Impulsivity: present during euthymia in bipolar disorder? - a systematic review

Newman, Antonia L; Meyer, Thomas D

doi:10.1186/2194-7511-2-2

International Journal of Bipolar Disorders

Table 1 Summary of studies included in the review

From: Impulsivity: present during euthymia in bipolar disorder? - a systematic review

Author and year of publication	Main focus of paper	Relevant aims or hypotheses	Participants	Clinical measures	Impulsivity measure/s	Statistical analysis	Main results relevant to impulsivity
Ancin et al. (2010)	Sustained attention	No aims or hypotheses relevant to this review	143 Euthymic BD patients	SCID	Computerised degraded stimulus CPT	T test and ANOVA	BD group had longer reaction times than controls. No group difference in false alarm rate or response criterion score in any of three CPT blocks
			101 Healthy controls	HDRS		T test and ANOVA
				YMRS		Median test for non-parametric data
				Vocabulary subtest of WAIS		Median test for non-parametric data
Bora et al. (2007)	Cognitive impairment	No aims or hypotheses relevant to this review	65 Euthymic BD-I patients (40 euthymic psychotic, 25 euthymic non-psychotic)	SCID	Conners' CPT II	MANOVA	Previously psychotic euthymic BD patients made more commission errors than controls. No difference between non-psychotic euthymic BD patients and controls on commission errors. No group differences in hit reaction time
				YMRS
			30 Healthy controls	HDRS
			30 Healthy controls	Brief Psychiatric Rating Scale
Brooks et al. (2010)	Sustained attention	No aims or hypotheses relevant to this review	16 Euthymic BD patients over age 50	MINI	Conners' CPT II	Mann-Whitney U test	No group differences in commission error rate or hit reaction time
			11 Healthy controls	MADRS
			11 Healthy controls	YMRS
Ekinci et al. (2011)	Impulsivity	Hypothesis: ‘some clinical appearances would be differentially related to impulsivity in subjects with BD’	71 Euthymic BD-I patients	SCIDI and II	BIS-11	Pearson’s correlation and ANOVA	Patient’s scores were significantly higher on total BIS score and on all subscales. They also scored more highly on the impulsiveness scale of the TCI
			50 Healthy controls	YMRS	Impulsiveness scale of Temperament and Character Inventory (TCI)
			50 Healthy controls	HDRS
Etain et al. (2013)	Impulsivity	Aim: ‘to study trait-impulsiveness in a large population of euthymic BD patients and healthy subjects’	385 Euthymic BD patients	MADRS	BIS-10	Wilcoxon and Mann-Whitney U test	Patients’ scores were significantly higher than controls on BIS total and all subscale scores
			185 Healthy controls	BRMAS		Wilcoxon and Mann-Whitney U test
			185 Healthy controls	Diagnostic Interview of Genetic Studies		Kruskal-Wallis
Fleck et al. (2005)	Sustained attention	No aims or hypotheses relevant to this review	25 Manic and mixed BD-I patients with psychotic features	SCID	Computerised degraded-stimulus CPT	ANOVA	Patients did not differ to controls on response bias (beta) outcome of CPT
			25 Manic and mixed BD-I patients with psychotic features	YMRS
			23 Remitted BD-I patients	HDRS
			28 Healthy controls	Scale for the Assessment of Positive Symptoms			Patients had significantly slower reaction times than controls
Henna et al. (2013)	Impulsivity	Main hypothesis: ‘euthymic BD and unipolar subjects have higher impulsivity than unaffected relatives and healthy controls’	54 Euthymic BD patients	SCID	BIS 11A	ANOVA	Patients scored more highly than unaffected relatives and healthy controls on BIS total, motor and non-planning subscales
			136 Healthy controls	YMRS
			14 Unaffected relatives	HDRS
			25 Euthymic unipolar patients
			25 Euthymic unipolar patients				Patients scored higher than controls on attentional impulsivity subscale
