Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.     

Correlation of risk-taking propensity with cross-frequency phase–amplitude coupling in the resting EEG

Objective

Recent evidence has suggested that the weak inhibitory influence of the prefrontal cortex on the subcortical structures may be responsible for risk-taking behaviour. The aim was to determine the possibility that this weakness in top-down control is reflected in changes in the cross-frequency phase–amplitude coupling (CFPAC) in the electroencephalography (EEG).

Methods

Nineteen-channel EEGs were recorded from 50 healthy volunteers with their eyes closed before risk-taking propensity was assessed by behavioural measures, the domain-specific risk-taking (DOSPERT) scale and the Barrett impulsiveness scale (BIS). Correlation analyses between the CFPACs and the behavioural measures were performed.

Results

The CFPACs were negatively correlated with the risk-taking DOSPERT and BIS scores in frontal (Fp2) and centro–parietal (C3, C4 and P4) regions. By contrast, the CFPACs were positively correlated with the risk-taking DOSPERT and BIS scores in the right hemisphere (T8 and P8).

Conclusions

We suggest that frequent risk-taking behaviour is closely associated with the reduced interference of the cortical control network on the reward-oriented system. The CFPAC, which reflects the degree of interactions among functional systems, provides information about an individual’s risk-taking propensity.

Significance

The CFPAC may be a useful neurophysiological indicator of an individual’s tendency towards risk-taking behaviours, which thus potentially contributes to evaluating the severity of the psychiatric diseases exhibiting abnormal risk-taking behaviours.     

Inhibitory Control and Impulsivity Levels in Women Crack Users

Objective: investigate impulsivity levels and inhibitory control in women crack users and explore the relationships between impulsivity and inhibitory control. Method and Design: 52 healthy women (M = 32.83 years; SD = 9.54) and 46 crack cocaine users (M = 31.02 years; SD = 7.73), in abstinence, performed the assessment protocol included a Sociodemographic Data Questionnaire, Mini-Mental State Examination (MMSE), a GO/No-Go Task and the Barratt Impulsiveness Scale–11 (BIS-11). It was a quantitative research with cross-sectional design and control group. Results: crack group showed higher levels of impulsivity in all domains when compared to the control group (crack group M = 76.39, SD = 11.39, control group M = 58.53, SD = 10.76, p <.01). Participants from the crack group presented a significantly higher total reaction time in the Go-NoGo task (F(1,93) = 9.93, p =.002; effect size =.09, observed power =.87) and significantly more commission (F(1,93) = 7.20, p =.009; effect size =.07, observed power =.75) and omission errors (F(1,93) = 6.04, p =.01; effect size =.06, observed power =.68), in Go/NoGo Task. Groups did also significantly differ on total standard deviations suggesting that variability in total reaction time was significantly greater in the crack group. Results showed that only in the crack group there were significant correlations between Go-NoGo parameters and Barratt Impulsiveness Scale. Conclusions: Our findings are consistent that impulsivity and inhibitory control are closely linked to crack use in women. Future studies should consider to evaluate crack users in different withdrawal times, controlling the impact of abstinence time in the variables studied.     

Characterizing impulsivity profile in patients with obsessive–compulsive disorder

Objective. Impulsivity represents a key dimension in obsessive–compulsive disorder (OCD), in relation to outcome and course. It can be assessed through the Barratt Impulsiveness Scale (BIS), which explores three main areas: attentional, motor, and nonplanning. Present study was aimed to assess level of impulsivity in a sample of OCD patients, in comparison with healthy controls, using the BIS. Methods. Seventy-five OCD outpatients, 48 of them having psychiatric comorbidities and 70 healthy controls, were assessed through the BIS, and their scores were analyzed using Student's t-test for independent samples, on the basis of demographic and clinical characteristics. Results. BIS total scores were significantly higher (P: 0.01) in patients compared to controls, with no difference between pure and comorbid patients. Attentional impulsivity scores were significantly higher than controls in patients with pure (P < 0.001) and comorbid OCD (P < 0.001), without differences among them. Patients with multiple OC phenotypes showed higher, though statistically non significant, total and attentional scores, compared to single phenotype patients. In addition, patients with comorbid major depressive disorder had higher, though statistically non significant, total and attentional scores, compared to patients with comorbid bipolar disorder, generalized anxiety disorder, and other disorders. Conclusions. Present findings showed higher impulsivity levels in OCD patients versus controls, particularly in the attentional area, and ultimately suggest a potential cognitive implication.     

