult drinking outcomes. Another correlate of alcohol use in early adulthood is impulsivity. The primary aim of this study was to examine the moderating role of impulsivity in the relation between patterns of past alcohol use and hazardous drinking during the first year of college. Participants (N=452; 49% male; mean age 18.5years; 82% Caucasian) completed self-report measures during the first year of college, including retrospective alcohol use calendars, current alcohol use and drinking problems, and personality. Group-based trajectory modeling was used to identify groups with similar adolescent drinking history from retrospective, self-report. Four groups were identified: abstainers/very light users, late/moderate users, early/moderate users, and steep increase/heavy users. The abstainer/very light user group reported the lowest levels of alcohol use and problematic drinking in college; the steep increase/heavy use group reported the highest levels of alcohol use and problematic drinking. As predicted, the role of personality-specifically urgency, or emotion-based rash action-was strongest among moderate use groups. These findings may be helpful in guiding targeted prevention and intervention programs for alcohol use and abuse.

Heterogeneity in drug abuse among juvenile offenders: is mixture regression more informative than standard regression?

Research on juvenile offenders has largely treated this population as a homogeneous group. However, recent findings suggest that this at-risk population may be considerably more heterogeneous than previously believed. This study compared mixture regression analyses with standard regression techniques in an effort to explain how known factors such as distress, trauma, and personality are associated with drug abuse among juvenile offenders. Researchers recruited 728 juvenile offenders from Missouri juvenile correctional facilities for participation in this study. Researchers investigated past-year substance use in relation to the following variables: demographic characteristics (gender, ethnicity, age, familial use of public assistance), antisocial behavior, and mental illness symptoms (psychopathic traits, psychiatric distress, and prior trauma). Results indicated that standard and mixed regression approaches identified significant variables related to past-year substance use among this population; however, the mixture regression methods provided greater specificity in results. Mixture regression analytic methods may help policy makers and practitioners better understand and intervene with the substance-related subgroups of juvenile offenders.

Development and validation of a fall-related impulsive behaviour scale for residential care

INTRODUCTION

impulsivity in older people with cognitive impairment has yet to be examined rigorously as a risk factor for falls. The objective of this study was to evaluate the psychometric properties of a new fall-related impulsive behaviour scale (FIBS) for a cognitively impaired population living in residential care.

METHODS

one hundred and nine care home residents (84.5 ± 8.3 years) were assessed on the FIBS and a range of behavioural, physical and neuropsychological measures. Participants were then prospectively followed up for falls for 6 months.

RESULTS

the internal reliability (Cronbach's α = 0.77) and test-retest reliability (intra-class correlation coefficient = 0.93) of the FIBS were both good. Construct validity was supported by significant correlations between the FIBS and the neuropsychiatric inventory (r = 0.43, P < 0.001), wandering (r = 0.33, P = 0.001) and global cognition (r = -0.2, P = 0.04). Compared with residents with FIBS scores <1, those with FIBS scores of ≥ 1 were nearly three times more likely to fall in the following 6 months, AOR = 2.92 (95% CI: 1.03-8.29).

CONCLUSION

the FIBS is a simple, valid and reliable scale for assessing fall-related impulsivity in care home residents and can be recommended for use in this group for both research and clinical purposes.

Domain-specific impulsivity in school-age children

Impulsivity is a salient individual difference in children with well-established predictive validity for life outcomes. The current investigation proposes that impulsive behaviors vary systematically by domain. In a series of studies with ethnically and socioeconomically diverse samples of middle school students, we find that schoolwork-related and interpersonal-related impulsivity, as observed by teachers, parents, and the students themselves, are distinct, moderately correlated behavioral tendencies. Each demonstrates differentiated relationships with dimensions of childhood temperament, Big Five personality factors, and outcomes, such as report card grades. Implications for theoretical conceptions of impulsivity as well as for practical applications (e.g. domain-specific interventions) are discussed.

