Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness

Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX 77030, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 06/2010; 121(6):453-61. DOI: 10.1111/j.1600-0447.2009.01528.x
Source: PubMed


We investigated trait impulsivity in bipolar disorder and antisocial personality disorder (ASPD) with respect to severity and course of illness.
Subjects included 78 controls, 34 ASPD, 61 bipolar disorder without Axis II disorder, and 24 bipolar disorder with ASPD, by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (SCID-I and -II). Data were analyzed using general linear model and probit analysis.
Barratt Impulsiveness Scale (BIS-11) scores were higher in ASPD (effect sizes 0.5-0.8) or bipolar disorder (effect size 1.45) than in controls. Subjects with both had more suicide attempts and previous episodes than bipolar disorder alone, and more substance-use disorders and suicide attempts than ASPD alone. BIS-11 scores were not related to severity of crimes.
Impulsivity was higher in bipolar disorder with or without ASPD than in ASPD alone, and higher in ASPD than in controls. Adverse effects of bipolar disorder in ASPD, but not of ASPD in bipolar disorder, were accounted for by increased impulsivity.

Download full-text


Available from: Alan C Swann, Oct 07, 2015
14 Reads
  • Source
    • "Reaction times were slower in bipolar disorder than in controls, unless ASPD was also present (Table 2). We have reported that these subjects were more likely than other subjects with bipolar disorder to have many previous episodes of illness (Swann et al., 2010), and that subjects with many previous episodes had faster reaction times than other subjects with bipolar disorder (Swann et al., 2009b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Bipolar disorder and antisocial personality disorder (ASPD) overlap in clinical characteristics and behavioral consequences. Impulsivity is prominent in both, but there is little information on how specific mechanisms of impulsivity differentiate, bridge, or underlie the disorders. Subjects, all males, were controls (n = 46), bipolar disorder without cluster B personality disorder (n = 21), ASPD without bipolar disorder (n = 50), and bipolar disorder with ASPD (n = 16). Impulsivity measures were the Immediate Memory Task (IMT), a continuous performance test of response inhibition measuring ability to evaluate a stimulus before responding, and the Two-Choice Impulsivity Paradigm (TCIP), a choice between smaller-sooner and larger-later reward. Data were analyzed using general linear models analysis. Subjects with bipolar disorder had fewer IMT correct detections and slower reaction times than controls. Reaction times were faster with combined diagnoses than in bipolar disorder alone. TCIP responding in either diagnosis alone resembled controls, but was more impulsive in combined disorders. These differences persisted after correction for age and education, which had significant independent effects. In combined ASPD and bipolar disorder, increased reaction speed, impulsive response bias, and reward-delay impulsivity occurred independent of substance-use disorder history. Impulsivity was increased in the combined disorders over either disorder alone. Results were consistent with at least partially distinct mechanisms of impulsivity in ASPD and bipolar disorder. Compensatory mechanisms for impulsivity in uncomplicated ASPD or bipolar disorder appear to be compromised or lost when the disorders are combined.
    Journal of Psychiatric Research 06/2011; 45(11):1477-82. DOI:10.1016/j.jpsychires.2011.06.009 · 3.96 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Lemogne C, Fossati P, Limosin F, Nabi H, Encrenaz G, Bonenfant S, Consoli SM. Cognitive hostility and suicide. Objective: To determine whether a specific component of hostility (i.e. cognitive or behavioural) may predict suicide in a prospective design, controlling for depressive mood. Method: In 1993, 14 752 members of the ‘GAZ et ELectricité’ (GAZEL) cohort (10 819 men, mean age = 49.0 years; 3933 women, mean age = 46.2 years) completed the Center for Epidemiologic Studies Depression Scale and at least one subscale (i.e. cognitive or behavioural hostility) of the Buss and Durkee Hostility Inventory. Dates and causes of death were obtained annually. Results: During a mean follow-up of 15.7 years, 28 participants completed suicide (24 men, four women). Suicide was predicted by depressive mood [relative index of inequality (RII) (95% CI) = 8.16 (1.97–33.85)] and cognitive hostility [RII (95% CI) = 10.76 (2.50–46.42)], but not behavioural hostility [RII (95% CI) = 1.37 (0.38–4.97)]. These associations remained significant after adjustment for potential confounders. After mutual adjustment, however, suicide remained significantly associated with cognitive hostility [RII (95% CI) = 8.87 (1.52–51.71)] (RII reduction: 34.6%), but no longer with depressive mood [RII (95% CI) = 2.03 (0.41–10.07)] (RII reduction: 79.1%). Conclusion: Cognitive rather than behavioural hostility is associated with an increased risk of suicide, independently of baseline depressive mood.
    Acta Psychiatrica Scandinavica 12/2010; 124(1). DOI:10.1111/j.1600-0447.2010.01658.x · 5.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Antisocial personality disorder (ASPD) and bipolar disorder are both characterized by impulsive behavior, increased incarceration or arrest, addictive disorders and suicidal behavior. These characteristics appear more severe in the combined disorders. Individuals with ASPD who also have bipolar disorder have higher rates of addictive disorders and suicidal behavior and are more impulsive, as measured by questionnaires or behavioral laboratory tests. Those with bipolar disorder who have ASPD have higher rates of addictive, criminal and suicidal behavior, earlier onset of bipolar disorder with a more recurrent and predominately manic course and increased laboratory-measured, but not questionnaire-rated, impulsivity. These characteristics may result in part from differential impulsivity mechanisms in the two disorders, with bipolar disorder driven more by excessive catecholamine sensitivity and ASPD by deficient serotonergic function.
    12/2011; 1(6):599-610. DOI:10.2217/NPY.11.69
Show more