1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
2 Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Aust N Z J Psychiatry. 2018 Sep;52(9):876-886. doi: 10.1177/0004867418783062. Epub 2018 Jul 4.
Bipolar disorder is a common, severe and chronic mental illness. Despite this, predictors of illness severity remain poorly understood. Impulsivity is reported to be associated with bipolar disorder and aggravating comorbidities. This study therefore sought to examine the predictive value of impulsivity for determining illness severity in euthymic bipolar disorder patients.
Baseline trait impulsivity of 120 bipolar euthymic patients (81 bipolar disorder I [68%], 80 female [67%]) and 51 healthy controls was assessed using Barratt Impulsiveness Scale 11. The impact of impulsivity on illness severity (measured with morbidity index) was prospectively tested in 97 patients with sufficient follow-up data (average observation time: 54.4 weeks), using linear regression analysis.
Barratt Impulsiveness Scale 11 total (β = 0.01; p < 0.01) and in particular Barratt Impulsiveness Scale 11 attentional subscale scores (β = 0.04; p < 0.001) predicted illness severity in bipolar disorder, while controlling for other clinical variables. Only age at onset persisted as an additional, but less influential predictor. Barratt Impulsiveness Scale 11 total scores and Barratt Impulsiveness Scale 11 attentional subscale scores were significantly higher in euthymic patients compared to controls. This was not observed for the motor or non-planning subscale scores.
The average year-long observation time might not be long enough to account for the chronic course of bipolar disorder.
Trait impulsivity and particularly attentional impulsivity in euthymic bipolar patients can be strong predictors of illness severity in bipolar disorder. Future studies should explore impulsivity as a risk assessment for morbidity and as a therapeutic target in bipolar disorder patients.
双相情感障碍是一种常见的、严重的、慢性精神疾病。尽管如此，疾病严重程度的预测因素仍知之甚少。冲动性被报道与双相情感障碍有关，并加重共病。因此，本研究旨在探讨冲动性对双相情感障碍缓解期患者疾病严重程度的预测价值。
采用巴瑞特冲动量表 11 评估 120 例双相情感障碍缓解期患者（81 例双相障碍 I 型[68%]，80 例女性[67%]）和 51 名健康对照者的基线特质冲动性。使用线性回归分析，对 97 例具有足够随访数据的患者（平均观察时间：54.4 周）进行前瞻性测试，以评估冲动性对疾病严重程度（用发病率指数衡量）的影响。
巴瑞特冲动量表 11 总得分（β=0.01；p<0.01）和特别是巴瑞特冲动量表 11 注意力分量表得分（β=0.04；p<0.001）在控制其他临床变量后，可预测双相情感障碍的疾病严重程度。只有发病年龄仍然是一个额外的但影响力较小的预测因素。与对照组相比，缓解期双相情感障碍患者的巴瑞特冲动量表 11 总得分和巴瑞特冲动量表 11 注意力分量表得分显著更高。然而，在运动或非计划分量表得分中并未观察到这种情况。
平均为期一年的观察时间可能不足以说明双相情感障碍的慢性病程。
缓解期双相情感障碍患者的特质冲动性，特别是注意力冲动性，可作为双相情感障碍疾病严重程度的有力预测因素。未来的研究应探索冲动性作为发病率的风险评估因素，并作为双相情感障碍患者的治疗靶点。
