Trait impulsivity in patients with mood disorders

BACKGROUND: Impulsivity is a key component of the manic behavior of bipolar disorder and is reported to occur in bipolar patients as a stable characteristic, i.e. a trait. Nevertheless, impulsivity has not been widely studied in depressed bipolar patients. We assessed impulsivity in depressed and euthymic bipolar and unipolar patients and healthy controls. We hypothesized that bipolar subjects would have higher levels of trait impulsivity than the comparison groups. METHODS: Twenty-four depressed bipolar, 24 depressed unipolar, 12 euthymic bipolar, and 10 euthymic unipolar patients, as well as 51 healthy subjects were evaluated with the Barratt Impulsiveness Scale (BIS). Analysis of covariance with age and sex as covariates was used to compare mean group differences. RESULTS: Depressed bipolar, euthymic bipolar, and depressed unipolar patients did not differ, and showed greater impulsivity than healthy controls on all of the BIS scales. Euthymic unipolar patients scored higher than healthy controls only on motor impulsivity. LIMITATIONS: Higher number of past substance abusers in the bipolar groups, and no control for anxiety and personality disorders, as well as small sample sizes, limit the reach of this study. CONCLUSIONS: This study replicates prior findings of stable trait impulsivity in bipolar disorder patients, and extends them, confirming that this trait can be demonstrated in depressed patients, as well as manic and euthymic ones. Trait impulsivity may be the result of repeated mood episodes or be present prior to their onset, either way it would influence the clinical presentation of bipolar disorder.     

Impulsivity: differential relationship to depression and mania in bipolar disorder

INTRODUCTION: Impulsivity, a component of the initiation of action, may have a central role in the clinical biology of affective disorders. Impulsivity appears clearly to be related to mania. Despite its relationship to suicidal behavior, relationships between impulsivity and depression have been studied less than those with mania. Impulsivity is a complex construct, and it may be related differently to depression and to mania. METHODS: In subjects with bipolar disorder, we investigated impulsivity in relationship to affective symptoms. Trait-like impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Affective symptoms were measured using the Change version of the Schedule for Affective Disorders and Schizophrenia (SADS-C). Measures were compared using analysis of variance, multiple regression and factor analysis. RESULTS: Impulsivity, as measured by the BIS, was related differentially to measures of depression and mania. Total and attentional impulsivity correlated independently with depression and mania scores. Motor impulsivity correlated with mania scores, while nonplanning impulsivity correlated with depression scores. These relationships were strongest in subjects who had never met criteria for a substance use disorder. Among manic symptoms, visible hyperactivity correlated most strongly with BIS scores, regardless of clinical state. Among depressive symptoms, hopelessness, anhedonia, and suicidality correlated most strongly with BIS scores. CONCLUSIONS: Depression and mania are differentially related to impulsivity. Impulsivity is related more strongly to measures of activity or motivation than to depressive or manic affect. The relationship between impulsivity and hopelessness may be an important factor in risk for suicide.     

Factors associated with parent-reported suicide threats by children and adolescents with community-diagnosed bipolar disorder

BACKGROUND: It has recently been suggested that indicators of suicidality in youth may differ for different diagnostic groups []. Aggression, impulsivity and risk-taking behaviors may be strong indicators of suicidality in children and adolescents with symptoms of bipolar disorder. METHODS: Parents completed the Child Bipolar Questionnaire (CBQ) via a secure, Internet-based data acquisition system. In multivariate modeling analyses, with age and sex as covariates, CBQ items that were most closely correlated with parent-reported suicide threat were identified. The strength of this multifactor association was then examined among subjects reported to have a community diagnosis of bipolar disorder compared to those who did not. RESULTS: In order of strength of association, the CBQ items most closely correlated with parent-reported suicide threat were: hallucinations, cursing/foul language, low energy/withdrawal, imagery-gore/violence, destroys property, poor self-esteem, excessive risk-taking, and excessive anxiety/worry. Of these 8 CBQ items, 3 (low energy, poor self-esteem, and anxiety/worry) have a dysphoric orientation, but the items with the strongest associations are related to psychosis, aggression and impulsivity. The association of the 8 CBQ items with suicidal threats was found to be much stronger in subjects with a reported prior or current bipolar diagnosis, compared with all other subjects. LIMITATIONS: Child report data is not available. Parent report data has not yet been validated by research diagnostic interview. CONCLUSIONS: The presence of aggression and impulsivity are importantly related to suicidal threats independently of the risk associated with dysphoria in children and adolescents who have been assigned a diagnosis of bipolar disorder or exhibit some symptoms of the disorder. This may have implications for treatment with antidepressant medication when the diagnosis of bipolar disorder may be present.     

