State Impulsivity Research Articles

Microstructural and functional substrates underlying dispositional greed and its link with trait but not state impulsivity

The interplay between personality traits and impulsivity has long been a central theme in psychology and psychiatry. However, the potential association between Greed Personality Traits (GPT) and impulsivity, encompassing both trait and state impulsivity and future time perspective, remains largely unexplored. To address these issues, we employed questionnaires and an inter-temporal choice task to estimate corresponding trait/state impulsivity and collected multi-modal neuroimaging data (resting-state functional imaging: n = 430; diffusion-weighted imaging: n = 426; task-related functional imaging: n = 53) to investigate the underlying microstructural and functional substrates. Behavioral analyses revealed that GPT mediated the association between time perspective (e.g., present fatalism) and trait impulsivity (e.g., motor impulsivity). Functional imaging analyses further identified that brain activation strengths and patterns related to delay length, particularly in the dorsomedial prefrontal cortex, superior parietal lobule, and cerebellum, were associated with GPT. Moreover, individuals with similar levels of greed exhibited analogous spontaneous brain activity patterns, predominantly in the Default Mode Network (DMN), Fronto-Parietal Network (FPN), and Visual Network (VIS). Diffusion imaging analysis observed specific microstructural characteristics in the spinocerebellar/pontocerebellar fasciculus, internal/external capsule, and corona radiata that support the formation of GPT. Furthermore, the corresponding neural activation pattern, spontaneous neural activity pattern, and analogous functional couplings among the aforementioned brain regions mediated the relationships between time perspective and GPT and between GPT and motor impulsivity. These findings provide novel insights into the possible pathway such as time perspective → dispositional greed → impulsivity and uncover their underlying microstructural and functional substrates.

B - 78 Examining how Adverse Childhood Experiences and the Underlying Processes of Trait and State Impulsivity Influence Suicidal Behavior

Abstract Objective This study sought to better understand how ACEs, suicidal behavior, and impulsivity are interconnected by first examining the relationships between reported ACEs and levels of trait and state impulsivity as well as how ACEs and multiple dimensions of trait and state impulsivity influence suicidal behavior. Method 311 participants (19–67 years old; 49.2% male; 40.2% Caucasian) were recruited through Amazon’s Mechanical Turk. Adverse Childhood Experiences and suicidal behaviors were assessed using the ACE-Q and SBQ-R. The short version UPPS-P scale was used to measure negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency whereas behavioral lab tasks were used to measure prepotent response inhibition, delay discounting, and distortions in elapsed time. Results Simple bivariate regressions revealed ACEs are a significant predictor of prepotent response inhibition and total S-UPPS-P scores as well as the specific subscales of negative urgency, positive urgency, and sensation seeking. Furthermore, a hierarchical regression found total ACE scores, poor time perception, and the tendency to act rashly while experiencing negative emotions (negative urgency) to be significant predictors of total suicidal behavior scores. Lastly, an ordinal logistic regression suggests a greater likelihood that individuals will go from suicidal ideation to planning, and from planning to attempting when they tend to act rashly while experiencing negative emotions, have less regard for consequences (lack of premeditation), and have experienced more ACEs. Conclusion By identifying the specific risk factors for suicidal behavior, we can recognize individuals at greater risk of attempting, as well as target and mitigate the effects of these behaviors through intervention.

Volitionally Regulated Breathing with Prolonged Expiration Influences Food Craving and Impulsivity

