Meta-cognitions in tourette syndrome, tic disorders, and body-focused repetitive disorder.

OBJECTIVE: To explore if self-reported presence of thinking about tics or body-focused repetitive behaviours (BFRBs; gests) are direct triggers of tic or gest onset in 3 groups: Tourette syndrome (TS; n =18), persistent chronic tic disorders (TDs; n = 42), and a comparison group with BFRB (n = 36). METHOD: The 3 groups completed a thinking about tics inventory, listing 22 items derived from clinician consensus that asked whether thoughts always, sometimes, or never exclusively triggered tic onset. Other questionnaires measured mood, perfectionism, impulsivity, premonitory urge, and self-rated tension. Sixty-three participants completed the inventory twice, and the inventory was completed pre- and post-behavioural intervention by a further 54. RESULTS: The ranking of the thoughts reported as likely to trigger tics or gests was positively correlated across TD and BFRB groups. Exploratory principal components analysis of a reduced 12-item set (the thinking about tics inventory) in TS and TD groups revealed that such thoughts could be grouped into 3 separate subscales: thoughts about the interference of tics or gests, thoughts anticipating tics or gests, and thoughts about whether the person has permission to perform the tic or the gest. The 3 sets of subscales showed good and acceptable internal consistency and overall score showed good test-retest reliability, suggesting thoughts about tics or gests are robust and measurable. The subscales correlated with impulsivity, tic or behaviour severity, and ratings of frequency decreased post-behavioural treatment. CONCLUSIONS: Thinking about tics or gests is reported as triggering tics or gests in both TD and BFRB, and meta-cognition seems independent of premonitory sensations and relates to distinct clinical characteristics in each clinical group.

Impulsivity, "advergames," and food intake.

BACKGROUND AND OBJECTIVES: Previous studies have focused on the effect of food advertisements on the caloric intake of children. However, the role of individual susceptibility in this effect is unclear. The aim of this study was to examine the role of impulsivity in the effect of advergames that promote energy-dense snacks on children's snack intake. METHODS: First, impulsivity scores were assessed with a computer task. Then a randomized between-subject design was conducted with 261 children aged 7 to 10 years who played an advergame promoting either energy-dense snacks or nonfood products. As an extra manipulation, half of the children in each condition were rewarded for refraining from eating, the other half were not. Children could eat freely while playing the game. Food intake was measured. The children then completed questionnaire measures, and were weighed and measured. RESULTS: Overall, playing an advergame containing food cues increased general caloric intake. Furthermore, rewarding children to refrain from eating decreased their caloric intake. Finally, rewarding impulsive children to refrain from eating had no influence when they were playing an advergame promoting energy-dense snacks, whereas it did lead to reduced intake among low impulsive children and children who played nonfood advergames. CONCLUSIONS: Playing an advergame promoting energy-dense snacks contributes to increased caloric intake in children. The advergame promoting energy-dense snacks overruled the inhibition task to refrain from eating among impulsive children, making it more difficult for them to refrain from eating. The findings suggest that impulsivity plays an important role in susceptibility to food advertisements.

Anxiety, depression, impulsivity and substance misuse in violent and non-violent adolescent boys in detention in China.

The present investigation aims to identify the factors which differentiate violent from non-violent juvenile offenders, with a particular emphasis on the association between internalizing psychiatric morbidity (i.e. anxiety and depression), impulsivity, substance misuse, and violence. A total of 323 incarcerated male juvenile offenders from one of three Youth Detention Centers (YDCs) in China were recruited between August 2007 and November 2008. Interviews were conducted by trained psychiatrists using the Barratt Impulsivity Scale (BIS-11), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Birleson Depression Self-Rating Scale (DSRS) to assess impulsivity, anxiety and depression, respectively. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was also used to assess psychiatric diagnoses. Violent offenders had significantly higher BIS-11 total scores, and attention and nonplanning subscale scores (p<0.05). In the multiple logistic regression model, substance use disorders (SUD) and BIS-11 total scores independently predicted violence. Prison-based treatment services designed to reduce impulsivity and substance misuse in juvenile detention facilities should be prioritized.

