Behavioral measures and self-report of impulsivity in bipolar disorder: no association between Stroop test and Barratt Impulsiveness Scale

Elisa Sophie Strasser, Paula Haffner, Jana Fiebig, Esther Quinlivan, Mazda Adli, Thomas Josef Stamm, Elisa Sophie Strasser, Paula Haffner, Jana Fiebig, Esther Quinlivan, Mazda Adli, Thomas Josef Stamm

Abstract

Background: Impulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder. It can be measured using behavioral tasks and self-report questionnaires. Previous findings revealed patients to show worse performance on at least one behavioral measure of impulsivity. Additionally, self-reported impulsivity seems to be higher among bipolar patients, both parameters being possibly associated with a more severe course of illness. In this study, our primary aim was to investigate the relationship between these two constructs of impulsivity among bipolar patients.

Methods: A total of 40 euthymic patients with bipolar disorder (21 female, 22 Bipolar I) and 30 healthy controls were recruited for comprehensive neuropsychological assessment. To assess inhibition control as a behavioral measure of impulsivity, the Stroop Color and Word Test (Stroop) was used. Additionally, both groups completed the Barratt Impulsiveness Scale (BIS) as a self-report of impulsivity. To compare the groups' performance on the Stroop and ratings on the BIS, the non-parametric Mann-Whitney U test was used. Within the bipolar group, we additionally examined the possibility of an association between Stroop performance and BIS total scores using Pearson's Correlation r.

Results: Patients and controls differed significantly on the Stroop and BIS, with patients performing worse on the Stroop and scoring higher on the BIS. However, there was no association between the Stroop and BIS within the bipolar group. As an exploratory analysis, a positive correlation between Stroop performance and number of episodes was found. Further, we detected a statistical trend in the direction of poorer Stroop performance among patients treated with polypharmacy.

Conclusions: Both difficulties with behavioral inhibition and self-reported impulsivity were observed to be higher in bipolar patients than controls in the current study. However, within the patient group we did not observe an association between patients' behavioral performance and self-report. This indicates that the parameters likely constitute distinct, dimensional factors of bipolar disorder. In future research, studies with larger samples should investigate which of the two markers constitutes the better marker for the illness and is more suitable to differentiate the most severe patients.

Keywords: Barratt Impulsiveness Scale; Bipolar disorder; Euthymic; Impulsivity; Inhibition; Stroop test.

Figures

Fig. 1
Fig. 1
Behavioral and self-reported impulsivity of euthymic patients (n = 40) and healthy controls (n = 30). On the Stroop test, poorer performance is indicated by higher scores (i.e., longer response duration). On the BIS, higher scores also indicated a greater affliction (i.e., more impulsive self-reports). Note: when comparing the subgroup of strictly euthymic patients to healthy controls, only the Stroop and the BIS sub-score attentional stay significantly different

