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PubMed2004

Suicidal behaviors and drug abuse: impulsivity and its assessment.

Impulsivity appears to play an important role in suicidal behaviors and drug abuse, which are two psychiatric problems that may interact with one another. Interpretation of the literature on impulsivity in these behaviors may be complicated by the variety of measurement techniques for the assessment of impulsivity. There are three general types of impulsivity assessment: self-report, biological, and laboratory behavioral. Because laboratory behavioral measures both meet an operational definition of impulsivity and are sensitive to state-dependent changes in impulsivity, this paper presents data that focuses on laboratory behavioral performance among samples emitting suicidal behaviors or substance abuse. To better account for influence of impulsivity in these psychiatric disturbances, no single source of measurement should be used without the consideration of other types of instruments.

Decision Making↗

PubMed2006

Dispositional impulsivity in normal and abnormal samples.

Impulsive behaviors, which can include aggression, substance use and suicide, are common and core features of the DSM Axis II Cluster B personality disorders. The construct of dispositional impulsivity is multidimensional and a number of self-report measures have been created to represent features of this trait (e.g., novelty seeking, behavioral disinhibition, nonplanning). Because these questionnaires are rarely administered together in the same sample, little is known about how they are related to one another. The current study was conducted to examine the structure of dimensional impulsive personality traits in a large normative sample (n=351). Analyses revealed that dispositional impulsivity was represented by three moderately correlated latent factors labeled thrill seeking, nonplanning and disinhibited behavior. Confirmatory factor analyses were also used to examine the extent to which the internal structure of these impulsive personality traits was similar in a sample defined as abnormal (i.e., DSM-III-R Cluster B PD diagnoses; n=70). Results revealed that the structure of these traits was consistent across the two samples in a model that constrained factor loadings and structural covariances (NFI=0.89; CFI=95; RMSEA=0.04). In addition, correlational relationships between the impulsivity factor scores and behavioral and sociodemographic factors (e.g., socioeconomic status, substance use) were consistent across the two samples. These results help to establish a common framework for understanding the multidimensional nature of impulsivity. Results from these analyses also lend support to a large body of work that demonstrates that normal and abnormal personality features are related.

Aggression↗

PubMed2005

Aggression, and some related psychological constructs (anger, hostility, and impulsivity); some comments from a research project.

The purpose of the present study was: first, to offer a few theoretical considerations on the concept of human aggression and its main types; and second, to analyse the relationship between those types of aggression and other related psychological constructs, such as anger, hostility, and impulsivity, summarizing the main empirical results of our research in progress. In order to assess their eventual correlations, several self-report techniques were compared: (a) AQ, used to measure several kinds of aggression, anger, and hostility; (b) CAMA, a questionnaire already used in a variety of cultures, for measuring attitudes toward interpersonal aggression in different instrumental and hostile situations; (c) ASQ, an instrument for measuring experienced anger and its expression in assertive or aggressive ways; and (d) BIS, used to prove three impulsiveness sub-traits: motor, attentional, and non-planning impulsiveness. The different definitions of aggression may be grouped according to whether the primary goal is distress or harm, focusing primarily on the objective infliction of harm, or on the subjective intention of harming. Most classifications in the literature show two kinds of aggression, even if different names are used: Hostile Aggression (among other names it is also known as 'reactive, impulsive, or affective') is an act primarily oriented to hurt another individual; and Instrumental Aggression (also known as 'proactive, premeditated, or predative') is a means or tool for solving problems or for obtaining a variety of objectives. As predicted, there was a positive correlation between experience and expression of anger. Anger involved physiological arousal and prepared for aggression. Anger and impulsiveness were also positively correlated with hostile aggression, but not with instrumental aggression. In the case of impulsiveness, non-planning impulsiveness was positively correlated with some situations related to hostile aggression, such as emotional agitation or lack of communication, but not with instrumental one. Finally, hostility positively correlated with anger and different kinds of aggression, but not its degree of justification. In sum, aggression can be reflected in the different personality constructs, measured by self-reports.

Aggression↗

PubMed2004

Therapeutic doses of diazepam do not alter impulsive behavior in humans.

