Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history

• Published in: Bipolar disorders Vol. 15; no. 8; pp. 876 - 884
• Main Authors: Powers, Robyn L, Russo, Manuela, Mahon, Katie, Brand, Jesse, Braga, Raphael J, Malhotra, Anil K, Burdick, Katherine E
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.12.2013
• Subjects: Adult; Analysis of Variance; Attention; Bipolar Disorder - complications; Bipolar Disorder - epidemiology; Cognition Disorders - epidemiology; decision making; Decision Making - physiology; depression; Female; Games, Experimental; Humans; Impulsive Behavior - diagnosis; Impulsive Behavior - etiology; impulsivity; Iowa Gambling Task; Male; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; substance use; Substance-Related Disorders - epidemiology; substance use; impulsivity; depression; Iowa Gambling Task; decision making
• ISSN: 1398-5647; 1399-5618
• DOI: 10.1111/bdi.12124

Objectives Impulsivity is a core feature in bipolar disorder. Although mood symptoms exacerbate impulsivity, self‐reports of impulsivity are elevated, even during euthymia. Neurocognitive processes linked to impulsivity (e.g., attention, inhibition) are also impaired in patients with bipolar disorder, and a high frequency of comorbidities associated with impulsivity, such as substance use disorders, further highlights the clinical relevance of this dimension of the illness. Our objective was to assess the relationship between impulsivity and cognition in bipolar disorder. Methods We evaluated impulsivity in 98 patients with bipolar disorder and its relationship with symptoms, cognition, and substance use history. We assessed self‐reports of trait impulsivity [Barrett Impulsiveness Scale (BIS)] and impulsive behaviors on the Iowa Gambling Task (IGT). A comprehensive clinical and neurocognitive battery was also completed. Patients were compared with 95 healthy controls. Results Patients with bipolar disorder had higher scores versus healthy controls on all BIS scales. Performance on the IGT was significantly impaired and patients showed a tendency toward more erratic choices. Depressive symptoms were positively correlated with trait impulsivity and with an increased tendency to attend more readily to losses versus gains on the IGT. We found no significant associations between impulsivity and neurocognition in the full bipolar sample; however, when sub‐grouped based on substance abuse history, significant relationships were revealed only in subjects without a substance abuse history. Conclusions Our data support prior reports of increased trait impulsivity and impairment on behavioral tasks of impulsiveness in bipolar disorder and suggest a differential relationship between these illness features that is dependent upon history of substance abuse.