Links between self-reported and laboratory behavioral impulsivity.

A major problem in the research considering impulsivity is the lack of mutual understanding on how to measure and define impulsivity. Our study examined the relationship between self-reported impulsivity, behavioral excitatory and inhibitory processes and time perception. Impulsivity--fast, premature, thoughtless or disinhibited behavior--was assessed in 58 normal, healthy participants (30 men, mean age 21.9 years). Self-reported impulsivity as measured by Adaptive and Maladaptive Impulsivity Scale (AMIS) and behavioral excitatory and inhibitory processes as measured by Stop Signal Task were not directly related. Time perception, measured by the retrospective Time Estimation Task, was related to both. The length of the perceived time interval was positively correlated to AMIS Disinhibition subscale and negatively to several Stop Signal Task parameters. The longer subjects perceived the duration to last, the higher was their score on Disinhibition scale and the faster were their reactive responses in the Stop Signal Task. In summary our findings support the idea of cognitive tempo as a possible mechanism underlying impulsive behavior.

The effect of 5-HTT gene promoter polymorphism on impulsivity depends on family relations in girls.

The short (S) allele of the 5-HTT gene promoter region polymorphism (5-HTTLPR), in combination with adverse environmental influence, leads to higher likelihood of depression. Impulsivity has been related to low serotonin turnover, poor regulation of affect, and problems in the family, including child maltreatment. The current study explored the effect of the 5-HTTLPR polymorphism in the serotonin transporter gene and adverse family environment on impulsivity in adolescents. Healthy adolescents participating in the Estonian Children Personality Behaviour and Health Study (n=483) filled the Adaptive and Maladaptive Impulsivity Scale (AMIS), Barratt Impulsiveness Scale (BIS-11), a scale measuring family relations, and were genotyped. While genotype alone was not associated with thoughtlessness, BIS-11 impulsiveness, fast decision-making or excitement seeking, 5-HTTLPR S allele carriers, however, had higher scores of disinhibition. In girls carrying the S allele, scores of thoughtlessness and disinhibition depended on family relations, being higher with less warmth in the family. Adverse family relations had no effect on impulsivity in girls with LL genotype. In boys, the effects of family relations on maladaptive impulsivity did not depend on genotype. However, the S allele and high maltreatment in the family both independently increased disinhibition and the BIS-11 score in boys. Family environment and the 5-HTTLPR genotype had no interactive effect on excitement seeking or fast decision-making. In summary, carrying the S allele may lead to high maladaptive impulsivity due to higher sensitivity to environmental adversity, which is more significantly expressed in girls.

Association of 5-HTT gene polymorphism, platelet MAO activity, and drive for thinness in a population-based sample of adolescent girls.

OBJECTIVE: Several lines of evidence suggest that alterations in serotonergic activity contribute to the pathophysiology of abnormal eating behaviors. Since platelet monoamine oxidase (MAO) activity and the 5-HT transporter gene promoter polymorphism (5-HTTLPR) have been associated with eating disorders, the knowledge from a population-based sample may provide useful information which changes in 5-HT function observed in eating disorders represent trait vs. state effects. METHOD: The sample was based on both cohorts of the Estonian Children Personality, Behavior and Health Study (ECPBHS). The current study was conducted during the second follow-up where altogether 82% from the original sample was recruited. EDI-2 subscales--Drive for Thinness and Bulimia--were used to determine eating attitudes and behaviors. Platelet MAO activity was measured and the participants were genotyped for the 5-HTTLPR. RESULTS: Allelic variation of 5-HTTLPR or platelet MAO activity were not independently associated with drive for thinness or binge eating, but girls homozygous for the 5-HTTLPR long allele and with high platelet MAO activity, both considered indicators of a higher capacity 5-HT system, exhibited higher scores of drive for thinness. CONCLUSION: The results suggest that drive for thinness is the highest in girls with the presence of two markers of higher serotonergic capacity.