This study examined the effects of low, therapeutic doses of diazepam on several measures of impulsive behavior in healthy volunteers. Volunteers (N=35) participated in a three-session double-blind randomized design in which they received diazepam (5 or 10 mg) or placebo. The volunteers were classified as high and low impulsive based on the Barratt Impulsiveness Scale-11 (BIS-11). One hour after ingesting the capsule on each session, participants completed mood questionnaires and five impulsivity tasks: go/no-go task, delay discounting task, time estimation task, stop task, and the balloon analogue risk task (BART). Diazepam (5 and 10 mg) produced its prototypic sedative-like mood effects. However, the drug did not affect performance on any of the measures of impulsive behavior in either the high or low BIS participants. These results suggest that low doses of diazepam, including doses that are used therapeutically, do not increase impulsive behavior. Whether higher doses would increase impulsivity remains to be determined.

Adolescent↗

PubMed2002

Frontal white matter microstructure, aggression, and impulsivity in men with schizophrenia: a preliminary study.

BACKGROUND: Aggression and impulsivity may involve altered frontal white matter. METHODS: Axial diffusion tensor images were acquired in 14 men with schizophrenia using a pulsed gradient, double spin echo, echo planar imaging method. White matter microstructural measures (fractional anisotropy and trace) were calculated from these data. Regions of interest were placed in frontal white matter on four slices. Impulsivity was measured using the Motor Impulsiveness factor of the Barratt Impulsiveness Scale. Aggressiveness was measured using the Assaultiveness scale of the Buss Durkee Hostility Inventory and the Aggression scale of the Life History of Aggression. RESULTS: Lower fractional anisotropy in right inferior frontal white matter was associated with higher motor impulsiveness. Higher trace in these regions was associated with aggressiveness. CONCLUSIONS: Inferior frontal white matter microstructure was associated with impulsivity and aggression in men with schizophrenia. These results implicate frontal lobe dysfunction in aggression and certain aspects of impulsivity.

Adult↗

PubMed1997

Studies of violent and nonviolent male parolees: II. Laboratory and psychometric measurements of impulsivity.

Males parolees were recruited into a laboratory study to determine the relationship between their previous criminal history (violent versus nonviolent), and behavioral and psychometric measures of impulsivity. During sessions, subjects were given two response options defined as: 1) an impulsive choice--small monetary reward after a short fixed delay; and 2) a self-control choice--a larger monetary reward after a variable longer delay. Based upon an extensive experimental literature in animals and humans related to delay of gratification, the degree of impulsivity was defined as the proportion of trials on which the subject selected the impulsive option. Our results indicated that the violent subjects selected the impulsive option significantly more often than the nonviolent parolees. The number of impulsive responses parolees emitted was significantly correlated with the number of aggressive responses reported in an earlier paper. This study provides support for the relationship between impulsivity and aggression among male parolees.

Adult↗

PubMed1998

Whole blood serotonin content, tryptophan concentrations, and impulsivity in anorexia nervosa.

BACKGROUND: We hypothesized that anorectics with or without bulimic features would differ on impulsivity and indices of central serotoninergic function (high impulsivity being correlated with reduced serotoninergic function). METHODS: For all patients impulsivity rating scales and questionnaires detailing severity of eating disorder were assessed, and whole blood serotonin concentration (5-HT), free and total tryptophan (TT) concentrations, and large neutral amino acids (LNAA) were assayed. RESULTS: Nineteen patients with anorexia nervosa were included, 10 presented associated bulimic features and nine did not. Twelve healthy matched controls were also included. Our hypothesis was not verified. However, tryptophan concentration and the ratio of tryptophan concentration to LNAA allow us to separate controls from anorectics, whereas 5-HT concentration does not. Two significant and positive correlations were found: between impulsivity and anxiety in the total anorectic population, and between anxiety and serotonin in the impulsive group. CONCLUSIONS: All measured peripheral biologic indices except 5-HT concentration may be of interest in this pathology. Impulsivity and anxiety seem to be two personality components involved in anorexia nervosa. This study lead us to the necessity of redefining impulsivity in anorexia nervosa.