Impulsivity and phase of illness in bipolar disorder

BACKGROUND: Impulsivity is prominent in bipolar disorder, but there is little quantitative information relating it to phase of illness. METHODS: We measured impulsivity in patients with bipolar disorder who had not met episode criteria for at least 6 months, patients who were manic, and healthy control subjects. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and performance on the computerized Immediate Memory-Remote Memory Task (IMT-DMT), based on the Continuous Performance Test, which has been shown to reflect risk of impulsivity in other populations. RESULTS: BIS scores in euthymic and manic bipolar subjects were identical, and were significantly elevated compared to controls. Commission errors (impulsive responses) on the IMT-DMT were elevated in manic subjects but were identical to controls in euthymic subjects. Measures of impulsivity did not appear related to depressive symptoms. LIMITATIONS: The number of subjects was too small for detailed investigation of the role of comorbidities; subjects were receiving pharmacological treatments. CONCLUSIONS: Impulsivity has state- and trait-related aspects in bipolar disorder.     

Refining the ADHD phenotype using affected sibling pair families.

Attention deficit hyperactivity (ADHD) is a highly heritable behavioral disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity. Detection of susceptibility genes underlying ADHD may benefit from refinement of the ADHD phenotype into components that reflect more specific gene to behavior pathways and through the reduction of etiological heterogeneity. Using affected sibling pair (ASP) families, we are examining familial clustering of ADHD symptoms, neurocognitive task performance, and the occurrence of comorbid conditions to attempt to refine the phenotype and/or identify clinical features that may be used to stratify ADHD subjects to reduce etiological heterogeneity.     

Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior

BACKGROUND: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. METHODS: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. RESULTS: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the Ia group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. LIMITATIONS: Long-term data are needed to assess the stability of these groups. CONCLUSIONS: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.     

Use of Adaptol in the Treatment of Attention Deficit Hyperactivity Disorder in Children

The efficacy of Adaptol (a non-benzodiazepine tranquilizer) in the treatment of children with attention deficit hyperactivity disorder (ADHD) was studied. At a dose of 500 mg twice daily for one month, Adaptol decreased hyperactivity and impulsivity without producing significant changes in attention or reaction times (the authors emphasize the importance of this factor, as we are dealing with side effects often encountered when benzodiazepine tranquilizers are used). These results lead to the conclusion that Adaptol can be used in the treatment of ADHD as monotherapy in cases in which there is a predominance of hyperactivity/impulsivity and as a component of complex therapy in other types of the disorder, particularly when ADHD is combined with anxiety disorders.     

Effects of antisocial or social attitudes on neurobiological functions

Antisocial personality disorder is characterized by triats like a failure to conform to social norms, impulsivity, hostility, irritability and aggressiveness, recklessness, irresponsibility, criminality, a lack of guilt or remorse, and deceitfulness. A large number of investigations revealed that there is evidence for a neurobiological underpinning of antisocial behavior. The precise nature and causal aspects of the relationship between neurobiological abnormalities and antisocial behavior is still unknown. There is, however, some evidence that some antisocial patients are able to influence their neurobiological functions, which are related to sensation seeking, aggressiveness, impulsivity, criminality and a lack of fear (associated with an inability to learn from experiences). The author hypothesizes that a reduction of antisocial behavior/attitude, may consequently result in normalization of neurobiological functions, which are linked to specific attitudes and behavioral dimensions.     

Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies

Impulsivity, broadly defined as action without foresight, is a component of numerous psychiatric illnesses including attention deficit/hyperactivity disorder (ADHD), mania and substance abuse. In order to investigate the mechanisms underpinning impulsive behavior, the nature of impulsivity itself needs to be defined in operational terms that can be used as the basis for empirical investigation. Due to the range of behaviors that the term impulsivity describes, it has been suggested that impulsivity is not a unitary construct, but encompasses a variety of related phenomena that may differ in their biological basis. Through fractionating impulsivity into these component parts, it has proved possible to devise different behavioral paradigms to measure various aspects of impulsivity in both humans and laboratory animals. This review describes and evaluates some of the current behavioral models of impulsivity developed for use with rodents based on human neuropsychological tests, focusing on the five-choice serial reaction time task, the stop-signal reaction time task and delay-discounting paradigms. Furthermore, the contributions made by preclinical studies using such methodology to improve our understanding of the neural and neurochemical basis of impulsivity and ADHD are discussed, with particular reference to the involvement of both the serotonergic and dopaminergic systems, and frontostriatal circuitry.     

