Rapid-response impulsivity: definitions, measurement issues, and clinical implications

The role of Iowa gambling task performance in response to citalopram treatment for cocaine use disorder

Background: Cocaine use disorder (CUD) is associated with executive functioning impairments linked to serotonergic function. Previous studies reported efficacy with the selective serotonin reuptake inhibitor citalopram in reducing cocaine use.Objectives: The current study explored moderation and mediation of citalopram effects on cocaine use by performance across executive function domains.Methods: We conducted a secondary analysis of a double-blind, placebo-controlled, randomized Bayesian adaptive trial investigating citalopram efficacy in CUD treatment-seeking adults. At baseline and mid-treatment, participants completed assessments of decision-making (Iowa Gambling Task; IGT), attention, response inhibition, and cognitive flexibility. Outcomes were longest duration of abstinence (LDA; count of consecutive cocaine-negative urine tests) and Treatment Effectiveness Score (TES; count of cocaine-negative urine tests from study midpoint to endpoint). Bayesian models estimated independent moderation and mediation effects of cognitive ability on the association between treatment (citalopram 40 mg vs. placebo) and LDA/TES.Results: Of the four assessments, only the IGT demonstrated concurrent moderation and mediation in the sample (N = 80; 82% males). Treatment effects on LDA (IRR = 1.02) and TES (IRR = 1.03) were strongest in participants with higher baseline IGT scores, which indicate less risky decision-making (posterior probabilities >93%). Models supported a positive indirect effect of treatment on TES (IRR = 1.12, posterior probability = 81.6%), with 52.3% of the total effect mediated by changes in IGT scores from baseline to mid-treatment.Conclusion: We found evidence for IGT as a moderator and mediator of citalopram's effects on cocaine use. Decision-making ability may play a role in predicting who responds to citalopram and how.

A multi-level examination of impulsivity and links to suicide ideation among Native American youth

BACKGROUND

Despite preliminary evidence that links impulsivity to suicide risk among Native American youth, impulsivity has not been directly studied in relation to suicide ideation (SI) or behaviors in this population. We examined indexes of rapid-response impulsivity (RRI) across multiple levels of analysis (self-report, behavioral, neurobiological) and associations with SI among Native American youth ages 9-10 in the Adolescent Brain Cognitive Development Study.

METHODS

Data from the sample (n = 284) included self-report (UPPS-P), behavioral (Stop Signal Task), and neurobiological (right inferior frontal gyrus activation) indicators of RRI. RRI indicators were modeled using variable-centered (i.e., traditional multivariable regression) and person-centered (i.e., clustering analyses) approaches in measuring their association with SI.

RESULTS

Logistic regression analysis demonstrated that higher negative urgency was associated with higher odds of SI (Adjusted Odds Ratio = 1.23, p = 0.015). Latent profile analysis clustered youth into five profiles based on within-individual variation in RRI indicators. Youth with an elevated self-reported negative and positive urgency profile had higher odds of reporting SI than "normative" youth (Adjusted Odds Ratio = 2.38, p = 0.019).

LIMITATIONS

Limitations of this study include the modest sample size particularly regarding SI (14.1 %), potential bias in estimates of lifetime SI, and generalizability to youth from specific Native American communities.

CONCLUSIONS

Negative urgency may increase risk for SI among Native American youth in late childhood. Clinical implications, including the potential for person-centered RRI profiles to act as candidate markers of suicide risk and resilience in adolescence and inform safety assessments and planning, are discussed.

Evaluating the effect of an individualised reward-related impulsivity induction on ad libitum alcohol consumption: A pilot study

Impulsivity has well-documented associations with risky alcohol use. Little evidence exists on the causal mechanisms, but emerging experimental evidence suggests a role for reward-related impulsivity. Recent work experimentally increased reward-related impulsivity to increase drinking using standardised reward-cue stimuli. The present study piloted participant-generated reward-cue stimuli to increase laboratory alcohol consumption. Sixteen participants (56.3 % male; M age = 20.13, SD = 1.78) attended two laboratory sessions (experimental and control). In the experimental session, the Individualised Reward-seeking Induction Schedule (IRIS) had participants re-experience an intense, vivid memory of an approach motivational state (control session: no induction) before completing a laboratory drinking task. Self-reported reward-seeking, positive, and negative affect were measured. IRIS significantly increased alcohol consumption by 53.65 ml (SE = 29.11, p <.001) when controlling for positive and negative affect. IRIS also produced significantly higher state reward-seeking (Δꭓ2 (1) = 14.02, p <.001). Findings provide preliminary validation of IRIS, a new experimental methodology to investigate impulsivity-related alcohol use. Replication of observed effects in a larger sample is required. The present study supports the use of IRIS in future research to understand the causal role of reward-related impulsivity on alcohol consumption.

Feasibility and reliability of online vs in-person cognitive testing in healthy older people

BACKGROUND

Early evidence in using online cognitive assessments show that they could offer a feasible and resource-efficient alternative to in-person clinical assessments in evaluating cognitive performance, yet there is currently little understanding about how these assessments relate to traditional, in-person cognitive tests.

OBJECTIVES

In this preliminary study, we assess the feasibility and reliability of NeurOn, a novel online cognitive assessment tool. NeurOn measures various cognitive domains including processing speed, executive functioning, spatial working memory, episodic memory, attentional control, visuospatial functioning, and spatial orientation.

DESIGN

Thirty-two participants (mean age: 70.19) completed two testing sessions, unsupervised online and in-person, one-week apart. Participants were randomised in the order of testing appointments. For both sessions, participants completed questionnaires prior to a cognitive assessment. Test-retest reliability and concurrent validity of the online cognitive battery was assessed using intraclass correlation coefficients (ICCs) and correlational analysis, respectively. This was conducted by comparing performance in repeated tasks across testing sessions as well as with traditional, in-person cognitive tests.

RESULTS

Global cognition in the NeurOn battery moderately validated against MoCA performance, and the battery demonstrated moderate test-retest reliability. Concurrent validity was found only between the online and paper versions of the Trail Making Test -A, as well as global cognitive performance between online and in-person testing sessions.

CONCLUSIONS

The NeurOn cognitive battery provides a promising tool for measuring cognitive performance online both longitudinally and across short retesting intervals within healthy older adults. When considering cost-effectiveness, flexible administration, and improved accessibility for wider populations, online cognitive assessments show promise for future screening of neurodegenerative diseases.

Pharmacological management of gambling disorder: an update of the literature

INTRODUCTION

Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions.

AREAS COVERED

This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion).

EXPERT OPINION

Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation.

Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis

BACKGROUND

Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control.

METHODS

We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA.

RESULTS

We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A.

LIMITATIONS

There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included.

CONCLUSIONS

Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.

The Effects of Cognitive Impulsivity on the Duration of Remission in Alcohol-Dependent Patients

BACKGROUND

Cognitive impulsivity manifesting in impaired inhibitory control and decision-making impulsivity is observed both in alcohol-dependent and substance-dependent individuals and may affect the ability to maintain long-term (persistent) remission.

AIM

To evaluate the effects of cognitive parameters of impulsivity on the duration of remission in alcohol-dependent patients.