Risky driving and the persistent effect of a randomized intervention focusing on impulsivity: The role of the serotonin transporter promoter polymorphism.

Road traffic accidents are a serious public health issue, and real-life traffic offences are an excellent indicator of the behavioural tendencies of impulsivity and risk-taking. We have previously reported on short-term efficacy of a brief intervention in driving schools to reduce traffic risks (Paaver et al., Accid. Anal. Prev., 2013; 50, 430-437), and have now addressed the question of whether does the impact of the intervention last for a few years, and whether traffic behaviour and the intervention effect are associated with the serotonin transporter polymorphism (5-HTTLPR) genotype as the central serotonin system is strongly associated with impulse control. Participants of the study were 1866 novice car-drivers (mean age 23.0, SD = 7.2 years). Data on traffic violations were obtained four years after intervention from the police database and on traffic collisions from the national traffic insurance database. DNA samples were available for 767 participants and 5-HTTLPR genotypes were classified using the triallelic model. For the observation period after the intervention, speeding, drunk driving and involvement in traffic accidents were significantly lower in the intervention group. 5-HTTLPR genotype was associated with traffic behaviour: The S'-allele carriers had significantly lower odds for speeding offences and traffic accidents. The lower prevalence of S'-allele carriers among those who had committed speeding offences was statistically significant in females, while the lower prevalence of having been involved in a traffic accident was rather observed in males. Statistically significant intervention effects were observed only in the L'/L' homozygotes who had higher prevalence of traffic incidents. Conclusively, the brief intervention in traffic schools had a significant impact on traffic safety within subsequent four years, and traffic behaviour was associated with the serotonin transporter genotype. These findings suggest that subjects who are less likely to self-regulate their driving habits while gaining experience would benefit from training of impulsivity recognition.

Platelet MAO activity and the 5-HTT gene promoter polymorphism are associated with impulsivity and cognitive style in visual information processing.

RATIONALE: Low capacity of the central serotonergic system has been associated with impulsive behaviour. Both low platelet monoamine oxidase (MAO) activity and the short (S) allele of the serotonin transporter gene promoter region polymorphism (5-HTTLPR) are proposed to be markers of less efficient serotonergic functioning. OBJECTIVES: The effect of the two markers for serotonin system efficiency on performance in a visual comparison task (VCT) and self-reported impulsiveness (Barratt Impulsiveness Scale, BIS-11) were investigated in healthy adolescents participating in the Estonian Children Personality Behaviour and Health Study. Possible confounding effect of general cognitive abilities on the performance in VCT was controlled for. RESULTS: Low platelet MAO activity and carrying of the S allele of 5-HTTLPR were both associated with higher error-rate and more impulsive performance in VCT. Platelet MAO activity and 5-HTTLPR S allele had a significant interactive effect on self-reported impulsivity (BIS-11). The effect of platelet MAO activity on both self-reported and performance impulsivity was significant only in the S allele carriers. The effect of 5-HTTLPR S allele on impulsive performance remained significant after controlling for general cognitive abilities. CONCLUSIONS: The two markers of lower serotonergic capacity, 5-HTTLPR S allele and low platelet MAO activity, have a similar and partly synergistic influence on self-reported as well as performance measures of impulsivity.

Adaptive and maladaptive impulsivity, platelet monoamine oxidase (MAO) activity and risk-admitting in different types of risky drivers.

