Trait impulsivity in suicide attempters: Preliminary study

Suicide attempt is a risk factor for suicide. To investigate trait impulsivity among suicide attempters, 93 attempters admitted to an emergency department and 113 healthy controls were evaluated using the Japanese version of the Barratt Impulsiveness Scale (BIS‐11J). Impulsivity was analyzed in relation to clinical data in the attempters. Total BIS‐11J, attention impulsiveness, and motor impulsiveness scores were significantly higher in the attempters than in the controls. Both total BIS‐11J and non‐planning impulsiveness scores were significantly higher in attempters with schizophrenia and other psychotic disorders among the diagnostic groups. Control of impulsivity should be considered as one of the targets for suicide prevention.     

Family History of Suicide and Personality

The objective of this study was to analyze the impact of family history of suicidal behaviour on psychopathlogical features of inmates. A sample of 1,179 prisoners had a psychiatric interview including the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA). Prisoners completed the Barratt Impulsivity Scale (BIS), Buss-Durkee Hostility Inventory (BDHI), and Eysenck Personality Questionnaire (EPQ). Prisoners with a family history of suicide were compared with prisoners without a family history of suicide on clinical and personality variables. Seventy of the 1,179 prisoners (5.9%) had a family history of suicide. Significantly more FHS positive prisoners had attempted suicide compared with FHS negative prisoners (36% vs. 12%, P < 0.0001). Significantly more FHS positive prisoners had a previous history of convictions, a history of juvenile convictions, and had exhibited aggressive behavior in jail. FHS positive prisoners had significantly higher aggression scores on the BGLHA, higher hostility scores on the BDHI, higher impulsivity scores on the BIS, and higher neuroticism scores on the EPQ. A family history of suicide may be a useful clinical indicator that a prisoner is at increased risk for suicidal behaviour and may have problems with impulsive-aggression.     

Suicide attempts and impulsivity

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one–year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Becks Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.     

Normative data and a short form of the Barratt Impulsiveness Scale

The Barratt Impulsiveness Scale is one of the most commonly used scales to measure impulsivity. It has demonstrated validity in several neuropsychiatric populations and correlates with objective neuropsychological measures and impulsivity-related behaviors in healthy individuals. Neuroimaging studies show that BIS scores relate to prefrontal structure and function, as well as central serotonergic function. This study reports normative data and demographic influences in a community sample (n = 700). A 15-item short form of the BIS (BIS 15) is presented that retains the 3-factor structure (nonplanning, motor impulsivity, and attention impulsivity), and maintained good reliability and validity.     

Impulsivity and BOLD fMRI activation in MDMA users and healthy control subjects

The correlation between scores on the Barratt Impulsiveness Scale (BIS) and activation measured by functional magnetic resonance imaging in a dorsolateral prefrontal cortical (DLPFC) activating task was examined in 15 MDMA-using subjects and 19 controls. A significant correlation between BIS scores and DLPFC activation was found, supporting a role for the DLPFC in BIS-measured impulsivity.     

Family history of suicide and impulsivity.

A family history of suicide indicates a raised risk for suicidal behavior; this liability might be familially transmitted as an impulsive-aggression trait. To examine the impulsivity factor, data from 258 abstinent drug dependent patients who were interviewed about their family history of suicidal behavior and who completed the Barratt Impulsivity Scale (BIS) were examined. The results showed that patients with a family history of suicidal behavior had significantly higher BIS scores for risk taking than patients without a family history of suicidal behavior. Also, patients with a family history of suicidal behavior who had themselves attempted suicide had significantly higher BIS scores for both impulsivity and risk taking than patients with a family history of suicidal behavior who had never attempted suicide.     

Family History of Suicide and Impulsivity

A family history of suicide indicates a raised risk for suicidal behavior; this liability might be familially transmitted as an impulsive-aggression trait. To examine the impulsivity factor, data from 258 abstinent drug dependent patients who were interviewed about their family history of suicidal behavior and who completed the Barratt Impulsivity Scale (BIS) were examined. The results showed that patients with a family history of suicidal behavior had significantly higher BIS scores for risk taking than patients without a family history of suicidal behavior. Also, patients with a family history of suicidal behavior who had themselves attempted suicide had significantly higher BIS scores for both impulsivity and risk taking than patients with a family history of suicidal behavior who had never attempted suicide.     

