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Impulsivity is a key feature of opioid use disorder (OUD) and other psychiatric conditions, including posttraumatic stress disorder (PTSD). The relationship between disorders and impulsivity may be additive, such that individuals with multiple disorders exhibit greater impulsivity than those with a single disorder. However, the association between impulsivity, OUD, and PTSD is unclear. Accordingly, this study compared individuals with concurrent OUD and PTSD (OUD + PTSD; n = 55), OUD without PTSD (OUD-PTSD; n = 34), PTSD without OUD (n = 32), and healthy controls (HCs; n = 55) on the Short Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale (SUPPS-P), and the 27-item Monetary Choice Questionnaire (MCQ). With respect to the SUPPS-P, the OUD + PTSD, OUD-PTSD, and PTSD without OUD groups reported more impulsivity on the negative urgency, positive urgency, and lack of premeditation subscales compared to HCs (ps < .001). The OUD + PTSD group also reported greater negative urgency compared to the OUD-PTSD group (p = .001) and HCs (p < .001), but not the PTSD without OUD group (p = .07). Furthermore, participants with OUD + PTSD exhibited greater discounting of delayed rewards on the MCQ than those in the PTSD without OUD group and HCs (p's < .001). However, no significant differences were observed between the two OUD groups (p = .86). These results support impulsivity as a mechanism underlying both OUD and PTSD. Future research should examine whether interventions targeting impulsivity, emotion regulation, and delay discounting are associated with meaningful improvements in functioning among individuals with OUD and PTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Risky substance use among college students is widespread, and associated with numerous adverse consequences. Current interventions focus primarily on students' current substance use; we hypothesize that shifting focus from current use to underlying risk factors is a complementary approach that may improve effectiveness of prevention/intervention programming. This approach aligns with the personalized medicine movement, which aims to harness knowledge about underlying etiological factors to provide individuals with specific information about their unique risk profiles and personalized recommendations, to motivate and enable individuals to better self-regulate their health. Method: Our group is building and evaluating an online Personalized Feedback Program (PFP) for college students that provides feedback about the individual's underlying genetically influenced externalizing and internalizing risk factors for substance use, along with personalized recommendations/resources. The project capitalizes on work from a university-wide research project (Spit for Science; S4S), in which > 12,000 students (˜70% of 5 years of incoming freshmen) are being followed longitudinally to assess substance use and related factors across the college years. In this article, we describe our foundational work to develop the PFP. Results: From the S4S data, we have identified risk factors across four domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism) that are correlated with college students' substance use. We developed an online self-guided PFP, in collaboration with professionals from student affairs, and using feedback from students, with the ultimate goal of conducting a randomized clinical trial. Conclusion: The provision of personalized risk information represents a novel approach to complement and extend existing college substance use programming. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE: Substance use is a public health concern and cross-sectional studies have found that impulsivity and drinking motives influence substance use in emerging adults. Despite these findings, longitudinal studies with nuanced measures of impulsivity and drinking motives are needed. PARTICIPANTS: The current study investigated the three-year relationship between impulsivity-related traits, drinking motives, sex, and drinking outcomes in a sample of 509 college students (47.47% male; 81% White). METHODS: The effects of impulsivity traits and drinking motives on problematic drinking outcomes were evaluated using linear mixed effects models. RESULTS: The results confirmed the hypothesized relationship between traits of impulsivity, drinking motives, and alcohol outcomes over time. Further, sex significantly interacted with drinking motives longitudinally in its relationship with alcohol use outcomes. CONCLUSIONS: These results indicate that intervention efforts may need to be tailored to specific individual attributes to target direct correlates of alcohol use behavior to increase effectiveness.

Episodic future thinking (EFT) denotes our capacity to imagine prospective events. It has been suggested to promote farsighted decisions that entail a trade-off between short-term versus long-term gains. Here, we meta-analyze the evidence for the impact of EFT on such intertemporal choices that have monetary or health-relevant consequences. Across 174 effect sizes from 48 articles, a three-level model yielded a medium-sized effect of g = .44, 95% (CI) [.33, .55]. Notably, this analysis included a substantial number of unpublished experiments, and the effect remained significant following further adjustments for remaining publication bias. We exploited the observed heterogeneity to determine critical core components that moderate the impact of EFT. Specifically, the effect was stronger when the imagined events were positive, more vivid, and related to the delayed choice. We further obtained evidence for the contribution of the episodicity and future-orientedness of EFT. These results indicate that the impact of EFT cannot simply be accounted for by other modes of prospection (e.g., semantic future thinking). Of note, EFT had a greater impact in samples characterized by choice impulsivity (e.g., in obesity), suggesting that EFT can ameliorate maladaptive decision making. It may accordingly constitute a beneficial intervention for individuals who tend to make myopic decisions. Our analyses moreover indicated that the effect is unlikely to merely reflect demand characteristics. This meta-analysis highlights the potential of EFT in promoting long-term goals, a finding that extends from the laboratory to real-life decisions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Food craving is a motivational and physiological response for eating specific foods, mainly with high caloric content. To assess food craving, self-reports, inventories and questionnaires are used. The Food Cravings Questionnaire-Trait is multi-dimensionally structured and has been validated in several countries, since it is sensitive and adaptable to contextual-cultural changes.To validate and standardize the Food Cravings Questionnaire-Trait in adults of Mexico City.Non-experimental, cross-sectional, randomized study of 1059 subjects of both genders, between 18 and 84 years of age; 71.86 % of the female gender. Psychometric properties were examined with exploratory and confirmatory factor analyses.The domains of the questionnaire were reduced and the items were reorganized differently from the original version. The confirmatory factor analysis showed an adequate fit and acceptable standardization of factors. High internal consistency was found for the global questionnaire (a = 0.973 and rho = 0.975) for each one of the domains.This study determines the viability of the Food Cravings Questionnaire for the population of Mexico City.El food craving o “ansia por comer” es una respuesta motivacional y fisiológica por comer alimentos específicos, principalmente con alto contenido calórico. Para evaluarlo se usa, entre otros, el Food Craving Questionnaire Trait, estructurado multidimensionalmente y validado en diversos países, el cual ha mostrado ser sensible y adaptable a los cambios contextuales-culturales.Validar y estandarizar el Food Craving Questionnaire-Trait en adultos de la Ciudad de México.Estudio no experimental, transversal y aleatorizado de 1059 sujetos de uno y otro sexo, entre 18 y 84 años; 71.86 % del sexo femenino. Se examinaron propiedades psicométricas con análisis factoriales exploratorios y confirmatorios.Se redujeron los factores del cuestionario y los ítems se reorganizaron de forma diferente al original. El análisis factorial confirmatorio mostró ajuste adecuado y estandarización aceptable de los factores. Se encontró alta consistencia interna para el cuestionario global (a = 0.973 y rho = 0.975) para cada uno de los factores.Este estudio determina la viabilidad del Food Craving Questionnaire para población de la Ciudad de México.

