Cukurova University, Faculty of Medicine, Department of Psychiatry, Adana, Turkey.
Compr Psychiatry. 2011 Jul-Aug;52(4):378-85. doi: 10.1016/j.comppsych.2010.08.004. Epub 2010 Oct 30.
Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients.
A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V.
The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(-) group. Length of time between mood episodes was higher in the ICD(-) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients as compared with the ICD(-) patients. There was no statistically significant difference between the age of first episode, seasonality, presence of psychotic features, and chronicity of illness. A statistically significant difference was observed between the ICD(+) and ICD(-) groups in terms of total impulsivity, attention, nonplanning, and motor impulsivity scores as determined by the Barratt Impulsiveness Scale Version 11.
The present study revealed that there is a high comorbidity rate between bipolar disorder and ICDs based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Alcohol/substance use disorders, a high number of previous suicide attempts, and depressive episodes should alert the physician to the presence of comorbid ICDs among bipolar patients that could affect the course and treatment of the disorder.
冲动与心境不稳定、行为问题以及双相障碍患者无计划行为有关。在所有类型的心境发作中，报告的冲动水平都有所增加。这种关联表明冲动控制障碍（ICD）与双相障碍之间存在高度共病。本研究的目的是比较双相 I 型情感稳定期患者 ICD 的患病率以及相关的临床和社会人口统计学变量。
从我们的双相情感障碍科门诊的定期就诊者中招募了 124 名连续的双相 I 型患者参与本研究。所有患者的症状均已缓解。使用《精神障碍诊断与统计手册》第四版的结构性临床访谈来确认双相情感障碍的诊断。使用改良版明尼苏达州冲动障碍访谈来调查冲动控制障碍。使用巴雷特冲动量表第 11 版来测量冲动性。此外，所有患者都完成了 Zuckerman 感觉寻求量表第五版。
在我们的样本中，所有共病 ICD 的患病率为 27.4%（n=34）。最常见的 ICD 亚型是病理性皮肤搔抓，其次是强迫性购买、间歇性爆发障碍和拔毛癖。没有出现纵火狂或强迫性行为。在有或没有 ICD 的双相情感障碍患者的社会人口统计学特征方面，年龄、性别、教育程度或婚姻状况没有统计学差异。在 ICD(+)组中，酒精/物质滥用和自杀未遂的共病率高于 ICD(-)组。在 ICD(-)组中，心境发作之间的时间间隔较长。两组之间的总心境发作次数存在统计学差异，但 ICD(+)患者的抑郁发作次数高于 ICD(-)患者。在首次发作年龄、季节性、精神病特征存在和疾病慢性方面，两组之间没有统计学差异。在巴雷特冲动量表第 11 版确定的总冲动、注意力、无计划和运动冲动评分方面，ICD(+)和 ICD(-)组之间存在统计学差异。
本研究表明，根据《精神障碍诊断与统计手册》第四版修订版的标准，双相障碍和 ICD 之间存在高共病率。酒精/物质使用障碍、多次自杀企图和抑郁发作应引起医生的注意，因为双相障碍患者可能存在共病 ICD，这可能会影响疾病的病程和治疗。