Effects of two self-control procedures on modifying Type A behavior

Two groups of Type A subjects who received either anxiety management training focused on coping with anger and hostility or operant self-control procedures were compared with a control group. Treated subjects compared to controls showed significant reductions in the overall Type A behavior, hard-driving/competitive, and speed/impatience scores. The results supported the hypothesis that both self-control training methods provide the opportunity to adapt more effective coping strategies and to rely less on Type A coping techniques. Self-control procedures such as anxiety management training and operant self-control are promising methods for reducing Type A behaviors even in the Japanese culture. Implications of selecting the most effective treatment for each CHD-pathogenic behavior are discussed.     

The effectiveness of EEG-feedback on attention,impulsivity and EEG: A sham feedback controlled study

EEG-feedback, also called neurofeedback, is a training procedure aimed at altering brain activity, and is used as a treatment for disorders like Attention Deficit/Hyperactivity Disorder (ADHD). Studies have reported positive effects of neurofeedback on attention and other dependent variables. However, double-blind studies including a sham neurofeedback control group are lacking. The inclusion of such group is crucial to control for unspecific effects. The current work presents a sham-controlled, double-blind evaluation. The hypothesis was that neurofeedback enhances attention and decreases impulsive behavior. Participants (n = 27) were students selected on relatively high scores on impulsivity/inattention questionnaires (Barrat Impulsivity Scale and Broadbent CFQ). They were assigned to a neurofeedback treatment or a sham group. (sham)Neurofeedback training was planned for 15 weeks consisting of a total of 30 sessions, each lasting 22 min. Before and after 16 sessions (i.e., interim analyses), qEEG was recorded and impulsivity and inattention was assessed using a stop signal task and reversed continuous performance task and two questionnaires. Results of the interim analyses showed that participants were blind with respect to group inclusion, but no trend towards an effect of neurofeedback on behavioral measures was observed. Therefore in line with ethical guidelines the experiment was ceased. These results implicate a possible lack of effect of neurofeedback when one accounts for non-specific effects. However, the specific form of feedback and application of the sham-controlled double-blind design may have diminished the effect of neurofeedback.     

Face-to-Face Versus Online Behavioral Parent Training for Young Children at Risk for ADHD: Treatment Engagement and Outcomes

Attention deficit/hyperactivity disorder (ADHD) is associated with significant challenges in child functioning. Although behavioral parent training (BPT) can reduce ADHD symptoms, factors associated with traditional face-to-face (F2F) delivery results in only about half of families receiving BPT. The purpose of this pilot randomized controlled trial was to examine parent engagement and program acceptability of F2F and online BPT, as well as the efficacy of both formats relative to a waitlist control (WLC) group. Participants were 47 families with preschool children (30 boys, 17 girls) who were between the ages of 3 years 0 months (3;0) and 5 years 11 months (5;11) old who were identified at risk for ADHD. Children were randomly assigned to F2F or online BPT or to WLC; parents in the two treatment conditions received 10 sessions of BPT. Assessment data for all groups were collected at pre-, mid-, and posttreatment. Both intervention formats resulted in high attendance (M = 80%) and significantly improved parent knowledge of interventions, treatment implementation fidelity, and child behavior (reduced restlessness and impulsivity, improved self-control, affect, and mood) compared with WLC. However, parents in the F2F group reported significantly higher acceptability ratings than parents in the online group. Findings indicate a streamlined BPT delivered online or F2F results in high levels of engagement, acceptability, as well as parent treatment knowledge and fidelity. Online BPT is associated with similar efficacious outcomes with F2F BPT, suggesting the need for further research to determine variables that predict greater acceptability for and adoption of this format.     