Recent advances in diagnostic research identified that individuals with higher impulsivity and sensation-seeking scores tend to report more positive subjective responses to stimulant drugs such as amphetamine. The current exploratory study hypothesized that differences in underlying mesocorticolimbic circuitry may mediate the relationship between personality and responses to stimulants due to its previously established implication in reward processes as well as the overlap between its dopaminergic projections and the pharmacodynamics of many stimulants. Forty participants (20 female) were recruited with relatively high- and low-impulsivity and sensation-seeking scores as defined by the Zuckerman-Kuhlman Personality Questionnaire (Form IIIR; Zuckerman, Kuhlman, Joireman, Teta, & Kraft, 1993) for a double-blind, placebo-controlled, intranasal amphetamine administration study conducted within an MRI scanner. Active state seed-to-voxel connectivity analyses assessed the effects of amphetamine, personality, subjective responses to amphetamine, and their interactions with mesocorticolimbic seeds on data collected during monetary incentive delay and go/no-go task performance. Results indicated that amphetamine administration largely disrupted brain activity as evidenced by connectivity values shifting toward no correlation among brain stem, striatal, and frontal cortex regions. Additionally, associations of impulsivity and connectivity between ventral tegmental and medial orbitofrontal as well as lateral orbitofrontal and putamen regions were inverted from negative to positive during the placebo and amphetamine conditions, respectively. Personality was unrelated to subjective responses to amphetamine. Results are interpreted as providing evidence of underlying differences in mesocorticolimbic circuitry being a potential target for requisite diagnostic and treatment strategies implicated with stimulant use disorders, but further research is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Orexin and its receptors are involved in the mechanisms of pathological craving for alcohol and psychoactive drugs. The orexin system is also involved in the mechanisms of non-chemical forms of addiction: binge eating and gambling. The aim of this work was to study the level of orexin receptor mRNA in the hypothalamus, hippocampus, and prefrontal cortex of rats prone to impulsivity in behavior in a model for studying the elements of gambling addiction (a variant of the Iowa Gambling Task test). Brain structures were isolated on the 22nd day of the experiment. The expression of the OX1R gene was higher in the hypothalamus by 122% and in the hippocampus by 149% in rats that preferred to receive a high reward, but with a low probability as compared with a group of animals that preferred a low level of reinforcement, but with a 100% probability. In the prefrontal cortex, on the contrary, no significant changes were observed in the level of OX1R mRNA. The level of OX2R mRNA insignificantly changed in the hypothalamus, hippocampus, and prefrontal cortex of rats prone to impulsivity in behavior. The data indicate involvement of OX1R in the hypothalamus and hippocampus in mechanisms mediating impulsive behavior and the choice of the significance of positive reinforcement in terms of its varying strength and probability.Oreksin i ego retseptory vovlecheny v mekhanizmy patologicheskogo vlecheniia k alkogoliu i psikhoaktivnym veshchestvam. Sistema oreksina takzhe uchastvuet v mekhanizmakh nekhimicheskikh form zavisimosti — pishchevoĭ i igrovoĭ. Tsel'iu nastoiashchego issledovaniia bylo izuchenie urovnia mRNK retseptorov oreksina v gipotalamuse, gippokampe i prefrontal'noĭ kore mozga krys, sklonnykh k povyshennoĭ impul'sivnosti v povedenii, v modeli dlia izucheniia élementov igrovoĭ zavisimosti. Dlia étogo ispol'zovali variant metoda Iowa Gambling Task v trekhluchevom labirinte. Struktury mozga vydeliali na 22 den' éksperimenta. Ékspressiia gena oreksinovogo retseptora pervogo tipa (OX1R) byla vyshe v gipotalamuse na 122% i gippokampe — na 149% u krys, predpochitavshikh poluchat' vysokoe voznagrazhdenie, no s nizkoĭ doleĭ veroiatnosti po sravneniiu s gruppoĭ zhivotnykh, predpochitavshikh nizkiĭ uroven' podkrepleniia, no so 100% stepen'iu veroiatnosti. V prefrontal'noĭ kore, naprotiv, ne nabliudalos' dostovernykh izmeneniĭ v urovne mRNK OX1R. Pri issledovanii urovnia mRNK oreksinovogo retseptora vtorogo tipa (OX2R) dostovernykh izmeneniĭ u krys, sklonnykh k povyshennoĭ impul'sivnosti v povedenii, v gipotalamuse, gippokampe i prefrontal'noĭ kore otmecheno ne bylo. Dannye ukazyvaiut na vovlechennost' OX1R v gipotalamuse i gippokampe v mekhanizmy, oposreduiushchie impul'sivnoe povedenie i vybor zhivotnymi znachimosti polozhitel'nogo podkrepleniia v usloviiakh ego razlichnoĭ sily i veroiatnosti.

Background Impulsivity and impulse control disorders are common in Parkinson’s disease and lead to increased morbidity and reduced quality of life. Impulsivity is thought to arise from aberrant reward processing and inhibitory control, but it is unclear why deep brain stimulation of either the subthalamic nucleus (STN) or globus pallidus internus (GPi) affects levels of impulsivity. Our aim was to assess the role of the STN and GPi in impulsivity using invasive local field potential (LFP) recordings from deep brain stimulation electrodes. Methods We measured LFPs during a simple rewarding Go/NoGo paradigm in 39 female and male human patients with Parkinson’s disease manifesting variable amounts of impulsivity who were undergoing unilateral deep brain stimulation of either the STN (18 nuclei) or GPi (28 nuclei). We identified reward-specific LFP event-related potentials and correlated them to impulsivity severity. Results LFPs in both structures modulated during reward-specific Go and NoGo stimulus evaluation, reward feedback, and loss feedback. Motor and limbic functions were anatomically separable in the GPi but not in the STN. Across participants, LFP reward processing responses in the STN and GPi uniquely depended on the severity of impulsivity. Conclusions This study establishes LFP correlates of impulsivity within the STN and GPi regions. We propose a model for basal ganglia reward processing that includes the bottom-up role of the GPi in reward salience and the top-down role of the STN in cognitive control.

Background: Impulsivity and sleep and circadian rhythm disturbance are core features of bipolar spectrum disorders (BSDs) that are antecedents to onset and persist even between mood episodes; their pervasive presence in BSD suggests that they may be particularly relevant to understanding BSD onset and course. Considerable research demonstrates bidirectional associations between impulsivity and sleep disturbance in healthy individuals; thus, it is important to examine how these features interact to impact BSD symptomatology. Methods: Young adults (N = 107, 55% female, M age = 21.82 years) at high risk for developing BSD (based on high self-reported reward sensitivity) or with recent-onset BSD participated in ecological momentary assessment (EMA) to examine relationships between impulsivity, sleep and circadian rhythm alterations, and mood symptoms in everyday life. Impulsivity was measured via self-report/behavioral task, sleep was measured via actigraphy, circadian rhythms were measured via dim light melatonin onset (DLMO) time, and mood symptoms were measured three times daily via self-report. Results: Multi-level modeling revealed that less total sleep time predicted increased next-day mood symptoms. Moreover, DLMO, total sleep time, and sleep onset latency moderated the relationship between impulsivity and EMA-assessed mood symptoms. Fewer minutes of sleep and later DLMO strengthened the positive relationship between impulsivity and mood symptoms. Limitations: Mood symptoms in our sample were mild; future studies should replicate findings in populations with more severe mood symptoms. Conclusions: This multi-method assessment of dynamic relationships revealed novel associations between impulsivity, sleep and circadian rhythm disturbance, and symptoms within individuals at high-risk for or with recent-onset BSD.

