Impulsivity as a Risk Factor for Suicide in Bipolar Disorder

Abstract

The accurate assessment of suicide risk in psychiatric, especially affective disorder diagnosed patients, remains a crucial clinical need. In this study, we applied temperament and character inventory (TCI), Barratt impulsiveness scale 11 (BIS-11), PEBL simple reaction time (SRT) test, continuous performance task (CPT), and Iowa gambling task (IGT) to seek for variables linked with attempted suicide in bipolar affective disorder group (n = 60; attempters n = 17). The main findings were: strong correlations between self-report tool scores and objective parameters in CPT; the difference between attempters and non-attempters was found in the number of correctly responded trials in IGT; only one parameter differed between attempters and non-attempters in BPI diagnosis; and no significant differences between suicide attempters and non-attempters in TCI, BIS-11, and SRT were found. These justify the conclusion that impulsivity itself is not a strong predictor, and used as a single variable might not be sufficient to indicate the high suicide risk group among bipolar patients.

Genetics and epigenetics of self‐injurious thoughts and behaviors: Systematic review of the suicide literature and methodological considerations

“…Specifically, while self‐injurious outcomes have been considered transdiagnostic, in that they are observed across a wide range of psychiatric phenotypes rather than being secondary symptoms of specific constellations (as has sometimes been thought for MDD), there might also be some degree of disease type specificity. For example, suicide in BD has been suggested to exhibit some unique underlying mechanisms (Zakowicz et al, 2021). Genetic correlations approaches and PRS studies that were included in this review have associated SITB to some extent with many varied psychiatric disorders, but the question still remains whether in further studies it is advantageous to stratify SITB by psychiatric diagnosis (e.g., suicide in BD, suicide in SCZ, suicide in MDD) vs. take a wholly transdiagnostic, or diagnosis‐blind, approach which hypothesizes that the underlying mechanisms for SITB are largely resistant to other aspects of individual constitution.…”

Which Clinical and Biochemical Parameters Are Associated with Lifetime Suicide Attempts in Bipolar Disorder?

“…However, multiple factors should be considered in interpreting the association between suicide attempts and substance-use disorders in bipolar patients. Particularly, some authors argued a potential role of aggressive-impulsive traits in the association between substance-use disorders and suicide attempts in BD [ 59 ]. Nevertheless, genetic factors, a family history of BD, childhood trauma, tobacco smoking, early onset of BD, and comorbid anxiety disorders may also potentiate the possibility of self-harm among bipolar patients with a history of poly-substance-use disorders [ 54 , 59 , 60 , 61 ].…”

“…Particularly, some authors argued a potential role of aggressive-impulsive traits in the association between substance-use disorders and suicide attempts in BD [ 59 ]. Nevertheless, genetic factors, a family history of BD, childhood trauma, tobacco smoking, early onset of BD, and comorbid anxiety disorders may also potentiate the possibility of self-harm among bipolar patients with a history of poly-substance-use disorders [ 54 , 59 , 60 , 61 ]. On the other hand, substance misuse favors mood instability and impulsivity with an increased risk of suicidal behavior in patients affected by BD [ 62 ].…”

Hippocampal Dynamic Functional Connectivity, HPA Axis Activity, and Personality Trait in Bipolar Disorder with Suicidal Attempt

“…Personality traits have been found to play a significant role in predicting suicide [41], including multiple SAs in the future [42]. In patients with BD, traits such as high neuroticism, harm avoidance [43], and impulsivity [44] have been identified as substantial risk factors for suicidal behavior. Additionally, traits such as novelty seeking, self-transcendence, and self-directedness have also been found to be associated with suicide in patients with BD [45].…”