Impaired decisional impulsivity in pathological videogamers

Background

Pathological gaming is an emerging and poorly understood problem. Impulsivity is commonly impaired in disorders of behavioural and substance addiction, hence we sought to systematically investigate the different subtypes of decisional and motor impulsivity in a well-defined pathological gaming cohort.

Methods

Fifty-two pathological gaming subjects and age-, gender- and IQ-matched healthy volunteers were tested on decisional impulsivity (Information Sampling Task testing reflection impulsivity and delay discounting questionnaire testing impulsive choice), and motor impulsivity (Stop Signal Task testing motor response inhibition, and the premature responding task). We used stringent diagnostic criteria highlighting functional impairment.

Results

In the Information Sampling Task, pathological gaming participants sampled less evidence prior to making a decision and scored fewer points compared with healthy volunteers. Gaming severity was also negatively correlated with evidence gathered and positively correlated with sampling error and points acquired. In the delay discounting task, pathological gamers made more impulsive choices, preferring smaller immediate over larger delayed rewards. Pathological gamers made more premature responses related to comorbid nicotine use. Greater number of hours played also correlated with a Motivational Index. Greater frequency of role playing games was associated with impaired motor response inhibition and strategy games with faster Go reaction time.

Conclusions

We show that pathological gaming is associated with impaired decisional impulsivity with negative consequences in task performance. Decisional impulsivity may be a potential target in therapeutic management.

Functional impairment in adults positively screened for attention-deficit hyperactivity disorder: the role of symptom presentation and executive functioning

BACKGROUND

While the number of symptoms of attention-deficit hyperactivity disorder (ADHD) decreases with age, a high proportion of adults with ADHD symptoms suffer from persistent functional impairment (Fi) linked to these symptoms. Our objective was to investigate the specific roles of two potentially important predictors of this Fi: the clinical symptom presentation and the deficit in executive functions (EFs).

METHODS

A total of 158 subjects from a community sample positively screened for ADHD were classified into two groups: those with and without Fi. Following a detailed diagnostic process, participants were administered a self-rating scale for ADHD symptoms as well as a neuropsychological test battery containing tests of EF and attention relevant as potential cognitive endophenotypes for ADHD.

RESULTS

The overall number as well as the number of inattentive, hyperactive and impulsive symptoms, confirmed both by examiner and self-report, were significantly higher among Fi subjects. The highest odds ratio for Fi was associated with impulsive symptoms. Additionally, self-reported complaints of problems with self-concept were significantly higher among Fi subjects. No significant relationship between Fi and neuropsychological measures of EF and attention was detected.

CONCLUSIONS

This study revealed that the number of symptoms, in particular that of impulsivity, had a significant impact on Fi in adults with symptoms of ADHD. Furthermore, our results underline the importance of assessing complaints and behaviors related to self-concept, which are not included in DSM-IV diagnostic criteria of ADHD but nonetheless may be associated with functional outcome of the disorder.

Not all risks are equal: the risk taking inventory for high-risk sports

Although high-risk sport participants are typically considered a homogenous risk-taking population, attitudes to risk within the high-risk domain can vary considerably. As no validated measure allows researchers to assess risk taking within this domain, we validated the Risk Taking Inventory (RTI) for high-risk sport across four studies. The RTI comprises seven items across two factors: deliberate risk taking and precautionary behaviors. In Study 1 (n = 341), the inventory was refined and tested via a confirmatory factor analysis used in an exploratory fashion. The subsequent three studies confirmed the RTI's good model-data fit via three further separate confirmatory factor analyses. In Study 2 (n = 518) and in Study 3 (n = 290), concurrent validity was also confirmed via associations with other related traits (sensation seeking, behavioral activation, behavioral inhibition, impulsivity, self-esteem, extraversion, and conscientiousness). In Study 4 (n = 365), predictive validity was confirmed via associations with mean accidents and mean close calls in the high-risk domain. Finally, in Study 4, the self-report version of the inventory was significantly associated with an informant version of the inventory. The measure will allow researchers and practitioners to investigate risk taking as a variable that is conceptually distinct from participation in a high-risk sport.

Revisiting the concept of the 'problem young driver' within the context of the 'young driver problem': who are they?

