Abstract
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.
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References
Ahn W, Rass O, Fridberg DJ, Bisharz AJ, Forsyth JK, Breier A et al (2011). Temporal discounting of rewards in patients with bipolar disorder and schizophrenia. J Abnorm Psychol 120: 911–921.
Aichert DS, Wöstmann NM, Costa A, Macare C, Wenig JR, Möller HJ et al (2012). Associations between trait impulsivity and prepotent response inhibition. J Clin Exp Neuropsychol 34: 1016–1032.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR). American Psychiatric Press: Washington, DC.
Beck AT, Rector NA (2005). Cognitive approaches to schizophrenia: theory and therapy. Annu Rev Clin Psychol 1: 577–606.
Bornovalova M, Daughters SB, Richards J, Hernandez GD, Lejuez CW (2005). Differences in impulsivity and risk taking propensity between urban crack/cocaine and heroin users. Exp Clin Psychopharmacol 13: 311–318.
Cazzell M, Li L, Lin Z, Patel SJ, Liu H (2012). Comparison of neural correlates of risk decision making between genders: an exploratory FNIRS study of the Balloon Analogue Risk Task (BART). Neuroimage 62: 1896–1911.
Cheng GF, Tang JY, Li FS, Lau EY, Lee TC (2012). Schizophrenia and risk-taking: impaired reward but preserved punishment processing. Schizophr Res 136: 122–127.
Corruble EA, Benyamina A, Bayle F, Falissard B, Hardy P (2003). Understanding impulsivity in severe depression? A psychometrical contribution. Prog Neuropsychopharmacol Biol Psychiatry 27: 829–833.
Courtney KE, Arellano R, Barkley-Levenson E, Gálvan A, Poldrack RA, Mackillop J et al (2012). The relationship between measures of impulsivity and alcohol misuse: An integrative structural equation modeling approach. Alcohol Clin Exp Res 36: 923–931.
Dalley JW, Roiser JP (2012). Dopamine, serotonin and impulsivity. Neuroscience 215: 42–58.
Dervaux A, Goldberger C, Gourion D, Bourdel M, Laqueille X, Lôo H et al (2010). Impulsivity and sensation seeking in cannabis abusing patients with schizophrenia. Schizophr Res 123: 278–280.
Dursun SM, Szemis A, Andrews H, Whitaker P, Reveley MA (2000). Effects of clozapine and typical antipsychotic drugs on plasma 5-HT turnover and impulsivity in patients with schizophrenia. J Psychiatry Neurosci 25: 347–352.
Enticott PG, Ogloff JRP, Bradshaw JL (2008). Response inhibition and impulsivity in schizophrenia. Psychiatry Res 157: 251–254.
First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.
First MB, Gibbon M, Spitzer RL, JBW Williams, Benjamin LS (1997) Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). American Psychiatric Press: Washington, DC.
Gold JM, Waltz JA, Matveeva TM, Kasanova Z, Strauss GP, Herbener ES et al (2012). Negative symptoms and the failure to represent the expected reward value of actions. Arch Gen Psychiatry 69: 129–138.
Green MF, Hellemann G, Horan WP, Lee J, Wynn JK (2012). From perception to functional outcome in schizophrenia. Arch Gen Psychiatry 69: 1216–1224.
Gut-Fayand A, Dervaux A, Olié JP, Lôo H, Poirier MF, Krebs MO (2001). Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity. Psychiatry Res 102: 65–72.
Hamilton M (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry 23: 56–62.
Heerey EA, Bell-Warren KR, Gold JM (2008). Decision-making impairments in the context of intact reward sensitivity in schizophrenia. Biol Psychiatry 64: 62–69.
Heerey EA, Matveeva TM, Gold JM (2011). Imagining the future: degraded representations of future rewards and events in schizophrenia. J Abnorm Psychol 120: 483–489.
Heerey EA, Robinson BM, McMahon RP, Gold JM (2007). Delay discounting in schizophrenia. Cogn Neuropsychiatry 12: 213–221.
Holmes M, Bearden CE, Barguil M, Fonseca M, Monkul E, Nery FG et al (2009). Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse. Bipolar Disorders 11: 33–40.
Janicak PG, Marder SR, Pavuluri MN (2011) Principles and Practice of Psychopharmacotherapy, 5th edn. Harvey Whitney Books: Philadelphia, PA.
Johnson SL, Edge MD, Holmes M, Carver CS (2012). The behavioral activation system and mania. Annu Rev Clin Psychol 8: 243–267.
Kim S, Lee D (2011). Prefrontal cortex and impulsive decision making. Biol Psychiatry 69: 1140–1146.