References

    1. Aichert DS, Wostmann NM, Costa A, Macare C, Wenig JR, Moller HJ, et al. Associations between trait impulsivity and prepotent response inhibition. J Clin Exp Neuropsychol. 2012;34(10):1016–1032. doi: 10.1080/13803395.2012.706261.
    1. APA . Diagnostic and statistical manual of mental disorders. Washington DC: American Psychiatric Association; 1994.
    1. Arts B, Jabben N, Krabbendam L, van Os J. Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med. 2008;38(6):771–785. doi: 10.1017/S0033291707001675.
    1. Aschenbrenner S, Tucha O, Lange KW. Regensburger Wortflüssigkeits-Test: RWT. Hogrefe: Verlag für Psychologie; 2000.
    1. Bader K. Emotionale Modulation von Impulsivität bei Patientinnen mit Borderline Persönlichkeitsstörung. 2010. . Accessed Jan 2016.
    1. Bäumler G, Stroop JR. Farbe-Wort-Interferenztest nach JR Stroop (FWIT). Hogrefe, Verlag für Psychologie. 1985.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Bonnin CM, Sanchez-Moreno J, Martinez-Aran A, Sole B, Reinares M, Rosa AR, et al. Subthreshold symptoms in bipolar disorder: impact on neurocognition, quality of life and disability. J Affect Disord. 2012;136(3):650–659. doi: 10.1016/j.jad.2011.10.012.
    1. Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord. 2009;113(1–2):1–20. doi: 10.1016/j.jad.2008.06.009.
    1. Cheema MK, MacQueen GM, Hassel S. Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition. Cogn Neuropsychiatry. 2015;20(5):424–437. doi: 10.1080/13546805.2015.1076722.
    1. Christodoulou T, Lewis M, Ploubidis GB, Frangou S. The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder. Eur Psychiatry. 2006;21(4):270–273. doi: 10.1016/j.eurpsy.2006.04.006.
    1. Comalli PE, Jr, Wapner S, Werner H. Interference effects of Stroop color-word test in childhood, adulthood, and aging. J Genet Psychol. 1962;100:47–53. doi: 10.1080/00221325.1962.10533572.
    1. Dempster FN. The rise and fall of the inhibitory mechanism: toward a unified theory of cognitive development and aging. Dev Rev. 1992;12(1):45–75. doi: 10.1016/0273-2297(92)90003-K.
    1. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135–168. doi: 10.1146/annurev-psych-113011-143750.
    1. Ekinci O, Albayrak Y, Ekinci AE, Caykoylu A. Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients. Psychiatry Res. 2011;190(2–3):259–264. doi: 10.1016/j.psychres.2011.06.010.
    1. El-Badri SM, Ashton CH, Moore PB, Marsh VR, Ferrier IN. Electrophysiological and cognitive function in young euthymic patients with bipolar affective disorder. Bipolar Disord. 2001;3(2):79–87. doi: 10.1034/j.1399-5618.2001.030206.x.
    1. Enticott PG, Ogloff JRP, Bradshaw JL. Associations between laboratory measures of executive inhibitory control and self-reported impulsivity. Personal Individ Differ. 2006;41(2):285–294. doi: 10.1016/j.paid.2006.01.011.
    1. Enticott PG, Ogloff JR, Bradshaw JL, Fitzgerald PB. Cognitive inhibitory control and self-reported impulsivity among violent offenders with schizophrenia. J Clin Exp Neuropsychol. 2008;30(2):157–162. doi: 10.1080/13803390701290055.
    1. Etain B, Mathieu F, Liquet S, Raust A, Cochet B, Richard JR, et al. Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients. J Affect Disord. 2013;144(3):240–247. doi: 10.1016/j.jad.2012.07.005.
    1. Goswami U, Sharma A, Varma A, Gulrajani C, Ferrier IN, Young AH, et al. The neurocognitive performance of drug-free and medicated euthymic bipolar patients do not differ. Acta Psychiatr Scand. 2009;120(6):456–463. doi: 10.1111/j.1600-0447.2009.01390.x.
    1. Gruber SA, Rosso IM, Yurgelun-Todd D. Neuropsychological performance predicts clinical recovery in bipolar patients. J Affect Disord. 2008;105(1–3):253–260. doi: 10.1016/j.jad.2007.04.014.
    1. Haffner P, Quinlivan E, Fiebig J, Sondergeld L, Strasser ES, Adli M, et al. Improving functional outcome in bipolar disorder: a pilot-study on metacognitive training. 2016. (in progress).