For decades there have been two young driver concepts: the 'young driver problem' where the driver cohort represents a key problem for road safety; and the 'problem young driver' where a sub-sample of drivers represents the greatest road safety problem. Given difficulties associated with identifying and then modifying the behaviour of the latter group, broad countermeasures such as graduated driver licensing (GDL) have generally been relied upon to address the young driver problem. GDL evaluations reveal general road safety benefits for young drivers, yet they continue to be overrepresented in fatality and injury statistics. Therefore it is timely for researchers to revisit the 'problem young driver' concept to assess its potential countermeasure implications. This is particularly relevant within the context of broader countermeasures that have been designed to address the 'young driver problem' Personal characteristics, behaviours and attitudes of 378 Queensland novice drivers aged 17-25 years were explored during their pre-, Learner and Provisional 1 (intermediate) licence as part of a larger longitudinal project. Self-reported risky driving was measured by the Behaviour of Young Novice Drivers Scale (BYNDS), and five subscale scores were used to cluster the drivers into three groups (high risk n=49, medium risk n=163, low risk n=166). High risk 'problem young drivers' were characterised by greater self-reported pre-Licence driving, unsupervised Learner driving, and speeding, driving errors, risky driving exposure, crash involvement, and offence detection during the Provisional period. Medium risk drivers were also characterised by more risky road use than the low risk group. Interestingly problem young drivers appear to have some insight into their high-risk driving, since they report significantly greater intentions to bend road rules in future driving. The results suggest that tailored intervention efforts may need to target problem young drivers within the context of broad countermeasures such as GDL which address the young driver problem in general. Experiences such as crash-involvement could be used to identify these drivers as a preintervention screening measure.

Examining gender differences for gambling engagement and gambling problems among emerging adults

Gambling is fast becoming a public health problem in the United States, especially among emerging adults (18-25 year olds). Since 1995, rates have recently doubled with around 7-11 % of the emerging adult population having problems with gambling (Shaffer et al. in Am J Public Health 89(9):1369-1376, 1999; Cyders and Smith in Pers Individ Diff 45(6):503-508, 2008). Some states have lowered their gambling age to 18 years old; in turn, the gambling industry has recently oriented their market to target this younger population. However, little is known about the gender variation and the factors placing emerging adults at risk for getting engaged and developing problems with gambling. The purpose of the study was to determine the risk factors accounting for gender differences at the two levels of gambling involvement: engagement and problems. Mediation analyses revealed that impulsive coping and risk-taking were significant partial mediators for gender differences on engagement in gambling. Men took more risks and had lower levels of impulsive coping than women, and those who took more risks and had lower levels of impulsive coping were more likely to engage in gambling. Risk-taking and social anxiety were the significant mediators for gender differences in problems with gambling. Men took more risks and were more socially anxious than women, and greater risk-taking and more socially anxious individuals tended to have more problems with gambling. Implications for counseling preventions and intervention strategies are discussed.

Major depressive disorder and impulsive reactivity to emotion: toward a dual-process view of depression

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.

Attentional switching forms a genetic link between attention problems and autistic traits in adults

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) symptoms and autistic traits often occur together. The pattern and etiology of co-occurrence are largely unknown, particularly in adults. This study investigated the co-occurrence between both traits in detail, and subsequently examined the etiology of the co-occurrence, using two independent adult population samples. Method Data on ADHD traits (Inattention and Hyperactivity/Impulsivity) were collected in a population sample (S1, n = 559) of unrelated individuals. Data on Attention Problems (AP) were collected in a population-based family sample of twins and siblings (S2, n = 560). In both samples five dimensions of autistic traits were assessed (social skills, routine, attentional switching, imagination, patterns).

RESULTS

Hyperactive traits (S1) did not correlate substantially with the autistic trait dimensions. For Inattention (S1) and AP (S2), the correlations with the autistic trait dimensions were low, apart from a prominent correlation with the attentional switching scale (0.47 and 0.32 respectively). Analyses in the genetically informative S2 revealed that this association could be explained by a shared genetic factor.

