Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1300 Moursund Street, Room 270, Houston, TX 77030, USA.
Curr Psychiatry Rep. 2009 Dec;11(6):481-7. doi: 10.1007/s11920-009-0073-2.
Impulsivity, a breakdown in the balance between initiation and screening of action that leads to reactions to stimuli without adequate reflection or regard for consequences, is a core feature of bipolar disorder and is prominent in manic episodes. Catecholaminergic function is related to impulsivity and mania. Manic individuals have abnormal dopaminergic reactions to reward and abnormal responses in the ventral prefrontal cortex that are consistent with impulsive behavior. Impulsivity in mania is pervasive, encompassing deficits in attention and behavioral inhibition. Impulsivity is increased with severe course of illness (eg, frequent episodes, substance use disorders, and suicide attempts). In mixed states, mania-associated impulsivity combines with depressive symptoms to increase the risk of suicide. Clinical management of impulsivity in mania involves addressing interpersonal distortions inherent in mania; reducing overstimulation; alertness to medical-, trauma-, or substance-related problems; and prompt pharmacologic treatment. Manic episodes must be viewed in the context of the life course of bipolar disorder.
冲动性，即启动和筛选行动之间的平衡崩溃，导致对刺激的反应而没有充分的思考或考虑后果，是双相情感障碍的核心特征，在躁狂发作中尤为突出。儿茶酚胺能功能与冲动性和躁狂有关。躁狂个体对奖励有异常的多巴胺反应，腹侧前额叶皮层的反应异常，与冲动行为一致。躁狂中的冲动性普遍存在，包括注意力和行为抑制的缺陷。严重的疾病病程（例如，频繁发作、物质使用障碍和自杀企图）会增加冲动性。在混合状态下，与躁狂相关的冲动性与抑郁症状相结合，增加了自杀的风险。躁狂中冲动性的临床管理包括解决躁狂中固有的人际扭曲；减少过度刺激；警惕与医疗、创伤或物质相关的问题；以及及时进行药物治疗。必须从双相情感障碍的生命历程来看待躁狂发作。