Background Borderline Personality Disorder (BPD) is characterized by mood dysregulation, impulsivity, identity disturbances, and a higher risk for suicide. Currently, the diagnosis is solely based on clinical observation of overt symptoms, and this can delay the detection of the disease and the timely start of appropriate treatment. Several candidate clinical tools have been studied to better characterize BPD, including event-related potentials (ERP). This review aimed at summarizing the results of the available ERP studies on BPD to clarify the possible application of this technique in the early diagnosis of BPD. Methods A bibliographic search on PubMed and PsycInfo was performed in order to identify studies comprising individuals with BPD diagnosis and a control group that evaluated the ERP elicited by auditory stimuli. Results Ten studies that explored various ERP components associated with auditory stimuli in BPD were included. Overall, the results showed that positive ERP (P50, P100, and P300) amplitude and latencies as well as loudness dependance were altered in BPD patients compared to controls, possibly reflecting deficits involving attention, mainly at its early stage, and executive functions. Limitations The reviewed studies used different ERP approaches and non-homogeneous BPD diagnostic criteria. Conclusions Auditory ERP appear to be a promising tool for the assessment of BPD patients, especially for early diagnosis and evaluation of cognitive symptoms.

Background: Impulsive compulsive behaviors (ICBs) can affect a significant number of Parkinson’s disease (PD) patients. Objective: We have studied brain samples from a brain bank of PD patients who received apomorphine via continuous infusion in life to assess the prevalence and outcome of ICBs. Methods: A search on the Queen Square Brain Bank (QSBB) database for cases donated from 2005 to 2016 with a pathological diagnosis of idiopathic PD was conducted. Notes of all donors who used apomorphine via continuous infusion for at least three months were reviewed. Clinical and demographic data were collected, as well as detailed information on treatment, prevalence and outcomes of ICBs. Results: 193 PD cases, 124 males and 69 females, with an average age at disease onset of 60.2 years and average disease duration of 17.2 years were reviewed. Dementia occurred in nearly half of the sample, depression in one quarter, and dyskinesias in a little over 40%. The prevalence of ICBs was 14.5%. Twenty-four individuals used apomorphine infusion for more than three months. Patients on apomorphine had younger age at disease onset, longer disease duration, and higher prevalence of dyskinesias. The prevalence of de novo ICB cases among patients on apomorphine was 8.3%. Apomorphine infusion was used for an average of 63.1 months on an average maximum dose of 79.5 mg per day. Ten patients remained on apomorphine until death. Conclusions: Apomorphine can be used as an alternative treatment for patients with previous ICBs as it has low risk of triggering recurrence of ICBs. RESUMO Antecedentes: Comportamentos impulsivo-compulsivos (CICs) podem acometer uma parcela significativa de indivíduos com doença de Parkinson (DP). Objetivo: Nós estudamos amostras de tecido cerebral de uma população de pacientes com DP de um banco de cérebros que receberam apomorfina por infusão contínua em vida, com a finalidade de avaliar a prevalência e o desfecho dos CICs. Métodos: Uma pesquisa no banco de dados do Banco de Cérebros de Queen Square foi conduzida à procura de doações recebidas entre 2005 e 2016 com diagnóstico anatomopatológico de DP idiopática. Os prontuários de todos os doadores que usaram apomorfina por infusão contínua por um período mínimo de três meses foram revisados. Dados clínicos e demográficos foram coletados, assim como informações detalhadas sobre o tratamento, prevalência e desfecho dos CICs. Resultados: 193 casos de DP, 124 do sexo masculino e 69 do sexo feminino, com idade média de início da doença de 60,2 anos e tempo médio de duração da doença de 17,2 anos, foram revisados. Aproximadamente metade dos casos apresentaram demência, um quarto depressão, e um pouco mais de 40% discinesias. A prevalência de CICs foi 14,5%. Vinte e quatro indivíduos usaram infusão de apomorfina por mais de três meses. Os pacientes que usaram apomorfina apresentaram DP mais cedo, maior duração da doença, e uma maior prevalência de discinesias. A prevalência de novos casos de CICs entre pacientes usando apomorfina foi de 8,3%. Infusão de apomorfina foi usada em média por 63,1 meses a um dose máxima média de 79,5 mg por dia. Dez pacientes permaneceram usando apomorfina até o óbito. Conclusões: Apomorfina pode ser usada como opção de tratamento alternativo para pacientes que apresentarem CICs no passado considerando seu baixo risco de causar recorrência de CICs.

Dopamine functioning is an essential mechanism underlying addictive behaviors. This paper evaluates the association of Internet gaming disorder (IGD) with the catechol‐O‐methyltransferase (COMT) val158met polymorphism and examines the roles of impulsivity and reinforcement sensitivity in this association. Using diagnostic interviews, this study recruited 69 participants with IGD and 138 participants without. All participants underwent diagnostic interviews for IGD and an evaluation for the COMT val158met polymorphism, impulsivity, and reinforcement sensitivity. Among participants with the Val/Val genotype, the odds ratio (95% confidence interval) for IGD was 2.09 (1.15–3.80). The IGD–Val/Val genotype association was mediated by impulsivity and fun‐seeking. The Val/Val genotype is indicative of low frontal functioning and is a predictive factor of IGD, with this effect being confounded by impulsivity and fun‐seeking. Interventions targeting impulsivity and fun‐seeking might attenuate the risk of IGD, particularly among individuals with the Val/Val genotype. Additional studies are necessary to elucidate the possible role of dopamine functioning.

This study aimed to address a gap in concussion literature by investigating the relation between personality and return to play. It is important to know that earlier return to play places individuals at higher risk of sustaining a new concussion after an initial concussion.Participants were undergraduate students recruited from psychology courses in 2019 who reported medically confirmed sports-related concussion and medically advised return to play (N = 202). Participants completed an online battery in a supervised laboratory setting that included self-report survey measures, concussion history items, and behavioral impulsivity tasks. Kaplan-Meier analysis and Cox proportional hazards models were used to analyze time to return to play after participants' first reported sports-related concussion.Results showed that one subdimension of sensation seeking, experience seeking, and two subdimensions of self-reported impulsivity, attentional and motor impulsivity, were positively associated with earlier return to play after a sports-related concussion. In contrast, higher levels of conscientiousness were associated with later return to play.Despite a heterogeneous sample, significant relations were found between timing of return to play and sensation seeking, impulsivity, and conscientiousness. Because earlier return to play can heighten the risk of sustaining a new concussion after an initial concussion, it is important to identify characteristics-such as personality traits-that influence individuals' return-to-play behaviors.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.Upon completion of this article, the reader should be able to: (1) Distinguish between personality traits that resulted in earlier versus later return to play in this sample; (2) Describe why certain personality traits might be related to an earlier or later return-to-play timeline; and (3) List practical ways that these study results could be used to reduce adverse outcomes related to early return to play.Advanced.The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