CONCLUSIONS

Our findings suggest that the co-occurrence of ADHD traits and autistic traits in adults is not determined by problems with hyperactivity, social skills, imagination or routine preferences. Instead, the association between those traits is due primarily to shared attention-related problems (inattention and attentional switching capacity). As the etiology of this association is purely genetic, biological pathways involving attentional control could be a promising focus of future studies aimed at unraveling the genetic causes of these disorders.

Associations of symptoms and subtypes of attention-deficit hyperactivity disorder with visuospatial planning ability in youth

Little is known about which ADHD core symptom or subtype is most associated with visuospatial planning deficit. This issue was investigated in a sample of 408 youths with current DSM-IV diagnosis of ADHD, and 332 youths without lifetime ADHD, aged 8-17 years (mean age 12.02±2.24). All the participants and their mothers were interviewed using the Chinese Kiddie Epidemiologic version of the Schedule for Affective Disorders and Schizophrenia to obtain information about ADHD symptoms and diagnosis and other psychiatric disorders. In addition to clinical assessments, the participants were assessed with the WISC-III and the Stocking of Cambridge task of the Cambridge Neuropsychological Test Automated Battery. Multi-level regression models were used for data analysis. The results showed that univariate analyses revealed that inattention, hyperactivity, and impulsivity were significantly associated with visuospatial planning, and the magnitude of such association was amplified with increased task difficulties. Only inattention independently predicted visuospatial planning in a model that included all three ADHD symptoms. After further controlling for comorbidity, age of assessment, treatment with methylphenidate, and Full-scale IQ, inattention was still independently associated with visuospatial planning indexed by mean moves needed to solve problems. In subtype comparison, participants with combined subtype and those with prominently inattentive subtype, rather than prominently hyperactivity/impulsivity subtype, had poorer visuospatial planning performance. Our findings indicate that inattention is independently associated with impaired visuospatial planning, and dimensional approach retains the important distinction among ADHD symptoms than subtype approach in understanding the neuropsychological functioning of ADHD.

Acute alcohol effects on subtypes of impulsivity and the role of alcohol-outcome expectancies

RATIONALE

It is well established that alcohol acutely impairs the ability to inhibit a pre-potent response (motor impulsivity), but its effects on cognitive impulsivity, including temporal (delayed gratification) and reflection (decision making) impulsivity, are not clear. An important factor contributing to the effects of alcohol is cognitive expectancies of alcohol-related outcomes.

OBJECTIVES

The current study investigated the effect of alcohol, and alcohol outcome expectancies, on subtypes of impulsivity.

METHODS

Impulsivity was tested using the Stop Signal, the Single Key Impulsivity and the Information Sampling Task for motor, temporal and reflection impulsivity, respectively. Participants (n = 48) received placebo, a low (0.4 g/kg) or high dose (0.8 g/kg) of alcohol, before completing the impulsivity measures.

RESULTS

Motor impulsivity was affected by alcohol dose; participants receiving a high dose displayed reduced inhibitory control. Reflection impulsivity was affected by cognitive alcohol expectancies, but not by alcohol condition; participants expecting greater cognitive and behavioural impairment by alcohol exhibited low impulsivity. Temporal impulsivity was not affected by either alcohol dose or outcome expectancies.

CONCLUSIONS

These data suggest that the effects of alcohol on the subtypes of impulsivity are dissociable. Motor impulsivity is sensitive to the pharmacological effects of alcohol, whereas the reflection subtype is affected by cognitive alcohol expectancies. The findings have implications for the understanding of impulsive behaviour under the influence of alcohol.