Behavioral implications of lowering cholesterol levels: a double-blind pilot study

The treatment of hypercholesterolemia may be associated with greater noncardiac mortality. This current pilot study sought to determine which behaviors, if any, are associated with decreases in cholesterol level. Twelve subjects received one of two cholesterol-reducing drugs or placebo. Cholesterol and behavioral ratings were measured at baseline, 4, and 52 weeks with standardized scales. Cholesterol levels markedly declined with concomitant significant increases in impulsivity ratings at 4 weeks. At 52 weeks, the increase in impulsivity ratings was no longer apparent, but depression ratings showed a significant improvement. This pilot study, although limited in size, raises the possibility that cholesterol-lowering drugs are associated with mild, time-limited increases in impulsivity and with mild, time-delayed improvements in depression ratings.     

Social Reasoning and Social Behavior in Reflective and Impulsive Children

Forty-one reflective and forty-five impulsive third-grade boys were administered a social reasoning task. Impulsives chose assertive responses to conflicts less often than reflectives. However, no style group differences were found for other types of self-rated responses or for teacher and male peer ratings of social behavior. Impulsives were rated by their female peers as more physically aggressive on the playground and more verbally aggressive, likely to leave social conflicts, and assertive in the classroom. Highly reliable group differences were found for the teacher, peer, and experimenter ratings of motivation, with impulsive being rated as less motivated than reflectives. The fact that impulsives demonstrated maladaptive social behavior and inadequate motivation, in spite of their adequate social reasoning, is noteworthy. These findings, supported by a growing body of research, imply that the traditional social cognitive skill deficit model of maladaptive behavior is inadequate. As well, they suggest that control deficits (e.g., impulsivity) and production deficits (e.g., low motivation) merit consideration in our treatment of maladaptive behavior in general and impulsivity in particular.     

Depressive symptoms as a function of trait anxiety and impulsivity

This research examined differences in depressive symptomatology as assessed by the Beck Depression Inventory (BDI) in a large sample (n = 267) of young adults who scored in the upper ranges on trait anxiety and/or impulsivity measures. Given previous research which has identified anxiety and impulsivity as important organizing dimensions for personality, personality pathology, and behavior, a goal of this present research was to identify specific depressive symptoms that were uniquely associated with either anxiety or impulsivity. Results indicated that the presence of impulsivity without coexisting anxiety was associated with the endorsement of fewer depressive symptoms and lower BDI scores. An examination of specific depressive symptoms as a function of anxiety and impulsivity revealed three general response patterns across 20 of the 21 BDI items. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 129–135, 1998.     

重复经颅磁刺激联合认知行为训练治疗注意力缺陷伴多动障碍儿童的疗效

目的:观察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合认知行为训练治疗注意力缺陷伴多动障碍(attention deficit hyperactivity disorder,ADHD)患儿的临床疗效.方法:60例ADHD患儿按随机数字表法分为对照组和实验组,每组30例.对照组常规采用认知行为治疗,实验组在采用认知行为训练基础上加用rTMS,治疗前后采用数字划消测试(Number Cancel Test,NCT)和Conners父母量表(Parents Symptom Questionnaire,PSQ)进行评估.结果:对照组治疗前后数字划消测试及Co n n e r s父母量表评分差异均有统计学意义(P<0.01),实验组治疗前后数字划消测试及Conners父母量表评分差异均有统计学意义(P<0.01).实验组与对照组治疗后数字划消测试划在对数、划漏数和净分三项评分差异亦均有统计学意义(均P<0.01),在Conners父母量表评分中学习问题和多动指数两项评分差异亦均有统计学意义(均P<0.05).结论:认知行为训练、rTMS联合认知行为训练治疗ADHD患者均有显著疗效.rTMS联合认知行为训练在治疗ADHD患者与单纯认知行为训练相比有疗效优势.     

Impulsivity in anxiety disorder patients: is it related to comorbid cyclothymia?

Objective

The relationship between anxiety and impulsivity is controversial and not well explored. In a previous study we compared impulsivity, measured by different rating tools, in patients with anxiety disorders vs. healthy controls. In the same sample we now explore the influence of comorbid soft bipolar spectrum disorders on the relationship between anxiety disorders and impulsivity.

Method

A sample including 47 subjects with anxiety disorder(s) and 45 control subjects matched for demographic, educational and work characteristics underwent a diagnostic evaluation by the Mini Neuropsychiatric Interview (MINI); a symptomatological evaluation by the Bech-Rafaelsen Depression and Mania Scale (BRDMS), the State-Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); a temperamental and personological evaluation by the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego—Modified (TEMPS-M), the Separation Anxiety Symptoms Inventory (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI); and, finally, a psychometric and a neuro-cognitive evaluation of impulsivity by the Barratt Impulsiveness Scale (BIS) and the Immediate and Delayed Memory Task (IMT/DMT). The initial sample of patients with anxiety disorders was then subdivided into two subgroups depending on the presence of comorbid cyclothymia (Cyclo+, n = 26 and Cyclo−, n = 21). For the diagnosis of cyclothymic disorder, we used both the DSM-IV-TR criteria and also a modified threshold for hypomania with a duration of 2 days. We compared symptomatological, temperamental, personological and impulsivity measures in Cyclo+, Cyclo− and controls.