    1. Hajek T, Alda M, Hajek E, Ivanoff J. Functional neuroanatomy of response inhibition in bipolar disorders–combined voxel based and cognitive performance meta-analysis. J Psychiatr Res. 2013;47(12):1955–1966. doi: 10.1016/j.jpsychires.2013.08.015.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Hamilton KR, Littlefield AK, Anastasio NC, Cunningham KA, Fink LH, Wing VC, et al. Rapid-response impulsivity: definitions, measurement issues, and clinical implications. Personal Disord. 2015;6(2):168–181. doi: 10.1037/per0000100.
    1. Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. Wechsler Gedächtnis Test-Revidierte Fassung (WMS-R) Bern: Huber; 2000.
    1. Hartmann AS, Rief W, Hilbert A. Psychometric properties of the German version of the Barratt Impulsiveness Scale, version 11 (BIS-11) for adolescents. Percept Mot Skills. 2011;112(2):353–368. doi: 10.2466/08.09.10.PMS.112.2.353-368.
    1. Heffner JL, Fleck DE, DelBello MP, Adler CM, Strakowski SM. Cigarette smoking and impulsivity in bipolar disorder. Bipolar Disord. 2012;14(7):735–742. doi: 10.1111/bdi.12010.
    1. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfähigkeitstest (VLMT). [Verbal learn and memory test (VLMT)] Göttingen: Hogrefe; 2001.
    1. Henna E, Hatch JP, Nicoletti M, Swann AC, Zunta-Soares G, Soares JC. Is impulsivity a common trait in bipolar and unipolar disorders? Bipolar Disord. 2013;15(2):223–227. doi: 10.1111/bdi.12034.
    1. Henry C, Etain B. New ways to classify bipolar disorders: going from categorical groups to symptom clusters or dimensions. Curr Psychiatry Rep. 2010;12(6):505–511. doi: 10.1007/s11920-010-0156-0.
    1. Horn W. Leistungsprüfsystem. [Performance exerciser] Göttingen: Hogrefe; 1983.
    1. Jimenez E, Arias B, Castellvi P, Goikolea JM, Rosa AR, Fananas L, et al. Impulsivity and functional impairment in bipolar disorder. J Affect Disord. 2012;136(3):491–497. doi: 10.1016/j.jad.2011.10.044.
    1. Kathleen Holmes M, Bearden CE, Barguil M, Fonseca M, Serap Monkul E, Nery FG, et al. Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse. Bipolar Disord. 2009;11(1):33–40. doi: 10.1111/j.1399-5618.2008.00657.x.
    1. Kemps E, Wilsdon A. Preliminary evidence for a role for impulsivity in cognitive disinhibition in bulimia nervosa. J Clin Exp Neuropsychol. 2010;32(5):515–521. doi: 10.1080/13803390903264122.
    1. Kurtz MM, Gerraty RT. A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state. Neuropsychology. 2009;23(5):551–562. doi: 10.1037/a0016277.
    1. Lehrl S. Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B). [Multiple vocabulary intelligence test (MWT-B)] Balingen: Spitta Verlag; 2005.
    1. Levy B, Manove E. Functional outcome in bipolar disorder: the big picture. Depress Res Treat. 2012;2012:949248.
    1. Lewis M, Scott J, Frangou S. Impulsivity, personality and bipolar disorder. Eur Psychiatry. 2009;24(7):464–469. doi: 10.1016/j.eurpsy.2009.03.004.
    1. Lombardo LE, Bearden CE, Barrett J, Brumbaugh MS, Pittman B, Frangou S, et al. Trait impulsivity as an endophenotype for bipolar I disorder. Bipolar Disord. 2012;14(5):565–570. doi: 10.1111/j.1399-5618.2012.01035.x.
    1. Mann-Wrobel MC, Carreno JT, Dickinson D. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord. 2011;13(4):334–342. doi: 10.1111/j.1399-5618.2011.00935.x.
    1. Nery FG, Hatch JP, Monkul ES, Matsuo K, Zunta-Soares GB, Bowden CL, et al. Trait impulsivity is increased in bipolar disorder patients with comorbid alcohol use disorders. Psychopathology. 2013;46(3):145–152. doi: 10.1159/000336730.
    1. Newman AL, Meyer TD. Impulsivity: present during euthymia in bipolar disorder?—a systematic review. Int J Bipolar Disord. 2014;2:2. doi: 10.1186/2194-7511-2-2.
    1. Ng TH, Stange JP, Black CL, Titone MK, Weiss RB, Abramson LY, et al. Impulsivity predicts the onset of DSM-IV-TR or RDC hypomanic and manic episodes in adolescents and young adults with high or moderate reward sensitivity. J Affect Disord. 2016;198:88–95. doi: 10.1016/j.jad.2016.03.045.
    1. Nigg JT. On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychol Bull. 2000;126(2):220–246. doi: 10.1037/0033-2909.126.2.220.