Ibanez et al. (2012)	Decision-making and reward processing	No aims or hypotheses relevant to this review	13 Euthymic BD-II patients	SCID	Iowa Gambling Task	ANOVA	Only one significant difference between BD group and controls on outcomes of Iowa Gambling Task. BD patients were impaired compared to controls on blocks 4 and 5 of the task
			12 ADHD patients	MADRS	BIS
			25 Healthy controls	YMRS	Go/no go task
				BDI
				State-Trait Anxiety Inventory
				Rey Auditory Verbal Learning Test
Iosifescu et al. (2009)	Cognitive function	No aims or hypotheses relevant to this review	20 Remitted BD-I and BD-II patients	HDRS	Conners' CPT	T tests	BD patients made significantly more commission errors than controls
			20 Remitted BD-I and BD-II patients	YMRS
			10 Healthy controls	Affective Disorder Evaluation
Kaladjian et al. (2009)	Response inhibition	No aims or hypotheses relevant to this review	27 Euthymic BD-I patients	SCID	Go/no go task	T tests	No group differences on impulsivity outcomes, including response bias (beta) and reaction time
			25 Healthy controls	YMRS
				HDRS
				NART
Kolur et al. (2006)	Sustained attention	No aims of hypotheses relevant to this review	30 Euthymic BD patients ages 17 to 30. Illness duration <5 years and no more than two affective episodes	YMRS	CPT	Wilcoxon signed rank test	No group differences on commission errors. Patients had significantly slower reaction time than controls
				HDRS		Wilcoxon signed rank test
				MMSE		Mann-Whitney U test for subgroup analyses	Within BD group, patients with a history of two mood episodes made significantly more commission errors than those with only one previous episode
			30 Healthy controls	MINI
Kung et al. (2010)	Sustained attention	No aims of hypotheses relevant to this review	51 Euthymic BD patients (22 BD-I and 29 BD-II)	HDRS	Conners' CPT-II	Pearson’s correlation	BD-I patients had significantly longer reaction times and more commission errors than BD-II patients and healthy controls
Kung et al. (2010)	Sustained attention	No aims of hypotheses relevant to this review	20 Healthy controls	YMRS	Conners' CPT-II	MANOVA
Lewis et al. (2009)	Impulsivity	Aim: ‘to examine the relationship of impulsivity to clinical status and personality characteristics in patients with BD’	36 Remitted BD patients	Clinical Global Impressions Scale	BIS-11	ANCOVA	No difference between remitted BD patients and controls on BIS total scores or any of the subscales
			25 Subsyndromal BD patients	MADRS		Pearson’s correlation
			45 Syndromal BD patients	YMRS
			30 Healthy controls	SCID
Lombardo et al. (2012)	Impulsivity	Hypothesis: ‘euthymic individuals with BD and their clinically unaffected siblings would have higher levels of trait impulsivity compared to healthy subjects’	54 Euthymic BD-I patients	SCID	BIS-11	Linear mixed model	Patients had significantly elevated BIS total and subscale scores compared to siblings and healthy controls
			57 Clinically unaffected siblings	GAF
			57 Clinically unaffected siblings	HDRS
			49 Healthy controls	YMRS
Malloy-Diniz et al. (2011)	Impulsivity	Aim: ‘to assess different impulsivity components in BD sub-grouped by suicidal attempt and healthy controls’	95 Euthymic BD patients (41 with lifetime history of suicide attempt)	MINI	CPT-II	Mann-Whitney	BD patients made more commission errors than controls on the CPT. They had slower hit reaction times than the controls
				Brazilian version of BDI	Iowa Gambling Task
			94 Healthy controls	YMRS
				Raven’s progressive matrices
				Raven’s progressive matrices			BD patients were impaired compared to controls on blocks 3,4 and 5 and overall task performance of the Iowa Gambling Task
Martino et al. (2008)	Cognitive functioning	No aims of hypotheses relevant to this review	20 Euthymic BD older adults	YMRS	CPT	T test	No difference between groups on any of the outcome measures of the CPT
