Study of impulsivity in bipolar affective disorder across the spectrum

Introduction: Bipolar Disorder runs across a spectrum between depression and mania. Impulsivity is known to be a core symptom of Bipolar disorder. This study aims at investigating the relationship between specific aspects of impulsivity and the affective symptoms in subjects with Bipolar Disorder. Methodology: Eligible candidates were assessed using a semi-structured proforma. The study participants were divided into four groups according to the nature of their current episode, namely: manic, depressed, mixed state or euthymic (control) group. Young’s Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) were used to assess affective symptom severity. Barratt’s Impulsivity Scale (BIS-11) was used to assess state impulsivity in each participant and the collected data was then analysed for correlation with patient profile and clinical parameters. Results: Impulsivity was higher in mania (p<0.0001) and mixed state (p=0.016) as compared to control group. Attentional impulsivity was significantly impaired in all phases of Bipolar Disorder; mania (p=0.013), depression (p<0.0001) and mixed state (p=0.001). Motor impulsivity was higher in mixed state (p<0.0001) and mania (p<0.0001). And non-planning impulsivity was significantly higher in mixed mood states (p=0.011). Non-planning impulsivity worsened with age in Bipolar disorder (p=0.012) especially in Bipolar Depression (p=0.005). Impulsivity was higher in females, specifically attentional (p=0.011), motor impulsivity (p=0.001). Total impulsivity (p=0.038) was higher in females in Bipolar Depression. A longer duration of illness also worsened total (p=0.022) and attentional (p=0.026) impulsivity over the years. Conclusion: Impulsivity varies significantly across the spectrum of Bipolar Disorder. While mania correlates more with motor impulsivity, depression correlates with attentional impulsivity and the mixed state correlates with all three. The illness correlates and patient profile do not significantly affect the overall expression of impulsivity as a whole.