Adolescent↗

PubMed1999

Laboratory and psychometric measurements of impulsivity among violent and nonviolent female parolees.

BACKGROUND: Female parolees participated in a study to determine the relationship between behavioral and psychometric measures of impulsivity and their previous criminal history. METHODS: Subjects were assigned to a violent (n = 10) or nonviolent group (n = 20) based upon their criminal history. Subjects were given two response options defined as: 1) an impulsive choice--small monetary reward (5 cents) after a short fixed delay of 5 sec, and 2) a self-control choice--a larger monetary reward (15 cents) after a variable longer delay initially set at 15 sec. The measure of impulsivity in this behavioral choice procedure was the number of trials on which the subject selected the impulsive option. This definition of impulsivity is based upon an extensive experimental literature in nonhumans and humans related to delay of gratification, that is, the ability to tolerate long delays imposed between the initiation of behavior and the presentation of a reinforcer. RESULTS: Our results indicated that the violent female subjects selected the impulsive option significantly more often than the nonviolent female parolees. CONCLUSIONS: The correlation between impulsive and aggressive responses among the female parolees was nonsignificant and negative, in contrast to a significant positive correlation previously reported among male parolees.

Adult↗

PubMedDate not supplied

Impulsivity in self-mutilative behavior: psychometric and biological findings.

This paper examines impulsivity as a central factor in moderate/superficial self-mutilation such as skin-cutting and burning. A sample of 165 subjects were divided into four groups, namely self-mutilators, patients with any modes of impulsive behavior other than self-mutilation, patients without any impulsive behavior, and normal probands. All were administered the 10th version of the Barratt Impulsiveness Scale, the State-Trait Anger Expression Inventory, and the Inventory for the Assessment of Factors of Aggressiveness. They also were interviewed carefully in regards to both impulsive and self-mutilative behavior. A d-fenfluramine challenge test was administered to 36 females and prolactin levels were measured. On the whole results implicate impulsive personality functioning as a major factor in subjects with moderate/superficial self-mutilative behavior whose trait pathology is similar to personality disordered patients with other modes of self-harming impulsive behavior.

Adult↗

PubMed2000

Serotonin transporter gene regulatory region polymorphism (5-HTTLPR), [3H]paroxetine binding in healthy control subjects and alcohol-dependent patients and their relationships to impulsivity.

The aim of this study was to investigate [3H]paroxetine binding and impulsivity in alcohol-dependent and age-matched control subjects in relation to a 5'-promoter region serotonin transporter (5-HTT) polymorphism (5-HTTLPR). Alcohol-dependent subjects were hypothesized to show a decreased number of bindings sites and a lower dissociation constant. 5-HTTLPR S-genotype carriers in both alcohol-dependent and control subjects were expected to show significantly fewer binding sites and a lower dissociation constant. Influences of impulsive traits, chronic daily alcohol intake, duration of alcohol dependence, age of onset and age on [3H]paroxetine binding were also investigated. Inpatients meeting DSM IV alcohol dependence criteria and of German descent were recruited to avoid ethnic stratification effects. One hundred and seventeen control subjects of similar social status were recruited from a town community. Blood samples were taken from both alcohol-dependent and control subjects to determine 5-HTTLPR genotypes using PCR of lymphocyte DNA, and to perform platelet [3H]paroxetine binding (binding capacity: B(max); and dissociation constant: K(D)). Impulsivity was assessed using the Barratt impulsiveness scale version 5 (BIS-5) in alcohol-dependent subjects only. Alcohol-dependent subjects were subdivided into low or high impulsivity groups using a median-split of the BIS-5 scale. The control group was slightly older than the alcohol-dependent group (not statistically significant). [3H]paroxetine binding was investigated in 72 control subjects and 72 patients, of which five patients met type 2 alcohol dependence criteria. Genotyping was carried out in all patients and control subjects. A significant influence of duration of alcohol dependence was found on the [3H]paroxetine binding K(D) but not B(max.) Neither alcohol-dependent nor control subjects showed any differences in B(max) or K(D). S-allele carriers did not show a decreased binding or lower dissociation constant. Furthermore, no significant interaction between B(max) and K(D) with either 5-HTTLPR genotype or impulsivity was revealed. This was the first study to investigate platelet [3H]paroxetine binding in alcohol-dependent and age-matched control subjects in relation to the 5-HTTLPR genotype. No differences concerning 5-HTTLPR-alleles were found in these groups Furthermore, no significant interaction between these parameters and impulsivity was shown in alcohol-dependent subjects. These results do not support previous results of altered [3H]paroxetine binding sites in alcohol-dependent subjects or 5-HTTLPR S-allele carriers. K(D) might be influenced by duration of alcohol dependence, but not sufficiently to yield differences between alcohol-dependent and control subjects.