Lejuez CW, Read JP, Kahler CW, Richards JB, Ramsey SE, Stuart GL (2002). Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). J Exp Psychol Appl 8: 75–84.
Lombardo LE, Bearden CE, Barrett J, Brumbaugh MS, Pittman B, Frangou S (2012). Trait impulsivity as an endophenotype for bipolar I disorder. Bipolar Disorders 14: 565–570.
Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC (2001). Psychiatric aspects of impulsivity. Am J Psychiatry 158: 1783–1793.
Najt P, Perez J, Sanches M, Peluso M, Glahn D, Soares J (2007). Impulsivity and bipolar disorder. Eur Neuropsychopharmacol 17: 313–320.
Nolan KA, D'Angelo D, Hoptman MJ (2011). Self-report and laboratory measures of impulsivity in patients with schizophrenia or schizoaffective disorder and healthy controls. Psychiatry Res 187: 301–303.
Nuechterlein KH, Green MF (2006) MATRICS Consensus Cognitive Battery. MATRICS Assessment: Los Angeles, CA.
Ouzir M (2013). Impulsivity in schizophrenia: A comprehensive update. Aggress Viol Behav 18: 247–254.
Pattij T, Vanderschuren LJ (2008). The neuropharmacology of impulsive behaviour. Trends Pharmacol Sci 29: 192–199.
Patton JH, Stanford MS, Barratt ES (1995). Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 51: 768–774.
Peluso MM, Hatch JP, Glahn DC, Monkul ES, Sanches MM, Najt PP (2007). Trait impulsivity in patients with mood disorders. J Affect Disord 100: 227–231.
Perroud N, Baud P, Mouthon D, Courtet P, Malafosse A (2011). Impulsivity, aggression and suicidal behavior in unipolar and bipolar disorders. J Affect Disord 134: 112–118.
Rahman S, Robbins TW, Hodges JR, Mehta MA, Nestor PJ, Clark L et al (2005). Methylphenidate (‘Ritalin’) can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia. Neuropsychopharmacol 31: 651–658.
Riba J, Krämer UM, Heldmann M, Richter S, Münte TF (2008). Dopamine agonist increases risk taking but blunts reward-related brain activity. PLoS One 3: e2479.
Shurman B, Horan WP, Nuechterlein KH (2005). Schizophrenia patients demonstrate a distinctive pattern of decision-making impairment on the Iowa Gambling Task. Schizophr Res 72: 215–224.
Simon NW, Montgomery KS, Beas BS, Mitchell MR, LaSarge CL, Mendez IA et al (2011). Dopaminergic modulation of risky decision-making. J Neurosci 31: 17460–17470.
Spivak B, Mester R, Wittenberg N, Maman Z, Weizman A (1997). Reduction of aggressiveness and impulsiveness during clozapine treatment in chronic neuroleptic-resistant schizophrenic patients. Clin Neuropharmacol 20: 442–446.
St Onge JR, Floresco SB (2009). Dopaminergic modulation of risk-based decision making. Neuropsychopharmacol 34: 681–697.
Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH (2009). Fifty years of the Barratt Impulsiveness Scale: an update and review. Personal Indiv Diff 47: 385–395.
Swann AC, Pazzaglia P, Nicholls A, Dougherty DM, Moeller FG (2003). Impulsivity and phase of illness in bipolar disorder. J Affect Disord 73: 105–111.
van der Meer L, de Vos AE, Stiekema APM, Pijnenborg GHM, van Tol MJ, Nolen WA et al (2012). Insight in schizophrenia: involvement of self-reflection networks? Schizophr Bull 27: 27.
Ventura J, Green MF, Shaner A, Liberman RP (1993). Training and quality assurance with the Brief Psychiatric Rating Scale: 'The drift busters'. Int J Methods Psychiatr Res 3: 221–244.
White TL, Lejuez CW, de Wit H (2008). Personality and gender differences in effects of d-amphetamine on risk taking. Exp Clin Psychopharmacol 16: 565–570.
Young RC, Biggs JT, Ziegler VE, Meyer DA (1978). ‘A rating scale for mania: reliability, validity and sensitivity.’. Br J Psychiatry 133: 429–435.
Yücel M, Brewer WJ, Harrison BJ, Fornito A, O'Keefe GJ, Olver J et al (2007). Anterior cingulate activation in antipsychotic-naïve first-episode schizophrenia. Acta Psychiatr Scand 115: 155–158.
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Reddy, L., Lee, J., Davis, M. et al. Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia. Neuropsychopharmacol 39, 456–463 (2014). https://doi.org/10.1038/npp.2013.218
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DOI: https://doi.org/10.1038/npp.2013.218
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