Introduction: Previously, an intervention involving volitional slow breathing reduced trait food craving with protective effects on cardiac vagal activity (CVA). Breathing with a low inspiration-to-expiration (i/e) ratio also increases CVA. High CVA was separately associated with low unregulated eating and lesser impulsivity. Hence, the present study assessed breathing with a low i/e for effects on state food craving, hunger and satiety, state impulsivity, and heart rate variability (HRV) in healthy obese persons. Methods: Forty obese persons were randomized to two groups. The intervention group (mean age ± SD, 41.15 ± 12.63, M:F, 10:10) practiced metronome-regulated breathing with low i/e at 12 breaths per minute (expiration 72% of total breath duration) and attained expiration 55.8% of total breath duration, while the active control group (mean age ± SD, 44.45 ± 11.06, M:F, 13:07) sat motionless and directed their gaze and awareness to the stationary metronome without modifying their breath consciously. The HRV was recorded before, during, and after breathing intervention (or control) (standard limb lead I, acquisition at 2,000 Hz, with an LF filter = 0.5 Hz and HF filter = 50 Hz). Time-domain and frequency-domain HRV parameters were obtained with Kubios software. State food craving, and hunger and satiety were recorded before and after the intervention/control. Results: The intervention group decreased total state food craving scores and the sub-domains (i.e., desire to eat, positive reinforcement, lack of control and hunger), increased current satisfaction with food, decreased total state impulsivity (repeated measures ANOVA, p < 0.05 in all cases), increased HF-HRV and RMSSD (linear mixed model analyses with age and gender as fixed factors; p < 0.05 in all cases) during the intervention compared to the preceding baseline. The intervention group also showed an increase in positive mood and a decrease in aroused and negative mood states. Conclusion: Changes in state food craving and impulsivity could be related to an increase in HRV or to changes in subjective relaxation and positive mood or to both.

State Perceived Stress Is Concurrently, but Not Prospectively, Associated With State Impulsivity in Youths

Stress is considered a transdiagnostic mechanism underlying psychopathology. Research has suggested that when people experience more stress, they also act more impulsively. Most prior work has focused on between-persons associations or tested broad conceptualizations of impulsivity. We tested associations of momentary reports of perceived stress and appraisal of coping difficulty with three dimensions of impulsivity (urgency, planning, and persistence). High school and college students ( N = 146) self-reported momentary perceived stress, coping appraisals, affect, urgency, planning, and persistence three times per day for 10 days. Higher perceived stress was concurrently associated with higher urgency and lower persistence, even after controlling for negative affect. Higher coping appraisals were concurrently associated with higher planning and persistence. No prospective effects were observed. Perceived stress may relate to a time-limited decreased ability to regulate responses to negative affect and persist, whereas coping appraisals may be associated with changes in multiple types of self-regulation.

The Effects of Selective Serotonin Reuptake Inhibitors on Impulsivity in Young Adults with Major Depression in the Early Phase of Treatment.

Whether selective serotonin reuptake inhibitors (SSRI) increase suicide risk, especially in young adults, is still a controversial issue. This study aimed to examine the change in impulsivity characteristics and to evaluate the relationship between impulsivity and suicidality in young adults with major depression who were started on SSRIs. The study included 50 patients between the ages of 18-24 years with a diagnosis of major depression who were planned to start SSRIs. Participants were evaluated with the Beck Depression Scale, Beck Anxiety Scale, Young Mania Rating Scale, Columbia Suicide Severity Rating Scale, Barratt Impulsivity Scale, Daily Impulsivity Scale (DIS), and Go/ No-Go Task (GNG) before and at the end of the first week of treatment. Seventy percent of the patients (n: 35) completed the assessments at baseline and at the end of the first week. At the end of one-week there was a statistically significant decrease in the DIS (t=2.283, p=0.029) and commission errors in GNG (t=3.19, p=0.003). In addition, 7 out of 11 patients who had suicidal ideation at the first evaluation did not continue to have suicidal ideation at the end of the first week and there was a significant decrease in the severity of suicidal ideation at the end of the follow-up (W:132.0, p<0.001). One-week SSRI use in young adults resulted in a decrease in impulsivity in self-report scales assessing state impulsivity and in the GNG. It was observed that the severity of suicidal ideation decreased at the end of the one-week treatment period.

