Impulsivity in mood disorders: the role of anxiety and substance use comorbidity
Bibliographic record
Abstract
Background: Major depressive disorder (MDD) and bipolar disorder (BP) are debilitating mood disorders that are associated with both long-term economic costs and functional impairment. Impulsivity has been implicated in mood disorders, and primarily in BP. Impulsivity is strongly associated with aggression, risk of suicidal behaviour, and overall functional impairment in mood disorders. Studies have found that BP individuals have significantly higher levels of impulsivity than controls, although fewer studies have examined the specific link between impulsivity and BP compared to MDD. Furthermore, there has been very little research pertaining to the differentiation between levels of impulsivity in BP subtypes, including bipolar type I (BPI) and bipolar type II (BPII). As well, impulsivity has been linked with other psychiatric comorbidities, including anxiety disorders as well as substance use disorders (SUDs). However, the role of impulsivity in mood disorders with anxiety disorder or SUD comorbidity has not been established. Objectives: There are two objectives for this study. The first objective is to compare a) MDD and BP subjects and b) MDD, BPI, and BPII subjects on impulsivity, specifically total impulsivity as well as each of the three dimensions of impulsivity: attentional impulsivity, motor impulsivity, and nonplanning impulsivity. The second objective is to examine if comorbid lifetime (a) anxiety disorders or (b) SUDs modify the association between mood disorder (BP and MDD) and impulsivity, specifically total impulsivity as well as each of the three dimensions of impulsivity. Methods: 115 euthymic outpatients with a primary DSM-IV diagnosis of MDD (N=45), BPI (N=53), or BPII (N=17) from the Mood Disorders Program of the McGill University Health Centre were recruited. The Structured Clinical Interview for DSM-IV (SCID) was conducted to diagnose psychiatric disorders. Impulsivity was measured using the self-report questionnaire - Barratt Impulsiveness Scale (BIS-11) - which assesses three dimensions of impulsivity: attentional, motor, and nonplanning impulsivity. A medical chart review was conducted to obtain socio-demographic and psychiatric disorder information. Results: BP subjects had significantly higher total impulsivity as well as motor and nonplanning impulsivity compared to MDD subjects. With regards to specific BP subtypes, BPI subjects had significantly higher total impulsivity and motor impulsivity than MDD subjects, and BPII subjects had significantly higher total impulsivity, as well as attentional, motor, and nonplanning impulsivity than MDD subjects. Finally, BPII subjects had significantly higher attentional impulsivity than BPI subjects. With regards to lifetime psychiatric comorbidity, mood disorder subjects with anxiety disorders had higher levels of attentional impulsivity. For lifetime SUD diagnosis, SUD comorbidity was associated with higher levels of total impulsivity as well as motor and nonplanning impulsivity in mood disorder subjects. There was no interaction between anxiety or SUD comorbidity and mood diagnosis on total or dimensional impulsivity. Conclusions: Impulsivity is an important factor in the clinical presentation of mood disorders. Our results emphasize the importance of impulsivity primarily in BP, as well as impulsivity in BP individuals with a comorbid anxiety disorder or SUD. Further research measuring impulsivity in BP subtypes with different psychiatric comorbidities (e.g., anxiety disorders, SUDs) would help guide health professionals and clinicians in the assessment of impulsivity and the treatment of impulsive aggression, suicidal behaviours, and other clinical correlates of impulsivity in BP subjects.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".