RATIONALE: Platelet monoamine oxidase (MAO) activity reflects serotonergic functioning associated with impulsive behaviour, but the significance of these associations to real-life impulsive behaviour in healthy subjects is not clear. OBJECTIVES: The present study explores impulsivity and platelet MAO activity among people with driving violations. MATERIALS AND METHODS: We compared facets of impulsivity and platelet MAO activity in 1,004 male drivers, out of whom 203 had been caught by the police driving drunk and 292 had been caught exceeding speed limits and committing other non-alcohol-related driving violations. Subjects with speeding and other non-alcohol-related violations were further divided according to their self-reported risk-admitting of exceeding speed limits. RESULTS: While drunk driving was associated only with maladaptive types of impulsivity, exceeding speed limits was associated with functional impulsivity and excitement seeking and, to a lesser degree, with dysfunctional impulsivity. Drunk drivers had lower platelet MAO activity. Risk-admitting high-risk drivers had higher platelet MAO activity, neuroticism-related impulsivity, dysfunctional impulsivity and excitement seeking compared to all other groups and higher functional impulsivity compared to controls. Risk-denying high-risk drivers had only higher functional impulsivity compared to controls. CONCLUSIONS: This study demonstrates different expressions of functional and dysfunctional impulsivity in behaviour. While platelet MAO activity is lower in alcohol-related risky behaviour, non-alcohol-related self-acknowledged risky behaviour is related to higher platelet MAO activity. Thus, deviance towards lower as well as higher end of central serotonergic functioning may lead to impulsive behaviour. While self-reported impulsivity did not correlate with MAO activity, both MAO activity and impulsivity were related to risky behaviour.

Mechanisms of mindfulness: The dynamics of affective adaptation during open monitoring.

Mindfulness - the nonjudgmental awareness of the present experience - is thought to facilitate affective adaptation through increased exposure to emotions and faster extinction of habitual responses. To test this framework, the amplification of the Late Positive Potential (LPP) by negative relative to neutral images was analyzed across stimulus repetitions while 37 novices performed an open monitoring mindfulness exercise. Compared to two active control conditions where attention was either diverted to a distracting task or the stimuli were attended without mindfulness instructions, open monitoring enhanced the initial LPP response to negative stimuli, indicating increased emotional exposure. Across successive repetitions, mindfulness reduced and ultimately removed the affective LPP amplification, suggesting extinction of habitual emotional reactions. This effect arose from reduced negative as well enlarged neutral LPPs. Unlike stimuli from control conditions, the images previously viewed with mindfulness instructions did not elicit affective LPP amplification during subsequent re-exposure, suggesting reconsolidation of stimulus meaning.

Further evidence for the association of the NPSR1 gene A/T polymorphism (Asn107Ile) with impulsivity and hyperactivity.

Administration of neuropeptide S (NPS) elicits anxiolysis, arousal and higher activity in rodents. In humans, the NPS receptor (NPSR1) gene rs324981 A/T (Asn(107)Ile) polymorphism is associated with fear responses and anxiety. We have recently revealed an association of NPSR1 with impulsivity-related traits and psychopathology. In the present study the association of the NPSR1 genotype with impulsivity and attention-deficit/hyperactivity disorder (ADHD)-related symptoms was re-examined in two independent non-clinical cohorts. We used self-reports of two population-derived samples of the Estonian Psychobiological Study of Traffic Behaviour (EPSTB): a community car driving sample (n=491, MAge=37) and a driving school student sample (n=773, MAge=24). Impulsivity was measured with the Adaptive and Maladaptive Impulsivity Scale (AMIS) in both samples, and with the Barratt Impulsivity Scale (BIS) in driving schools only. For the latter sample, also measurement of ADHD symptoms was carried out with the Adult ADHD Self-Report Scale (ASRS). NPSR1 T-allele carriers had higher scores of impulsivity, motor restlessness and total ADHD scores. The effect on impulsivity originated from male participants but for ADHD symptoms the association was independent of sex. Thus we have confirmed in two additional population-derived samples that the T-allele of the NPSR1 rs324981 polymorphism is associated with increased impulsivity and ADHD-related traits.

Low platelet MAO activity associated with high dysfunctional impulsivity and antisocial behavior: evidence from drunk drivers.