Adult↗

PubMed2003

Possible association between serotonin transporter promoter region polymorphism and impulsivity in Koreans.

Serotonin has become the major focus of biological studies of suicidal behavior and impulsive-aggressive behavior in humans. The serotonin transporter (5-HTT) gene is one of the important genes involved in the regulation of serotonin transmission. We examined the association of impulsivity in Korean populations with a functional polymorphism of the promoter region of the 5-HTT gene (5-HTTLPR). We recruited 186 adolescent prisoners and 64 medical students. Impulsivity was measured using the Barratt Impulsiveness Scale and we divided all subjects into three groups: impulsive subjects (IS, N=121), non-impulsive subjects (NIS, N=115) and an intermediate group (excluded, N=14). The 5-HTTLPR genotype was determined by polymerase chain reaction. All subjects were Korean men unrelated to each other. There were no significant differences in the genotype frequency of 5-HTTLPR-S/S, S/L and -L/L between the two groups in the Korean population (IS vs. NIS: 47.9 vs. 61.7%; 43.0 vs. 32.2%; and 9.1 vs. 6.1%, respectively). However, there was a statistically significant difference in allelic frequency of 5-HTTLPR-S and 5-HTTLPR-L between the two groups in the Korean population (IS vs. NIS: 69.4 vs. 77.8%; and 30.6 vs. 22.2%, respectively. From our results, this 5-HTTLPR polymorphism appears to be a possible candidate gene for impulsivity in the Korean population.

Adolescent↗

PubMed2000

The biology of impulsivity and suicidality.

Abnormalities of 5-HT and noradrenergic functioning have been implicated in aggressive impulsivity, SIB, and suicidal behavior. The role of DA and GABA in human studies of these behaviors requires further investigation. Most studies suggest that impulsive aggression is related to lower levels of CNS 5-HT. Some studies demonstrate that increasing NE correlates to impulsive aggression, whereas other studies demonstrate an opposite relationship. The role of NE in impulsive aggressive behavior is still unclear. Self-injurious behavior is similar to impulsive aggression in that it seems to be mediated by the neurotransmitter systems previously mentioned. For example, the presence of lower levels of 5-HT and abnormalities in the DA system are related to SIB in patients with BPD and depression. SIB severity also seems to be influenced by neglect (e.g., severe isolation during rearing). As animal studies suggest, increasing the amount of isolation and an earlier onset of isolation increase the severity of SIB. Suicidal behaviors and the lethality of suicide attempts may also be linked to the abnormalities in neurotransmitter systems similar to those found in patients with impulsive aggression and SIB, namely, lowered 5-HT transmission and enhanced DA and NE functioning. Understanding the biological triggers of impulsive aggression or SIB may allow for the evaluation of suicidal attempts and completion from a different perspective and, in conjunction with genetic predictors, may eventually help with the early prediction and prevention of suicidal behaviors. Additional studies of live subjects and postmortem brains will assist in clarifying the neurobiology of suicidal behaviors that are common to many disorders and are clinically relevant to BPD.

Aggression↗

PubMed2001

The impact of impulsivity on cocaine use and retention in treatment.

To determine whether impulsivity was related to severity of drug use and treatment outcome, 50 cocaine dependent subjects underwent baseline measures of severity of current cocaine use and the Barratt Impulsiveness Scale (BIS-11). The hypothesis of the study was that there would be a significant correlation between impulsivity and cocaine use severity. As predicted, there was a significant correlation between BIS-11 total scores and self-reported average daily cocaine use as well as cocaine withdrawal symptoms. A subset of 35 patients underwent a 12-week double-blind placebo controlled trial of buspirone and group therapy. Subjects with high baseline impulsivity remained in the study a significantly shorter period than did subjects with lower baseline impulsivity. This study shows that impulsivity is a significant predictor of cocaine use and treatment retention, and suggests the need for targeting impulsivity in cocaine dependence treatment.