Laboratory method to induce state boredom increases impulsive choice in people who use cocaine and controls

ABSTRACT Background: Impulsive choice is associated with both cocaine use and relapse. Little is known about the influence of transient states on impulsive choice in people who use cocaine (PWUC). Objective: This study investigated the direct effects of induced boredom on impulsive choice (i.e., temporal discounting) in PWUC relative to well-matched community controls. Methods: Forty-one PWUC (≥1× cocaine use in past 3 months; 7 females) and 38 demographically matched controls (5 females) underwent two experimental conditions in counterbalanced order. Temporal discounting was assessed immediately after a standardized boredom induction task (peg-turning) and a self-selected video watched for the same duration (non-boredom). Subjective mood state and perceived task characteristics were assessed at baseline, during experimental manipulations, and after the choice task. Results: PWUC and controls were well matched on sex, age, and socioeconomic status. Groups were also similar in reported use of drugs other than cocaine, except for recent cigarette and alcohol use (PWUC > controls). As expected, peg-turning increased boredom in the sample overall, with higher boredom reported during peg-turning than the video (p < .001, η2 p = .20). Participants overall exhibited greater impulsive choice after boredom than non-boredom (p = .028, η2 p = .07), with no preferential effects in PWUC (p > .05, BF01 = 2.9). Conclusion: Experimentally induced boredom increased state impulsivity irrespective of cocaine use status – in PWUC and carefully matched controls – suggesting a broad link between boredom and impulsive choice. This is the first study to show that transient boredom directly increases impulsive choice. Data support a viable laboratory method to further parse the effects of boredom on impulsive choice.

Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry.

Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: β=-.09, 95% CI -0.14 to -0.04; control: β=-.03, 95% CI -0.05 to -0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life.

Episodic future thinking and compassion reduce non-compliance urges regarding public health guidelines: a randomised controlled trial

BackgroundPeople often feel urges to engage in activities that violate pandemic public health guidelines. Research on these urges has been reliant on measures of typical behaviour, which fail to capture these urges as they unfold. Guideline adherence could be improved through interventions, but few methods allow for ecologically valid observation of the range of behaviours that pandemic guidelines prescribe.MethodsIn this preregistered parallel randomised trial, 95 participants aged 18–65 from the UK were assigned to three groups using blinded block randomisation, and engaged in episodic future thinking (n = 33), compassion exercises (n = 31), or a control procedure (n = 31). Following an ecological momentary assessment procedure, participants report on the intensity of their occurrent urges (min. 1, max. 10) and their ability to control them. The study further investigates whether, and through which mechanism, state impulsivity and vaccine attitudes affect guideline adherence.ResultsEpisodic future thinking (b = -1.80) and compassion exercises (b = -1.45) reduced the intensity of urges. State impulsivity is associated with stronger urges, but we found no evidence that vaccine hesitancy predicts lesser self-control.ConclusionsWe conclude that episodic future thinking exercises and compassion training may be used to decrease non-compliance urges of individuals who are an acute public health risk for the community, such as those in voluntary isolation.

Linking Impulsivity to Activity Levels in Pre-Supplementary Motor Area during Sequential Gambling.

Impulsivity refers to the tendency to act prematurely or without forethought, and excessive impulsivity is a key problem in many neuropsychiatric disorders. Since the pre-supplementary motor area (pre-SMA) has been implicated in inhibitory control, this region may also contribute to impulsivity. Here, we examined whether functional recruitment of pre-SMA may contribute to risky choice behavior (state impulsivity) during sequential gambling and its relation to self-reported trait impulsivity. To this end, we performed task-based functional MRI (fMRI) after low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the pre-SMA. We expected low-frequency rTMS to modulate task-related engagement of the pre-SMA and, hereby, tune the tendency to make risky choices. Twenty-four healthy volunteers (12 females; age range, 19-52 years) received real or sham-rTMS on separate days in counterbalanced order. Thereafter, participants performed a sequential gambling task with concurrently increasing stakes and risk during whole-brain fMRI. In the sham-rTMS session, self-reported trait impulsivity scaled positively with state impulsivity (riskier choice behavior) during gambling. The higher the trait impulsivity, the lower was the task-related increase in pre-SMA activity with increasingly risky choices. Following real-rTMS, low-impulsivity participants increased their preference for risky choices, while the opposite was true for high-impulsivity participants, resulting in an overall decoupling of trait impulsivity and state impulsivity during gambling. This rTMS-induced behavioral shift was mirrored in the rTMS-induced change in pre-SMA activation. These results provide converging evidence for a causal link between the level of task-related pre-SMA activity and the propensity for impulsive risk-taking behavior in the context of sequential gambling.SIGNIFICANCE STATEMENT Impulsivity is a personal trait characterized by a tendency to act prematurely or without forethought, and excessive impulsivity is a key problem in many neuropsychiatric disorders. Here we provide evidence that the pre-supplementary motor area (pre-SMA) is causally involved in implementing general impulsive tendencies (trait impulsivity) into actual behavior (state impulsivity). Participants' self-reported impulsivity levels (trait impulsivity) were reflected in their choice behavior (state impulsivity) when involved in a sequential gambling task. This relationship was uncoupled after perturbing the pre-SMA with repetitive transcranial stimulation (rTMS). This effect was contingent on trait impulsivity and was echoed in rTMS-induced changes in pre-SMA activity. Pre-SMA is key in translating trait impulsivity into behavior, possibly by integrating prefrontal goals with corticostriatal motor control.

