Impulsivity

Written by an unknown source.

Impulsive behavior and unfiltered speech can leave a wake of hurt, angry and bewildered people. Then it’s time to deal with the guilt and regrets, while hoping that apologies and making amends will repair any rifts.

Impulsivity can be defined as….

A problem with emotional or behavioral self-control.
Common causes of this symptom
Impulsivity can have causes that aren’t due to underlying disease. Examples include normal individual variation or substance abuse.

Bipolar disorder
A disorder associated with episodes of mood swings ranging from depressive lows to manic highs.

Symptoms may include
Impulsivity
Agitated depression
Manic episode
Very common

Written by Michael F Green.

Impulsive risk taking contributes to deleterious outcomes among clinical populations. Indeed, pathological impulsivity and risk taking are common in patients with serious mental illness, and have severe clinical repercussions including novelty seeking, response disinhibition, aggression, and substance abuse. Thus, the current study seeks to examine self-reported impulsivity (Barratt Impulsivity Scale) and performance-based behavioral risk taking (Balloon Analogue Risk Task) in bipolar disorder and schizophrenia. Participants included 68 individuals with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Self-reported impulsivity was elevated in the bipolar group compared with schizophrenia patients and healthy controls, who did not differ from each other. On the risk-taking task, schizophrenia patients were significantly more risk averse than the bipolar patients and controls. Aside from the diagnostic group differences, there was a significant effect of antipsychotic (AP) medication within the bipolar group: bipolar patients taking AP medications were more risk averse than those not taking AP medications. This difference in risk taking because of AP medications was not explained by history of psychosis. Similarly, the differences in risk taking between schizophrenia and bipolar disorder were not fully explained by AP effects. Implications for clinical practice and future research are

INTRODUCTION
Impulsiveness is a clinical feature of both schizophrenia and bipolar disorder (Najt et al, 2007; Ouzir, 2013). Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences (Moeller et al, 2001) and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making (Courtney et al, 2012). It is also associated with poor clinical outcomes in patients with bipolar and schizophrenia including substance abuse (Dervaux et al, 2010; Gut-Fayand et al, 2001), suicidal acts (Gut-Fayand et al, 2001), and aggression (Perroud et al, 2011). However, the role that impulsivity has in bipolar disorder and schizophrenia are poorly understood.

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning (Johnson et al, 2012). Although risky-impulsive behavior is a diagnostic criterion for mania (American Psychiatric Association, 2000) and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought (Holmes et al, 2009; Lombardo et al, 2012). These differences may reflect the multi-faceted nature of impulsivity (Dalley and Roiser, 2012), or the measurement tools used to assess the construct (Ouzir, 2013).Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems (Pattij and Vanderschuren, 2008; Dursun et al, 2000), and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications (Spivak et al, 1997), whereas others find no such effect in psychotic samples (Ahn et al, 2011; Heerey et al, 2007; Shurman et al, 2005). Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.

METHODS
Participants
The total sample (N=142) included 68 participants with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Patients were recruited from outpatient treatment clinics at the University of California, Los Angeles (UCLA), and the Veterans Affairs Greater Los Angeles Healthcare System (GLA), and from board-and-care residences in Los Angeles. Inclusion criteria for patients included DSM-IV diagnosis of bipolar I, bipolar II, or schizophrenia; diagnoses were confirmed with the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I; First et al, 2002). Exclusion criteria for patients included substance dependence in the last 6 months, substance abuse in the last month, and IQ <70. Control participants were recruited through internet advertisements and screened with the SCID-I and SCID-II for Axis II disorders (First et al, 1997). Exclusion criteria for control participants included history of schizophrenia, other psychotic disorder, bipolar disorder, recurrent major depressive disorder, substance dependence, or abuse in the past month, history of psychotic or bipolar disorder among first-degree relatives, or any of the following Axis-II disorders: avoidant, paranoid, schizoid, schizotypal, or borderline personality disorder. Exclusion criteria for the entire sample included: history of head injury, identified neurological condition, or lack of English proficiency to understand consent and testing procedures. Patients were considered to be clinically stable, indicated by at least a month since the last mood episode, no medication changes in the previous 6 weeks, no inpatient hospitalization in the previous 3 months, and no changes in housing in the previous 2 months.

Of the 68 patients with bipolar disorder, 46 were diagnosed with bipolar I disorder and 22 with bipolar II disorder. Of the patients with bipolar I, 15 had a history of psychosis and 31 were diagnosed with bipolar I without psychosis. Forty of the bipolar patients were taking AP medications at the time of the study, 28 were not taking AP medications, and 11 were taking lithium or divalproex sodium but not AP medication. Thirty-seven out of thirty-nine schizophrenia patients were taking AP medications at the time of testing.

All participants gave written informed consent after receiving a detailed explanation of study procedures, according to procedures approved by the Institutional Review Boards at UCLA and GLA.

Measures
Clinical ratings Patients’ psychiatric symptoms were evaluated using the expanded 24-item version of the Brief Psychiatric Rating Scale (BPRS; Ventura et al, 1993), the Hamilton Depression Rating Scale (Hamilton, 1960), and the Young Mania Rating Scale (YMRS; Young et al, 1978). All clinical interviewers were trained through the Treatment Unit of the Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center. SCID raters were trained to a minimum kappa of 0.75 and symptom raters were trained to a minimum ICC of 0.80Written by an unknown source.

Impulsive behavior and unfiltered speech can leave a wake of hurt, angry and bewildered people. Then it’s time to deal with the guilt and regrets, while hoping that apologies and making amends will repair any rifts.