Adult↗

PubMed1998

Recreational use of "ecstasy" (MDMA) is associated with elevated impulsivity.

Recent preclinical evidence suggests that repeated exposure to 3, 4-methylenedioxy-methamphetamine (MDMA; "ecstasy") produces long-term reductions in serotonin (5-HT) levels. 5-HT has been implicated in the regulation of mood, anxiety, aggression, impulsivity, and cognition. Accordingly, in the first of two separate studies, these variables were investigated in three groups: (1) MDMA group--recreational ecstasy users (who also used other illicit substances); (2) polydrug controls--who had never taken ecstasy, but otherwise had drug histories and personal characteristics similar to the ecstasy users; and (3) nondrug controls--who had never used illicit drugs, but had similar personal characteristics. All participants completed mood (Likert) scales, personality questionnaires (which included the impulsiveness, venturesomeness and empathy questionnaire-IVE), spatial span and "Tower of London" (TOL) tests, and a behavioural measure of impulsivity, the matching familiar figures test (MFF20). There were no group differences in mood, anxiety, anger/hostility, and cognitive performance, but the MDMA group committed significantly more errors in the MFF20. Subsequently, a larger sample of participants were administered mood (the General Health Questionnaire or GHQ) and personality (IVE) questionnaires before the administration of a TOL test, followed by the MFF20, and a second TOL test. Although there were no group differences in TOL performance, ecstasy users were again found to commit more errors in the MFF20 than polydrug users. Furthermore, the GHQ and IVE scores of the ecstasy users in the second study indicated, respectively, that they were more psychologically disturbed and impulsive than nondrug controls. The combined data from the two studies indicated that ecstasy users exhibited elevated impulsivity on both self-report and behavioral measures and that those who had taken the most ecstasy had the most elevated trait impulsiveness scores. These findings are consistent with previous evidence that elevated levels of impulsivity in humans are associated with reduced levels of serotonergic function.

Adult↗

PubMed2003

Impulsivity and prefrontal hypometabolism in borderline personality disorder.

Prefrontal hypoperfusion and decreased glucose uptake in the prefrontal cortex (PFC) are found in violent criminal offenders, murderers and aggressive psychiatric patients. These abnormalities may be independent of diagnosis and associated with impulsive-aggression as a personality trait. Impulsive-aggression is a clinical characteristic of borderline personality disorder (BPD) where it is associated with assaultive and suicidal behaviors. We conducted FDG-PET studies in 13 non-depressed, impulsive female subjects with BPD and 9 healthy controls to look for abnormalities in glucose metabolism in areas of the PFC associated with regulation of impulsive behavior. Statistical Parametric Mapping-99 (SPM99) was used to analyze the PET data with Hamilton depression scores as covariate. Significant reductions in FDG uptake in BPD subjects relative to healthy controls were found bilaterally in medial orbital frontal cortex, including Brodmann's areas 9, 10 and 11. There were no significant areas of increased uptake in BPD subjects compared to control subjects. Covarying for measures of impulsivity or impulsive-aggression rendered insignificant the differences between groups. Decreased glucose uptake in medial orbital frontal cortex may be associated with diminished regulation of impulsive behavior in BPD.

Adult↗

PubMed2000

Impulsiveness, serotonin genes and repetition of deliberate self-harm (DSH).