Impulsivity in Drug Dependent Patients Who Attempt Suicide

Impulsivity is a personality dimension often implicated in suicidal behavior. However, it has been little studied in drug dependent patients who attempt suicide. Therefore, 292 recently abstinent opiate or cocaine dependent patients were asked to complete the Barratt Impulsivity Scale (BIS). Those who had attempted suicide were compared with those who had never attempted suicide for their scores on the BIS. The results showed that there was no significant difference between the drug dependent patients who had attempted suicide (N = 91) and those who had never attempted suicide (N = 201) on BIS scores. The possible clinical implication may be that the high impulsivity associated with drug dependent patients may mitigate the utility of impulsivity in the suicide risk assessment of such patients.     

Validation of a short Italian version of the Barratt Impulsiveness Scale (BIS-15) in non-clinical subjects: psychometric properties and normative data

Neurological Sciences - The Barratt Impulsiveness Scale (BIS) is a questionnaire employed to measure impulsivity, which is associated with risky behaviors and mental disorders. We aimed to assess...     

NORMATIVE DATA AND A SHORT FORM OF THE BARRATT IMPULSIVENESS SCALE

The Barratt Impulsiveness Scale is one of the most commonly used scales to measure impulsivity. It has demonstrated validity in several neuropsychiatric populations and correlates with objective neuropsychological measures and impulsivity-related behaviors in healthy individuals. Neuroimaging studies show that BIS scores relate to prefrontal structure and function, as well as central serotonergic function. This study reports normative data and demographic influences in a community sample (n = 700). A 15-item short form of the BIS (BIS 15) is presented that retains the 3-factor structure (nonplanning, motor impulsivity, and attention impulsivity), and maintained good reliability and validity.     

Impulsivity is related to striatal dopamine transporter availability in healthy males

Impulsivity characterises various psychiatric disorders, particularly attention-deficit/hyperactivity disorder (ADHD). Evidence shows that ADHD symptoms are associated with dopamine dysfunction and alleviated with methylphenidate, a drug that reduces dopamine transporter availability. ADHD-like symptoms and impulsive traits are continuously distributed across the general population. Here, we aimed to investigate the dopaminergic basis of impulsivity and other ADHD-related traits in healthy individuals by studying the association of these traits with striatal dopamine transporter availability. Single-photon emission computed tomography with [¹²³I] FP-CIT was performed on 38 healthy males. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and hyperactivity-impulsivity and inattention using the Adult ADHD Self-Report Scale (ASRS). We found that greater dopamine transporter availability was associated with higher BIS impulsivity but not with ADHD-related traits. The association with BIS was significant after accounting for individual differences in age and neuroticism. These results suggest that individual differences in the dopamine system may be a neural correlate of trait impulsivity in healthy individuals.     

Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients

The purpose of this study was to examine trait impulsivity in patients with bipolar disorder and explore the possible connections between impulsivity and clinical presentation of the illness. Diagnoses were based on the Structured Clinical Interview for DSM-IV. The sociodemographic and clinical properties of 71 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated by using the Barratt Impulsiveness Scale (BIS) and impulsivity subscale of the Temperament and Character Inventory, and the results were compared with 50 age- and sex-matched healthy controls and among patients with different clinical properties. All BIS-11 subscale scores were higher in bipolar than in comparison subjects. There were no effects of education and age. Elevated BIS-11 scores were associated with predominant depressive polarity, longer duration of illness and a history of psychotic mood episodes and suicide attempts. These relationships persisted when age, gender, and education were taken into account. These results show that after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects and may vary according to different clinical presentations.     

Relationship of temperament and behaviour measures to the prolactin response to fenfluramine in depressed men

Low central nervous systems (CNS) serotonin has been linked to aggression, impulsivity and disinhibition in both animal and human studies. Low cerebrospinal fluid (CSF) 5-hydroxindoleacetic acid (5HIAA) has been reported in violent criminals, arsonists and violent suicide attempters. Reduced prolactin response to fenfluramine has been found in aggressive patients and criminal offenders. Cloninger's dimension of harm avoidance is hypothesised to be related to CNS serotonin levels, but studies have reported contradictory results. Forty-eight men with major depression received a fenfluramine challenge as well as a number of measures of temperament and behaviour: the Tridimensional Personality Questionnaire (TPQ); the Eysenck Personality Questionnaire (EPQ); the Barratt Impulsivity Scale (BIS); the Hopkins Symptom Checklist (SCL-90); and clinician-rated personality disorder symptoms. The prolactin response to fenfluramine was not related to EPQ or TPQ measures except the TPQ dimension of reward dependence and the EPQ Lie scale. The prolactin response to fenfluramine was not related to BIS measures or to SCL-90 measures except the SCL-90 somatization scale. The prolactin response to fenfluramine was not related to personality disorder diagnoses or to a measure of repeated self-harm. Thus, in a sample of moderately depressed male outpatients, there was very little relationship between personality, behavioural measures and the prolactin response to fenfluramine. We suggest that alterations in serotonin functioning, when measured using the prolactin response to fenfluramine, may be more commonly linked to behavioural abnormalities in personality-disordered or criminal samples.     

Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness

Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness. Objective: We investigated trait impulsivity in bipolar disorder and antisocial personality disorder (ASPD) with respect to severity and course of illness. Method: Subjects included 78 controls, 34 ASPD, 61 bipolar disorder without Axis II disorder, and 24 bipolar disorder with ASPD, by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) (SCID‐I and ‐II). Data were analyzed using general linear model and probit analysis. Results: Barratt Impulsiveness Scale (BIS‐11) scores were higher in ASPD (effect sizes 0.5–0.8) or bipolar disorder (effect size 1.45) than in controls. Subjects with both had more suicide attempts and previous episodes than bipolar disorder alone, and more substance‐use disorders and suicide attempts than ASPD alone. BIS‐11 scores were not related to severity of crimes. Conclusion: Impulsivity was higher in bipolar disorder with or without ASPD than in ASPD alone, and higher in ASPD than in controls. Adverse effects of bipolar disorder in ASPD, but not of ASPD in bipolar disorder, were accounted for by increased impulsivity.     

Impulsivity: a link between bipolar disorder and substance abuse

Background:  Substance abuse is present in most patients with bipolar disorder and associated with poor treatment outcome and increased risk of suicide. Increased impulsivity may be a link between bipolar disorder and substance abuse.
Methods:  First, we compared impulsivity as a stable trait (Barratt Impulsiveness Scale, BIS) and as state-dependent behavioral laboratory performance (Immediate Memory–Delayed Memory task, derived from the Continuous Performance Task) in interepisode bipolar and non-bipolar subjects with and without substance abuse. Secondly, we compared impulsivity in interepisode and manic bipolar subjects with and without substance abuse.
Results:  The BIS scores were increased in interepisode bipolar disorder and in subjects with histories of substance abuse, and were increased further in interepisode bipolar subjects with substance abuse. Performance impulsivity was increased in subjects with substance abuse, regardless of whether they had bipolar disorder. Among subjects with bipolar disorder, after correction for age, BIS scores were increased in those with substance abuse. Performance impulsivity was increased in manic compared with interepisode subjects, regardless of substance abuse history, and was increased in interepisode subjects with substance abuse similarly to manic subjects without substance abuse. These differences could not be accounted for by age, gender, or course of illness.
Conclusions:  Trait impulsivity is increased additively in bipolar disorder and substance abuse. Performance impulsivity is increased in interepisode bipolar disorder only if a history of substance abuse is present. This increased predisposition to impulsivity when not manic may contribute to the decrement in treatment outcome and compliance, and increased risk for suicide and aggression, in bipolar disorder with substance abuse.     

Psychometrische Evaluation der deutschsprachigen Version der Barratt-Impulsiveness-Skala

BACKGROUND: Impulsive behavior is an important characteristic in a range of psychiatric disorders. A unanimous definition of impulsivity is still under discussion, but a questionnaire to measure it has been available for quite some time, i.e. the Barratt Impulsiveness Scale Version 11 (BIS11). However, it lacks adequate psychometric characterization for German speakers. MATERIALS AND METHODS: Control persons were recruited from the Munich city population. Patients with alcohol dependence, suicide attempts, and borderline personality disorders treated as inpatients at the Munich University Psychiatric Clinic were recruited. RESULTS: Confirmatory analysis of the originally suggested factor structure did not adequately represent the data in our sample. The BIS11 sum score, which showed adequate internal consistencies in all subgroups, significantly differentiated the extent of impulsivity between patients and control persons. CONCLUSIONS: Use of the BIS11 sum score in German-speaking regions can be recommended. This sum score shows adequate internal consistency and well differentiated the extent of impulsivity between different groups of patients with psychiatric diagnoses and control persons.     

