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    Antisocial personality and bipolar disorder: interactions in impulsivity and course of illness

    Antisocial personality disorder (ASPD) and bipolar disorder are both characterized by impulsive behavior, increased incarceration or arrest, addictive disorders and suicidal behavior. These characteristics appear more severe in the combined disorders. ...

    Neuropsychiatry (London). Author manuscript; available in PMC 2012 Jan 8.

    Published in final edited form as:

    Neuropsychiatry (London). 2011; 1(6): 599–610.

    doi: 10.2217/NPY.11.69

    PMCID: PMC3253316

    NIHMSID: NIHMS342665

    PMID: 22235235

    Antisocial personality and bipolar disorder: interactions in impulsivity and course of illness

    Alan C Swann*

    Author information Copyright and License information Disclaimer

    See other articles in PMC that cite the published article.

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    Antisocial personality disorder (ASPD) and bipolar disorder are both characterized by impulsive behavior, increased incarceration or arrest, addictive disorders and suicidal behavior. These characteristics appear more severe in the combined disorders. Individuals with ASPD who also have bipolar disorder have higher rates of addictive disorders and suicidal behavior and are more impulsive, as measured by questionnaires or behavioral laboratory tests. Those with bipolar disorder who have ASPD have higher rates of addictive, criminal and suicidal behavior, earlier onset of bipolar disorder with a more recurrent and predominately manic course and increased laboratory-measured, but not questionnaire-rated, impulsivity. These characteristics may result in part from differential impulsivity mechanisms in the two disorders, with bipolar disorder driven more by excessive catecholamine sensitivity and ASPD by deficient serotonergic function.

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    Dimensions that cut across psychiatric illnesses

    Our nosological system is based on descriptively defined clinical syndromes. Brain systems governing fundamental aspects of behavior underlie these entities. One interesting challenge in psychiatry is the manner in which dysregulation of systems governing basic aspects of behavior may cut across recurrent psychiatric disorders and personality disorders. These relationships contribute to diagnostic and treatment dilemmas. For example, bipolar disorder and cluster B personality disorders could be part of a continuum [1], as originally suggested by Kraepelin [2]. Alternatively, they could represent disorders that share important clinical features but have distinct mechanisms that combine dimensionally in severe cases [3-7].

    Cluster B personality disorders and bipolar disorder share impulsivity as a core feature [3,8]. Substance abuse, suicidality and criminal behavior, potentially related to impulsivity, cut across antisocial personality disorder (ASPD) and bipolar disorder [8]. Yet there is only limited information comparing impulsivity and its mechanisms in bipolar disorder with personality disorders.

    Characteristics & mechanisms of impulsivity

    Impulsivity may represent an imbalance between behavioral activation and inhibition [9]. It can be measured by questionnaires, such as the Barratt Impulsiveness Scale (BIS-11). The BIS-11, developed over a 50-year period, measures three aspects of trait impulsivity: affective and cognitive instability (‘attentional’); acting on the spur of the moment (‘motor’); and lack of future sense (‘nonplanning’). Questionnaires rely on recall and interpretation of behavior and attitudes, and are therefore subject to bias.

    Human behavioral-laboratory measures have been developed that measure aspects of cognitive performance related to animal models of impulsivity, without the biases of questionnaires [10,11], including:

    Rapid-response impulsivity represents an inability to adequately evaluate a stimulus before responding to it, or to conform responses to their context. Measurements include: continuous performance tests, where a subject must typically respond if a stimulus matches a relatively complex test stimulus given every 500 ms, and a response to a stimulus almost matching the test stimulus is considered impulsive; or stop-signal tasks, where a subject must inhibit a prepotent response [10,11]. Noradrenergic stimulation increases rapid-response impulsivity in healthy controls [12] and in rats [13]; this is a proposed mechanism of poor impulse control in post-traumatic stress disorder [14]. Serotonin counteracts catecholamine effects on rapid-response impulsivity; for example, stimulation of postsynaptic 5-HT1A receptors decreases correct detections and slows response times in rats [15].

    Reward-delay impulsivity, or inability to delay response for a larger reward, is based on the idea that impulsivity is characterized by an acceleration in the normal loss of value of a reward over time (called ‘delay discounting’), and is measured by tasks requiring a choice between smaller–sooner and larger–later rewards [10,11].

    Rapid-response and reward-delay impulsivity are increased in bipolar disorder, especially with recurrent or complicated courses of illness [5]. They are also components of low self-control, which is relevant to criminal behavior [16,17].

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    In order to explore this topic, we conducted a related series of literature searches in Medline, using, as key words or as items in indexed fields, bipolar disorder and ASPD or crime and: impulsive behavior or impulse control disorders or response inhibition; family or genetics or gene expression; suicide or attempted suicide; and diagnosis. In addition, we used other papers cited in articles from these searches, or cited in articles used in our own work.

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    Why bipolar disorder & ASPD?

    Source : www.ncbi.nlm.nih.gov

    Psychology Chapter 14 Flashcards

    Start studying Psychology Chapter 14. Learn vocabulary, terms, and more with flashcards, games, and other study tools.