BACKGROUND: Few studies have investigated independent associations of psychological, biological and social variables with repeated deliberate self-harm (DSH). Serotonin function has been linked to impulsive and suicidal behaviour and genetic polymorphisms have been identified within the serotonin system that could account for this link. This study tested hypotheses linking impulsiveness, genetic polymorphisms of tryptophan hydroxylase (TPH) and the 5-HT2c receptor and repeated DSH. METHODS: Individuals presenting after DSH were interviewed, completed personality questionnaires and gave venous blood samples. Genotypes were determined for TPH intron7 and 5-HT2c (cys-ser) polymorphisms. Follow-up to identify repetition of DSH was for 1 year. RESULTS: Males with the 5-HT2c serine variant were more impulsive than those with the cysteine variant (039 standardized units, P = 0.041, 95% CI 0.017 to 0.076). There was no association between impulsiveness and the TPH intron7 polymorphism overall but a weak association with the L allele in men (0.41 standardized units, P = 0.05, 95 % CI 0.001 to 0.82). Impulsiveness, although high in the group as a whole, did not distinguish those who repeated DSH. CONCLUSIONS: The personality trait of impulsiveness may in part be related to genotypes of the 5-HT2c receptor and TPH gene in men. Impulsiveness does not differ between those who do and do not repeat DSH.

Adult↗

PubMed2006

Blunted hormone responses to Ipsapirone are associated with trait impulsivity in personality disorder patients.

Impulsive aggression is associated with central serotonergic dysfunction. Animal models particularly implicate the 5-HT(1A) receptor in this behavior. We tested the hypothesis that central 5-HT(1A) receptor function is impaired in impulsive aggressive personality disorder patients. A total of 52 individuals with DSM-III-R personality disorders, all medically healthy adult outpatients without concurrent psychiatric medication treatment, underwent serial plasma cortisol, prolactin, and temperature measurements before and after ipsapirone 20 mg oral administration. Subjects completed self-report measures of impulsivity, hostility, depression and anxiety, and childhood maltreatment. Stepwise regression analysis revealed impulsivity alone among symptom measures to be associated with significantly decreased peak cortisol and prolactin responses. Diagnoses of borderline personality disorder (BPD) and intermittent explosive disorder-revised (IED-R) were associated with significantly increased and decreased cortisol responses, respectively. However, post hoc analyses indicated that impulsivity was significantly negatively correlated with cortisol responses in the BPD group, and may mediate the association of both BPD and IED-R with altered cortisol responses. Temperature response was associated with neither diagnostic nor symptom measures. Neither diagnostic nor dimensional measures of depression or anxiety, nor severity of childhood maltreatment, were significantly associated with cortisol, prolactin, or temperature responses. Impulsivity is related to impaired function at (or downstream to) postsynaptic 5-HT(1A) receptors, and this relationship may be partly responsible for the association of impaired serotonergic function with diagnoses such as BPD and IED-R. In addition, D(2) receptor dysfunction may play a role in impulsivity, whereas 5-HT(1A) cell-body autoreceptor function may be spared in these disorders.

Adult↗

PubMed2003

Familial transmission of Continuous Performance Test behavior: attentional and impulsive response characteristics.

Continuous Performance Tests (CPTs) provide information on attentional processing and impulsive behavior. The results of previous research that used self-report measures have provided evidence for familial transmission (through genetic and/or environmental influences) of impulsive characteristics. The authors of the present study examined whether the impulsive behavioral parameters that are measured by the CPT also share familial relationships. The researchers asked 26 healthy parent-adolescent pairs to complete the Immediate and Delayed Memory Tasks (IMT/DMT; D. M. Dougherty, 1999; D. M. Dougherty, D. M. Marsh, & C. W. Mathias, 2002), a modified CPT (B. A. Cornblatt, N. J. Risch, G. Faris, D. Friedman, & L. Erlenmeyer-Kimling, 1988; H. E. Rosvold, A. Mirsky, I. Sarason, E. D. Breansome, Jr., & L. H. Beck, 1956), and the Barratt Impulsiveness Scale (BIS; J. H. Patton, M. S. Stanford, & E. S. Barratt, 1995), a self-report measure. The main findings can be summarized as follows: (a) commission errors (but not correct detections) on the IMT and DMT were correlated between parents and their adolescent children, (b) adolescents emitted a higher proportion of commission errors than did their parents, and (c) self-reported impulsivity (i.e., BIS) was correlated with commission errors for parents, but not for adolescents. The findings of this study support the use of an objective behavioral measure of impulsivity to assess familial relationships of impulsivity.

Adolescent↗