Abstract
BackgroundImpulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder. It can be measured using behavioral tasks and self-report questionnaires. Previous findings revealed patients to show worse performance on at least one behavioral measure of impulsivity. Additionally, self-reported impulsivity seems to be higher among bipolar patients, both parameters being possibly associated with a more severe course of illness. In this study, our primary aim was to investigate the relationship between these two constructs of impulsivity among bipolar patients.MethodsA total of 40 euthymic patients with bipolar disorder (21 female, 22 Bipolar I) and 30 healthy controls were recruited for comprehensive neuropsychological assessment. To assess inhibition control as a behavioral measure of impulsivity, the Stroop Color and Word Test (Stroop) was used. Additionally, both groups completed the Barratt Impulsiveness Scale (BIS) as a self-report of impulsivity. To compare the groups’ performance on the Stroop and ratings on the BIS, the non-parametric Mann–Whitney U test was used. Within the bipolar group, we additionally examined the possibility of an association between Stroop performance and BIS total scores using Pearson’s Correlation r.ResultsPatients and controls differed significantly on the Stroop and BIS, with patients performing worse on the Stroop and scoring higher on the BIS. However, there was no association between the Stroop and BIS within the bipolar group. As an exploratory analysis, a positive correlation between Stroop performance and number of episodes was found. Further, we detected a statistical trend in the direction of poorer Stroop performance among patients treated with polypharmacy.ConclusionsBoth difficulties with behavioral inhibition and self-reported impulsivity were observed to be higher in bipolar patients than controls in the current study. However, within the patient group we did not observe an association between patients’ behavioral performance and self-report. This indicates that the parameters likely constitute distinct, dimensional factors of bipolar disorder. In future research, studies with larger samples should investigate which of the two markers constitutes the better marker for the illness and is more suitable to differentiate the most severe patients.
Highlights
Impulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder
All patients were recruited from the psychiatric outpatient clinic at the Charité Mitte Campus University Hospital in Berlin based on the following inclusion criteria: diagnosis of bipolar disorder according to the DSM-IV; clinical remission meeting the criteria of euthymia [Hamilton Depression Rating Scale version 21 (HAMD-21) (Hamilton 1960) ≤9 and Young Mania Rating Scale (YMRS) (Young et al 1978) ≤12] for at least 6 weeks; absence of affective symptoms; medication with a mood stabilizer for at least three months; minimum age of 18 years
It should be noted that the broad age range in our sample may have affected a potential correlation between Stroop Color and Word Test (Stroop) and Barratt Impulsiveness Scale (BIS) (Comalli et al 1962). In our study, both behavioral and self-reported impulsivities were increased within our patient group as compared to controls; we did not find a correlation between these two constructs
Summary
Impulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder It can be measured using behavioral tasks and self-report questionnaires. Patients seem to experience either one extreme or the other This definition disregards a number of factors that are present throughout all phases of the illness, including euthymia (Levy and Manove 2012). For this reason, establishing a better understanding of such particular dimensional factors present in bipolar disorders is warranted (Henry and Etain 2010). If subgroups of patients with specific dimensional characteristics were to be identified, it could help investigate possible pathophysiological mechanisms (Henry and Etain 2010)
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