RATIONALE: Low platelet monoamine oxidase (MAO) activity is associated with problem drinking and other deviant behaviors. Since the majority of alcohol abusers are smokers, and tobacco smoke has a direct inhibitory effect on the enzyme, these associations may not be meaningful. OBJECTIVE: The authors compared platelet MAO activity and impulsivity in police-referred subjects caught driving while intoxicated and in control subjects, controlling for smoking. METHODS: Platelet MAO activity was measured radioenzymatically and impulsivity scores obtained from questionnaires. Smoking status was self-reported. RESULTS: Subjects caught driving while intoxicated had significantly higher dysfunctional impulsivity and lower platelet MAO activity than control subjects. This difference in platelet MAO activity between the two groups was significant in non-smokers and ex-smokers. CONCLUSIONS: These findings demonstrate that platelet MAO activity is lower in subjects with socially deviant behavior, and the association of low platelet MAO and problem drinking is not an artifact of smoking.

Preventing risky driving: A novel and efficient brief intervention focusing on acknowledgement of personal risk factors.

Impulsive personality is an important predictor of risky driving. Acknowledging their impulsive tendencies may help novice drivers to drive more safely. The aim of this study was to evaluate the efficacy of a novel brief intervention targeting novice drivers' risky behavior in traffic, taking into account potential moderator effects. Driving school students (n=1866) were divided into an intervention group and a control group. The intervention consisted of a lecture and group work (1.5h). Subjects' traffic offenses and crashes were monitored during the following year using police and traffic insurance fund databases. The groups were similar in their baseline characteristics. The intervention group had half as many speeding violations in the year following the intervention compared with the controls. The proportion of speeders was significantly lower in the intervention group compared with the control group in subgroups of subjects with medium cognitive abilities and low or medium BIS-11 impulsiveness levels. In alpha(2A)-adrenoceptor gene (ADRA2A) G allele carriers, general traffic risk and speeding decreased in response to the intervention, unlike in subjects with the CC genotype. It is concluded that brief interventions that are integrated into the driving education program and focus on personal psychological risk factors may be effective for improving traffic safety.

Drunk driving among novice drivers, possible prevention with additional psychological module in driving school curriculum.

Road traffic collisions caused by drunk driving pose a significant public health problem all over the world. Therefore additional preventive activities against drunk driving should be worked out. The aim of the study was to assess drunk driving in novice drivers after a psychological intervention taking into account also impulsivity, law obedience, and alcohol-related measures. An intervention study was started with 1889 car driver's license attempters during their driving school studies. Subjects were classified as intervention group (n=1083, mean age 23.1 (SD=7.4) years), control group (n=517, mean age 22.8 (SD=7.1) years) and "lost" group (n=289, mean age 23.0 (SD=6.9) years). "Lost" group subjects had been assigned into the intervention group, but they did not participate in the intervention. Subjects of the intervention group participated in a psychological intervention on the dangers of impulsive behavior in traffic. After a three year follow-up period it appeared that in the control group and in the lost group there was a significantly higher proportion of drunk drivers than in the intervention group, 3.3% (n=17), 3.5% (n=10) and 1.5% (n=10) (p=0.026), respectively. Survival analysis confirmed that psychological intervention had a significant impact on drunk driving (p=0.015), and the impact of the intervention was persistent also in the case of higher scores in Mild social deviance. In subjects with higher scores in impulsivity measures and alcohol-related problems the impact of short psychological intervention was not sufficient for preventing drunk driving. It can be concluded that psychological intervention used during the driving school studies is an effective primary prevention activity against drunk driving. However, for drivers with high scores in impulsivity measures and alcohol-related problems, the short psychological intervention is not sufficient in reducing drunk driving behavior.

A functional NOS1 promoter polymorphism interacts with adverse environment on functional and dysfunctional impulsivity.