A pilot study on differences in aggression in New York City and Madrid, Spain, and their possible impact on suicidal behavior

OBJECTIVE: Published results from a U.S. study of depressed suicide attempters and a Madrid, Spain, study including all consecutively admitted suicide attempters suggested that aggression scores were higher in U.S. attempters. This observation led us to compare depressed attempters and controls from both suicide research centers and explore whether New York City (NYC) patients carry out suicidal acts of greater lethality than patients in Madrid. The study goals were (1) to compare aggression scores in attempters and healthy volunteers between the 2 cities and (2) to determine whether higher aggression scores are associated with greater medical lethality of suicide attempts. METHOD: The respective samples from NYC and Madrid included attempters with a DSM-IV diagnosis of major depressive disorder (N = 117 and N = 133) and healthy controls (N = 90 and N = 317). Aggression scores, measured by the Brown-Goodwin Scale, in attempters and healthy volunteers from both sites were compared using an analysis of variance model. The relationship between lethality of suicidal acts and aggression scores in attempters was assessed using logistic regression analyses. NYC subjects were recruited from 1998 to 2001, and Madrid subjects were selected from consecutive admissions in 1999. RESULTS: Depressed suicide attempters from NYC made attempts of greater lethality and reported more lifetime aggressive behavior than depressed attempters in Madrid. NYC healthy volunteers also reported more aggression than their Madrid counterparts. CONCLUSIONS: This pilot study suggests that the greater lethality of suicidal behavior in NYC compared to Madrid is related to higher aggression levels, although the data have limitations. Cross-cultural studies are needed to verify whether aggression and higher lethality suicide attempts share a common diathesis explaining the higher suicide rates in NYC.     

Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder

Background: Impulsivity is a prominent and measurable characteristic of bipolar disorder that can contribute to risk for suicidal behavior. The purpose of this study was to investigate the relationship between impulsivity and severity of past suicidal behavior, a potential predictor of eventual suicide, in patients with bipolar disorder. METHOD: In bipolar disorder subjects with either a definite history of attempted suicide or no such history, impulsivity was assessed with both a questionnaire (Barratt Impulsiveness Scale) and behavioral laboratory performance measures (immediate memory/delayed memory tasks). Diagnosis was determined with the Structured Clinical Interview for DSM-IV. Interviews of patients and review of records were used to determine the number of past suicide attempts and the medical severity of the most severe attempt. RESULTS: Subjects with a history of suicide attempts had more impulsive errors on the immediate memory task and had shorter response latencies, especially for impulsive responses. Impulsivity was highest in subjects with the most medically severe suicide attempts. Effects were not accounted for by presence of depression or mania at the time of testing. Barratt Impulsiveness Scale scores were numerically, but not significantly, higher in subjects with suicide attempts. A history of alcohol abuse was associated with greater probability of a suicide attempt. Multivariate analysis showed that ethanol abuse history and clinical state at the time of testing did not have a significant effect after impulsivity was taken into account. DISCUSSION: These results suggest that a history of severe suicidal behavior in patients with bipolar disorder is associated with impulsivity, manifested as a tendency toward rapid, unplanned responses.     

Childhood trauma and impulsivity. Possible relevance to suicidal behavior.

Social factors are thought to contribute to impulsivity. As childhood traumas predispose to suicidal behavior it was decided to examine whether they may be a determinant of impulsivity, a personality dimension often associated with suicidal behavior. Thus 268 abstinent drug dependent patients completed both the Childhood Trauma Questionnaire (CTQ) and the Barratt Impulsivity Scale (BIS). The results showed that there were significant relationships, albeit small, between CTQ scores and BIS impulsivity scores. These results suggest that childhood trauma may be one determinant of impulsivity as an adult.     

Serum cholesterol and leptin levels in patients with borderline personality disorder

The association between low or lowered cholesterol and impulsivity, aggressive behaviours and suicide remains controversial. In the present study, cholesterol and leptin levels of patients with borderline personality disorder in whom impulsivity, aggressive behaviours and suicide attempts are clearly established have been compared with those of healthy controls. The study group consisted of 16 patients with borderline personality disorder and 16 healthy controls. All patients were assessed with the Barratt Impulsivity Scale (BIS), Buss-Durkee Hostility Inventory (BDHI) and Hamilton Depression Rating Scale (HDRS). Fasting serum cholesterol and leptin levels were measured. The mean cholesterol and leptin levels of the patient group were significantly lower than those of the controls. Likewise, the patients with current suicidal thoughts and a history of suicide attempt had statistically significantly lower cholesterol and leptin levels compared with the patients without those features. There was an inverse correlation between both cholesterol and leptin levels, and impulsivity as determined by the BIS or aggression as determined by the BDHI, but no correlation between both cholesterol and leptin levels and the HDRS was found in the patients. In conclusion, the present study demonstrates that the patients with borderline personality disorder have lower cholesterol and leptin levels than healthy controls. Low serum cholesterol and leptin levels are associated with all dimensions of the disorder - impulsivity, aggression and suicidality - but are not associated with the presence and the severity of comorbid depression.