The Effect of State, Trait, and Situational Factors on Young Men's Coercive Condom Use Resistance.

Coercive Condom Use Resistance (CUR) is a significant problem, associated with increases in STIs, unplanned pregnancy, feelings of betrayal, and a loss of sexual autonomy. Furthermore, young men are much more likely to perpetrate coercive CUR than young women. Thus, the present study sought to examine the past experiences, trait characteristics, and state emotions which may precede coercive CUR perpetration intentions, including alcohol intoxication, childhood emotional abuse, trait impulsivity, sexual sensation seeking, state impulsivity, and state anxiety, using an alcohol administration procedure. Young, single, non-problem drinking, and sexually active men who have sex with women from the United States (N = 297; 66% White, 9.4% Black, 10.7% Multi-racial, 5.1% Asian, 1.0% Native American, 1.0% Pacific Islander, and 10.4% Hispanic or Latino) were recruited for participation. They were randomly assigned to either receive alcohol or remain sober before projecting themselves into a hypothetical sexual scenario with a woman who asked to use a condom. Results showed that greater levels of childhood emotional abuse were associated with increased trait impulsivity and sexual sensation seeking, and that sexual sensation seeking was associated with increased state impulsivity and subsequent anxiety during the scenario. Finally, alcohol intoxication moderated the relationship between state anxiety and coercive CUR such that state anxiety was positively associated with coercive CUR among intoxicated men only. Findings suggest that interventions targeting coercive CUR behavior may be improved by focusing on men who have experienced childhood trauma, as well as their alcohol consumption and in-the-moment experiences of impulsivity and anxiety.

State impulsivity amplifies urges without diminishing self-control

A disproportionate amount of research on impulsivity has focused on trait-related aspects rather than state fluctuations. As a result, the relationship between state impulsivity and moment-to-moment behaviour is unclear. Impulsivity is assumed to negatively affect self-control, but an alternative explanation, yet to be tested, could be that changes in state impulsivity and its homeostatic drivers influence the intensity of urges. We tested whether state impulsivity and hunger affected behaviour through a dual-process model, affecting both the experience of various urges, and self-control, using a smartphone-based experience sampling approach. We found that state impulsivity is associated with stronger urges, but we found no evidence of an association with diminished self-control. Being hungry amplifies urges across different types of urges, and both hunger and late hours are negatively related to the likelihood of controlling urges. These findings imply that the influence of hunger is not limited to the food domain, and provide new insight into the role of state impulsivity in daily life.

Commentary on Chai et al: Drug use, self-harm, suicide, and use of registry data in epidemiological research.