    1. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–774. doi: 10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>;2-1.
    1. Peluso MA, Hatch JP, Glahn DC, Monkul ES, Sanches M, Najt P, et al. Trait impulsivity in patients with mood disorders. J Affect Disord. 2007;100(1–3):227–231. doi: 10.1016/j.jad.2006.09.037.
    1. Porter RJ, Robinson LJ, Malhi GS, Gallagher P. The neurocognitive profile of mood disorders—a review of the evidence and methodological issues. Bipolar Disord. 2015;17(Suppl 2):21–40. doi: 10.1111/bdi.12342.
    1. Powers RL, Russo M, Mahon K, Brand J, Braga RJ, Malhotra AK, et al. Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history. Bipolar Disord. 2013;15(8):876–884. doi: 10.1111/bdi.12124.
    1. Preuss UW, Rujescu D, Giegling I, Watzke S, Koller G, Zetzsche T, et al. Psychometric evaluation of the German version of the Barratt Impulsiveness Scale. Der Nervenarzt. 2008;79(3):305–319. doi: 10.1007/s00115-007-2360-7.
    1. Quinlivan E, Dallacker M, Renneberg B, Strasser ES, Fiebig J, Stamm T. Overgeneral autobiographical memory in bipolar disorder: the role of neuropsychological functions. 2016. (in progress).
    1. Robinson LJ, Thompson JM, Gallagher P, Goswami U, Young AH, Ferrier IN, et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord. 2006;93(1–3):105–115. doi: 10.1016/j.jad.2006.02.016.
    1. Rosa AR, Sanchez-Moreno J, Martinez-Aran A, Salamero M, Torrent C, Reinares M, et al. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3:5. doi: 10.1186/1745-0179-3-5.
    1. Ryan KA, Vederman AC, Kamali M, Marshall D, Weldon AL, McInnis MG, et al. Emotion perception and executive functioning predict work status in euthymic bipolar disorder. Psychiatry Res. 2013;210(2):472–478. doi: 10.1016/j.psychres.2013.06.031.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.
    1. Strakowski SM, Fleck DE, DelBello MP, Adler CM, Shear PK, Kotwal R, et al. Impulsivity across the course of bipolar disorder. Bipolar Disord. 2010;12(3):285–297. doi: 10.1111/j.1399-5618.2010.00806.x.
    1. Stroop JR. Studies of interference in Serial Verbal Reactions editor’s note: reprint of an original work published in 1935 in the journal of experimental psychology, 18, 643–662. J Exp Psychol Gen. 1992;121:15–23. doi: 10.1037/0096-3445.121.1.15.
    1. Swann AC, Anderson JC, Dougherty DM, Moeller FG. Measurement of inter-episode impulsivity in bipolar disorder. Psychiatry Res. 2001;101(2):195–197. doi: 10.1016/S0165-1781(00)00249-3.
    1. Swann AC, Pazzaglia P, Nicholls A, Dougherty DM, Moeller FG. Impulsivity and phase of illness in bipolar disorder. J Affect Disord. 2003;73(1–2):105–111. doi: 10.1016/S0165-0327(02)00328-2.
    1. Swann AC, Dougherty DM, Pazzaglia PJ, Pham M, Moeller FG. Impulsivity: a link between bipolar disorder and substance abuse. Bipolar Disord. 2004;6(3):204–212. doi: 10.1111/j.1399-5618.2004.00110.x.
    1. Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Increased trait-like impulsivity and course of illness in bipolar disorder. Bipolar Disord. 2009;11(3):280–288. doi: 10.1111/j.1399-5618.2009.00678.x.
    1. Torres IJ, Boudreau VG, Yatham LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl. 2007;434:17–26. doi: 10.1111/j.1600-0447.2007.01055.x.
    1. Volkert J, Kopf J, Kazmaier J, Glaser F, Zierhut KC, Schiele MA, et al. Evidence for cognitive subgroups in bipolar disorder and the influence of subclinical depression and sleep disturbances. Eur Neuropsychopharmacol. 2015;25(2):192–202. doi: 10.1016/j.euroneuro.2014.07.017.
    1. Wilson SP, Kipp K. The development of efficient inhibition: evidence from directed-forgetting tasks. Dev Rev. 1998;18(1):86–123. doi: 10.1006/drev.1997.0445.
    1. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429–435. doi: 10.1192/bjp.133.5.429.
    1. Zimmerman P, Fimm B. Testbatterie zur Aufmerksamkeitsprüfung (TAP) Version 2.0. [Test battery to measure attention Version 2.0] Herzogenrath: Psytest; 2006.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다