“…Increased impulsivity, which is often a characteristic of cyclothymic temperament, is associated with a worse prognosis of BD [52,53], and with a more severe clinical course of the disease with history of rapid cycling, mixed episodes and substance abuse [54]. Our findings are in line with other studies showing that cyclothymic temperament is associated with a behavioral instability, increased sensitivity to a stressful event and higher levels of impulsivity [22,55,56,57], and a risk factor for suicide attempts [21]. Therefore, identifying those conditions such as cyclothymic temperament, a rapid cycling course or mixed episodes, more related to an impulsive dimension in patients with BD, could help to more easily typify a subpopulation of patients at risk of committing violent suicide attempts.…”