METHODS

The study included 83 patients with alcohol dependence and 51 mentally healthy study subjects as the control group. The distribution of patients by duration of remission was based on the DSM-5 criteria. Patients were divided into two groups according to the duration of their most recent remission: patients with early remission (n=48) and patients with sustained remission (n=35). Impulsivity was assessed using the Go/No-Go task, which included a response inhibition component (inhibitory control). Choice impulsivity was assessed using two cognitive tests that encompass its separate components: decision-making under risk (Cambridge Gambling Task, CGT), and decision making under uncertainty (Iowa Gambling Task, IGT).

RESULTS

The study groups (patients and the controls) differed significantly in all domains of impulsivity: decision making under risk [GT: decision making quality (H(2, N=134)=30.233, p <0.001) and decision-making time (H(2, N=134)=18.433, p <0.001)] and decision making under uncertainty [IGT: selecting cards from "losing" decks (H(2, N=134)=9.291, p=0.009)]. The group of patients with sustained alcohol remission was characterized by longer decision times in CGT compared to the group of patients with early remission (z=2.398, p=0.049). Decision quality in CGT (z=0.673, p=0.999) and IGT scores (z=1.202, p=0.687) were not statistically significantly different between the groups of patients with sustained and early remission from alcohol dependence. The assessment of impulsive actions showed that the study groups were significantly different in terms of their ability to suppress their dominant behavioral response when performing the GNG task [false presses when seeing the "No-Go" signal (H(2, N=134)=28.851, p <0.001)]. The group of patients in sustained remission from alcohol dependence was characterized by better suppression of the behavioral response to the "No-Go" signal relative to the patients in early remission [H(2, N=134)=2.743, p=0.044)]. The regression analysis showed that the decision-making quality (t=2.507, р =0.049) and decision-making time (t=3.237, р=0.031) and the number of false presses when seeing the "No-Go" signal in the GNC task had a statistically significant impact on the duration of remission (t=3.091, р =0.043).

CONCLUSION

The results of this study indicate that impaired decision-making processes and the ability to inhibit the dominant behavioral response have a significant impact on the ability of alcohol-dependent patients to maintain long-term remission.

Mediating effects of impulsivity and alexithymia in the association between traumatic brain injury and aggression in incarcerated males

Studies suggest both alexithymia and impulsivity (partially) explain aggressive behavior in traumatic brain injury (TBI) patients, but none of these studies use both questionnaire and performance-based measures as recommended, nor simultaneously investigate both impulsivity and alexithymia. The available studies therefore likely miss part of the constructs of alexithymia and impulsivity, and do not comprehensively assess the mediating effects of both constructs in the relationship between TBI and aggression. A sample of N = 281 incarcerated individuals were recruited from Dutch penitentiary institutions, and completed the Buss Perry Aggression Questionnaire (aggression), BIS-11 (impulsivity) and Toronto Alexithymia Scale-20 (alexithymia) questionnaires, as well as a stop-signal task and an emotion recognition paradigm. Several multiple mediation analyses were conducted using structural equation modelling, to assess the viability of a causal theoretical model of aggression. The final planned models were the original models with a good fit with the data (comparative fit index > 0.95, root mean square error of approximation and Standardized root mean square residual < 0.05), and results indicate that only questionnaire-based impulsivity mediated the relationship between TBI and aggression. TBI was unrelated to alexithymia, stop-signal or emotion recognition performance. Aggression was predicted by both alexithymia and impulsivity, but not by the performance measures. Post hoc analyses shows that alexithymia moderates the relationship between impulsivity and aggression. These results imply that aggressive incarcerated individuals showing impulsive behavior should be screened for TBI, since TBI is often overlooked or misdiagnosed, and indicate that both impulsivity and alexithymia are potential focus points for aggression reduction treatment in TBI patients.

Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review

Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.

Interval timing relative to response inhibition in the differential reinforcement of low-rate responding in normally developing young adults

With recent proposal suggesting the multifaceted nature of impulsivity, researchers have been intrigued by the question of whether the impulsive behaviour measured in the traditionally psychological paradigms is unitary. One such paradigm, the differential reinforcement of low-rate responding (DRL), has been used to assess response inhibition, but its underlying mechanism has still been debated. In present research, we examined and differentiated the effects of both response inhibition and interval timing on a multisession DRL-10 s (DRL-10 s) in a large sample of normally developing young adults, as well as with three other measures including the stop-signal reaction task (SSRT), time production task-10 s (TPT-10 s), and the Barrett impulsivity scale-11 (BIS-11). The results showed that behavioural changes existed in DRL. As the task sessions progressed, there was an increase in both reinforcement probability and peak time, but a decrease in burst responses. Most importantly, both principal component analysis and generalized multilevel modeling yielded consistent results that as the task progressed, there was an increasing involvement of the TPT in the late sessions of DRL. However, none of the effect of SSRT was found. In sum, the differential degrees of involvement of the timing process, relative to response inhibition, were observed in DRL.

Neural correlates of impulsivity in bipolar disorder: A systematic review and clinical implications

Impulsivity is a common feature of bipolar disorder (BD) with ramifications for functional impairment and premature mortality. This PRISMA-guided systematic review aims to integrate findings on the neurocircuitry associated with impulsivity in BD. We searched for functional neuroimaging studies that examined rapid-response impulsivity and choice impulsivity using the Go/No-Go Task, Stop-Signal Task, and Delay Discounting Task. Findings from 33 studies were synthesized with an emphasis on the effect of mood state of the sample and affective salience of the task. Results suggest trait-like brain activation abnormalities in regions implicated in impulsivity that persist across mood states. During rapid-response inhibition, BD exhibit under-activation of key frontal, insular, parietal, cingulate, and thalamic regions, but over-activation of these regions when the task involves emotional stimuli. Delay discounting tasks with functional neuroimaging in BD are lacking, but hyperactivity of orbitofrontal and striatal regions associated with reward hypersensitivity may be related to difficulty delaying gratification. We propose a working model of neurocircuitry dysfunction underlying behavioral impulsivity in BD. Clinical implications and future directions are discussed.

Use of experimental medicine approaches for the development of novel psychiatric treatments based on orexin receptor modulation

Despite progress in understanding the pathological mechanisms underlying psychiatric disorders, translation from animal models into clinical use remains a significant bottleneck. Preclinical studies have implicated the orexin neuropeptide system as a potential target for psychiatric disorders through its role in regulating emotional, cognitive, and behavioral processes. Clinical studies are investigating orexin modulation in addiction and mood disorders. Here we review performance-outcome measures (POMs) arising from experimental medicine research methods which may show promise as markers of efficacy of orexin receptor modulators in humans. POMs provide objective measures of brain function, complementing patient-reported or clinician-observed symptom evaluation, and aid the translation from preclinical to clinical research. Significant challenges include the development, validation, and operationalization of these measures. We suggest that collaborative networks comprising clinical practitioners, academics, individuals working in the pharmaceutical industry, drug regulators, patients, patient advocacy groups, and other relevant stakeholders may provide infrastructure to facilitate validation of experimental medicine approaches in translational research and in the implementation of these approaches in real-world clinical practice.

[Features of the reward-based decision-making in patients with alcohol use disorders]

Foreign studies increasingly emphasize the role of reward-based cognitive decision-making and its contribution to alcohol and drug abuse. Unfortunately, such studies are extremely few in Russia. Given the importance of the insufficiency of cognitive functions, primarily the decision-making process based on reward, among the risk factors of addictive pathology, increasing the severity of alcoholism, reducing the effectiveness of its therapy and rehabilitation, research in this direction is extremely relevant. This review summarizes and systematizes current data on the features of the cognitive decision-making process based on reward in patients with alcohol dependence. An analysis of the literature has shown that reward-based decision making is an important component of addictive behavior. Patients with alcohol dependence, as well as people, who abuse alcohol, demonstrate clear impairment of this cognitive function. Thus, the relative value of diagnosing disorders in decision-making in modern psychiatry is beyond doubt. It is recommended to include the above tests in the diagnostic complex of a psychiatrist, along with standard psychometric tools.