Examination of a short English version of the UPPS-P Impulsive Behavior Scale.

The current study examines a recently developed short English version of the UPPS-P Impulsive Behavior Scale. Participants were 251 undergraduate students (59.3% male; mean age=21.16 (SD=4.18); 72% Caucasian). The short version generally replicated the internal consistency (0.74-0.88 across subscales) and inter-scale correlations of the full English UPPS-P. Moreover, the estimated loss of shared variance was small (0%-6.4% reductions across subscales) as compared to a 66% time-savings. Structural equation modeling replicated previously supported factor structures and relationships to external outcomes using the full UPPS-P. This short UPPS-P scale should be considered a valid and reliable alternative to the full UPPS-P in English-speaking non-clinical adult samples.

Emotional and behavioral dyscontrol after traumatic brain injury.

Emotional and behavioral dyscontrol are relatively common neuropsychiatric sequelae of traumatic brain injury and present substantial challenges to recovery and community participation. Among the most problematic and functionally disruptive of these types of behaviors are pathologic laughing and crying, affective lability, irritability, disinhibition, and aggression. Managing these problems effectively requires an understanding of their phenomenology, epidemiology, and clinical evaluation. This article reviews these issues and provides clinicians with brief and practical suggestions for the management of emotional and behavioral dyscontrol.

Impulsivity and risk taking in bipolar disorder and schizophrenia.

Impulsive risk taking contributes to deleterious outcomes among clinical populations. Indeed, pathological impulsivity and risk taking are common in patients with serious mental illness, and have severe clinical repercussions including novelty seeking, response disinhibition, aggression, and substance abuse. Thus, the current study seeks to examine self-reported impulsivity (Barratt Impulsivity Scale) and performance-based behavioral risk taking (Balloon Analogue Risk Task) in bipolar disorder and schizophrenia. Participants included 68 individuals with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Self-reported impulsivity was elevated in the bipolar group compared with schizophrenia patients and healthy controls, who did not differ from each other. On the risk-taking task, schizophrenia patients were significantly more risk averse than the bipolar patients and controls. Aside from the diagnostic group differences, there was a significant effect of antipsychotic (AP) medication within the bipolar group: bipolar patients taking AP medications were more risk averse than those not taking AP medications. This difference in risk taking because of AP medications was not explained by history of psychosis. Similarly, the differences in risk taking between schizophrenia and bipolar disorder were not fully explained by AP effects. Implications for clinical practice and future research are discussed.

Individual differences in negative affect and weekly variability in binge eating frequency.

OBJECTIVE: To examine the relationship of neuroticism and negative affect (NA) lability with weekly binge eating fluctuations between binge eating disorder (BED) and bulimia nervosa (BN). METHOD: Individuals with BED (n = 30) and BN (n = 54) from the community completed self-report measures at baseline and prospectively for 12 consecutive weeks. Weekly data were analyzed by using (mean) squared successive deviation to account for fluctuations in NA and binge eating from week to week. RESULTS: Generalized estimating equations revealed the presence of a two-way interaction between neuroticism and NA lability predicting binge eating fluctuations (Wald χ(2) = 8.25; df = 1; p = .004), indicating that higher NA lability was only related to larger fluctuations in the frequency of binge eating episodes when present in individuals who were also high on neuroticism. An interaction was also detected between eating disorder diagnosis and NA lability, but this was accounted for by differences in average NA between the diagnoses. DISCUSSION: This study highlights the relevance of two traits and their interaction in understanding individual differences in binge eating fluctuations. Additionally, findings indicate that diagnostic differences in average NA may impact binge eating fluctuations and NA lability.

[The OCD spectrum disorder revisited. Toward a bipolar impulsion-compulsion configuration]. / Spectre du trouble obsessionnel-compulsif revisité à travers un bipôle impulsion-compulsion.

