title: Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Psychiatry Research, The Zucker Hillside Hospital-North Shore Long Island Jewish Health System, Glen Oaks, USA.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Powers
authors.forename: Manuela
authors.initials: M
authors.lastname: Russo
authors.forename: Katie
authors.initials: K
authors.lastname: Mahon
authors.forename: Jesse
authors.initials: J
authors.lastname: Brand
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Braga
authors.forename: Anil K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Burdick
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology*; D003072:Cognition Disorders / Q000453:epidemiology*; D003657:Decision Making / Q000502:physiology; D005260:Female; D005717:Games, Experimental; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000453:epidemiology*
keywords: Iowa Gambling Task; decision making; depression; impulsivity; substance use
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