OBJECTIVES Eating disorders (EDs) are severe psychiatric conditions characterized by malnutrition, dysfunctional behaviors, and hypovitaminosis D. In various psychiatric conditions, including EDs, preliminary evidence has correlated impulsivity to a low level of 25-hydroxyvitamin D [25(OH)D]. This study aims to reinforce this evidence by examining different facets, both behavioral and psychological, of the impulsivity construct in patients with ED. METHODS A sample of 119 women was evaluated with a validated questionnaire and computerized neuropsychological tasks: the UPPS-P impulsive behavior scale, a go/no-go task, and the Balloon Analogue Risk Task (BART). A clinical evaluation for EDs and blood sample collection were also performed to assess specific psychopathology and determine the serum level of 25(OH)D. RESULTS Significant correlations were found between serum levels of 25(OH)D and BART scores (p = 0.012) and lack of perseverance (p = 0.034). Moreover, regression analyses showed that higher BART scores may be explained by hypovitaminosis D and higher levels of lack of perseverance in patients with EDs. CONCLUSIONS The specific aspect of impulsivity linked to goal strategy and behaviors may be explained in patients with EDs by hypovitaminosis D. A possible connection to the brain inflammatory system is also discussed, along with possible directions for future research.

Objective: The relationship between the level of gambling fallacy endorsement and type of gambler (nongambler, recreational gambler, at-risk gambler, and problem/pathological gambler) was assessed both concurrently and prospectively in a large national cohort of Canadian adults. Method: This cohort (n = 10,199 at baseline; 18-24 years, n = 481, 43% female; 25-34 years, n = 1,335, 62% female; 35-44 years, n = 1,543, 55% female, 45-54 years, n = 1,985, 58% female; 55-64 years, n = 2,459, 55% female; 65-74 years, n = 1,865, 44% female, 75+ years, n = 531, 43% female) was recruited from LEO, Leger Opinion's registered online panelists. The follow-up survey was completed by 55.9% of the cohort, 1 year after baseline. The full survey can be viewed at https://www.ucalgary.ca/research/national-gambling-study/. For the current study, scores on the Gambling Fallacies Measure, the Problem and Pathological Gambling Measure, Gambling Participation Instrument, and Impulsivity were analyzed. Results: There were three main findings. The first is that gambling fallacies are common in all categories of gamblers but somewhat more prevalent in problem and pathological gamblers. Second, the multivariate analysis determined that gambling fallacies are significant concurrent and prospective predictors of the problem/pathological gambling category, but not strong predictors relative to other variables. Third, problem gambling and heavier gambling involvement are also predictors of a future higher level of gambling fallacies. Conclusions: Collectively, these results show that gambling fallacies have some etiological relationship to problem gambling but are not the main cause of problem gambling and should not be the exclusive focus of problem gambling treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia. Methods This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. Results Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia. Conclusion Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.

BACKGROUND AND AIMS The pathways model is a highly cited etiological model of problem gambling. In the past two decades, a number of studies have found support for the model's utility in classifying gambling subtypes. The aims of this paper were to refine empirically the model subtypes and to revise and update the model based on those findings. DESIGN AND MEASUREMENT Observational study using data collected from treatment-seeking problem gamblers using the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ). SETTING Treatment clinics in Canada, Australia and the United States. PARTICIPANTS A convenience sample of 1168 treatment-seeking problem gamblers, aged 18 years or older. FINDINGS Empirically validated risk factors were analyzed using latent class analyses, identifying a three-class solution as the best-fitting model. Those in the largest class (class 1: 44.3%, n = 517) reported the lowest levels of all etiological risk factors. Participants in class 2 (39.5%, n = 461) reported the highest rates of anxiety and depression, both before and after gambling became a problem, as well as childhood maltreatment, and a high level of gambling for stress-coping. Those in class 3 (16.3%, n = 190) reported high levels of impulsivity; risk-taking, including sexual risk-taking; antisocial traits; and coping to provide meaning in life and to alleviate stress. CONCLUSIONS The revised pathways model of problem gambling includes three classes of gamblers similar to the three subtypes in the original pathways model, but class 3 in the revised pathways model is distinct from class 2, showing higher levels of risk-taking and antisocial traits and gambling motivated by a desire for meaning/purpose and/or to alleviate stress. Class 2 in the revised pathways model demonstrates high levels of childhood maltreatment as well as gambling for stress-coping.

Research in the past decade has highlighted the nuances of adolescent decision making. In this review article, we summarize several themes evident in the field of developmental science including the redefinition of adolescence and the ways in which adolescent decision-making capabilities converge with or diverge from those of adults. While the decision-making process is similar for adolescents and adults in contexts that encourage deliberation and reflection, adolescents and adults differ in contexts which preclude deliberation vis-à-vis high emotional arousal. We also discuss the reconceptualization of adolescent behavior, including risk taking, as adaptive. That is, characteristics of adolescence, including impulsivity, the importance of peers, and novelty seeking, are normative, evolutionarily advantageous, and essential for positive development. While these features manifest in negative, health-compromising ways (e.g., risky driving and criminal behavior), they also foster growth and exploration. We conclude with a discussion of potential avenues for future research.

Chronic exposure to delayed reinforcement has been shown to increase choice for larger, later reinforcement in a subsequent delay discounting task. In the three experiments presented in this paper, the opposite was tested: effects of chronic exposure to immediate reinforcement on choice in a subsequent delay discounting task. In Experiment 1, larger, later reinforcement choice was significantly reduced as a result of exposure to immediate reinforcement, compared to a maturation/handle control group, in experienced, male Lewis rats. In Experiment 2, with naive male and female Wistar rats, and Experiment 3, with naïve male Long Evans rats, the impact of exposure to immediate reinforcement was less robust, but directionally consistent with results from Experiment 1. These results align with some previous work reporting that exposure to immediate reinforcement may decrease choice for larger, later reinforcement in a delay discounting task, and/or blunt maturational increases in choice for larger, later reinforcement. These findings have implications for future research investigating experience-based interventions to manipulate delay discounting behavior. They also have clinical implications for understanding and treating disorders involving maladaptive choice.