The so-called obsessive-compulsive spectrum disorder (OCD spectrum) is represented by a large variety of clinical entities. There are in general obsessive-compulsive disorder, trichotillomania or Gilles de la Tourette disease among the impulse control disorders, body dysmorphic disorder and hypochondriasis among the somatoform disorders. Updated overview of the OCD spectrum through a bipolar configuration with the impulsion-compulsion (I-C) spectrum, characterized by a failure to resist and control intrusive thoughts associated with repetitive behaviors that seem to be uncontrollable or require considerable efforts to suppress their execution. There are several disrupted processes in the I-C spectrum, including cognitive control, flexibility and behavioural inhibition. All these psychiatric affections demonstrated to share apparent similarities regarding clinical symptomatology, demographic considerations, comorbidity and course pattern, and responses to the serotonine reuptake inhibitors and cognitive behavioural therapy. The concept of I-C spectrum pleads for less categorical and more dimensional approach that seems to be consistently adapted to clinical, genetic, pathophysiology and therapeutic realities.

Gender-based measurement invariance of the substance use risk profile scale.

Gender may influence the psychometric properties of psychological and affect-related measures. The American Psychological Association has made recommendations to conduct tests of group-level measurement invariance (MI) before comparing scores between groups. Gender-based measurement invariance has been examined in many well-known psycho-social scales such as the CES-D and the Big Five Inventory. The Substance Use Risk Profile is a 23-item scale measuring affective- and personality-related traits known to increase risk for substance use, with 4 dimensions: anxiety sensitivity, hopelessness, sensation seeking and impulsivity. Despite similarities in the constructs assessed by the SURPS, the CES-D and the Big Five Inventory, gender-based measurement invariance of the SURPS has not yet been published. Multi-group confirmatory factor analysis was used to assess the measurement invariance of the four dimensions of the SURPS across gender. MI was conducted with M-Plus 6.2 using a 2-step analysis for ordinal variables suggested by Muthén and Muthén, and model fit was assessed using the comparative fit index (CFI) criteria recommended by Cheung and Rensvold. A single group confirmatory factor analysis (CFA) was also conducted. The sample was composed of 1352 adolescents (56% female, mean age of 14years) participating in the BC Adolescent Substance Use Survey, an online survey capturing substance use and psychosocial trends in secondary students across British Columbia, Canada. Measurement invariance across gender was demonstrated for the SURPS (ΔCFI=0.003), and the single group CFA supported a four-dimensional structure for the SURPS items (CFI=0.92, RMSEA=061, 95% CI=0.058-0.065).

Development and validation of a fall-related impulsive behaviour scale for residential care.

INTRODUCTION: impulsivity in older people with cognitive impairment has yet to be examined rigorously as a risk factor for falls. The objective of this study was to evaluate the psychometric properties of a new fall-related impulsive behaviour scale (FIBS) for a cognitively impaired population living in residential care. METHODS: one hundred and nine care home residents (84.5 ± 8.3 years) were assessed on the FIBS and a range of behavioural, physical and neuropsychological measures. Participants were then prospectively followed up for falls for 6 months. RESULTS: the internal reliability (Cronbach's α = 0.77) and test-retest reliability (intra-class correlation coefficient = 0.93) of the FIBS were both good. Construct validity was supported by significant correlations between the FIBS and the neuropsychiatric inventory (r = 0.43, P < 0.001), wandering (r = 0.33, P = 0.001) and global cognition (r = -0.2, P = 0.04). Compared with residents with FIBS scores <1, those with FIBS scores of ≥ 1 were nearly three times more likely to fall in the following 6 months, AOR = 2.92 (95% CI: 1.03-8.29). CONCLUSION: the FIBS is a simple, valid and reliable scale for assessing fall-related impulsivity in care home residents and can be recommended for use in this group for both research and clinical purposes.

Test-retest reliability of behavioral measures of impulsive choice, impulsive action, and inattention.