Results

The comparison between Cyclo+, Cyclo− and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by greatest symptomatological impairment, highest scores in temperamental scales, and highest levels of interpersonal sensitivity and separation anxiety. Cyclo− subjects resulted to be more impulsive compared to controls concerning the retrospective trait measures, but not in the neuro-cognitive test.

Limitations

Correlational cross-sectional study.

Conclusion

In our patients with anxiety disorders, without lifetime comorbidity with major mood episodes, trait and state impulsivity resulted to be greater than in controls. In particular impulsivity was highest in patients with both anxiety disorders and cyclothymia. In anxious-cyclothymic patients also separation anxiety and interpersonal sensitivity were more severe than in anxious patients without cyclothymia and controls. Our findings suggest that impulsivity, rather than being directly related to the presence of the anxiety disorder, could be associated with comorbidity with cyclothymia.     

A rose is a rose is a rose

This young man presented initially and repeatedly over a period of twenty years with symptoms of irritability, depressed and withdrawn mood, impulsivity, out-of-control behavior, and suicidal ideation and behavior. These symptoms occurred with disabling intensity at ages 3 year, 6 1/2 years, and 8 1/2 years, when he had not yet been adequately diagnosed and treated with appropriate psychopharmacology. Symptoms re-occurred in early adulthood after medication had been discontinued by the patient. While he had symptoms characteristic of ADHD before age seven, these were present episodically and only in the context of significant mood disturbance and behavior disruption, which were more characteristic of mood disorder than oppositional behavior associated with ADHD. His reaction to stimulants alone was significant. His response to Ritalin suggested dysphoria and/or neurovegetative slowing. On Dexedrine, he developed frank visual hallucinations. Both reactions can be typically seen in youths with underlying mood or psychotic disorders. This patient's symptoms and their repeated occurrence, in the face of significant family history of mood disorder, demonstrate the utility of DSM-IV criteria and longitudinal history taking in making the diagnosis of bipolar disorder in prepubertal children.     

Autonomic activity in boys with disruptive behavior disorders

Skin conductance (SC) and heart rate (HR) were measured during rest, a series of tones, and a reaction time task in 34 boys with disruptive behavior disorder to ascertain (a) if this broadly defined group differed from control boys (n= 33) and (b) if there were differences within the spectrum related to component diagnoses or to target behaviors. Disruptive boys had higher resting HR than controls, due largely to those without a subdiagnosis of conduct disorder. Disruptive boys showed a smaller increment in SC response frequency for task instructions. They did not show a general deficit in phasic SC reactivity but habituated to signal stimuli at a faster rate than did controls. However, their SC response latencies were shorter despite slower motor reaction time. Responsivity variables were similar in boys with and without a subdiagnosis of conduct disorder. The data are not compatible with the hypothesis of low autonomic nervous system (ANS) baselines in disruptive boys but partially suggest low ANS reactivity. They generally support the validity of the disruptive behavior disorder spectrum. Correlations with measures of aggression and impulsivity suggest that individual differences within the spectrum might be more fruitfully described by behavior dimensions than by conventional subdiagnoses.     

Characteristics of women seeking treatment for premenstrual syndrome

Controversy has developed about the existence of a relatively discrete condition of severe premenstrual dysphoric changes in the absence of underlying mental disorder (late luteal phase dysphoric disorder). With careful screening and evaluation, women with this disorder can be identified. In this study, women who sought treatment for premenstrual syndrome were divided into two groups: individuals who experienced mood and behavior changes and impaired social functioning that were limited to the premenstrual period (n = 86), and women with persistent mental disorders who experienced exacerbation or complication of symptoms during the premenstrual period (n = 54). These groups were compared with a control group of women who had no significant premenstrual changes and no current mental disorder (n = 61). Most of the differences between subjects seeking treatment and controls that were not attributable to premenstrual changes were accounted for by the women with persistent mental disorders.