Impulsivity across the course of bipolar disorder


  • The authors of this paper have no competing or financial interests in the results reported. Full disclosure of all potential conflicts of interest, even though unrelated to this work, has been provided to Bipolar Disorders, as required.

Corresponding author:
Stephen M. Strakowski, M.D.
Center for Imaging Research
University of Cincinnati College of Medicine
231 Albert Sabin Way (ML0583)
Cincinnati, OH 45267-0583
Fax: 513-558-0187


Strakowski SM, Fleck DE, DelBello MP, Adler CM, Shear PK, Kotwal R, Arndt S. Impulsivity across the course of bipolar disorder.
Bipolar Disord 2010: 12: 285–297. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.

Objective:  To determine whether abnormalities of impulse control persist across the course of bipolar disorder, thereby representing potential state markers and endophenotypes.

Methods:  Impulse control of 108 bipolar I manic or mixed patients was measured on three tasks designed to study response inhibition, ability to delay gratification, and attention; namely, a stop signal task, a delayed reward task, and a continuous performance task, respectively. Barrett Impulsivity Scale (BIS-11) scores were also obtained. Patients were then followed for up to one year and reassessed with the same measures if they developed depression or euthymia. Healthy comparison subjects were also assessed with the same instruments on two occasions to assess measurement stability.

Results:  At baseline, bipolar subjects demonstrated significant deficits on all three tasks as compared to healthy subjects, consistent with more impulsive responding in the bipolar manic/mixed group. In general, performance on the three behavioral tasks normalized upon switching to depression or developing euthymia. In contrast, BIS-11 scores were elevated during mania and remained elevated as bipolar subjects developed depression or achieved euthymia.

Conclusions:  Bipolar I disorder patients demonstrate deficits on laboratory tests of various aspects of impulsivity when manic, as compared to healthy subjects, that largely normalize with recovery and switching into depression. However, elevated BIS-11 scores persist across phases of illness. These findings suggest that impulsivity has both affective-state dependent and trait components in bipolar disorder.