The temporal course and clinical correlates of subjective impulsivity in bipolar disorder as revealed through ecological momentary assessment

Abstract

Background Impulsivity is frequently linked with bipolar disorder and is associated with mania and negative outcomes. The temporal dynamics of subjective impulsivity are unclear, in particular whether impulsivity precedes or follows changes in positive or negative affect. Methods A total of 41 outpatients with bipolar disorder (I or II) were provided with mobile devices for 11 weeks and completed twice-daily surveys about affective states and subjective impulsivity. We examined the association between aggregate subjective impulsivity with baseline global cognitive function, suicide risk ratings, and medication adherence, as well as concurrent and lagged associations with momentary positive and negative affect ratings. Results A total of 2902 ratings were available across study subjects. Higher aggregate mean ratings of impulsivity were associated with worse baseline global cognitive function, prior suicide attempts, and self-reported problems with medication adherence, as well as more severe manic (but not depressive) symptoms. Time-lagged models indicated that greater negative affect, but not positive affect, predicted subsequent increases in subjective impulsivity, which, in turn, predicted diminished positive affect. Limitations Other measures of impulsivity with which to validate subjective ratings were unavailable and the sample was restricted to generally clinically stable outpatients. Conclusions Subjective impulsivity as measured by daily monitoring was associated with worse cognitive function and self-rated medication adherence, and higher suicide risk ratings. Impulsivity may be a maladaptive strategy to regulate negative affect in bipolar disorder.

Applications for self‐administered mobile cognitive assessments in clinical research: A systematic review

“…Depending on the research question, these assessments may be event‐based, time‐based, or randomly prompted. EMA possesses a number of advantages over typical point‐in‐time assessments, which include: (1) the reduction of retrospective recall biases, (2) the ability to model within‐person trends over time, (3) the assessment of temporal sequences among theoretically‐linked constructs (Depp et al, ; Depp et al, ), (4) the generation of more stable estimates of constructs for outcomes research (Moore, Depp, Wetherell, & Lenze, ), (5) the capacity to monitor treatment response or progress in real‐time, and (6) the assessment of phenomena as they occur in real‐world settings. The ability to assess fluctuation and change in affect, personality, and behavior over time, known as dynamic processes, represents one of the greatest strengths of EMA.…”

The convergence and divergence of impulsivity facets in daily life

“…ESM assesses participants in their normal daily environment, thereby increasing ecological validity; repeatedly assesses participants in the moment, thereby decreasing retrospective bias; and allows for the examination of context of experience. Several studies have employed ESM to examine associations of impulsivity with psychopathology in daily life, including nonsuicidal self‐injury (Bresin, Carter, & Gordon, ), disordered eating (Engel et al, ; Myers et al, ; Steiger, Lehoux, & Gauvin, ), alcohol use (Simons, Dvorak, Batien, & Wray, ; Simons, Gaher, Oliver, Bush, & Palmer, ), bipolar disorder (Depp et al, ), attention‐deficit/hyperactivity disorder (Rosen & Factor, ), and borderline personality disorder (Tomko et al, ). Sperry, Lynam, Walsh, Brown, and Kwapil () examined the original UPPS model and found that, in general, facets were differentially expressed in daily life.…”

Digital health technology for use in patients with serious mental illness: a systematic review of the literature

“…The majority of DHTs described in the selected studies (14 of 18 [77.8%]) were mobile/smartphone apps that collected patient data in real time. In five studies, mobile device apps were used to collect ecological momentary assessments (EMAs) 32,34,38,41,42. In three studies, smartphone apps were used for daily mood and symptom monitoring 26,37,40.…”

“…Scores on MZ items were validated against established self- report questionnaires. In the third example of a smartphone-based app for monitoring patients with bipolar disorder, users completed a web-enabled survey of current momentary mood and related experiences 38. The data were used to assess impulsivity.…”

“…Such information has the potential to improve our understanding of the illness and offers an opportunity to intervene in a timely manner when predictors of disease worsening are identified. Indeed, several studies noted a correlation between mobile self-assessments and disease symptoms 26,34,35,37,38,41,46. For example, higher impulsivity was shown to be associated with worse baseline cognitive function, prior suicide attempts, medication-adherence problems, and more severe manic symptoms 38.…”