Trait impulsivity linked to smoking initiation in bipolar disorder

Trait impulsivity is associated with the initiation, but not maintenance, of smoking in patients with bipolar disorder (BD), study results suggest.

The researchers found that current and former smokers with BD had higher trait impulsivity scores than BD patients who had never smoked. However, there was no significant difference in trait impulsivity scores between the two smoking groups.

They also found that there was no significant association between smoking and behavioral measures of impulsivity in patients with BD.

The findings come from a study of 97 individuals, aged 16‑50 years, with BD I disorder who were receiving inpatient or outpatient treatment for a manic or mixed episode. Of the participants, 33 were current smokers, 22 were former smokers, and 42 had never smoked.

All of the participants were assessed for trait impulsivity using the self-report Barratt Impulsiveness Scale-11 (BIS-11). They were also assessed for behavioral impulsivity using the Logan Stop-Signal Task (SST), a measure of inhibitory control, the Delayed Reward Task (DRT), a measure of inability to delay gratification, and the Degraded Stimulus Continuous Performance Task (DSCPT), a measure of attentional impulsivity.

The team found that current and former smokers had significantly higher BIS-11 scores than those who had never smoked, at 79.1 and 76.1 versus 65.1, respectively. The difference in scores between current and former smokers was not significant.

The researchers note that the strength of the association between smoking status and trait impulsivity was not reduced after excluding patients with co-occurring ADHD (n=39) ‑ a common comorbidity in BD that is associated with an increased risk for initiating and maintaining smoking.

There were no significant differences between current and former smokers and those who had never smoked regarding performance on the SST, DRT, and DSCPT.

Jaimee Heffner (University of Cincinnati College of Medicine, Ohio, USA) and colleagues conclude: "Trait impulsivity may play a role in the high prevalence of smoking in BD, with the results of our multivariate analyses suggesting that the relationship is moderate in strength and primarily related to the initiation rather than the maintenance of smoking."

They add: "These results provide a foundation for future efforts to identify factors contributing to the high rates of smoking in adolescents and adults with BD, a critical step toward the development of improved prevention and interventions for tobacco smoking."

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