A study of specific drugs as risk factors for suicide and self-harm can be linked to the bigger issue of the relative harm of various substances. The role and impact of the interplay between psychiatric co-morbidity and impulsivity can be related more widely to the link between substance use and self-harm and suicide. Chai et al. [1] have made an important contribution to the literature on substance use and self-harm and suicide (SHS) by linking specific types of substance use disorders recorded at presentation to accident and emergency departments to subsequent SHS, using a population-based cohort in Hong Kong. Chai et al. [1] used an epidemiological framework with control for multiple factors to assess the contribution of each drug to SHS and adjusted their analyses for psychiatric co-morbidity, which is an extremely important confounder, because psychiatric co-morbidity is the single strongest predictor of SHS and is closely related to substance use [2]. Compared with other patients, patients with drug use disorders, regardless of type of drug, were at elevated risk for SHS. The authors concluded that all types of drug use disorders pose a risk of SHS and underlined the importance of approaches that seek to prevent and regulate drug use, including supply-oriented approaches. It is notable that some drugs, such as ketamine and opioids, were associated with very high risk of SHS, whereas other drugs, such as hallucinogens or cannabis, were associated with somewhat lower risk of SHS. Similarly, in some previous studies, psycho-depressants, such as opioids or alcohol, were associated with completed suicide, whereas cannabis and stimulants were not [2]. Further, Chai et al. [1] found that previous drug use disorders and psychiatric disorders were significantly associated with increased risk of SHS, but noted that this link is complicated and that the potential contribution of state impulsivity to SHS because of drug use disorders should be considered. The findings from their study fit into the framework of degrees of harm from various substances exemplified by the work of Nutt and colleagues [3, 4] and are a prime example of what can be achieved by using register data. By understanding how various drugs contribute to harms, it is possible to prioritize the often scarce health service and law enforcement resources [5]. Longitudinal research, as presented by Chai et al. [1], can indicate that a drug may be an important contributor to an adverse outcome. Using record-linkage to predict future outcomes is an under-used method in substance use research and is able to produce knowledge about exactly the kind of links identified in this study [6]. However, if such findings are to inform policy and practice, it is important to try to identify causal links rather than simply longitudinal associations [7]. When considering whether adverse outcomes such as SHS are directly attributable to the use of a specific drug, cross-cultural robustness of associations, biological plausibility, dose–response relationships, and experimental evidence from laboratory findings can all contribute to understanding the contribution of the drug itself, and therefore, the implications for practice and policy. Importantly, the increased risk associated with specific drugs found in the study by Chai et al. [1] must be considered in relation to the local drug and alcohol culture and to differences in access to and use of health care services. Considering the current evidence base, we are not yet at the point where we can safely say that SHS is a consequence of drug use. However, studies such as the one by Chai et al. [1] point to the possibility that some substances do increase the risk. We wish to thank doctoral student Julie Brummer for her useful input on the manuscript before submission. None. Morten Hesse: Conceptualization. Birgitte Thylstrup: Conceptualization. Jens Skogen: Conceptualization.

Sleep disturbances predict active suicidal ideation the next day: an ecological momentary assessment study

BackgroundSleep disturbances are an underestimated risk factor for suicidal ideation and behavior. Previous research provided preliminary support of a temporal relationship between sleep disturbances and suicidal ideation. The present study therefore sought to investigate the prospective association between sleep disturbances, passive and active suicidal ideation, and further psychological risk factors, such as state impulsivity and depression.MethodsSeventy-three psychiatric inpatients (71% female) with unipolar depressive disorder and current or lifetime suicidal ideation took part in an ecological momentary assessment (EMA). Participants filled out a baseline assessment and data were collected via smartphones over a 6-days period. Multilevel analyses with sleep disturbance as predictor for active and passive suicidal ideation, state impulsivity, and depression were carried out.ResultsPatients with sleep disturbance experienced more active suicidal ideation, but no passive suicidal ideation, the following day. Of the four state impulsivity items, one item was significantly associated with sleep disturbance. Sleep disturbance had no effect on next-day depression. Limiting factors are the small and homogeneous sample along with the rather short observation period in an inpatient setting.ConclusionsThe micro-longitudinal study provides preliminary support for sleep disturbance as a proximal risk factor for next-day active suicidal ideation. Clinically, results indicate to consider the evaluation and treatment of sleep disturbances for an improved risk assessment and prevention of suicide.