Behavioral measures of impulsivity are widely used in substance abuse research, yet relatively little attention has been devoted to establishing their psychometric properties, especially their reliability over repeated administration. The current study examined the test-retest reliability of a battery of standardized behavioral impulsivity tasks, including measures of impulsive choice (i.e., delay discounting, probability discounting, and the Balloon Analogue Risk Task), impulsive action (i.e., the stop signal task, the go/no-go task, and commission errors on the continuous performance task), and inattention (i.e., attention lapses on a simple reaction time task and omission errors on the continuous performance task). Healthy adults (n = 128) performed the battery on two separate occasions. Reliability estimates for the individual tasks ranged from moderate to high, with Pearson correlations within the specific impulsivity domains as follows: impulsive choice (r range: .76-.89, ps < .001); impulsive action (r range: .65-.73, ps < .001); and inattention (r range: .38-.42, ps < .001). Additionally, the influence of day-to-day fluctuations in mood, as measured by the Profile of Mood States, was assessed in relation to variability in performance on each of the behavioral tasks. Change in performance on the delay discounting task was significantly associated with change in positive mood and arousal. No other behavioral measures were significantly associated with mood. In sum, the current analysis demonstrates that behavioral measures of impulsivity are reliable measures and thus can be confidently used to assess various facets of impulsivity as intermediate phenotypes for drug abuse.

Cocaine-induced psychosis and impulsivity in cocaine-dependent patients.

Cocaine-dependent patients have high impulsiveness. Cocaine-induced psychosis is common among cocaine-dependent patients. Different risk factors associated with cocaine-induced psychosis have been reported. The aim of this study is to analyze the relationship between psychotic symptoms in cocaine-dependent patients and impulsivity and mental disorders characterized by impulsivity. This descriptive study included 287 outpatients with cocaine dependence according to the DSM-IV-TR criteria. The Structured Clinical Interview for DSM-IV Axis I and II, the Barratt Impulsiveness Scale, and a specific questionnaire on the presence of cocaine-induced psychosis were used to assess patients. Symptoms were observed in 59.9% of the study population. Total and cognitive impulsiveness scores obtained from the Barratt Impulsiveness Scale were significantly higher in patients with cocaine-induced psychosis. Individuals from this group reported more overdose incidents, initiated more treatments during their lifetime, and had a significantly greater prevalence of attention deficit hyperactivity disorder. Patients with cocaine-induced psychosis have a greater degree of impulsivity and a higher prevalence of attention deficit hyperactivity disorder. Thus, if these disorders are observed in cocaine-dependent participants, the presence of psychotic symptoms should be evaluated to prevent further occurrence and their consequences.

Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history.

OBJECTIVES: Impulsivity is a core feature in bipolar disorder. Although mood symptoms exacerbate impulsivity, self-reports of impulsivity are elevated, even during euthymia. Neurocognitive processes linked to impulsivity (e.g., attention, inhibition) are also impaired in patients with bipolar disorder, and a high frequency of comorbidities associated with impulsivity, such as substance use disorders, further highlights the clinical relevance of this dimension of the illness. Our objective was to assess the relationship between impulsivity and cognition in bipolar disorder. METHODS: We evaluated impulsivity in 98 patients with bipolar disorder and its relationship with symptoms, cognition, and substance use history. We assessed self-reports of trait impulsivity [Barrett Impulsiveness Scale (BIS)] and impulsive behaviors on the Iowa Gambling Task (IGT). A comprehensive clinical and neurocognitive battery was also completed. Patients were compared with 95 healthy controls. RESULTS: Patients with bipolar disorder had higher scores versus healthy controls on all BIS scales. Performance on the IGT was significantly impaired and patients showed a tendency toward more erratic choices. Depressive symptoms were positively correlated with trait impulsivity and with an increased tendency to attend more readily to losses versus gains on the IGT. We found no significant associations between impulsivity and neurocognition in the full bipolar sample; however, when sub-grouped based on substance abuse history, significant relationships were revealed only in subjects without a substance abuse history. CONCLUSIONS: Our data support prior reports of increased trait impulsivity and impairment on behavioral tasks of impulsiveness in bipolar disorder and suggest a differential relationship between these illness features that is dependent upon history of substance abuse.

[Obsessive compulsive disorder--intrusive thoughts, impulses and repetitive behaviours as an expression of a significant disease]. / Zwangsstörungen--wenn wiederholte gedanken, impulse und handlungen ausdruck einer erkrankung sind.