Blockade of the orexin 1-receptors and 'cocaine- and amphetamine-regulated transcript' in the nucleus accumbens shell alters impulse control in rats

Impulsivity is a multifaceted construct and alterations in impulsiveness are often associated with psychiatric diseases, including drug addiction and binge eating disorder. Impulse control involves several brain regions. The present study assessed the role of the orexigenic, appetite stimulating neuropeptide orexin (OX) and the anorexigenic, appetite reducing neuropeptide cocaine- and amphetamine-regulated transcript (CART) within the nucleus accumbens shell (NAcSh) in impulse control in rats. The animals were ranked for their trait impulsivity based on a screening in the 5-choice serial reaction time task (5-CSRTT). The rats' performances were analysed after bilateral infusions of the OX 1-receptor antagonist SB-334867 (SB) and CART-antibodies (CART-ABs) into the NAcSh. After SB infusions, there was no change in premature responses observed on average. Further analysis revealed a negative linear correlation between the effect of intra-NAcSh SB infusions on premature responses and trait impulsivity. The effect of SB ranged from an increase, no change to a decrease in premature responses in the individual animals with increasing trait impulsivity. Infusions of CART-ABs led to consistently enhanced impulse control with fewer irrelevant actions, independent of trait impulsivity. These data suggest that both OX, especially OX A, and CART in the NAcSh, can be considered endogenous regulators of impulsive action, dependent on underlying impulsivity in the case of OX and independent from trait impulsivity in the case of CART.

Impulsivity Predicts Relapse—but Not Dropout—in Outpatients with SUD: a Longitudinal Study

The objective of this study was to compare performance on a comprehensive impulsivity battery of SUD outpatients who dropout versus those who do not dropout and of abstainers versus relapsers at 3 and 12 months of treatment follow-up. Impulsivity was measured at the start of treatment and adherence and relapse at 3 and 12 months. The participants are 115 outpatients with SUD. Motor impulsivity (Affective Go/No Go), attentional impulsivity (Stroop), delay discounting (Monetary Choice Questionnaire; MCQ), and decision making (Iowa Gambling Task; IGT) were assessed. Impulsivity was not associated with dropout. There were no relationships between treatment outcomes and the MCQ and IGT. Stroop and affective Go-No Go were associated with relapse at 3 and 12 months. Affective motor disinhibition and cognitive disinhibition predict relapse in outpatients. No cognitive aspect of impulsiveness is related to dropout.

Neurocognitive Impulsivity in Opiate Users at Different Lengths of Abstinence

The aim of the current study was to examine the effects of length of abstinence on decision making (impulsive choice) and response inhibition (impulsive action) in former opiate users (OU). Participants included 45 OU in early remission [0−12 months of abstinence], 68 OU in sustained remission [>12 months of abstinence], and 68 control participants. Decision making was assessed with the Iowa Gambling Task (IGT), the Cambridge Gambling Task (CGT), and the Monetary Choice Questionnaire (MCQ). Response inhibition was examined with the Stop Signal Task (SST), and the Go/No-Go Task (GNG). Results revealed group differences in decision making under risk (CGT) and ambiguity (IGT), where control participants displayed better decision making compared to OU in early remission. Both groups of former OU were also characterized by higher discounting of delayed rewards (MCQ). Regression analyses revealed minimal effects of length of abstinence on performance on decision-making tasks and no effects on delay discounting. In addition, both OU groups showed reduced action inhibition (GNG) relative to controls and there were no group differences in action cancellation (SST). Length of abstinence had no effect on response inhibition. Overall, our findings suggest that neurocognitive function may not fully recover even with protracted abstinence, which should be addressed by relapse prevention and cognitive remediation programs for OU.

Dissociable behavioural signatures of co-existing impulsivity and apathy in decision-making

Apathy and impulsivity are expressed in a wide range of neuropsychiatric disorders, and, to a less severe extent, in healthy people too. Although traditionally considered to be opposite extremes of a single motivational spectrum, recent epidemiological questionnaire-based data suggest that both traits can in fact co-exist within the same individual. Here, we sought to investigate the relationship between these constructs in healthy people within a controlled task environment that examines the ability to make a decision under temporal uncertainty and measures the vigour of the response. Sixty participants performed a new version of the Traffic Light Task and completed self-report questionnaire measures of apathy and impulsivity. The task required individuals to make rapid decision-making for time-sensitive reward by squeezing a hand-held dynamometer as quickly as possible after a predictable event occurred (a traffic light turning green). Although apathy and impulsivity were positively correlated in questionnaire assessments, the two traits were associated with distinct behavioural signatures on the task. Impulsivity was expressed as an inflexible tendency to generate rapid anticipatory responses, regardless of cost-benefit information. Apathy, on the other hand, was associated with a blunted effect of reward on response vigour. These findings reveal how apathy and impulsivity are related to distinct dimensions of goal-directed behaviour, explaining how these traits might co-exist in the same individuals.

Cognitive Flexibility and Impulsivity Deficits in Suicidal Adolescents

Although neurocognitive deficits have been documented in adolescents with suicidal ideation (SI) and suicide attempts (SA), it is unclear whether certain impairments differentiate these groups, potentially suggesting heightened risk for SA. Focus on specific facets of impulsivity and cognitive control may indicate distinctions between adolescents with SA vs. SI. The current study examined dimensions of impulsivity and cognitive control in 141 adolescents with SA (n = 41) vs. SI without SA (n = 49) vs. typically-developing controls (TDCs; n = 51). Adolescents completed cross-sectional neurocognitive tasks via the Cambridge Neuropsychological Testing Automated Battery, in addition to demographic and clinical measures. Analyses involved ANOVAs and ANCOVAs. Results indicated that adolescents with SA demonstrated less set shifting/cognitive flexibility (reduced ability to adapt to/disengage from stimuli) and greater impulsive decision making (reduced ability to collect/evaluate information before making decisions) compared to TDCs. In addition, both TDCs and adolescents with SA had greater response inhibition (increased ability to stop motor responses that have begun/become prepotent) than those with SI. Similar results were found when analyzing female adolescents separately. There were no significant differences for male adolescents, potentially due to the small subsample (n = 40). There were no significant findings for spatial planning/problem solving or visuospatial working memory. Findings suggest: 1) less set shifting/cognitive flexibility and greater impulsive decision making for adolescents with SA vs. TDCs; and 2) greater response inhibition for TDCs and adolescents with SA vs. SI. Such information may be useful for improving risk assessments (adding neurocognitive tasks) and targeted treatments (incorporating cognitive remediation) for this impaired population.

