Review
Introduction
Method
Results
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 | ||||||
YMRS | Median test for non-parametric data | ||||||
Vocabulary subtest of WAIS | |||||||
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 | ||||||
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 | ||||||
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) | |||||
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 | ||||||
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 |
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 | |||||||
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 |
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 | |||||||
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 |
20 Healthy controls | YMRS | 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 | ||||||
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 | |||||||
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 | ||||||
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 | |||||
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 | ||||
NART | |||||||
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 | |||||||
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 |
SADS-C | IMT-DMT version of CPT | ||||||
35 Individuals with history of SA | |||||||
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 |
Self-report personality measures
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ekinci et al. (2011) | N = 71 | N = 50 | 3.97 |
74.33 (7.85) | 50.36 (3.48) | ||
Etain et al. (2013)a | N = 385 | N = 185 | 0.65 |
66.1 (11.1) | 59.5 (8.4) | ||
Henna et al. (2013) | N = 54 | N = 136 | 2.02 |
73.9 (13.2) | 53.2 (9.1) | ||
Ibanez et al. (2012) | N = 13 | N = 25 | 0.83 |
54.2 (22.3) | 40.9 (12.8) | ||
Lewis et al. (2009) | N = 36 | N = 30 | -0.23 |
58.7 (8.2) | 60.8 (10.0) | ||
Lombardo et al. (2012) | N = 54 | N = 49 | 2.45 |
72.9 (12.1) | 52.4 (8.9) | ||
Peluso et al. (2007) | N = 12 | N = 51 | 1.99 |
75.0 (15.1) | 56.1 (8.2) | ||
Strakowski et al. (2010) | N = 28 | N = 35 | 1.07 |
61 (11) | 51 (8) | ||
Swann et al. (2003) | N = 22 | N = 35 | 1.43 |
77.1 (13.8) | 59.9 (9.3) | ||
Swann et al. (2004) | Not provided | Not provided |
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ekinci et al. (2011) | N = 71 | N = 50 | 2.73 |
24.90 (3.23) | 17.02 (2.25) | ||
Etain et al. (2013)a | N = 385 | N = 185 | 0.41 |
23.0 (4.57) | 21.29 (3.34) | ||
Henna et al. (2013) | N = 54 | N = 136 | 1.71 |
26.1 (5.0) | 19.4 (3.5) | ||
Lewis et al. (2009) | N = 36 | N = 30 | -0.69 |
20.2 (3.3) | 22.8 (4.3) | ||
Lombardo et al. (2012) | N = 54 | N = 49 | 1.56 |
26.1 (4.9) | 19.8 (3.1) | ||
Peluso et al. (2007) | N = 12 | N = 51 | 1.33 |
24.3 (6.7) | 18.6 (3.7) | ||
Strakowski et al. (2010) | N = 28 | N = 35 | 1.03 |
23 (5) | 19 (3) | ||
Swann et al. (2003) | N = 22 | N = 35 | 1.14 |
27.7 (4.8) | 22.8 (4.0) | ||
Swann et al. (2004) | N = 15 | N = 37 | 0.23 |
23.5(3.9) | 22.6 (4.0) |
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ekinci et al. (2011) | N = 71 | N = 50 | 2.38 |
28.11 (2.86) | 21.39 (2.70) | ||
Etain et al. (2013)a | N = 385 | N = 185 | 0.52 |
26.0 (5.1) | 23.5 (4.1) | ||
Henna et al. (2013) | N = 54 | N = 136 | 1.49 |
26.6 (6.0) | 19.7 (4.1) | ||
Lewis et al. (2009) | N = 36 | N = 30 | 0.08 |