Impulsivity can be defined as….

A problem with emotional or behavioral self-control.
Common causes of this symptom
Impulsivity can have causes that aren’t due to underlying disease. Examples include normal individual variation or substance abuse.

Bipolar disorder
A disorder associated with episodes of mood swings ranging from depressive lows to manic highs.

Symptoms may include
Impulsivity
Agitated depression
Manic episode
Very common

Written by Michael F Green.

Impulsive risk taking contributes to deleterious outcomes among clinical populations. Indeed, pathological impulsivity and risk taking are common in patients with serious mental illness, and have severe clinical repercussions including novelty seeking, response disinhibition, aggression, and substance abuse. Thus, the current study seeks to examine self-reported impulsivity (Barratt Impulsivity Scale) and performance-based behavioral risk taking (Balloon Analogue Risk Task) in bipolar disorder and schizophrenia. Participants included 68 individuals with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Self-reported impulsivity was elevated in the bipolar group compared with schizophrenia patients and healthy controls, who did not differ from each other. On the risk-taking task, schizophrenia patients were significantly more risk averse than the bipolar patients and controls. Aside from the diagnostic group differences, there was a significant effect of antipsychotic (AP) medication within the bipolar group: bipolar patients taking AP medications were more risk averse than those not taking AP medications. This difference in risk taking because of AP medications was not explained by history of psychosis. Similarly, the differences in risk taking between schizophrenia and bipolar disorder were not fully explained by AP effects. Implications for clinical practice and future research are discussed.

Keywords: schizophrenia, psychopharmacology, behavioral sciences, dopamine
INTRODUCTION
Impulsiveness is a clinical feature of both schizophrenia and bipolar disorder (Najt et al, 2007; Ouzir, 2013). Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences (Moeller et al, 2001) and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making (Courtney et al, 2012). It is also associated with poor clinical outcomes in patients with bipolar and schizophrenia including substance abuse (Dervaux et al, 2010; Gut-Fayand et al, 2001), suicidal acts (Gut-Fayand et al, 2001), and aggression (Perroud et al, 2011). However, the role that impulsivity has in bipolar disorder and schizophrenia are poorly understood.

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning (Johnson et al, 2012). Although risky-impulsive behavior is a diagnostic criterion for mania (American Psychiatric Association, 2000) and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought (Holmes et al, 2009; Lombardo et al, 2012). These differences may reflect the multi-faceted nature of impulsivity (Dalley and Roiser, 2012), or the measurement tools used to assess the construct (Ouzir, 2013).Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems (Pattij and Vanderschuren, 2008; Dursun et al, 2000), and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications (Spivak et al, 1997), whereas others find no such effect in psychotic samples (Ahn et al, 2011; Heerey et al, 2007; Shurman et al, 2005). Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.

METHODS
Participants
The total sample (N=142) included 68 participants with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Patients were recruited from outpatient treatment clinics at the University of California, Los Angeles (UCLA), and the Veterans Affairs Greater Los Angeles Healthcare System (GLA), and from board-and-care residences in Los Angeles. Inclusion criteria for patients included DSM-IV diagnosis of bipolar I, bipolar II, or schizophrenia; diagnoses were confirmed with the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I; First et al, 2002). Exclusion criteria for patients included substance dependence in the last 6 months, substance abuse in the last month, and IQ <70. Control participants were recruited through internet advertisements and screened with the SCID-I and SCID-II for Axis II disorders (First et al, 1997). Exclusion criteria for control participants included history of schizophrenia, other psychotic disorder, bipolar disorder, recurrent major depressive disorder, substance dependence, or abuse in the past month, history of psychotic or bipolar disorder among first-degree relatives, or any of the following Axis-II disorders: avoidant, paranoid, schizoid, schizotypal, or borderline personality disorder. Exclusion criteria for the entire sample included: history of head injury, identified neurological condition, or lack of English proficiency to understand consent and testing procedures. Patients were considered to be clinically stable, indicated by at least a month since the last mood episode, no medication changes in the previous 6 weeks, no inpatient hospitalization in the previous 3 months, and no changes in housing in the previous 2 months.

Of the 68 patients with bipolar disorder, 46 were diagnosed with bipolar I disorder and 22 with bipolar II disorder. Of the patients with bipolar I, 15 had a history of psychosis and 31 were diagnosed with bipolar I without psychosis. Forty of the bipolar patients were taking AP medications at the time of the study, 28 were not taking AP medications, and 11 were taking lithium or divalproex sodium but not AP medication. Thirty-seven out of thirty-nine schizophrenia patients were taking AP medications at the time of testing.

All participants gave written informed consent after receiving a detailed explanation of study procedures, according to procedures approved by the Institutional Review Boards at UCLA and GLA.

Measures
Clinical ratings Patients’ psychiatric symptoms were evaluated using the expanded 24-item version of the Brief Psychiatric Rating Scale (BPRS; Ventura et al, 1993), the Hamilton Depression Rating Scale (Hamilton, 1960), and the Young Mania Rating Scale (YMRS; Young et al, 1978). All clinical interviewers were trained through the Treatment Unit of the Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center. SCID raters were trained to a minimum kappa of 0.75 and symptom raters were trained to a minimum ICC of 0.80.

Published by Jeannette_PTSD

Hi, My name is Jeannette I'm 32. I'm diagnosed with Depression, Anxiety, Adhd, Panic Attacks, Bipolar2, PTSD and Borderline Personality Disorder. Im here to help others understand what life like now with these disorders they have.

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