Predicting forensic inpatient violence with odor identification and neuropsychological measures of impulsivity: A preliminary study

Although most persons with a schizophrenia-spectrum disorder are not aggressive, a minority is at higher risks to commit violent acts, especially in forensic settings. The first goal of this study was to assess inpatients in a maximum-security hospital with a self-report questionnaire, neuropsychological tests of behavioral impulsivity/attentional capacities and olfactory functions to determine the strength of association between these measures. A secondary objective was to assess the predictive value of these measures for the commission of violent acts within the institution. Sixty-two male inpatients were evaluated with the neuropsychological battery. As expected, self-report assessment of trait impulsivity (questionnaire) did not significantly correlate with behavioral measures of state impulsivity. In addition, neuropsychological measures of impulsivity and attention were significantly associated with odor identification capacities. Finally, attentional deficits (but not impulsivity) and odor identification were both significant and independent predictors of institutional violence. Neuropsychological assessments and odor functions might help predicting (and explaining) institutional violence committed in forensic settings.

Trajectories of state impulsivity domains before and after alcohol consumption in the naturalistic environment

Background and AimsStudies have demonstrated that ecological momentary assessment (EMA) can effectively capture within-person variations in impulsive states and that this relates to alcohol use. The current study aimed to examine the daily trajectories of five facets of impulsivity prior to and following drinking initiation. Additionally, we explored how race, sex, baseline trait impulsivity facets, and ADHD may moderate this relation. Design and SettingEMA was used to collect real-time data at 6 semi-random time points and self-initiated reports of drinking onset throughout the day over a 10-day periodMeasurementsFive state and trait impulsivity facets were assessed via the UPPS-P. Naturalistic alcohol use, ADHD history, and demographic characteristics were also assessed ParticipantsParticipants were 135 adult drinkers from a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD FindingsGeneralized estimating equations showed that the linear trajectory of negative urgency significantly increased prior to drinking. Following drinking initiation, the linear trajectory of sensation seeking significantly decreased. There was not significant change in the trajectories of positive urgency, lack of premeditation and lack of perseverance before or after drinking initiation. Additionally, race and ADHD history moderated the trajectory of sensation seeking and race moderated the trajectory of lack of planning. ConclusionsFindings highlight the possibility of identifying proximal changes in impulsivity facets prior to and after initiation of drinking. Results can be used to inform real-time interventions that target risk periods to ultimately decrease alcohol use

Alcohol use in daily life: Examining the role of trait and state impulsivity facets.

Using ecological momentary assessment (EMA) methods we aimed to investigate the influence of trait and state (momentary) impulsivity on alcohol use behaviors in daily life. Facets of the UPPS trait model of impulsivity (Whiteside & Lynam, 2001) have been found to differentially relate to alcohol-related outcomes and behaviors in cross-sectional and longitudinal studies. The present work expands on this by assessing UPPS facets in daily life and examining the contributions of trait and state impulsivity facets to daily life drinking behavior. Forty-nine participants were prompted at least 6 times per day for 21 days. A total of 4,548 collected EMA reports were included in analyses. Multilevel models were computed predicting daily life alcohol use behaviors from state and trait impulsivity facets and relevant covariates. Individual facets of momentary impulsivity differentially related to alcohol outcomes, such that (lack of) premeditation and, to a lesser extent, sensation seeking showed unique patterns of association with drinking and drinking quantity. Only trait levels of (lack of) premeditation were related to drinking behavior in daily life; no other trait UPPS scale significantly related to alcohol use. These results highlight state difficulties with premeditation as particularly relevant to drinking behavior in daily life. Our results also support the incremental validity of state impulsivity facets over trait level measures in relation to drinking behavior in daily life. These findings offer important insight into the phenomenology of daily life alcohol use and highlight possible avenues for intervention and prevention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

MPulse Mobile Sensing Model for Passive Detection of Impulsive Behavior: Exploratory Prediction Study.