RATIONALE: Neuronal nitric oxide synthase (NOS1) knockout results in increased impulsive aggression in mice under adverse housing conditions. In line with this, we have previously shown that a functional promoter polymorphism of NOS1, termed NOS1 ex1f-VNTR, is associated with impulsivity-related traits and related disorders. OBJECTIVE: This study aims to examine whether adverse environment interacts with the risk allele on impulsivity-related measures. METHODS: We here studied a population-based cohort of Estonian pupils, recruited at the age of 9 years and followed up for another 9 years. For 435 subjects, measures on impulsivity (Adaptive and Maladaptive Impulsivity Scale, BIS-11, Stop Signal data, and Visual Comparison Test, VCT), environmental conditions (stressful life events and family environment), and NOS1 ex1f-VNTR genotype were available. RESULTS: We found a genotype main effect in that presence of a short NOS1 ex1f-VNTR allele was associated with higher levels of adaptive impulsivity, especially in males, but also worse performance in the VCT and the Stop Signal test. Both stressful life events as well as adverse family environment interacted with the risk genotype to increase maladaptive impulsivity. CONCLUSIONS: This study provides further evidence that short alleles of NOS1 ex1f-VNTR go along with impulsive behavior. In the absence of adverse environmental conditions, this may lead to a beneficial effect as functional forms of impulsivity are affected. This however is reversed under negative conditions, as dysfunctional impulsivity is increased under these circumstances. This data provides evidence that NOS1 ex1f-VNTR is subject to balancing selection potentially explaining persistence of the risk allele in the population.

Factors associated with speeding penalties in novice drivers.

Novice drivers are an important risk group in traffic and speed limit exceeding is one of the major risk factors for traffic collisions. In this paper we explore how impulsivity measures, driving skills and driving safety are associated with speed limit exceeding in novice drivers if described variables are measured on the same subjects. Participants of the study were 909 novice car-drivers (mean age 24.7(SD=7.5) years). Subjects filled Barratt Impulsivity Scale, Adaptive and Maladaptive Impulsivity Scale (AMIS), Social Motivation Scale and Driver Skill Inventory (DSI). The data on traffic violations were obtained from the police database and the data on traffic collisions from the national traffic insurance database. During the one year follow-up time 49 drivers received penalties by the traffic police for exceeding the speed limits. Based on the traffic police penalties for speed limit exceeding, subjects were classified as speed limit exceeders (cases) and controls. Among speed limit exceeders, the proportions of drunk drivers (6.1% vs 0.7%), subjects with other violations (44.9 % vs 12.7%), and passive traffic collisions (the subject was not guilty in the traffic collisions) (18.4 % vs 6.4%) were greater in comparison with controls. Simple logistic regression analysis revealed that speed limit exceeders were more likely to have higher scores in Excitement Seeking (OR(95%CI)=1.09(1.02-1.16)) and Fast Decision-Making (OR(95%CI)=1.09(1.02-1.17)) in AMIS, and in Driving skills in DSI (OR(95%CI)=1.19(1.13-1.25)) than controls. Overestimated Driving skills in DSI was the strongest predictor of speed limit exceeding if compared to other psychometrical variables in the total sample and in men, and besides Disinhibition in women. The results show that speed limit exceeders perceive their driving skills inadequately. We see a need to develop new possibilities where drivers can objectively estimate their own skills and impulsivity tendencies.

Predicting drunk driving: contribution of alcohol use and related problems, traffic behaviour, personality and platelet monoamine oxidase (MAO) activity.

AIMS: The aim of the study was to characterize the predictive value of socio-economic data, alcohol consumption measures, smoking, platelet monoamine oxidase (MAO) activity, traffic behaviour habits and impulsivity measures for actual drunk driving. METHODS: Data were collected from 203 male drunk driving offenders and 211 control subjects using self-reported questionnaires, and blood samples were obtained from the two groups. RESULTS: We identified the combination of variables, which predicted correctly, approximately 80% of the subjects' belonging to the drunk driving and control groups. Significant independent discriminators in the final model were, among the health-behaviour measures, alcohol-related problems, frequency of using alcohol, the amount of alcohol consumed and smoking. Predictive traffic behaviour measures were seat belt use and paying for parking. Among the impulsivity measures, dysfunctional impulsivity was the best predictor; platelet MAO activity and age also had an independent predictive value. CONCLUSIONS: Our results support the notion that drunk driving is the result of a combination of various behavioural, biological and personality-related risk factors.