Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse.
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.


CONCLUSIONS
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.
Kathleen Holmes
M
M
Research Imaging Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Bearden
Carrie E
CE
Barguil
Marcela
M
Fonseca
Manoela
M
Serap Monkul
E
E
Nery
Fabiano G
FG
Soares
Jair C
JC
Mintz
Jim
J
Glahn
David C
DC
D000328:Adult; D000339:Affect / Q000502:physiology; D000437:Alcoholism / Q000150:complications* / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018532:Pisum sativum; D011569:Psychiatric Status Rating Scales; D012309:Risk-Taking; D013223:Statistics as Topic; D055815:Young Adult