Obsessive-compulsive disorder (OCD) is common and associated with marked impairment and reduced quality of life. In the general practitioner's office as well as in the specialist's consultation, patients with OCD usually present intrusive thoughts (obsessions) and repetitive behaviours (compulsions). OCD sufferers generally recognize their obsessions and compulsions as irrational. Without treatment, OCD often takes a chronic course. Some basic aspects can help to identify patients suffering from OCD earlier and to initiate sufficient therapy. With evidence-based treatment with cognitive-behavioral therapy and adequate psychopharmacotherapy, many patients can achieve complete symptom remission. Initial treatment can be initiated in the general practitioner's office.

Le trouble obsessionnel-compulsif est une maladie mentale qui affecte la qualité de vie d'une manière significative. Dans le cabinet du médecin généraliste, mais aussi chez le spécialiste, les patientes souffrant de troubles obsessionnels-compulsifs décrivent souvent des pensées intrusives inhabituelles et des comportements répétitifs. Bien que les pensées obsessionnelles et les compulsions sont reconnues par les patients comme insensées, elles continuent à se manifester. Sans traitement, le trouble obsessionnel-compulsif devient souvent chronique. Des connaissances de base peuvent déjà aider les médecins à reconnaître le plus tôt possible les patients souffrant de troubles obsessionnels et à proposer un traitement approprié. Avec thérapie cognitivo-comportementale, qui peut être combinée avec un traitement pharmacologique, on obtient souvent une réduction significative, même complète des symptômes. Bien que ce traitement doive être effectué par des psychothérapeutes qualifiés, des premières mesures thérapeutiques peuvent déjà être utilisées par les médecins généralistes.

Untreated major depressive disorder with and without atypical features: a clinical comparative study.

AIMS AND METHOD: A comparative study of major depression with and without atypical features (as per DSM IV TR criteria) was planned to assess illness characteristics, resulting dysfunction and co-morbidities, which can have important implications in its management. Serially, 107 newly registered patients with depression not taking any treatment for at least a month were included. Patients with psychotic features in present or past, known bipolar disorder and likely organic aetiology were excluded. They were interviewed using SCID I (Structured clinical interview for DSM IV axis I disorders). Impulsiveness, suicidal ideation and functioning in various spheres was also assessed and compared between those with and without atypical features. RESULTS: Atypical features were seen in a significant number (55.14%) of patients especially from urban and semi-urban areas. Interpersonal sensitivity and leaden paralysis were the commonest atypical features apart from mood reactivity. Presence of hypersomnia and/or hyperphagia documented in 36 (33.65%) of 107 patients. Comparison of patients with and without atypical features revealed no significant difference in illness characteristics including suicidal ideation. However, they differed in level of impulsiveness and associated psychiatric co-morbidities. Also, deterioration of functioning with rising HDRS was more significant in patients without atypical features. CLINICAL IMPLICATIONS: Presence of atypical features is common in patients with major depressive disorder. These patients should be vigilantly assessed and managed in view of equal morbidity but different co-morbidities like anxiety and soft bipolar disorders than those without atypical features.

Assessing impulsivity in prepubertal male rats: a novel device and method to assess motor and cognitive impulsivity.

The use of animal models in studies of impulsivity has made valuable contributions to our understanding of this behavioral trait as it relates to disorders such as attention deficit hyperactivity disorder. The objective of this work was to develop a paradigm that would make it possible to evaluate both motor and cognitive impulsivity using the same device after a short training period. The operant behavior demanded in this device consists in having rats cross a bridge after receiving a signal to obtain a reward that is available on a goal platform in a Wait-to-Go-signal task, or in crossing a bridge after the animals make a choice between two alternatives in a Delay-discounting task. To test this device and method, a study was conducted using an animal model of dopaminergic dysfunction produced by prenatal alcohol treatment (which has been shown to cause attention deficits and alterations of impulsivity in adult rats). Compared with controls, prepubertal male rats treated prenatally with alcohol showed both higher cognitive and higher motor impulsivity as assessed by the parameters used. Although attention changes proved not to be dependent on prenatal treatment, they were sensitive to the task performed. The device and methods introduced herein thus constitute useful instruments for evaluating impulsivity. Their significant advantages include a short investment in training time, and the ability to assess different types of impulsivity from the vantage point of distinct theoretical perspectives.