Strategy and processing speed eclipse individual differences in control ability in conflict tasks

Response control or inhibition is one of the cornerstones of modern cognitive psychology, featuring prominently in theories of executive functioning and impulsive behavior. However, repeated failures to observe correlations between commonly applied tasks have led some theorists to question whether common response conflict processes even exist. A challenge to answering this question is that behavior is multifaceted, with both conflict and nonconflict processes (e.g., strategy, processing speed) contributing to individual differences. Here, we use a cognitive model to dissociate these processes; the diffusion model for conflict tasks (Ulrich et al., 2015). In a meta-analysis of fits to seven empirical datasets containing combinations of the flanker, Simon, color-word Stroop, and spatial Stroop tasks, we observed weak (r < .05) zero-order correlations between tasks in parameters reflecting conflict processing, seemingly challenging a general control construct. However, our meta-analysis showed consistent positive correlations in parameters representing processing speed and strategy. We then use model simulations to evaluate whether correlations in behavioral costs are diagnostic of the presence or absence of common mechanisms of conflict processing. We use the model to impose known correlations for conflict mechanisms across tasks, and we compare the simulated behavior to simulations when there is no conflict correlation across tasks. We find that correlations in strategy and processing speed can produce behavioral correlations equal to, or larger than, those produced by correlated conflict mechanisms. We conclude that correlations between conflict tasks are only weakly informative about common conflict mechanisms if researchers do not control for strategy and processing speed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavioral measures of impulsivity and compulsivity in adolescents with nonsuicidal self-injury

BACKGROUND

Nonsuicidal self-injury (NSSI) is prevalent among adolescents and research is needed to clarify the mechanisms which contribute to the behavior. Here, the authors relate behavioral neurocognitive measures of impulsivity and compulsivity to repetitive and sporadic NSSI in a community sample of adolescents.

METHODS

Computerized laboratory tasks (Affective Go/No-Go, Cambridge Gambling Task, and Probabilistic Reversal Task) were used to evaluate cognitive performance. Participants were adolescents aged 15 to 17 with (n = 50) and without (n = 190) NSSI history, sampled from the ROOTS project which recruited adolescents from secondary schools in Cambridgeshire, UK. NSSI was categorized as sporadic (1-3 instances per year) or repetitive (4 or more instances per year). Analyses were carried out in a series of linear and negative binomial regressions, controlling for age, gender, intelligence, and recent depressive symptoms.

RESULTS

Adolescents with lifetime NSSI, and repetitive NSSI specifically, made significantly more perseverative errors on the Probabilistic Reversal Task and exhibited significantly lower quality of decision making on the Cambridge Gambling Task compared to no-NSSI controls. Those with sporadic NSSI did not significantly differ from no-NSSI controls on task performance. NSSI was not associated with behavioral measures of impulsivity.

CONCLUSIONS

Repetitive NSSI is associated with increased behavioral compulsivity and disadvantageous decision making, but not with behavioral impulsivity. Future research should continue to investigate how neurocognitive phenotypes contribute to the onset and maintenance of NSSI, and determine whether compulsivity and addictive features of NSSI are potential targets for treatment.

High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex may reduce impulsivity in patients with methamphetamine use disorders: A pilot study

Background

Individuals who use methamphetamine (MA) for a long period of time may experience decreased inhibition and increased impulsivity. In order to reduce impulsivity or improve inhibitory control ability, high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has attracted much attention of researchers. Recent studies on addiction have shown that rTMS can stimulate different brain regions to produce different therapeutic effects. Recent work also suggests that HF-rTMS over right dorsolateral prefrontal cortex (DLPFC) does not affect the impulsivity of patients with alcohol use disorder; while HF-rTMS over left DLPFC could improve the impulsivity of patients with alcohol use disorder and cigarette smokers. However, it should be noted that empirical studies applying HF-rTMS over left DLPFC of patients with MA use disorders (MAUD) (to evaluate its effect on impulsivity) are still lacking.

Methods

Twenty-nine patients with MAUD underwent five sessions of HF-rTMS on the left DLPFC per week for 4 consecutive weeks. The cue-induced craving and stop-signal and NoGo task were assessed pre-rTMS and post-rTMS (at the end of the 4-week rTMS treatment). In addition, 29 healthy controls were recruited. There was no rTMS intervention for the controls, the performance of the stop-signal and NoGo task was evaluated on them.

Results

In total, HF-rTMS of the left DLPFC significantly decreased MA-dependent patients’ cue-induced craving and stop-signal reaction time (SSRT). For SSRT, the pre-test of experimental group was significantly higher than the score of control group. In the experimental group, the pre-test score was significantly higher than the post-test score. For Go and stop-signal delay (SSD), the pre-test scores of the experimental group was significantly lower than the scores of the control group. No significant difference was found between the pre-test and the post-test scores of the experimental group.

Conclusion

Add-on HF-rTMS of left DLPFC may be an effective intervention for reducing impulsivity and cue-induced craving of patients with MAUD. Future research with a control group of MAUD that does not undergo the treatment is needed to confirm the effectiveness.

The use of transcranial direct current stimulation (tDCS) to reduce impulsivity and aggression in adults with mild intellectual developmental disabilities: the tDCS-RIADD randomised controlled trial protocol

Background

Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS).

Methods

This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomised, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessing impulsivity and aggression will be collected for up to 1 month following the last tDCS session.

Discussion

The results of this study may pave the way for developing targeted interventions for impulsivity and aggressive behaviours in people with IDD.

Development of an individualized procedure to induce reward-related impulsivity and evaluating its impact on drinking control

High impulsivity predisposes young adults to engage in hazardous alcohol use. Experimental research has shown that reward-related impulsivity is causally-related to heavier drinking. Correlational studies suggest that positive alcohol outcome expectancies mediate this effect, but causation has yet to be established. This study sought to clarify this relationship by: 1) developing a new, individualized procedure for inducing reward-related impulsivity with high generalizability; 2) experimentally manipulating positive alcohol expectancies to determine its mechanistic role in reward-related impulsivity risk for drinking. Eighty-seven young adults (67% female; M_age = 19.19, SD = 2.01) received either a covert manipulation to reduce positive alcohol expectancies (n = 43) or control (n = 44) after being administered the Individualized Reward-Seeking Induction Schedule (IRIS). The primary outcome was self-reported confidence in the ability to refuse alcohol in cued situations (drinking refusal self-efficacy). Results showed that IRIS increased reward-related impulsivity (p < .001, d_rm = 0.48) and reduced drinking refusal self-efficacy (p = .029, η²_P = .055, ω_p² = .043). Experimentally diminishing positive alcohol expectancies had a marginal effect on the reward-seeking induction when controlling for covariates (p = .057, η²_P = .044). Findings provide preliminary validation of IRIS as a new methodology for investigating the causal role of reward-related impulsivity in alcohol-related cognition and youth drinking.

Sports-betting-related gambling disorder: Clinical features and correlates of cognitive behavioral therapy outcomes

BACKGROUND AND AIMS

The number of patients with gambling disorder (GD) whose gambling preference is sports betting is increasing. However, their clinical profile and their responses to psychological treatments -compared to patients with other forms of gambling- have not been thoroughly studied. Therefore, the aims of this study were: (1) to compare the clinical characteristics of GD patients whose primary gambling activity was sports betting (SB+; n = 113) with GD patients with other primary gambling activities (SB-; n = 1,135); (2) to compare treatment outcomes (dropout and relapses) between SB + and SB- patients; and (3) to explore relationships between specific variables (GD severity, psychological distress and personality features) and treatment outcome in SB + and SB- GD patients, through correlation models and path-analysis.

METHODS

The cognitive behavioral treatment consisted of 16 weekly sessions. Personality features, psychopathology, and sociodemographic and clinical factors were assessed.

