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Correlation among impulsivity, temperament, character and neurocognitive performance in euthymic bipolar patients Daniela Bordalejo MD 1 , Oscar Boullosa MD 1, 2 , Eliana Hadid MD 1,2 , Luis Herbst MD 3 , Martín Puricelli MD 1 , Ester Romero PhD 1,2 ,

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Correlation among impulsivity, temperament, character and neurocognitive performance in euthymic bipolar patients

Daniela Bordalejo MD1, Oscar Boullosa MD1, 2, Eliana Hadid MD1,2, Luis Herbst MD3, Martín Puricelli MD1, Ester Romero PhD1,2,

Lucila Tannenhaus PhD1,2,3, Alejandra Vieitez MD1,2, Gustavo Vázquez MD PhD2

1. Centro Interdisciplinario en Neuropsiquiatría (CINeP) 2. Centro de Investigación en Neurociencia y Neuropsicología Clínicas de la Universidad de Palermo 3. Servicio de Consultorios Externos del Hospital T Borda

Table 2: Correlations between impulsivity vs. temperament and character

(TEMPS-A & TCI)

INTRODUCTION

Impulsivity is frequently associated to bipolar disorder (BD) and it has been proposed as a key feature of this illness.

The main objective of this study is to investigate the presence of clinical impulsivity and its correlation with affective temperaments, personality traits and neuropsychological performance among euthymic bipolar patients which would potentially constitute trait markers or endophenotypes for this recurrent affective disorder.

Impulsivity present in bipolar patients in depressive or hypo/manic phase in often the engine of risky behaviors for themselves and others. However, it is important to stress the existence of impulsivity as a feature component of this pathology, as it can lead to a behavioral change with a significant impact in daily life.

Table 1: Sociodemographic and clinical features of the sample

significance at .001 **, * significance at 0.05. T: Temperament, C: Character

Impaired neuropsychological functioning was shown in executive function, attention and memory tasks. The amount of tasks completed (4.85) in the Wisconsin CardSorting Test (WCST) was slightly below the expectations (6) while the amount of perseverative errors was higher than expected (23/17). In the Stroop test, scores were below expectations, but within the parameters of 1SD.

All neuropsychological tests related to executive functions were below mean, within 1SD.

METHODS

A total sample of 38 adult outpatients who fulfilled the American Psychiatric Association DSM-IV-TR criteria by SCID-I [Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)] interview for BD types I and II, were evaluated. All bipolar patients fulfilled the clinical criteria for euthymia [i.e. Young Mania Rating Scale (YMRS) ratings < 6 and Hamilton Depression Rating Scale (HAM-D) ratings < 8].

All participants provided written informed consent before completing the study. Impulsivity was assessed by using the Barratt Impulsiveness Scale (BIS-11). Affective temperaments were evaluated byusing the TEMPS-A Buenos Aires and personality traits were determined by the Temperament and Character Inventory (TCI 240R). All subjects completed a standard neurocognitive battery as well.

Exclusion criteria included adults aged < 18 and > 65, IQ score < 85, severe clinical or neurological pathologies, substance abuse as a main pathology or presence of a significant personality disorder (or other disorders in axis II).

RESULTS

38 euthymic BD subjects showed higher impulsivity scores compared to healthy controls, with no significant statistical differences between both subgroups of BD patients.

Euthymic BD individuals displayed significant higher total scores in their impulsivity (Total BIS), compared to healthy controls (44.6 vs. 35.5, respectively).Means cognitive and motor impulsivity scores were higher than healthy controls (13.9 vs. 9.5 and 15.4 vs. 9.5, respectively). Whereas for the non-planned impulsivity was similar (14 vs. 14.1, respectively).

We found a significant statistical correlation between impulsivity scores (BIS-11), dysthymic (p.009) and irritable (p.002) temperaments.

We also found a positive correlation between impulsivity scores and novelty seeking (extravagance) and a negative correlation with self-directedness, responsibility, dependence on reward and self-acceptance.

CONCLUSIONS

Impulsivity in patients with BD seems to be a characteristic trait or endophenotype, independent from mood, that manifests at multiple clinical levels (neuropsychological, temperamental and of character).

REFERENCES

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Najt P, Perez J, Sanches M, Peluso M, GlahnD, Soares JC. Impulsivity and bipolar disorder. EuropeanNeuropsychopharmacology 2007;17:313-320.

Oquendo M, Baca-García E, Graver R, Morales M, Montalvan VV, Mann J. Spanish adaptation of the Barratt Impulsiveness Scale (BIS-11). European Journ Psychiatry 2001; 15: 147-155.

Robinson LJ, Thompson JM, Gallagher P et al. A metaanalysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006; 93: 105–115.

Strakowski S, Fleck D, DelBello M, Shear P, Kotwal R, Arndt S. Impulsivity across the course of bipolar disorder. Bipolar Disorders 2010; 12: 285-297.

Swann AC, Moeller GF, Steinberg JL, Schneider L, Barratt ES, Dougherty DM. Manic symptoms and impulsivity during bipolar depressive episodes. Bipolar Disorder 2007; 9: 206–212.