BackgroundMobile health technology has demonstrated the ability of smartphone apps and sensors to collect data pertaining to patient activity, behavior, and cognition. It also offers the opportunity to understand how everyday passive mobile metrics such as battery life and screen time relate to mental health outcomes through continuous sensing. Impulsivity is an underlying factor in numerous physical and mental health problems. However, few studies have been designed to help us understand how mobile sensors and self-report data can improve our understanding of impulsive behavior.ObjectiveThe objective of this study was to explore the feasibility of using mobile sensor data to detect and monitor self-reported state impulsivity and impulsive behavior passively via a cross-platform mobile sensing application.MethodsWe enrolled 26 participants who were part of a larger study of impulsivity to take part in a real-world, continuous mobile sensing study over 21 days on both Apple operating system (iOS) and Android platforms. The mobile sensing system (mPulse) collected data from call logs, battery charging, and screen checking. To validate the model, we used mobile sensing features to predict common self-reported impulsivity traits, objective mobile behavioral and cognitive measures, and ecological momentary assessment (EMA) of state impulsivity and constructs related to impulsive behavior (ie, risk-taking, attention, and affect).ResultsOverall, the findings suggested that passive measures of mobile phone use such as call logs, battery charging, and screen checking can predict different facets of trait and state impulsivity and impulsive behavior. For impulsivity traits, the models significantly explained variance in sensation seeking, planning, and lack of perseverance traits but failed to explain motor, urgency, lack of premeditation, and attention traits. Passive sensing features from call logs, battery charging, and screen checking were particularly useful in explaining and predicting trait-based sensation seeking. On a daily level, the model successfully predicted objective behavioral measures such as present bias in delay discounting tasks, commission and omission errors in a cognitive attention task, and total gains in a risk-taking task. Our models also predicted daily EMA questions on positivity, stress, productivity, healthiness, and emotion and affect. Perhaps most intriguingly, the model failed to predict daily EMA designed to measure previous-day impulsivity using face-valid questions.ConclusionsThe study demonstrated the potential for developing trait and state impulsivity phenotypes and detecting impulsive behavior from everyday mobile phone sensors. Limitations of the current research and suggestions for building more precise passive sensing models are discussed.Trial RegistrationClinicalTrials.gov NCT03006653; https://clinicaltrials.gov/ct2/show/NCT03006653

The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study.

BackgroundThe classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life.ObjectiveThe aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public.MethodsThe DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app.ResultsWe used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research.ConclusionsThis study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions.Trial RegistrationClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653

1033. One year of Bictegravir in Mexico City: Differences in the Neuropsychiatric Adverse Events vs. Efavirenz

BackgroundIn Mexico, Efavirenz (EFV) was considered as first-line regimen for several years. However, the Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) had a history neuropsychiatric effects such as depression, suicidal thoughts, insomnia, hypersomnia, impairment cognition, impairment in quality of life, these adverse events cause poor adherence and abandon EFV regimens. Since June 2019, bictegravir (BIC) in a single tablet regimen was introduced in Mexico as a first-line treatment. Therefore, the objective of the study was to compare the presence of depressive and cognitive symptoms, suicidality, sleep disturbances, quality of life between BIC and EFV regimens.MethodsProspective cross-sectional study, non-probability sample, both groups BIC and EFV were matched according to age. Patients were recruited from June 2019 to May 2020 in Condesa Specialized Clinic in Mexico City. All the patients had 1 to 4 months from starting treatment. The evaluation test used were Medical Outcomes Study Short Form-36 (SF-36), Beck Depression Inventory (IDB-IA), Center for Epidemiologic Studies-Depression Suicidal Ideation subscale (CES-D IS), State Impulsivity Scale (SIS) and Pittsburgh Sleep Quality Index (PSQI).ResultsOne thousand six hundred patients, 800 in BIC group and 800 in EFV group. The mean age 37 years. Non-statistical difference was found in sociodemographic and HIV-related variables. Statistically significant differences were found between BIC and EFV groups (t = 1.91 - 15.28, p < 0.03). The largest differences were seen in cognitive symptoms such as impulsivity, quality of life mental score and suicidal ideation (t > 10.61). No differences were found in physical role and sleep disorders.BIC & EFV groups comparison ConclusionIn this study we found BIC group have fewer neuropsychiatric events than EFV group. The principal differences were in cognitive symptoms, suicidality, functionality associated with central nervous system symptoms. We suggest having a long-term follow-up of the sleep quality variables, to observe patient’s adaptation to treatment for a period over to 12 months.Disclosures All Authors: No reported disclosures

Momentary interpersonal processes of suicidal surges in borderline personality disorder.

Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.