The trait impulsivity theory suggests that a single, highly heritable externalizing liability factor, expressed as temperamental trait impulsivity, represents the core vulnerability for externalizing disorders. The present study sought to test the application of latent factor models derived from this theory to a clinical sample of children. Participants were 474 German children (age 6-12 years, 81% male) with symptoms of attention-deficit/hyperactivity disorder and externalizing behavior problems participating in an ongoing multicenter intervention study. Using confirmatory factor analyses (CFA) and exploratory structural equation modeling (ESEM), we evaluated several factor models of externalizing spectrum disorders (unidimensional; first-order correlated factors; higher-order factor; fully symmetrical bifactor; bifactor S-1 model). Furthermore, we assessed our prevailing factor models for measurement invariance across raters (clinicians, parents, teachers) and assessment modes (interview, questionnaires). While both CFA and ESEM approaches provided valuable insights into the multidimensionality, ESEM solutions were generally superior since they showed a substantially better model fit and less biased factor loadings. Among the models tested, the bifactor S-1 CFA/ESEM models, with a general hyperactivity-impulsivity reference factor, displayed a statistically sound factor structure and allowed for straightforward interpretability. Furthermore, these models showed the same organization of factors and loading patterns, but not equivalent item thresholds across raters and assessment modes, highlighting cross-situational variability in child behavior. Our findings are consistent with the assumption of the trait impulsivity theory that a common trait, presented as hyperactivity-impulsivity symptoms, underlies all externalizing disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by excessive risky behavior, and an impulsive trait has been proposed to be associated with risk-taking. However, the aspect of the cognitive process that impulsivity influences is not well understood. We hypothesized that impulsivity could be related to an overhasty shifting of beliefs during risk learning, thereby resulting in enhanced risk-taking behavior. In this study, we tested our hypothesis using the Bayesian modeling approach and predicted overhasty learning by a data-driven approach. We used an openly available task-based functional magnetic resonance imaging (fMRI) dataset. Participants with adult ADHD (n = 42) completed the balloon analog risk task (BART). By fitting our computational model that encapsulates the degree of overhasty learning, we estimated the degree of learning bias and investigated its relationship with Barratt Impulsiveness Scale (BIS) outcomes. Moreover, we created a connectome-based predictive model (CPM) based on fMRI data to predict the degree of risk-learning bias. The degree of overhasty learning in ADHD patients was significantly correlated with the BIS score (r = 0.424, p = 0.009). The CPM predicted the ‘learning bias’ parameter using negatively correlated edges (r = 0.341, p = 0.041; q2 = 0.092). The ‘hub nodes’ in the predictive network were in the frontal lobe, including the orbitofrontal area. Our findings suggest that impulsivity in ADHD patients is associated with overhasty updating of beliefs during risk learning. Weak functional connectivity to the both dorso-lateral prefrontal and orbitofrontal lobes is predictive of the degree of overhasty learning.

Threat sensitivity is thought to be a precursor for anxiety. Yet it remains unknown whether individuals have consistently high neural activation to different threatening situations. The current study (N = 161, Mage = 11.26, SD = 1.79) used three ERPs from different threat-related events: 1) the P3 to receiving negative feedback; 2) the ERN to making mistakes; 3) the N170 to viewing angry faces. Participants also completed self-report measures of threat sensitivity, impulsivity, and demographics. In a follow-up analysis, we also investigated whether the results replicate when using the difference score for each ERP. Youth with higher self-reported sensitivity to threats and lower self-reported impulsivity had consistently higher neural activation to threatening situations. Males also had consistently higher neural activation to threats compared with females. When using the difference score, we found that youth with higher self-reported threat sensitivity had consistently higher neural activation to threats than nonthreats. Although it is common for youth to have high neural activation during at least one threatening situation (e.g., making mistakes), only ~12% of youth have consistently high neural activation across a variety of different threats. Thus, detecting youth who are sensitive to a variety of different threats may be an important avenue to investigate to identify youth most at risk for the development of anxiety.

Purpose/background The link between substances of abuse, impulsivity, and violence in psychotic patients remains unclear. This study aims at unraveling whether cannabis use disorder is associated with violent and/or psychotic behavior in patients who are hospitalized in a high-security hospital. Methods/procedures We conducted a cross-sectional retrospective study in 124 patients with schizophrenia spectrum disorders admitted to a high-security hospital. Lifetime violent behavior was assessed using the History of Aggressive Behavior Form-Subject of the MacArthur Violence Risk Assessment Study and impulsivity using the Psychopathy Checklist-Revised (considering items: "proneness to boredom," "lack of self-control," and "impulsive thoughtless gestures"). Substance use disorder was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Positive and Negative Syndrome Scale was also administered. Findings/results Violent and nonviolent psychotic patients showed similar prevalence of cannabis use disorder. Alcohol and cocaine use disorders were more prevalent among violent psychotic patients. Cannabis use disorder was not associated with any dimension of impulsivity, whereas alcohol use disorder was positively correlated to impulsive thoughtless gestures (standardized β = 0.213, P = 0.027) and cocaine use disorder with proneness to boredom (standardized β = 0.290, P = 0.002). Finally, logistic regression analysis revealed that, unlike cannabis and cocaine use disorders, alcohol use disorder (odds ratio, 3.964; 95% confidence interval, 1.729-9.087; P = 0.001) was a factor associated with violence. Implications/conclusions These findings show that cannabis and alcohol are largely abused and coabused by psychotic patients with a propsensity for violence, but only alcohol is associated with impulsive and violent behavior. Therefore, especially alcohol abuse should be seriously considered by practitioners when evaluating the dangerousness of patients with schizophrenia spectrum disorders.

Purpose Adults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine. Methods Go/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment. Results After lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use. Conclusion Improved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment. Level of Evidence IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

The Reflective Functioning Questionnaire (RFQ) is an 8-item self-report measure of reflective functioning that is presumed to capture individual differences in hypo- and hypermentalizing. Despite its broad acceptance by the field, we argue that the validity of the measure is not well-established. The current research elaborates on problems of the RFQ related to its item content, scoring procedure, dimensionality, and associations with psychopathology. We tested these considerations across three large clinical and non-clinical samples from Germany and the US (total N = 2289). In a first study, we found that the RFQ may assess a single latent dimension related to hypomentalizing but is rather unlikely to capture maladaptive forms of hypermentalizing. Moreover, the RFQ exhibited very strong associations with measures of personality pathology, while associations with measures of symptom distress were less strong. In a second preregistered study focused on convergent and discriminant validity, however, a commonality analysis indicated that associations with indicators of personality pathology are inflated because some of the RFQ items tap into emotional lability and impulsivity rather than mentalizing. Our findings demonstrate limitations of the RFQ. We discuss key challenges in assessing mentalizing via self-report.

Mindfulness is a component of several psychotherapies. Nonetheless, its effectiveness in borderline personality disorder (BPD) management remains obscure. This systematic review examined the effect of mindfulness training in BPD patients. Cochrane Central Register of Controlled Trials, CAB Abstracts, Embase, MEDLINE and APA PsycInfo were searched until 30 June 2021. Five trials with 294 participants were included. Improvements were reported in participants' levels of impulsivity, in their emotion dysregulation patterns, in their attention skills and in their mindfulness-related capacities including decentering and nonjudging. The findings suggest that mindfulness training may be an effective tool for alleviating certain aspects of BPD symptomatology. More research is needed before definitive conclusions can be reached about the effectiveness of mindfulness training in the treatment of BPD patients, and this remains to be elucidated in larger structured clinical trials, with longer follow-ups.

