title: Impulsivity across the psychosis spectrum: Correlates of cortical volume, suicidal history, and social and global function.
abstract: Patients with psychotic disorders appear to exhibit greater impulsivity-related behaviors relative to healthy controls. However, the neural underpinning of this impulsivity remains uncertain. Furthermore, it remains unclear how impulsivity might differ or be conserved between psychotic disorder diagnoses in mechanism and manifestation. In this study, self-reported impulsivity, measured by Barratt Impulsiveness Scale (BIS), was compared between 305 controls (HC), 139 patients with schizophrenia (SZ), 100 with schizoaffective disorder (SZA), and 125 with psychotic bipolar disorder (PBP). In each proband group, impulsivity was associated with regional cortical volumes (using FreeSurfer analysis of T1 MRI scans), suicide attempt history, Global Assessment of Functioning (GAF), and Social Functioning Scale (SFS). BIS scores were found to differ significantly between participant groups, with SZA and PBP exhibiting significantly higher impulsivity than SZ, which exhibited significantly higher impulsivity than HC. BIS scores were significantly related to suicide attempt history, and they were inversely associated with GAF, SFS, and bilateral orbitofrontal cortex (OFC) volume in both SZA and PBP, but not SZ. These findings indicate that psychotic disorders, particularly those with prominent affective symptoms, are characterized by elevated self-reported impulsivity measures. Impulsivity's correlations with suicide attempt history, GAF, and SFS suggest that impulsivity may be a mediator of clinical outcome. The observed impulsivity-OFC correlations corroborate the importance of OFC deficits in impulsivity. These correlations' presence in SZA and PBP but not in SZ suggests that impulsivity may have different underlying mechanisms in affective and non-affective psychotic disorders.
authors.affiliation: College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Nanda
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Baylor College of Medicine, Texas Medical Center, Houston, TX, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Mathew
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, McLean Hospital, Belmont, MA, USA.
authors.forename: Jaya L
authors.initials: JL
authors.lastname: Padmanabhan
authors.affiliation: Department of Psychology, BioImaging Research Center, University of Georgia, Athens, GA, USA; Department of Neuroscience, BioImaging Research Center, University of Georgia, Athens, GA, USA.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Clementz
authors.affiliation: Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA; Departments of Psychiatry and Neurobiology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Godfrey D
authors.initials: GD
authors.lastname: Pearlson
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Sweeney
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Tamminga
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: mkeshava@bidmc.harvard.edu.
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000473:pathology / Q000523:psychology; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000473:pathology* / Q000523:psychology*; D012559:Schizophrenia / Q000473:pathology; D012565:Schizophrenic Psychology; D057566:Self Report; D013406:Suicide, Attempted / Q000523:psychology*
keywords: Cortical volume; Impulsivity; Orbitofrontal cortex; Psychosis spectrum; Psychotic disorders