تکانشگری در دو قطبی و اختلالات مصرف مواد

Background Bipolar disorder (BD) is commonly associated with increased impulsivity, particularly during manic and depressed episodes; also impulsivity remains elevated during euthymic phases. Impulsivity is also a factor in the initiation and maintenance of substance use disorders (SUD). Impulsivity can predispose to substance abuse or can result from it. Impulsivity appears to be relatively independent of mood state and is higher in individuals with past substance use. Thus, we wanted to compare the impulsivity of BD and SUD closely associated with impulsivity and identify potential differences. Methods Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A), in 35 bipolar interepisode disorder male patients without comorbid substance use disorder and 40 substance use disorder male patients. The BIS-11A mean scores for the two groups were compared through one-way between-groups ANOVA. Results There was no difference between the BD and substance use disorder groups on total and subscale attentional, motor impulsivity measures. However, for the male patients there was difference on the nonplanning subscale. The male BD patient group scored higher than the male substance use disorder patient group regarding nonplanning impulsivity. Conclusions Our results replicate the findings that interepisode BD and substance use disorder patients both have increased total impulsivity; furthermore, the findings also indicate that trait impulsivity is not completely the same in subscales. Both groups were similar on attention and motor impulsivity subscales; however, on the nonplanning subscale, BD patients were more impulsive than the substance use disorder patients.

Impulsivity is a disposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the self or to others [1]. Even though impulsivity is not itself a psychiatric diagnosis, it seems to be more common in some mental disorders such as certain personality disorders, bipolar disorders, impulse-control disorders (ICD) and substance abuse. Impulsivity is a frequent component of the course and presentation of bipolar disorder; it has therefore been proposed to represent a core feature of the illness that persists across different affective states [1], [2], [3], [4], [5], [6], [7] and [8]. Among bipolar patients, impulsivity appears to be especially important during manic episodes, but may also be found during euthymia and other mood phases [1], [2] and [9]. Both the impulsivity that appears in the manic phase of bipolar disorder (state impulsivity) and the stable impulsivity that may extend across mood states (trait impulsivity) are important features of bipolar disorder. Euthymic bipolar patients express trait impulsivity at higher levels than healthy individuals [9]; however, they do not differ from manic bipolar patients [3]. These findings indicate that the impulsivity present in bipolar patients may be independent of mood state. There is now widespread agreement that impulsivity plays a key role in the initiation and development of substance misuse problems. Impulsivity can predispose to substance abuse, and can result from it [10]. Substance users are known to be highly impulsive and this is reflected in their BIS-11 scores. Behavioral and rating scale measures of impulsivity are elevated in patients with substance abuse [11] and [12]. For instance, increased impulsivity is found for cocaine dependent adults [13] and ecstasy users [14] relative to controls. Impulsivity, which is prominent in both bipolar disorder and substance abuse, may have behavioral and biological substrata that contribute to the overlap between the two disorders [1]. Thus, the goal of this study was to compare the impulsivity scores of patients with BD and SUD. Our hypothesis is that BD and SUD have different impulsivity rates and profiles.

Trait impulsivity was elevated in patients with isolated interepisode BD and SUD, confirming that impulsivity is relatively independent of mood state, and is higher in past substance users. Interepisode BD and substance use disorder patients have increased total impulsivity. On the nonplanning subscale male BD patients are more impulsive than male substance use disorder patients. Nonplanning impulsivity appeared to be related to bipolar disorder than substance use disorder. So these findings should be explored and replicated in larger samples.