23.9 (4.4) | 23.5 (5.2) | ||
Lombardo et al. (2012) | N = 54 | N = 49 | 1.55 |
28.0 (5.5.) | 20.3 (4.4) | ||
Peluso et al. (2007) | N = 12 | N = 51 | 2.00 |
31.2 (6.8) | 22.6 (3.7) | ||
Strakowski et al. (2010) | N = 28 | N = 35 | 0.90 |
24 (5) | 20 (4) | ||
Swann et al. (2003) | N = 22 | N = 35 | 1.24 |
29.0 (6.2) | 22.4 (4.8) | ||
Swann et al. (2004) | N = 15 | N = 37 | 0.83 |
26.8 (5.8) | 22.6 (4.7) |
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ekinci et al. (2011) | N = 71 | N = 50 | 0.98 |
21.20 (3.94) | 18.30 (1.60) | ||
Etain et al. (2013)a | N = 385 | N = 185 | 0.61 |
17.1 (4.2) | 14.7 (3.3) | ||
Henna et al. (2013) | N = 54 | N = 136 | 1.72 |
21.1 (4.7) | 14.0 (3.9) | ||
Lewis et al. (2009) | N = 36 | N = 30 | 0.03 |
14.6 (3.1) | 14.5 (2.8) | ||
Lombardo et al. (2012) | N = 54 | N = 49 | 1.03 |
18.7 (4.2) | 12.3 (3.4) | ||
Peluso et al. (2007) | N = 12 | N = 51 | 1.41 |
19.6 (4.7) | 14.9 (3.0) | ||
Strakowski et al. (2010) | N = 28 | N = 35 | 0.69 |
14(4) | 12 (2) | ||
Swann et al. (2003) | N = 22 | N = 35 | 1.47 |
20.7 (4.7) | 14.8 (3.6) | ||
Swann et al. (2004) | N = 15 | N = 37 | 0.97 |
18.5 (4.3) | 15.1 (3.2) |
Behavioural measures of impulsivity
Response inhibition measures
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ancin et al. (2010) | N = 141 | N = 101 | |
False alarm rate, block 3 | 10.6 (12.3) | 8.6 (11.6) | 0.167 |
Response criterion, block 3 | 0.65 (0.72) | 0.53 (0.87) | 0.15 |
Brooks et al. (2010) | N = 16 | N = 11 | |
Commission errors | 15.5 (7.9) | 10.5 (5.5) | 0.68 |
Fleck et al. (2005) | N = 23 | N = 28 | |
Response criterion | 0.49 (0.22) | 0.52 (0.20) | -0.14 |
Iosifescu et al. (2009) | N = 20 | N = 10 | |
Commission errors | 12.41 (4.82) | 7.50 (4.93) | 1.01 |
Kolur et al. (2006) | N = 30 | N = 30 | |
Commission error | 21.40 (29.91) | 12.73 (7.15) | 0.47 |
Malloy-Diniz et al. (2011) | N = 95 | N = 94 | |
Commission errors | 16.17 (8.76) | 10.26 (7.2) | 0.74 |
Martino et al. (2008) | N = 20 | N = 20 | |
False alarm rate | 6.7 (6.1) | 4.0 (3.4) | 0.57 |
Strakowski et al. (2010) | N = 31 | N = 35 | |
Response criterion | 0.69 (0.28) | 0.67 (0.30) | 0.07 |
Swann et al. (2003) | N = 25 | N = 35 | |
DMT commission errors | 21.1 (18.8) | 17.9 (15.5) | 0.19 |
Swann et al. (2004) | N = 37 | N = 16 | |
DMT commission errors | 13.6 (9.0) | 18.4 (15.6) | -0.44 |
Thompson et al. (2009) | N = 63 | N = 63 | |
Commission errors | 2.61 (3.10) | 1.73 (2.23) | 0.33 |
Delay of gratification measures
Study | BD group | Control group | Effect size |
---|---|---|---|
Mean (SD) | Mean (SD) | ||
Ibanez et al. (2012) | N = 13 | N = 25 | |
IGT net score | 1526.5 (483.0) | 1847.1 (564.1) | -0.60 |
IGT blocks 1 and 2 | -1.3 (7.9) | 0.65 (7.1) | -0.26 |
IGT blocks 3 and 4 | 1.0 (8.4) | 4.3 (8.2) | -0.41 |
Malloy-Diniz et al. (2011) | N = 95 | N = 94 | |
IGT net score | 3.89 (24.28) | 20.57 (23.61) | -0.70 |
IGT block 1 | 1.87 (4.47) | 1.2 (5.99) | 0.13 |
IGT block 2 | 0.49 (5.18) | 2.14 (6.80) | -0.28 |
IGT block 3 | 1.20 (6.72) | 5.68 (6.84) | -0.66 |
IGT block 4 | 1.40 (7.68) | 6.93 (8.07) | -0.70 |
IGT block 5 | 1.52 (8.92) | 6.78 (9.13) | -0.58 |
Strakowski et al. (2010) | N = 31 | N = 35 | |
Delayed reward task (% impulsive) | 31 (26) | 28 (23) | 0.25 |