Test-retest reliability and gender differences in the sexual discounting task among cocaine-dependent individuals

The Sexual Discounting Task uses the delay discounting framework to examine sexual HIV risk behavior. Previous research showed task performance to be significantly correlated with self-reported HIV risk behavior in cocaine dependence. Test-retest reliability and gender differences had remained unexamined. The present study examined the test-retest reliability of the Sexual Discounting Task. Cocaine-dependent individuals (18 men, 13 women) completed the task in two laboratory visits ∼7 days apart. Participants selected photographs of individuals with whom they were willing to have casual sex. Among these, participants identified the individual most (and least) likely to have a sexually transmitted infection (STI), and the individual with whom he or she most (and least) wanted to have sex. In reference to these individuals, participants rated their likelihood of having unprotected sex versus waiting to have sex with a condom, at various delays. A money delay discounting task was also completed at the first visit. Significant differences in discounting among partner conditions were shown. Differential stability was demonstrated by significant, positive correlations between test and retest for all four partner conditions. Absolute stability was demonstrated by statistical equivalence tests between test and retest, and also supported by a lack of significant differences between test and retest. Men generally discounted significantly more than women for sexual outcomes but not money. Results suggest the Sexual Discounting Task to be a reliable measure in cocaine-dependent individuals, which supports its use as a repeated measure in clinical research, for example, studies examining acute drug effects on sexual risk and the effects of addiction treatment and HIV prevention interventions on sexual risk.

Pubertal development, personality, and substance use: a 10-year longitudinal study from childhood to adolescence

Most research linking early pubertal development to substance use has focused on the effects of pubertal timing (age at which a certain stage of pubertal development is reached or pubertal status at a particular age--related to the maturation disparity hypothesis), but little research has focused on pubertal tempo (rate of growth through pubertal stages--related to the maturation compression hypothesis). However, both timing and tempo have not only been identified as important components of pubertal development, with different predictors, but have also been shown to be independently associated with other adolescent psychopathologies. Using latent growth-curve modeling, this study examined how pubertal status at age 12 and pubertal tempo (between 11 and 13 years) related to substance use from 15 to 16 years in boys from low socioeconomic backgrounds (N = 871). Results showed that both pubertal status at age 12 and tempo were significant predictors of increased levels of substance use and problems in mid to late adolescence. In an attempt to identify mechanisms that may explain the association between pubertal development and substance use it was found that sensation seeking partially mediated the association between pubertal status at age 12 and substance use behaviors. Impulse control was found to moderate the association sensation seeking had with marijuana use frequency, with high sensation-seeking scores predicting higher marijuana use frequency only at low levels of impulse control. These findings highlight the importance of considering multiple sources of individual variability in the pubertal development of boys and provide support for both the maturational disparity and compression hypotheses.

Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention

Prisoners are at increased risk of suicide. Investigation of both individual and environmental risk factors may assist in developing suicide prevention policies for prisoners and other high-risk populations. We conducted a matched case-control interview study with 60 male prisoners who had made near-lethal suicide attempts in prison (cases) and 60 male prisoners who had not (controls). We compared levels of depression, hopelessness, self-esteem, impulsivity, aggression, hostility, childhood abuse, life events (including events occurring in prison), social support, and social networks in univariate and multivariate models. A range of psychosocial factors was associated with near-lethal self-harm in prisoners. Compared with controls, cases reported higher levels of depression, hopelessness, impulsivity, and aggression, and lower levels of self-esteem and social support (all p values <0.001). Adverse life events and criminal history factors were also associated with near-lethal self-harm, especially having a prior prison spell and having been bullied in prison, both of which remained significant in multivariate analyses. The findings support a model of suicidal behaviour in prisoners that incorporates imported vulnerability factors, clinical factors, and prison experiences, and underscores their interaction. Strategies to reduce self-harm and suicide in prisoners should include attention to such factors.

Does fertility status influence impulsivity and risk taking in human females? Adaptive influences on intertemporal choice and risky decision making

Informed by the research on adaptive decision making in other animal species, this study investigated human females' intertemporal and risky choices across the ovulatory cycle. We tested the hypothesis that at peak fertility, women who are exposed to environments that signal availability of higher quality mates (by viewing images of attractive males), become more impulsive and risk-seeking in economic decision tasks. To test this, we collected intertemporal and risky choice measures before and after exposure to images of either attractive males or neutral landscapes both at peak and low fertility conditions. The results showed an interaction between women's fertility status and image type, such that women at peak fertility viewing images of attractive men chose the smaller, sooner monetary reward option less than women at peak fertility viewing neutral images. Neither fertility status nor image type influenced risky choice. Thus, though exposure to images of men altered intertemporal choices at peak fertility, this occurred in the opposite direction than predicted--i.e., women at peak fertility became less impulsive. Nevertheless, the results of the current study provide evidence for shifts in preferences over the ovulatory cycle and opens future research on economic decision making.