RESULTS

The SB + group included higher proportions of younger patients who were single and had higher educational levels, older ages of GD onset, and greater GD severities. Regarding treatment outcomes, the dropout rate was lower in the SB + group, and no between-group differences were found regarding relapse. Dropout within the SB + group was related to being unemployed, and relapse was related to being unmarried and experiencing more psychological distress.

DISCUSSION AND CONCLUSION

The differences between SB + and SB- GD patients suggest that GD patients with sports-betting problems may benefit from tailored therapeutic approaches.

Impulsivity, aggression, and suicidality relationship in adults: A systematic review and meta-analysis

BACKGROUND

The aim of the study was to crystallize the nature of relationships between impulsivity, aggression, and suicidality. We reviewed studies of adults with published, psychometric measures of impulsivity and aggression, and measures of suicidality.

METHODS

Our primary data source was Web of Science (from inception to 31st December 2021). Quality of articles was assessed using a Joanna Briggs Appraisal Tool and publication bias using Trim and Fill. We synthesised results using random effects meta-analyses and explored moderation by measure of impulsivity, aggression, and suicidality, and population.

FINDINGS

77 studies were included in our analysis. We found weak positive relationships between impulsivity (r = 0·19 [95% CI: 0·15-0·22]), aggression (0·23 ([0·17, 0·29]), and impulsive aggression (0·16 [0·1, 0·22]) with suicidality. Heterogeneity was significant and only partially explained by moderators. Limitations included the lack of studies which assess impulsivity or aggression proximal to suicidality.

INTERPRETATION

Given small effect sizes and significant heterogeneity, the study suggests that additional studies are needed in the field to analyze the relation between impulsivity and aggression with suicidality.

FUNDING

None.

Functional and pharmacological role of the dopamine D4 receptor and its polymorphic variants

The functional and pharmacological significance of the dopamine D₄ receptor (D₄R) has remained the least well understood of all the dopamine receptor subtypes. Even more enigmatic has been the role of the very prevalent human DRD4 gene polymorphisms in the region that encodes the third intracellular loop of the receptor. The most common polymorphisms encode a D₄R with 4 or 7 repeats of a proline-rich sequence of 16 amino acids (D_4.4R and D_4.7R). DRD4 polymorphisms have been associated with individual differences linked to impulse control-related neuropsychiatric disorders, with the most consistent associations established between the gene encoding D_4.7R and attention-deficit hyperactivity disorder (ADHD) and substance use disorders. The function of D₄R and its polymorphic variants is being revealed by addressing the role of receptor heteromerization and the relatively avidity of norepinephrine for D₄R. We review the evidence conveying a significant and differential role of D_4.4R and D_4.7R in the dopaminergic and noradrenergic modulation of the frontal cortico-striatal pyramidal neuron, with implications for the moderation of constructs of impulsivity as personality traits. This differential role depends on their ability to confer different properties to adrenergic α_2A receptor (α_2AR)-D₄R heteromers and dopamine D₂ receptor (D₂R)-D₄R heteromers, preferentially localized in the perisomatic region of the frontal cortical pyramidal neuron and its striatal terminals, respectively. We also review the evidence to support the D₄R as a therapeutic target for ADHD and other impulse-control disorders, as well as for restless legs syndrome.

Transdiagnostic Perspective of Impulsivity and Compulsivity in Obesity: From Cognitive Profile to Self-Reported Dimensions in Clinical Samples with and without Diabetes

Impulsive and compulsive behaviors have both been observed in individuals with obesity. The co-occurrence of obesity and type 2 diabetes (T2D) is more strongly associated with impulsivity, although there are no conclusive results yet. A multidimensional assessment of impulsivity and compulsivity was conducted in individuals with obesity in the absence or presence of T2D, compared with healthy, normal-weight individuals, with highly impulsive patients (gambling disorders), and with highly compulsive patients (anorexia nervosa). Decision making and novelty seeking were used to measure impulsivity, and cognitive flexibility and harm avoidance were used for compulsivity. For impulsivity, patients with obesity and T2D showed poorer decision-making ability compared with healthy individuals. For compulsivity, individuals with only obesity presented less cognitive flexibility and high harm avoidance; these dimensions were not associated with obesity with T2D. This study contributes to the knowledge of the mechanisms associated with diabetes and its association with impulsive-compulsive behaviors, confirming the hypothesis that patients with obesity and T2D would be characterized by higher levels of impulsivity.

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Impulsivity and compulsivity in binge eating disorder: A systematic review of behavioral studies

BACKGROUND

Binge eating disorder (BED) often includes impulsive and compulsive behaviors related to eating behavior and food. Impulsivity and compulsivity generally may contribute to the etiology and maintenance of multiple psychiatric disorders including BED. This review aimed to identify and synthesize available behavioral studies of impulsivity and compulsivity among individuals with BED.

METHOD

A systematic search was performed focusing on BED and specific facets of impulsivity (rapid response and choice) and compulsivity (set-shifting, cognitive flexibility, and/or habit learning). All case-control studies comparing adults with either full-threshold or subthreshold BED to individuals with normal weight, overweight/obesity, or other eating disorders (e.g., bulimia nervosa) were included.

RESULTS

Thirty-two studies representing 29 unique samples met inclusion criteria. Increased choice impulsivity was observed among individuals with BED relative to individuals with normal weight. There were mixed findings and/or a lack of available evidence regarding rapid response impulsivity and compulsivity. The presence of between-group differences was not dependent on sample characteristics (e.g., full or sub threshold BED diagnosis, or treatment-seeking status). Heterogeneity relating to covariates, task methodologies, and power limited conclusions.

CONCLUSIONS

Literature supports a postive association between choice impulsivity and BED. More research is needed to determine if individuals with BED demonstrate elevated levels of either rapid response impulsivity or types of compulsivity. Careful selection of covariates and consideration of task methodologies and power would aid future research.

The effects of combination levodopa-ropinirole on cognitive improvement and treatment outcome in individuals with cocaine use disorder: A bayesian mediation analysis

BACKGROUND

Chronic cocaine users show impairments in cognitive processes associated with dopamine (DA) circuitry. Medications aimed at bolstering cognitive functions via DA modulation might enhance treatment outcome.

METHODS

The trial used a double-blind, double-dummy, parallel-group design with four treatment arms comparing placebo (PLC) to levodopa/carbidopa 800 mg/200 mg alone (LR0), levodopa plus extended release (XR) ropinirole 2 mg (LR2) or XR ropinirole 4 mg (LR4). Adults (n = 110) with cocaine use disorder attended thrice weekly clinic visits for 10 weeks. Potential cognitive mediators assessed at week 5 consisted of measures of decision-making (Iowa Gambling Task, Risky Decision-Making Task), attention/impulsivity (Immediate Memory Task), motivation (Progressive Ratio task), and cognitive control (Cocaine Stoop task). The primary outcome measure was the treatment effectiveness score (TES) calculated as the number of cocaine-negative urines collected from weeks 6-10.

RESULTS

Bayesian mediation examined indirect and total effects of the relationships between each active treatment (compared to PLC) and TES. Total (direct) effects were supported for LR0 and LR2, but not for LR4. Indirect effects were tested for each mediator. Notably, 22.3 % and 35.4 % of the total effects of LR0 and LR2 on TES were mediated by changes in attention/impulsivity.