Impulsiveness in obsessive-compulsive disorder: results from a family study

OBJECTIVE: Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.     

Psychological Characteristics of Problem Gamblers With and Without Mood Disorder

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.     

Fluoxetine reduces explosiveness and elevates mood of Vietnam combat vets with PTSD

Thirteen of 18 depressed Vietnam War combat veterans who had frequent, explosive outbursts of rage enjoyed reduced explosiveness when treated with fluoxetine, They displayed and reported a greater ability to think rather than act. Duration of anger also diminished; and mood improved.     

Associations between energy drink consumption and alcohol use among college students

Introduction: The aims of our study are to research the general features of energy drink consumption among college students, the association between energy drink consumption and alcohol use while controlling for demographic attributes and general risk taking propensity. Methods: The study was carried out using data collected from 2,632 college students at Trakya University (Edirne, Turkey). The study data were obtained from the Alcohol Use Disorders Identification Test, Addiction Profile Index, Energy Drink Consumption Data Form, Barratt Impulsiveness Scale, and Zuckerman Sensation Seeking Scale. Results: Of all the students, 59.9% had used energy drinks within the last year and 26.4% had used energy drinks within the last 1 month. Of the subjects who used energy drinks within the last month, 26.1% had high consumption frequency (≥6 days/month). Energy drink consumption within the last year and last month predicted alcohol use within the last year and last month, binge drinking, and hazardous/harmful alcohol use in the logistic regression analysis. In addition, the high energy drink consumption frequency predicted hazardous/harmful alcohol use. Discussion: The association between energy drink consumption and alcohol use, independent from other variables related to alcohol use, highlights the importance of raising awareness among college students.     

Impulsiveness and deliberate self-harm: a comparison of ‘first-timers' and ’repeaters‘

Evans J, Platts H, Liebenau A. Impulsiveness and deliberate self-harm: a comparison of ‘first-timers’ and ‘repeaters’. Acta Psychiatr Scand 1996: 93: 378–380. © Munksgaard 1996. This study investigated differences in impulsivity between patients admitted to hospital for the first time after an act of deliberate self-harm (DSH), and those admitted after repetition of DSH. A total of 185 subjects, who were admitted to general hospital wards and referred for psychiatric assessment after DSH, completed self-report questionnaires including the impulsiveness (I-V-E) questionnaire. The presence of factors known to be predictive of repetition was recorded. including any history of DSH. Subjects with a history of DSH had significantly higher scores for impulsiveness than those who were presenting for the first time. Those presenting for the first time had higher scores than expected when compared with normative data after correcting for age and sex. Impulsiveness appears to be an important personality trait in DSH, in particular repeated DSH, and merits further investigation.     

大学生自杀意念及其影响因素的调查分析

目的：研究冲动性、特质焦虑、抑郁情绪及绝望感等因素对自杀意念的影响。方法：采用修订的自杀意念问卷,对某省6所高校的608名大学生进行了调查分析。结果：①修订的自杀意念问卷有良好的信度。②大学生总体自杀意念筛查率为9．04％。有无自杀意念的大学生分别在抑郁、绝望和特质焦虑上存在显著差异（P〈0．01）,性别、年级、专业满意度和学习成绩对自杀意念有显著的预测作用。③结构方程模型检验的结果显示,抑郁情绪和绝望感对自杀意念有显著的预测力,冲动性和特质焦虑对自杀意念没有显著的预测力。