    Psychology Chapter 14

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    Jorge finds himself feeling depressed most of the day. He is constantly tired yet he sleeps very little. He has feelings of worthlessness that have come on suddenly and seemingly have no basis in reality. What might Jorge be diagnosed with?

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    Major Depressive Disorder

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    Studies have suggested the increase rates of major depressive disorder in women may have basis in ______.

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    gender roles, social factors, and emotional processing.

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    Terms in this set (38)

    Jorge finds himself feeling depressed most of the day. He is constantly tired yet he sleeps very little. He has feelings of worthlessness that have come on suddenly and seemingly have no basis in reality. What might Jorge be diagnosed with?

    Major Depressive Disorder

    Studies have suggested the increase rates of major depressive disorder in women may have basis in ______.

    gender roles, social factors, and emotional processing.

    What disorder seems to hold an association with bipolar disorder?


    Biological explanations of disorders mood have focused on the effects of several different brain chemicals, and medications used to treat these disorders are designed to work on these various neurotransmitter systems. Which of the following is not one the chemicals that has been implicated in mood disorders?


    Jasmine is a teenager who had been diagnosed with anorexia nervous. What percentage of individuals with anorexia that receive treatment make a recovery?


    Which of the following characteristics differences between bulimia nervosa and anorexia nervosa?

    Individuals with bulimia may have a normal body weight, whereas those with anorexia tend to be severely under their expected body weight.

    Researchers believe that 40-60% of the risk of anorexia, bulimia, and binge-eating disorder is due to...

    Genetic factors

    What is the major cause of sexual dysfunction?

    Psychological stress

    Surveys suggest that about ____ percent of women and ____ percent of men have at least one sexual dysfunction.

    4-45; 20-30

    Dean believes that characters in a popular science fiction show are secretly sending him messages. This would be an example of a delusion of...


    Dr. Haldol has several patients with schizophrenia who appear to exhibit excessive or distorted characteristics in relation to what one might consider normal functioning. Specific symptoms include varied hallucinations and multiple delusions. According to the DSM-5, these are refereed to as...

    Positive symptoms

    Aaron has suffered from schizophrenia for many years and now resides in a group treatment facility. One day a nurse approaches him and quietly tells him that his sister, who has been fighting cancer for many months, died that morning. Aaron has no appreciable facial reaction, and in a very monotone voice says, "okay." The nurse is not surprised by Aaron's lack of response to the awful news, because she knows that ____ is one symptom often seen in those suffering from schizophrenia.

    Flat affect

    Neuroimaging studies examining potential causes of schizophrenia have discovered that an area of the brain called the _____ appears to have significantly less myelin coating on the axons of its neurons in people with schizophrenia compared to those without the condition.

    Cingulum Bundle

    Which of the following is not an accurate portrayal of antisocial personality disorder?

    Most people with this disorder is female

    Studies show ____ personality disorders occur more frequently in women while ____ personality disorders happen more often in men.

    Borderline; antisocial

    One suggested physiological cause of antisocial personality disorder is that people with this condition have...

    Lower-than-normal levels of stress hormones

    Due to the types and degree of emotions often experienced by people with borderline personality disorder, their personal relationships are often characterized by_______.

    Intense emoticons, impassivity, and relative instability

    What was the most likely reason that someone would perform an exorcism?

    To release evil spirits.

    In 1972, a jet carrying a rugby team from Peru crashed high in the snow-covered Andes Mountains. Many of the players survived for more than 2 months by eating the remains of those who died. Psychologists justified their cannibalism because that was the only way they could have survived so long without food. By what definition might their behavior best be classified?

    Situational context

    Which of the following is an example of cultural relativity?

    While Dr. Gambon knows that his patient, Aki, believes her anxiety has a biological explanation, in learning more about her family of origin, he suspects it has a psychological cause.

    How many axes does the DSM-5 use to aid mental health professionals in making a diagnosis?

    Source : quizlet.com

    NIMH » Bipolar Disorder

    Learn about bipolar disorder, including signs and symptoms, types, risk factors, how it is diagnosed, and potential treatments and therapies.

    Bipolar Disorder

    Bipolar Disorder Overview

    Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

    There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

    Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

    Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.”

    Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

    Signs and Symptoms

    People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

    People having a manic episode may:People having a depressive episode may:

    Feel very “up,” “high,” elated, or irritable or touchy

    Feel very sad, “down,” empty, worried, or hopeless

    Feel “jumpy” or “wired”

    Feel slowed down or restless

    Have a decreased need for sleep

    Have trouble falling asleep, wake up too early, or sleep too much

    Have a loss of appetite

    Experience increased appetite and weight gain

    Talk very fast about a lot of different things

    Talk very slowly, feel like they have nothing to say, forget a lot

    Feel like their thoughts are racing

    Have trouble concentrating or making decisions

    Think they can do a lot of things at once

    Feel unable to do even simple things

    Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex

    Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”)

    Feel like they are unusually important, talented, or powerful

    Feel hopeless or worthless, think about death or suicide

    Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.

    A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.


    Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

    Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important. You can find tips for talking with your health care provider in the NIMH fact sheet on Taking Control of Your Mental Health: Tips for Talking with Your Health Care Provider.

    Source : www.nimh.nih.gov

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