CONCLUSIONS

The hypothesized mediation effect was strongest for levodopa plus 2 mg ropinirole, indicating that this DA medication combination predicted change (improvement) in attention/impulsivity, which in turn predicted change (reduction) in cocaine use. This finding provides modest support for cognitive enhancement as a target for medications to treat cocaine use disorder.

[Ordalie, sensation-seeking and impulsivity. Critical analysis of definitions]

BACKGROUND

In the fields of psychology and psychiatry, the use of the terms impulsivity, sensation-seeking and ordalie to refer to risk-taking behaviors can sometimes be confusing.

OBJECTIVE

The objective of this study was to establish a clinical definition of the concepts of ordalie, sensation-seeking and impulsivity, in order to analyze the similarities and differences between these concepts.

METHODS

We prioritized literature review articles with or without meta-analysis from the Medline database and supplemented with the Google-Scholar database. The articles were included in this review if their objectives were in line with ours. The research was conducted in November 2018.

RESULTS

Twenty-seven articles were selected. There are similarities in the clinical definitions of these concepts with measurable heterogeneous constructions, and an exacerbation in adolescence for engagement in harmful behaviors, but there are also nuances that highlight their differences.

CONCLUSION

We were able to describe areas of divergence and convergence between these three concepts but not to establish a quantitative diagram of the areas of divergence and convergence. It would seem that the coexistence of sensation-seeking and impulsivity in the same individual could explain that individual's involvement in ordalique behaviors. Further studies approaching this hypothesis would seem useful in terms of preventing risk-taking behaviors such as addictive behaviors.

Subanesthetic ketamine with an AMPAkine attenuates motor impulsivity in rats

The concept of 'impulse control' has its roots in early psychiatry and today has progressed into a well-described, although poorly understood, multidimensional endophenotype underlying many neuropsychiatric disorders (e.g., attention deficit hyperactivity disorder, schizophrenia, substance use disorders). There is mounting evidence suggesting that the cognitive and/or behavioral dimensions underlying impulsivity are driven by dysfunctional glutamate (Glu) neurotransmission via targeted ionotropic Glu receptor (GluR) [e.g., N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)] mechanisms and associated synaptic alterations within key brain nodes. Ketamine, a noncompetitive NMDAR antagonist and FDA-approved for treatment-resistant depression, induces a 'glutamate burst' that drives resculpting of the synaptic milieu, which lasts for several days to a week. Thus, we hypothesized that single and repeated treatment with a subanesthetic ketamine dose would normalize motor impulsivity. Next, we hypothesized that AMPAR positive allosteric modulation, alone or in combination with ketamine, would attenuate impulsivity and provide insight into the mechanisms underlying GluR dysfunction relevant to motor impulsivity. To measure motor impulsivity, outbred male Sprague-Dawley rats were trained on the one-choice serial reaction time task. Rats pretreated with single or repeated (3 days) administration of ketamine (10 mg/kg; i.p.; 24-h pretreatment) or with the AMPAkine HJC0122 (1 or 10 mg/kg; i.p.; 30-min pretreatment) exhibited lower levels of motor impulsivity vs. control. Combination of single or repeated ketamine plus HJC0122 also attenuated motor impulsivity vs. control. We conclude that ligands designed to promote GluR signaling represent an effective pharmacological approach to normalize impulsivity and subsequently, neuropsychiatric disorders marked by aberrant impulse control.

A unified online test battery for cognitive impulsivity reveals relationships with real-world impulsive behaviours

Impulsive behaviours are a major contributor to the global burden of disease, but existing measures of cognitive impulsivity have suboptimal reliability and validity. Here, we introduce the Cognitive Impulsivity Suite, comprising three computerized/online tasks using a gamified interface. We conceptualize rapid-response impulsive behaviours (disinhibition) as arising from the failure of three distinct cognitive mechanisms: attentional control, information gathering and monitoring/shifting. We demonstrate the construct and criterion validity of the Cognitive Impulsivity Suite in an online community sample (N = 1,056), show test-retest reliability and between-subjects variability in a face-to-face community sample (N = 63), and replicate the results in a community and clinical sample (N = 578). The results support the theoretical architecture of the attentional control, information gathering and monitoring/shifting constructs. The Cognitive Impulsivity Suite demonstrated incremental criterion validity for prediction of real-world, addiction-related problems and is a promising tool for large-scale research on cognitive impulsivity.

Gambling activity in the old-age general population

Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.

Out of control: An altered parieto-occipital-cerebellar network for impulsivity in bipolar disorder

Bipolar disorder is an affective disorder characterized by rapid fluctuations in mood ranging from episodes of depression to mania, as well as by increased impulsivity. Previous studies investigated the neural substrates of bipolar disorder mainly using univariate methods, with a particular focus on the neural circuitry underlying emotion regulation difficulties. In the present study, capitalizing on an innovative whole-brain multivariate method to structural analysis known as Source-based Morphometry, we investigated the neural substrates of bipolar disorder and their relation with impulsivity, assessed with both self-report measures and performance-based tasks. Structural images from 46 patients with diagnosis of bipolar disorder and 60 healthy controls were analysed. Compared to healthy controls, patients showed decreased gray matter concentration in a parietal-occipital-cerebellar network. Notably, the lower the gray matter concentration in this circuit, the higher the self-reported impulsivity. In conclusion, we provided new evidence of an altered brain network in bipolar disorder patients related to their abnormal impulsivity. Taken together, these findings extend our understanding of the neural and symptomatic characterization of bipolar disorder.

Rejecting impulsivity as a psychological construct: A theoretical, empirical, and sociocultural argument

We demonstrate through theoretical, empirical, and sociocultural evidence that the concept of impulsivity fails the basic requirements of a psychological construct and should be rejected as such. Impulsivity (or impulsiveness) currently holds a central place in psychological theory, research, and clinical practice and is considered a multifaceted concept. However, impulsivity falls short of the theoretical specifications for hypothetical constructs by having meaning that is not compatible with psychometric, neuroscience, and clinical data. Psychometric findings indicate that impulsive traits and behaviors (e.g., response inhibition, delay discounting) are largely uncorrelated and fail to load onto a single, superordinate latent variable. Modern neuroscience has also failed to identify a specific and central neurobehavioral mechanism underlying impulsive behaviors and instead has found separate neurochemical systems and loci that contribute to a variety of impulsivity types. Clinically, these different impulsivity types show diverging and distinct pathways and processes relating to behavioral and psychosocial health. The predictive validity and sensitivity of impulsivity measures to pharmacological, behavioral, and cognitive interventions also vary based on the impulsivity type evaluated and clinical condition examined. Conflation of distinct personality and behavioral mechanisms under a single umbrella of impulsivity ultimately increases the likelihood of misunderstanding at a sociocultural level and facilitates misled hypothesizing and artificial inconsistencies for clinical translation. We strongly recommend that, based on this comprehensive evidence, psychological scientists and neuroscientists reject the language of impulsivity in favor of a specific focus on the several well-defined and empirically supported factors that impulsivity is purported to cover. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Testing the factor structure underlying behavior using joint cognitive models: Impulsivity in delay discounting and Cambridge gambling tasks