Given the high comorbidity among psychological disorders, and in particular, personality disorders (PDs) and alcohol use disorder, screening and intervention efforts may benefit from the inclusion of transdiagnostic symptoms. Extant symptoms can improve the ability to efficiently gather important information about an individual that relates to a number of conditions, behaviors, and potential problems. Further, less time is needed to assess these symptoms, as compared with full diagnostic criteria sets, which have limitations of their own. This study examined the utility of two PD symptoms, affective instability and impulsivity, as compared with relevant categorical diagnoses (antisocial and borderline PDs), to provide useful information about alcohol use disorder and heaviness of alcohol consumption. Individual symptoms were comparable to the categorical diagnoses in predicting important treatment targets. In an effort to identify and treat comorbidities in a more efficient way, future research should investigate the applicability of these individual symptoms, and other transdiagnostic targets, to screening and brief intervention protocols. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background “Impulse Control Disorders” are behavioral conditions (e.g., gambling, hypersexuality), which are increasingly reported as reactions to dopamine agonists in Parkinson's disease. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease focuses only on 6 behaviors. Nonetheless, impulsivity could affect the entire range of human practices. Because of their heterogeneity and undefined boundaries, it is not clear what conditions should be considered as Impulse Control Disorders. This results in poorly standardized scientific literature and underdiagnosis. Objective We aimed to create a comprehensive list of possible manifestations of drug-induced Impulse Control Disorders in Parkinson's disease and test it on pharmacosurveillance data. Methods PubMed was used to identify reviews in English about Impulse Control Disorders in Parkinson's disease. Mentioned conditions were charted and translated to the lexicon of MedDRA, ICD-11, and DSM-5. The relevant MedDRA terms were used to test potential association with dopamine agonists on the FDA Adverse Event Reporting System. Results 50 reviews published between 2001 and 2020 were identified. 66 conditions were collected as possible Impulse Control Disorders. Pathological gambling, shopping, eating and sexuality, dopamine dysregulation syndrome, hobbyism and punding were the most frequently mentioned, together with leisure activities, body-focused compulsivity, disruptive, impulse control and conduct disorders, and substance abuse. All these conditions were disproportionately reported with dopamine agonists, except for substance abuse. Conclusions We defined a potential extended list of ICDs, which, along with its conversion to international taxonomies, can support the identification of drug-induced conditions in pharmacovigilance archives, as well as monitoring processes in clinical practice.

Despite a growing literature on the complex bidirectional relationship of ADHD and substance use, reviews specifically focusing on alcohol are scarce. ADHD and AUD show a significant genetic overlap, including genes involved in gluatamatergic and catecholaminergic neurotransmission. ADHD drives risky behavior and negative experiences throughout the lifespan that subsequently enhance a genetically increased risk for Alcohol Use Disorders (AUD). Impulsive decisions and a maladaptive reward system make individuals with ADHD vulnerable for alcohol use and up to 43 % develop an AUD; in adults with AUD, ADHD occurs in about 20 %, but is vastly under-recognized and under-treated. Thus, routine screening and treatment procedures need to be implemented in AUD treatment. Long-acting stimulants or non-stimulants can be used to treat ADHD in individuals with AUD. However, it is crucial to combine medical treatment for ADHD with pharmacotherapy and psychotherapy for AUD, and other comorbid disorders. Identification of individuals at risk for AUD, especially those with ADHD and conduct disorder or oppositional defiant disorder, is a key factor to prevent negative outcomes.

We investigated changes of impulsivity after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) patients, distinguishing functional from dysfunctional impulsivity and their contributing factors.Data of 33 PD patients treated by STN-DBS were studied before and 6 months after surgery: motor impairment, medication (dose and dopaminergic agonists), cognition, mood and occurrence of impulse control disorders. Impulsivity was assessed by the Dickman Impulsivity Inventory, which distinguishes functional impulsivity (FI), reflecting the potential for reasoning and rapid action when the situation requires it, and dysfunctional impulsivity (DI), reflecting the lack of prior reasoning, even when the situation demands it. The location of DBS leads was studied on postoperative MRI using a deformable histological atlas and by compartmentalization of the STN.After STN-DBS, DI was significantly increased (mean pre- and postoperative DI scores 1.9±1.6 and 3.5±2.4, P0.001) although FI was not modified (mean pre- and postoperative FI scores 6.2±2.7 and 5.8±2.6). Factors associated with a DI score's increase≥2 (multivariable logistic regression model) were: low preoperative Frontal Assessment Battery score and location of the left active contact in the ventral part of the STN.Our study suggests that STN-DBS may have a different impact on both dimensions of impulsivity, worsening pathological impulsivity without altering physiological impulsivity. The increase in dysfunctional impulsivity may be favoured by the location of the electrode in the ventral part of the STN.

Nonsuicidal self-injury (NSSI) and binge eating frequently co-occur. These behaviors are often used to alleviate distress. Previous studies examining this co-occurrence have used a variable-centered approach. The current study used a person-centered approach (mixture modeling) to examine how individuals cluster in groups based on their past-month NSSI, past-month objective and subjective binge episodes (OBEs and SBEs, respectively), and endorsement of coping motives for NSSI and eating in two large samples of emerging adults. Validators included self-report measures of emotion regulation, impulsivity, and negative affect. In Study 1, additional validators included lifetime history of mental health treatment and suicide attempts. In Study 2, additional validators included child abuse history. In both Study 1 and Study 2, a three-class solution provided the most interpretable fit with classes characterized as (a) low psychopathology; (b) the presence of OBEs and NSSI, and endorsement of NSSI coping motives; and (c) the presence of SBEs and NSSI, and endorsement of high levels of NSSI coping motives. In both studies, eating motives were equivalent in Classes 2 and 3, but NSSI motives were most strongly endorsed by Class 3. In Study 1, Class 2 endorsed higher rates of lifetime suicide attempts than Class 3. In Study 2, both Class 2 and Class 3 endorsed higher rates of child abuse than Class 1, although they did not differ from each other. The class structure and validator analysis were consistent across samples and measures. Results suggest that binge eating and NSSI tend to cluster together in otherwise healthy emerging adults.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate levels of inattention and/or hyperactivity-impulsivity. ADHD has been related to differences in white matter (WM) microstructure. However, much remains unclear regarding the nature of these WM differences and which clinical aspects of ADHD they reflect. We systematically investigated whether fractional anisotropy (FA) is associated with current and/or lifetime categorical diagnosis, impairment in daily life, and continuous ADHD symptom measures.METHODS: Diffusion-weighted imaging data were obtained from 654 participants (322 unaffected, 258 affected, 74 subthreshold; 7-29 years of age). We applied automated global probabilistic tractography on 18 major WM pathways. Linear mixed-effects regression models were used to examine associations of clinical measures with overall brain and tract-specific FA.RESULTS: There were significant interactions of tract with all ADHD variables on FA. There were no significant associations of FA with current or lifetime diagnosis, nor with impairment. Lower FA in the right cingulum angular bundle was associated with higher hyperactivity-impulsivity symptom severity (pfamilywise error = .045). There were no significant effects for other tracts.CONCLUSIONS: This is the first time global probabilistic tractography has been applied to an ADHD dataset of this size. We found no evidence for altered FA in association with ADHD diagnosis. Our findings indicate that associations of FA with ADHD are not uniformly distributed across WM tracts. Continuous symptom measures of ADHD may be more sensitive to FA than diagnostic categories. The right cingulum angular bundle in particular may play a role in symptoms of hyperactivity and impulsivity.