			20 Age-matched healthy controls	HDRS
				Mini-mental state examination
				Unified Parkinson's Disease Rating Scale-III
				GAF
				SCID
				WAIS
Martino et al. (2011)	Decision making	Aim: ‘to compare a large population of patients with BD types I and II strictly defined as euthymic with healthy controls on measures of decision making’	85 Euthymic BD patients	SCID	Iowa Gambling Task	ANOVA	No difference between BD-I or BD-II patients and controls on any of IOWA outcome measures
			34 Healthy controls	HDRS
			34 Healthy controls	YMRS
Peluso et al. (2007)	Impulsivity	Hypothesis: ‘bipolar subjects would have higher levels of trait impulsivity than the comparison group’	24 Depressed bipolar patients	HDRS	BIS	ANCOVA	Controls had significantly lower scores on all BIS scales compared to euthymic BD patients
			24 Depressed unipolar patients	SCID
			12 Euthymic bipolar patients
			10 Euthymic unipolar patients
			51 Healthy controls
Strakowski et al. (2010)	Impulsivity	Aim: ‘to determine whether abnormalities of impulse control persist across the course of BD’	31 Euthymic BD patients	SCID	Logan stop signal task	ANCOVA	Euthymic BD patients did not differ from controls on any of the behavioural tasks
			48 Healthy controls	YMRS	Delayed reward task	ANCOVA
			26 Depressed BD patients	MADRS	Degraded stimulus CPT		BIS total score, motor subscale and non-planning subscale were elevated in BD patients compared to controls. ttentional subscale did not differ to controls
			26 Depressed BD patients	NART	Degraded stimulus CPT
Swann et al. (2003)	Impulsivity	Aims: to investigate impulsivity in manic episodes of BD, compared to euthymic BD patients and controls	25 Euthymic BD patients	SCID	BIS	ANOVA	BIS total and sub-scale scores were elevated in euthymic BD patients compared to controls
			14 Manic BD patients	SADS-C	IMT-DMT version of CPT
			35 Healthy controls
			35 Healthy controls				No difference between euthymic BD patients and controls on IMT-DMT task
Swann et al. (2004)	Impulsivity	Hypotheses: ‘impulsivity as a trait (BIS-11) would be elevated in either substance abuse or in inter-episode BD, and would be elevated more in subjects with BD and substance abuse’	30 Inter-episode BD patients (12 with SA history)	SCID	BIS-11	ANOVA	BD patients showed elevated BIS total and subscale scores compared to controls patients
			30 Inter-episode BD patients (12 with SA history)	SADS-C	IMT-DMT version of CPT
			35 Individuals with history of SA
			37 Healthy controls
			37 Healthy controls				No difference in commission errors between BD patients and controls on IMT-DMT task
Thompson et al. (2009)	Executive control	No aims or hypotheses relevant to this review	63 Euthymic BD patients	SCID	Vigil CPT	T tests	No group difference in commission error rates
			63 Healthy controls	YMRS		ANOVA
				HDRS
				BDI
				Altman Mania Rating Scale
				NART
				MMSE
Yechiam et al. (2008)	Decision making	No aims relevant to this review	14 Remitted BD patients	SCID	Iowa Gambling Task	ANOVA	No group differences on outcomes for Iowa Gambling Task
			14 Acute BD patients	YMRS
			25 Healthy controls	YMRS

BDI, Beck Depression Inventory; BIS, Barratt Impulsivity Scale; BRMAS, Bech Rafaelsen Mania Scale; CPT, Continuous Performance Test; HDRS, Hamilton Depression Rating Scale; MADRS, Montgomery-Asberg Depression Rating Scale; MINI, Mini-International Neuropsychiatric Interview; MMSE, Mini Mental State Examination; NART, National Adult Reading Test; SADS-C; Schedule for Affective Disorder and Schizophrenia- Change version; SCID, Structured Clinical Interview for DSM-IV; WAIS, Weschler Adult Intelligence Scale; YMRS, Young Mania Rating Scale.

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