Neurocognitive tasks are frequently used to assess disordered decision making, and cognitive models of these tasks can quantify performance in terms related to decision makers' underlying cognitive processes. In many cases, multiple cognitive models purport to describe similar processes, but it is difficult to evaluate whether they measure the same latent traits or processes. In this article, we develop methods for modeling behavior across multiple tasks by connecting cognitive model parameters to common latent constructs. This approach can be used to assess whether 2 tasks measure the same dimensions of cognition, or actually improve the estimates of cognitive models when there are overlapping cognitive processes between 2 related tasks. The approach is then applied to connecting decision data on 2 behavioral tasks that evaluate clinically relevant deficits, the delay discounting task and Cambridge gambling task, to determine whether they both measure the same dimension of impulsivity. We find that the discounting rate parameters in the models of each task are not closely related, although substance users exhibit more impulsive behavior on both tasks. Instead, temporal discounting on the delay discounting task as quantified by the model is more closely related to externalizing psychopathology like aggression, while temporal discounting on the Cambridge gambling task is related more to response inhibition failures. The methods we develop thus provide a new way to connect behavior across tasks and grant new insights onto the different dimensions of impulsivity and their relation to substance use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools

INTRODUCTION

Impulsivity and compulsivity are important constructs, relevant to understanding behaviour in the general population, as well as in particular mental disorders (e.g. attention deficit hyperactivity disorder, obsessive-compulsive disorder). The current paper provides a narrative review of self-report impulsivity and compulsivity scales.

METHODS

A literature search was conducted using the following terms: ("impulsivity" OR "compulsivity") AND ("self-report" OR "questionnaire" OR "psychometric" OR "scale").

RESULTS

25 impulsive and 11 compulsive scales were identified, which varied considerably in psychometric properties, convenience, and validity. For impulsivity, the most commonly used scales were the BIS and the UPPS-P, whilst for compulsivity, the Padua Inventory was commonly used. The majority of compulsivity scales measured OCD symptoms (obsessions and compulsions) rather than being trans-diagnostic or specific to compulsivity (as opposed to obsessions). Scales capable of overcoming these limitations were highlighted.

DISCUSSION

This review provides clarity regarding relative advantages and disadvantages of different scales relevant to the measurement of impulsivity and compulsivity in many contexts. Areas for further research and refinement are highlighted.

Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users

Background: Psychopathy and substance use disorders (SUDs) are both characterized by neurocognitive impairments reflecting higher levels of impulsivity such as reward-driven decision-making and deficient inhibitory control. Previous studies suggest that psychopathy may exacerbate decision-making deficits, but it may be unrelated to other neurocognitive impairments among substance dependent individuals (SDIs). The aim of the present study was to examine the role of psychopathy and its interpersonal-affective and impulsive-antisocial dimensions in moderating the relationships between dependence on different classes of drugs and neurocognitive domains of impulsivity. Method: We tested 693 participants (112 heroin mono-dependent individuals, 71 heroin polysubstance dependent individuals, 115 amphetamine mono-dependent individuals, 76 amphetamine polysubstance dependent individuals, and 319 non-substance dependent control individuals). Participants were administered the Psychopathy Checklist: Screening Version (PCL:SV) and seven neurocognitive tasks measuring impulsive choice/decision-making (Iowa Gambling Task; Cambridge Gambling Task; Kirby Delay Discounting Task; Balloon Analog Risk Task), and impulsive action/response inhibition (Go/No-Go Task, Immediate Memory Task, and Stop Signal Task). Results: A series of hierarchical multiple regressions revealed that the interpersonal-affective dimension of psychopathy moderated the association between decision-making, response inhibition and both amphetamine and heroin dependence, albeit differently. For amphetamine users, low levels of interpersonal-affective traits predicted poor decision-making on the Iowa Gambling Task and better response inhibition on the Stop Signal task. In contrast, in heroin users high interpersonal-affective psychopathy traits predicted lower risk taking on the Cambridge Gambling Task and better response inhibition on the Go/No-Go task. The impulsive-antisocial dimension of psychopathy predicted poor response inhibition in both amphetamine and heroin users. Conclusions: Our findings reveal that psychopathy and its dimensions had both common and unique effects on neurocognitive function in heroin and amphetamine dependent individuals. Our results suggest that the specific interactions between psychopathy dimensions and dependence on different classes of drugs may lead to either deficient or superior decision-making and response inhibition performance in SDIs, suggesting that psychopathy may paradoxically play a protective role for some neurocognitive functions in specific subtypes of substance users.

Discrete Roles for Impulsivity and Compulsivity in Gambling Disorder

Background and Objective: Complex associations between gambling disorder (GD) and impulsivity have been identified. However, little is known regarding how compulsivity associates with different impulsivity domains in GD. In this study, we examined associations between self-reported and behavioral measures of impulsivity-assessed through the Barratt Impulsiveness Scale (BIS-11) and the Experiential Discounting Task (EDT), respectively- and compulsivity-measured using the Padua Inventory and the Wisconsin Card Sorting Test (WCST), respectively-, in an adult sample with GD (N = 132, 94 men and 38 women, ages ranging from 18 to 69 years). GD severity was assessed using the South Oaks Gambling Screen. Methods: Structural Equation Modeling was used to examine relationships between impulsivity and compulsivity measures, age, and GD severity. Results: BIS-11 non-planning and BIS-11 total scores positively correlated with GD severity. The standardized coefficients for the SEM showed direct positive contributions of BIS-11 non-planning, Padua and EDT scores to GD severity. Only participants' ages directly contributed to WCST perseverative errors, and no direct or indirect effects were found with respect to GD severity. Conclusion: The findings suggest that specific aspects of impulsivity and compulsivity contribute to GD severity. Interventions specifically targeting domains that are most relevant to GD severity may improve treatment outcomes.

Impulsivity traits and neurocognitive mechanisms conferring vulnerability to substance use disorders

Impulsivity - the tendency to act without sufficient consideration of potential consequences in pursuit of short-term rewards - is a vulnerability marker for substance use disorders (SUD). Since impulsivity is a multifaceted construct, which encompasses trait-related characteristics and neurocognitive mechanisms, it is important to ascertain which of these aspects are significant contributors to SUD susceptibility. In this review, we discuss how different trait facets, cognitive processes and neuroimaging indices underpinning impulsivity contribute to the vulnerability to SUD. We reviewed studies that applied three different approaches that can shed light on the role of impulsivity as a precursor of substance use related problems (versus a consequence of drug effects): (1) longitudinal studies, (2) endophenotype studies including non-affected relatives of people with SUD, and (3) clinical reference groups-based comparisons, i.e., between substance use and behavioural addictive disorders. We found that, across different methodologies, the traits of non-planning impulsivity and affect-based impulsivity and the cognitive processes involved in reward-related valuation are consistent predictors of SUD vulnerability. These aspects are associated with the structure and function of the medial orbitofrontal-striatal system and hyperexcitability of dopamine receptors in this network. The field still needs more theory-driven, comprehensive studies that simultaneously assess the different aspects of impulsivity in relation to harmonised SUD-related outcomes. Furthermore, future studies should investigate the impact of impulsivity-related vulnerabilities on novel patterns of substance use such as new tobacco and cannabinoid products, and the moderating impact of changes in social norms and lifestyles on the link between impulsivity and SUD. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Impulsivity as a multifactorial construct and its relationship to PTSD severity and threat sensitivity

Changes to the DSM-5's conceptualization of posttraumatic stress disorder (PTSD) highlight the importance of impulsivity within the context of PTSD-related arousal dysregulation. While the relationship between PTSD and threat sensitivity is well defined, how they relate to impulsivity remains understudied. We examined the relationship between PTSD symptom severity, threat sensitivity, and impulsivity. 124 participants completed the PTSD Checklist (PCL-C) and the Barratt Impulsiveness Scale 11th ed (BIS-11). BIS-11 items were separated to define cognitive and behavioral impulsivity subdomains. A trauma-exposed subsample of 39 participants were also exposed to no, ambiguous, and high threat conditions in a threat-enhanced acoustic startle paradigm with psychophysiological response as the outcome variable. PTSD severity was significantly associated with greater overall impulsivity and behavioral impulsivity. Greater overall impulsivity and both cognitive and behavioral impulsivity subdomains were significantly associated with psychophysiological magnitudes across threat conditions in the traumatized subsample. Our results suggest PTSD severity may linked to behavioral impulsivity and both cognitive and behavioral impulsivity are associated with threat sensitivity and hyperarousal. Assessing impulsivity within the context of PTSD, particularly in terms of its cognitive and behavioral subdomains, may provide important, clinically relevant information.

