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Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse |
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| Authors: | M Kathleen Holmes Carrie E Bearden Marcela Barguil Manoela Fonseca E Serap Monkul Fabiano G Nery Jair C Soares Jim Mintz David C Glahn |
| Affiliation: | Research Imaging Center, University of Texas Health Science Center at San Antonio, San Antonio, TX;, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA;, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA;, Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil;, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA |
| Abstract: | Background: Elevated levels of impulsivity and increased risk taking are thought to be core features of both bipolar disorder (BD) and addictive disorders. Given the high rates of comorbid alcohol abuse in BD, alcohol addiction may exacerbate impulsive behavior and risk-taking propensity in BD. Here we examine multiple dimensions of impulsivity and risk taking, using cognitive tasks and self-report measures, in BD patients with and without a history of alcohol abuse. Methods: Thirty-one BD subjects with a prior history of alcohol abuse or dependence (BD-A), 24 BD subjects with no history of alcohol abuse/dependence (BD-N), and 25 healthy control subjects (HC) were assessed with the Barratt Impulsiveness Scale (BIS) and the computerized Balloon Analogue Risk Task (BART). Results: Both BD groups scored significantly higher than controls on the BIS. In contrast, only the BD-A group showed impaired performance on the BART. BD-A subjects popped significantly more balloons than the BD-N and HC groups. In addition, subjects in the BD-A group failed to adjust their performance after popping balloons. Severity of mood symptomatology was not associated with performance on either task. Discussion: The current study supports a primary role of prior alcohol abuse in risk-taking propensity among patients with bipolar disorder. In addition, findings suggest that impulsivity and risky behavior, as operationalized by self-report and experimental cognitive probes, respectively, are separable constructs that tap distinct aspects of the bipolar phenotype. |
| Keywords: | alcohol abuse bipolar disorder impulsivity risk taking |