The role of fearless dominance in differentiating psychopathy from antisocial personality disorder: comment on Marcus, Fulton, and Edens

Comments on the original article by Marcus et al. (see record 2011-23134-001). Based on their meta-analytic review of the correlates of the two factors of the Psychopathic Personality Inventory (PPI), Fearless Dominance (FD) and Self-Centered Impulsivity (SCI), Marcus, Fulton, and Edens (this issue, pp. 70-79) raise important questions about the role of FD in diagnostic conceptualizations of psychopathy. In considering their findings, general limitations of metaanalyses (e.g., Ioannidis & Lau, 1999) should be borne in mind, along with specific limitations of their analysis. These limitations are discussed here.

Is psychopathy a syndrome? Commentary on Marcus, Fulton, and Edens

Comments on the original article by Marcus, Fulton, and Edens (see record 2011-23134-001). The term "syndrome" derives from the Greek, meaning to "run together." Accordingly, in organic medicine, syndromes are traditionally conceptualized as conditions marked by constellations of signs (observable indicators) and symptoms (subjective indicators) that covary across individuals (Kazdin, 1983; Lilienfeld, Waldman, & Israel, 1994). For example, panic disorder is a classical syndrome because it consists of signs (e.g., sweating and difficulty breathing) and symptoms (e.g., intense fear and fears of dying or losing control) that are positively correlated. In rare cases, syndromes also comprise constellations of largely uncorrelated traits that point to an underlying pathology. For example, Gerstmann's syndrome in neurology is marked by four indicators: dysgraphia/ agraphia, dyscalculia/acalculia, left-right disorientation, and finger agnosia (Benton, 1992). Across the general population, these four indicators are essentially uncorrelated. Nevertheless, when observed together, this constellation of four signs generally indicates a lesion in the left hemisphere near the angular gyrus.

Understanding the Psychopathic Personality Inventory (PPI) in terms of the unidimensionality, orthogonality, and construct validity of PPI-I and -II

Comments on an article by Marcus et al. (see record 2011-23134-001). Marcus et al. (this issue) hold that PPI-I and PPI-II are generally orthogonal (uncorrelated). Examination of the primary PPI scales calls this into question. Specifically, the scales that make up Psychopathic Personality Inventory (PPI)-I and PPI-II are differentially correlated in offenders (Neumann et al., 2008) and college students (as reported in Lilienfeld, 1990, final sample). This pattern of correlations indicates that the socalled orthogonal association between PPI-I and PPI-II may be attributable to a statistical "washout" effect, rather than zero correlations across scales. The scales that make up PPI-I and PPI-II may also be correlated differentially with external correlates, rendering interpretation of PPI-I and PPI-II associations with such correlates ambiguous. The overlap of PPI scale scores among forensic and nonforensic samples also is problematic, particularly for the PPI-I scales.

[Obsessive compulsive disorder--intrusive thoughts, impulses and repetitive behaviours as an expression of a significant disease]

Obsessive-compulsive disorder (OCD) is common and associated with marked impairment and reduced quality of life. In the general practitioner's office as well as in the specialist's consultation, patients with OCD usually present intrusive thoughts (obsessions) and repetitive behaviours (compulsions). OCD sufferers generally recognize their obsessions and compulsions as irrational. Without treatment, OCD often takes a chronic course. Some basic aspects can help to identify patients suffering from OCD earlier and to initiate sufficient therapy. With evidence-based treatment with cognitive-behavioral therapy and adequate psychopharmacotherapy, many patients can achieve complete symptom remission. Initial treatment can be initiated in the general practitioner's office.

Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students

BACKGROUND

Alcohol use, depression, and suicide are significant public health problems, particularly among college students. Impulsivity is associated with all of these factors. Additionally, impulsivity increases the effects of negative mood and alcohol use on maladaptive behavior.

METHODS

The current cross-sectional study examined the association between the four-factor model of impulsivity (urgency, (lack of) perseverance, (lack of) premeditation, and sensation seeking), depressive symptoms, and alcohol use as predictors of suicide proneness among college students. Participants (n=1100) completed online assessments of demographics, impulsivity, depressive symptoms, and suicide proneness.

RESULTS

All predictors were positively related to suicide proneness. The relation between depressive symptoms and suicide proneness was moderated by (lack of) perseverance, alcohol use, and joint interactions of urgency×alcohol use and sensation seeking×alcohol use. Despite some paradoxical findings regarding the depressive symptoms-suicide proneness relation when only one risk factor was elevated, the average level of suicide proneness increased as risk factors increased.

LIMITATIONS

This cross-sectional self-report data comes from a non-clinical sample of college students from a homogeneous background, limiting generalizability and causal predictions.

CONCLUSIONS

Overall, these findings indicate that the association between depressive symptoms and suicide proneness varies considerably by different facets of impulsivity and alcohol use. The results suggest that clinical risk-assessments should weigh two forms of impulsivity (urgency and sensation seeking) as particularly vital in the presence of heavy alcohol use. These findings highlight the importance of considering and exploring moderators of the mood-suicide relationship.

[Impulsivity in sexual offenders--new ideas or back to basics?]

Despite the fact that the group of sexual offenders remains a population which is still difficult to study, the results of current research are considered novel and interesting. Surprisingly, the very old descriptions applying to paraphilia, which is considered to be one of the reasons of sexual offences, appear to be accurate, especially in the context of similarities between impulsivity and pathologic sexual behaviors. Notably, the nomenclature concerning impulsivity enables a specific and reasonable description of behaviors associated with sexual offences. Moreover, the results of research studies show that it is the lack of inhibition, not pathologic arousal, which is the most important factor in the pathogenesis of forbidden sexual behaviors. In addition, it has been shown that behavioral manifestations of impulsivity (substance abuse, suicide attempts) appear commonly in sexual offenders. Mutual relationships between alcohol drinking, suicide attempts, history of child sexual abuse and sexual offences, both in symptomatologic and etiologic aspect, raise a suggestion that all these phenomena may share a common background of poor inhibitory control.

Dimensions of disinhibited personality and their relation with alcohol use and problems

Although alcohol use disorders (AUDs) have been associated with different aspects of disinhibited personality and antisociality, less is known about the specific relationships among different domains of disinhibited personality, antisociality, alcohol use, and alcohol problems. The current study was designed to address three goals, (i) to provide evidence of a three-factor model of disinhibited personality (comprised of impulsivity [IMP], risk taking/low harm avoidance [RTHA], excitement seeking [ES]), (ii) to test hypotheses regarding the association between each dimension and alcohol use and problems, and (iii) to test the hypothesis that antisociality (social deviance proneness [SDP]) accounts for the direct association between IMP and alcohol problems, while ES is directly related to alcohol use. Measures of disinhibited personality IMP, RTHA, ES and SDP and alcohol use and problems were assessed in a sample of young adults (N=474), which included a high proportion of individuals with AUDs. Confirmatory factor analyses supported a three-factor model of disinhibited personality reflecting IMP, RTHA, and ES. A structural equation model (SEM) showed that IMP was specifically associated with alcohol problems, while ES was specifically associated with alcohol use. In a second SEM, SDP accounted for the majority of the variance in alcohol problems associated with IMP. The results suggest that aspects of IMP associated with SDP represent a direct vulnerability to alcohol problems. In addition, the results suggest that ES reflects a specific vulnerability to excessive alcohol use, which is then associated with alcohol problems, while RTHA is not specifically associated with alcohol use or problems when controlling for IMP and ES.