Heritability of overlapping impulsivity and compulsivity dimensional phenotypes

Impulsivity and compulsivity are traits relevant to a range of mental health problems and have traditionally been conceptualised as distinct constructs. Here, we reconceptualised impulsivity and compulsivity as partially overlapping phenotypes using a bifactor modelling approach and estimated heritability for their shared and unique phenotypic variance within a classical twin design. Adult twin pairs (N = 173) completed self-report questionnaires measuring psychological processes related to impulsivity and compulsivity. We fitted variance components models to three uncorrelated phenotypic dimensions: a general impulsive-compulsive dimension; and two narrower phenotypes related to impulsivity and obsessiveness.There was evidence of moderate heritability for impulsivity (A² = 0.33), modest additive genetic or common environmental effects for obsessiveness (A² = 0.25; C² = 0.23), and moderate effects of common environment (C² = 0.36) for the general dimension, This general impulsive-compulsive phenotype may reflect a quantitative liability to related mental health disorders that indexes exposure to potentially modifiable environmental risk factors.

Considering Motor Excitability During Action Preparation in Gambling Disorder: A Transcranial Magnetic Stimulation Study

A lack of inhibitory control appears to contribute to the development and maintenance of addictive disorders. Among the mechanisms thought to assist inhibitory control, an increasing focus has been drawn on the so-called preparatory suppression, which refers to the drastic suppression observed in the motor system during action preparation. Interestingly, deficient preparatory suppression has been reported in alcohol use disorders. However, it is currently unknown whether this deficit also concerns behavioral, substance-free, addictions, and thus whether it might represent a vulnerability factor common to both substance and behavioral addictive disorders. To address this question, neural measures of preparatory suppression were obtained in gambling disorder patients (GDPs) and matched healthy control subjects. To do so, single-pulse transcranial magnetic stimulation was applied over the left and the right motor cortex to elicit motor-evoked potentials (MEPs) in both hands when participants were performing a choice reaction time task. In addition, choice and rapid response impulsivity were evaluated in all participants, using self-report measures and neuropsychological tasks. Consistent with a large body of literature, the MEP data revealed that the activity of the motor system was drastically reduced during action preparation in healthy subjects. Surprisingly, though, a similar MEP suppression was observed in GDPs, indicating that those subjects do not globally suffer from a deficit in preparatory suppression. By contrast, choice impulsivity was higher in GDPs than healthy subjects, and a higher rapid response impulsivity was found in the more severe forms of GD. Altogether, those results demonstrated that although some aspects of inhibitory control are impaired in GDPs, these alterations do not seem to concern preparatory suppression. Yet, the profile of individuals suffering of a GD is very heterogeneous, with only part of them presenting an impulsive disposition, such as in patients with alcohol use disorders. Hence, a lack of preparatory suppression may be only shared by this sub-type of addicts, an interesting issue for future investigation.

Childhood Maltreatment and Impulsivity: A Meta-Analysis and Recommendations for Future Study

Both childhood maltreatment and impulsivity have been implicated in a broad array of negative public health outcomes and have been much studied in relation to each other. Characterizing this relationship, and the processes underlying it, are important for informing intervention efforts targeting this association and its psychopathological sequelae. The current review presented a systematic meta-analysis of the empirical literature on childhood maltreatment and impulsivity. In all, 55 eligible studies were identified and included in this review. General support was found for a positive association between childhood maltreatment, including its specific subtypes, and general trait impulsivity, with pooled effect sizes ranging from small in the case of childhood sexual abuse (OR = 1.59 [95% CI = 1.38-1.84]) to medium-to-large in the case of childhood emotional abuse (OR = 3.10 [95% CI = 2.27-4.23]). Support for a relationship between childhood maltreatment and laboratory-based measures of impulsive behavior was generally lacking. The current findings must be interpreted with a degree of caution, given several methodological limitations characterizing much of the empirical literature. Recommendations for addressing these limitations and directions for future research are provided.

The 21-item Barratt Impulsiveness Scale Revised (BIS-R-21): An alternative three-factor model

BACKGROUND AND AIMS

Due to its important role in both healthy groups and those with physical, mental and behavioral disorders, impulsivity is a widely researched construct. Among various self-report questionnaires of impulsivity, the Barratt Impulsiveness Scale is arguably the most frequently used measure. Despite its international use, inconsistencies in the suggested factor structure of its latest version, the BIS-11, have been observed repeatedly in different samples. The goal of the present study was therefore to test the factor structure of the BIS-11 in several samples.

METHODS

Exploratory and confirmatory factor analyses were conducted on two representative samples of Hungarian adults (N = 2,457; N = 2,040) and a college sample (N = 765).

RESULTS

Analyses did not confirm the original model of the measure in any of the samples. Based on explorative factor analyses, an alternative three-factor model (cognitive impulsivity; behavioral impulsivity; and impatience/restlessness) of the Barratt Impulsiveness Scale is suggested. The pattern of the associations between the three factors and aggression, exercise, smoking, alcohol use, and psychological distress supports the construct validity of this new model.

DISCUSSION

The new measurement model of impulsivity was confirmed in two independent samples. However, it requires further cross-cultural validation to clarify the content of self-reported impulsivity in both clinical and nonclinical samples.

Trait impulsivity and acute stress interact to influence choice and decision speed during multi-stage decision-making

Impulsivity and stress exposure are two factors that are associated with changes in reward-related behavior in ways that are relevant to both healthy and maladaptive decision-making. Nonetheless, little empirical work has examined the possible independent and joint effects of these factors upon reward learning. Here, we sought to examine how trait impulsivity and acute stress exposure affect participants' choice behavior and decision speed in a two-stage sequential reinforcement-learning task. We found that more impulsive participants were more likely to repeat second-stage choices after previous reward, irrespective of stress condition. Exposure to stress, on the other hand, was associated with an increased tendency to repeat second-stage choices independent of whether these choices previously led to a reward, and this tendency was exacerbated in more impulsive individuals. Such interaction effects between stress and impulsivity were also found on decision speed. Stress and impulsivity levels interacted to drive faster choices overall (again irrespective of reward) at both task stages, while reward received on the previous trial slowed subsequent first-stage choices, particularly among impulsive individuals under stress. Collectively, our results reveal novel, largely interactive effects of trait impulsivity and stress exposure and suggest that stress may reveal individual differences in decision-making tied to impulsivity that are not readily apparent in the absence of stress.