Pathological gambling (PG) and methamphetamine-induced psychotic disorders (MIPD) both frequently occurs in methamphetamine-dependent individuals. The current study examined whether impulsivity mediated the relationship between MIPD and gambling severity. The sample consisted of 320 pathological gamblers with methamphetamine dependence (mean age 32.6 years, ranging from 15 to 64 years) voluntarily recruited from three rehabilitation centers in Hunan, China. The semistructured clinical interview of DSM-IV-TR Axis I Disorders Patient Edition was used to diagnosis the presence of MIPD and PG by registered psychiatrists. The severity of gambling symptoms was assessed using the global assessment of functioning scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. Of the sample, 53.4% of participants (n = 171) met diagnostic criteria for MIPD. Individuals with a dual diagnosis of MIPD were associated with higher levels of impulsivity and greater gambling severity. Notably, support for our hypothesized mediation model was found such that impulsivity mediated the association between MIPD and gambling severity. Our findings imply that impulsivity appears to be a transdiagnostic process, which may be targeted in treatment among pathological gamblers with a dual diagnosis of MIPD to reduce gambling behaviors. Limits and future directions for research are discussed.

Bayesian models successfully account for several of dopamine (DA)’s effects on contextual calibration in interval timing and reward estimation. In these models, tonic levels of DA control the precision of stimulus encoding, which is weighed against contextual information when making decisions. When DA levels are high, the animal relies more heavily on the (highly precise) stimulus encoding, whereas when DA levels are low, the context affects decisions more strongly. Here, we extend this idea to intertemporal choice and probability discounting tasks. In intertemporal choice tasks, agents must choose between a small reward delivered soon and a large reward delivered later, whereas in probability discounting tasks, agents must choose between a small reward that is always delivered and a large reward that may be omitted with some probability. Beginning with the principle that animals will seek to maximize their reward rates, we show that the Bayesian model predicts a number of curious empirical findings in both tasks. First, the model predicts that higher DA levels should normally promote selection of the larger/later option, which is often taken to imply that DA decreases ‘impulsivity,’ and promote selection of the large/risky option, often taken to imply that DA increases ‘risk-seeking.’ However, if the temporal precision is sufficiently decreased, higher DA levels should have the opposite effect—promoting selection of the smaller/sooner option (higher impulsivity) and the small/safe option (lower risk-seeking). Second, high enough levels of DA can result in preference reversals. Third, selectively decreasing the temporal precision, without manipulating DA, should promote selection of the larger/later and large/risky options. Fourth, when a different post-reward delay is associated with each option, animals will not learn the option-delay contingencies, but this learning can be salvaged when the post-reward delays are made more salient. Finally, the Bayesian model predicts correlations among behavioral phenotypes: Animals that are better timers will also appear less impulsive.

To summarize the reliable risk factors of impulsive-compulsive behaviors (ICBs) in Parkinson’s disease (PD) patients through a meta-analysis on studies in which PD-ICBs were diagnosed by clinical interview. PubMed, Embase, Web of Science, CNKI and Wanfang databases were searched. We selected studies ensuring that diagnosis of ICBs in PD patients depends on semi-structured interviews according to the clinical diagnostic criteria of ICBs. The Newcastle–Ottawa Scale was used to evaluate quality of the included studies. The analyzed factors included demographic information, clinical characteristics of PD and medications. A total of 856 records were screened and 66 full texts were evaluated, and 13 studies (684 PD patients with ICBs [PD-ICBs] and 3,382 PD patients without ICBs [PD-non-ICBs]) were included. Compared with PD-non-ICBs, PD-ICBs were younger in age (− 3.7 [− 5.53, − 1.87], P

Objective In light of the opioid epidemic, there is a need to identify factors that predict aberrant opioid behaviors including misuse and abuse. Impulsivity has been extensively studied in addiction literature, but not in the context of opioid misuse. Hence, this study aimed to identify which of the impulsivity facets (negative urgency, positive urgency, sensation seeking, lack of perseverance, and lack of premeditation) would predict current aberrant opioid-related behaviors in patients with chronic pain. Methods Data were collected through an online survey from patients with chronic pain who visited a tertiary pain clinic. Patients were predominately female (74%), middle aged (M = 55 years), and White/Caucasian (84%). Upon consent, they completed a series of surveys including UPPS-P Impulsive Behavior Scale, the Current Opioid misuse Measure, Pain Catastrophizing Scale, PROMIS-anxiety, depression, and physical function, and a 0-10 numerical pain rating scale. Ordinal regression analyses were conducted to test study hypotheses. Results Contrary to expectations, only lack of premeditation predicted higher odds of aberrant opioid-related behaviors in the past 30 days, after controlling for known covariates, and explained 26% of variance. Interestingly, lack of premeditation together with pain catastrophizing as a covariate explained 56% of the variance in aberrant opioid-related behaviors. Discussion The current study is the first to identify a potential role of lack of premeditation as an impulsivity facet predicting aberrant opioid-related behaviors among patients with chronic pain.

The Impulsivity/Reflexivity issue in inhibitory control ability has seldom been investigated in terms of individual differences in typically developing populations. Although there is evidence of changes in executive functioning (EF), including inhibition, in adolescence, very little is known about the role of individual differences. Using the data from 240 14-to-19-year-old high school students who completed a battery of EF tasks (Flanker, Go No-Go, Antisaccade, and Stop signal task), measures of emotion regulation strategies and behavioral difficulties, we performed a latent profile analysis to identify qualitatively distinct score profiles. The results showed the existence in adolescence of two inhibition profiles, Impulsive vs Reflexive, differing in performances at the inhibition tasks. The two profiles were not associated with socio-demographic characteristics, or to psychological variables, such as behavioral characteristics and emotional regulation strategies.