Sleep and impulsivity in Parkinson's disease.

BACKGROUND: Impulsive behavior and poor sleep are important non-motor features of Parkinson's disease (PD) that negatively impact the quality of life of patients and their families. Previous research suggests a higher level of sleep complaints in PD patients who demonstrate impulsive behaviors, but the nature of the sleep disturbances has yet to be comprehensively tested. METHODS: Consecutive idiopathic PD patients (N = 143) completed the Minnesota Impulse Disorder Interview and a sleep questionnaire that assessed sleep efficiency, excessive daytime sleepiness, restless legs symptoms, snoring, dreams/nightmares, and nocturia. Patients were also given a Unified Parkinson's Disease Rating Scale motor examination and they completed cognitive testing. RESULTS: Impulsive PD patients endorsed more sleep complaints than non-impulsive PD patients. The group difference was primarily attributable to poor sleep efficiency (e.g., greater nocturnal awakenings), p < .01, and greater daytime sleepiness, p < .01, in the impulsive PD patients. Interestingly, restless legs symptoms were also greater in the impulsive PD patients, p < .05. The results could not be explained by medications or disease severity. CONCLUSIONS: Poor sleep efficiency, restless legs symptoms, and increased daytime sleepiness are associated with impulsivity in PD. Longitudinal studies are needed to determine whether sleep disturbances precede impulsivity in PD.

The impact of self-reported life stress on current impulsivity in cocaine dependent adults.

Current cocaine treatments may be enhanced with a better understanding of the underlying mechanisms that contribute to the onset and maintenance of the disease, such as life stress and impulsivity. Life stress and impulsivity have previously been studied independently as contributors to drug use, and the current study expands upon past research by examining how these factors interact with one another. The aim of the current study was to evaluate the role of life stress in predicting impulsivity in a non-treatment seeking cocaine-dependent sample (N=112). Analyses revealed that trait impulsivity (as measured by the Barratt Impulsiveness Scale) was associated with education (r=-3.09, p<0.01), as those who had higher educational attainment also reported lower rates of trait impulsivity. In addition, those over the age of 30 demonstrated lower impulsivity in decision-making (as measured by delay discounting) than those under 30 (t=2.21, p=0.03). Overall exposure to life stress was not significantly correlated to either aspect of impulsivity. However several specific life stressors were significantly related to greater impulsivity including having been put up for adoption or in foster care (t=-2.96, p<0.01), and having a child taken away against their will (t=-2.68, p=0.01). These findings suggest that age and education relate to impulsivity; and that while an overall compilation of life stress scores was not related to impulsivity, specific types of stress related to either being taken away from a parent or having a child taken away were. Future studies should assess these constructs longitudinally to restrict response bias.

Executive functions in borderline personality disorder.

Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning.

Impulsive responses to emotion as a transdiagnostic vulnerability to internalizing and externalizing symptoms.

INTRODUCTION: This study explored the hypothesis that impulsive reactions to heightened emotion may reflect a transdiagnostic vulnerability to both externalizing and internalizing symptoms. METHODS: A sample of undergraduates completed self-report measures of aggression, borderline personality disorder symptoms, anxiety symptoms, and alcohol problems, and a subset completed interviews that assessed suicidality. All participants also completed self-report measures relating to impulsivity. We predicted that emotion-reactive impulsivity, but not other aspects of impulsivity, would be related to the set of psychopathology symptoms. RESULTS: Multiple regression analyses found that emotion-reactive impulsivity was uniquely related to each of the psychopathology scales, whereas non-emotion-relevant impulsivity was uniquely related only to alcohol problems. CONCLUSION: Discussion focuses on limitations and clinical implications.