Background Previous findings suggest that impulsivity is related to chronic low-grade inflammation. Inflammation is known to trigger the kynurenine pathway to a pathological level in various impulsivity-related disorders. Nonetheless, murine models and recent human studies have shown that physical exercise, in particular High Intensity Interval Training (HIIT), could counterbalance the negative effects of inflammation on the kynurenine pathway. Aim This study evaluates the effects of eight weeks of HIIT versus an active control group on impulsivity levels and accompanying alterations of inflammatory-mediated changes of the kynurenine pathway in a sample of emotionally impulsive humans. Methods Participants were randomly allocated to either HIIT or stretching conditions (three trainings per week for eight weeks). Fitness level was evaluated via VO2peak values at the beginning at end of the intervention. Kynurenine metabolites, pro-inflammatory cytokines, and impulsivity levels were evaluated at T0, T4, and T8 weeks. Statistical analyses were performed using mixed models. Results Fifty-three participants were included in the modified Intention To Treat analysis (45 finished the intervention). The HIIT group (n = 28) largely increased the aerobic fitness of its participants and produced physiological changes while the stretching group (n = 25) did not. HIIT reduced interleukin 6 levels (small to moderate interaction) and reduced the activity of the neurotoxic branch of the kynurenine pathway (small to moderate interaction for KYNA/QA and KYN/QA) after eight weeks of training while the active control did not change. Both interventions were effective to decrease emotion-related impulsivity, however only the HIIT group decreased participants’ emotion-unrelated levels. Changes in emotion-related and -unrelated impulsivity were moderately correlated to changes in KYNA/KYN. Conclusion This study demonstrated that HIIT was able to switch the kynurenine pathway from its neurotoxic branch to its neuroprotective one. This shift was associated with a decrease in impulsivity. Based on these findings, future work may consider investigating more intensively the effect of HIIT on impulsivity-related disorders.

Attention-deficit/hyperactive disorder (ADHD) is characterized by symptoms which are dynamic in nature: states of hyperactivity, inattention and impulsivity as core symptoms, and emotion dysregulation as associated feature. Although tremendous work has been done to investigate between-subject differences (how patients with ADHD differ from healthy controls or patients with other disorders), little is known about the relationship between symptoms with triggers and contexts, that may allow us to better understand their causes and consequences. Understanding the temporal associations between symptoms and environmental triggers in an ecologically valid manner may be the basis to developing just-in-time adaptive interventions. Fortunately, recent years have seen advances in methodology, hardware and innovative statistical approaches to study dynamic processes in daily life. In this narrative review, we provide a description of the methodology (ambulatory assessment), summarize the existing literature in ADHD, and discuss future prospects for these methods, namely mobile sensing to assess contextual information, real-time analyses and just-in-time adaptive interventions.

The role of fear of missing out (FoMO) in addictive behaviors has recently attracted growing attention. In view of negative effects of gaming disorder (GD) among adolescents and emerging adults, research examining the relationship between FoMO and GD is needed, alongside the roles of impulsivity and gender in the relationship between FoMO and GD. This study examined whether impulsivity as a mediator and gender as a moderator impacted on the relationship between FoMO and GD among a sample of Chinese university students. A sample of 1,288 Chinese university students from three universities completed an online survey through the Wenjuanxing platform. The Chinese Trait-State Fear of Missing Out Scale, the Barratt Impulsiveness Scale-Brief, and the Chinese Gaming Disorder Scale were used in this study. The model results indicated that impulsivity partially mediated the relationship between FoMO and GD, and that there was a larger effect size between impulsivity and GD among males. High levels of FoMO among individuals may impact on executive functions leading to more impulsivity, and are associated with GD. Gender may moderate the relationship between impulsivity and GD. This study deepens the understanding of the relationship between FoMO and GD, and provides new perspectives for practitioners to incorporate into health prevention programs to help regulate emotion, control impulsivity, and decrease GD.

BACKGROUND Family history of alcohol use disorder; AUD (FH +) and impulsivity-related traits are known risk factors for problem drinking that have been investigated in predominately White samples. This cross-sectional study examined whether these risk factors vary by sex in the overall, majority White sample and in a Black subsample. METHOD A model building regression procedure was used to investigate the combined effect of FH + and impulsivity-related traits on alcohol quantity, frequency, and problems by sex (overall sample: N = 757, 50% female, 73% White, agemean = 33.74, SD = 11.60; Black subsample: n = 138, 47% female, agemean = 33.60, SD = 9.87). RESULTS Overall Sample. No sex differences were found in the compounding effects of FH + and impulsivity-related traits on alcohol outcomes. Males reported more physical, social, and overall alcohol-related problems than females. FH + was positively associated with all alcohol-related consequences. Poor self-regulation was the only trait associated with all alcohol outcomes. Black Subsample: A three-way interaction suggested a negative association between inhibition and frequency of alcohol use among FH + males only. A two-way interaction also suggested impulse control was associated with more interpersonal alcohol-related problems among males only. Main effects were also found in the expected direction such that higher impulsivity and FH + were associated with poorer alcohol outcomes. CONCLUSION These findings suggest no sex differences in the overall sample in the interactive effects of established risk factors for AUD on alcohol outcomes, and that poor self-regulation may be key for personality-targeted alcohol prevention and intervention programs. Preliminary findings of sex differences in the Black subsample should be replicated. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND Impulsivity has been defined by acting rashly during positive mood states (positive urgency; PU) or negative mood states (negative urgency; NU) and by excessive de-valuation of deferred rewards. These behaviors reflect a "live in the now" mentality that is not only characteristic of many individuals with severe substance use disorder (SUD) but also impedes medical treatment compliance and could result in repeated hospitalizations or other poor health outcomes. Purpose/objectives: We sought preliminary evidence that impulsivity may relate to adverse health outcomes in the veteran population. Impulsivity measured in 90 veterans receiving inpatient or outpatient SUD care at a Veterans Affairs Medical Center was related to histories of inpatient/residential care costs, based on VA Health Economics Resource Center data. Results: We found that positive urgency, lack of persistence and lack of premeditation, but not sensation-seeking or preference for immediate or risky rewards, were significantly higher in veterans with a history of one or more admissions for VA-based inpatient or residential health care that either included (n = 30) or did not include (n = 29) an admission for SUD care. Among veterans with a history of inpatient/residential care for SUD, NU and PU, but not decision-making behavior, correlated with SUD care-related costs. Conclusions/Importance: In veterans receiving SUD care, questionnaire-assessed trait impulsivity (but not decision-making) related to greater care utilization within the VA system. This suggests that veterans with high impulsivity are at greater risk for adverse health outcomes, such that expansion of cognitive interventions to reduce impulsivity may improve their health.

Understanding the underlying mechanisms of mindfulness has been a hot topic in recent years, not only in clinical fields but also in neuroscience. Most neuroimaging findings demonstrate that critical brain regions involved in mindfulness are responsible for cognitive functions and mental states. However, the brain is a complex system operating via multiple circuits and networks, rather than isolated brain regions solely responsible for specific functions. Mindfulness-based treatments for attention deficit hyperactivity disorder (ADHD) have emerged as promising adjunctive or alternative intervention approaches. We focus on four key brain circuits associated with mindfulness practices and effects on symptoms of ADHD and its cognitive dysfunction, including executive attention circuit, sustained attention circuit, impulsivity circuit, and hyperactivity circuit. We also expand our discussion to identify three key brain networks associated with mindfulness practices, including central executive network, default mode network, and salience network. We conclude by suggesting that more research efforts need to be devoted into identifying putative neuropsychological mechanisms of mindfulness on how it alleviates ADHD symptoms.

The study objectives were to investigate correlates of healthy orthorexia (HeOr), its relation with impulsivity, and the moderating role of adaptive personality traits among a Lebanese adult sample. The sample was recruited from seven community pharmacies, from the five districts in Lebanon, chosen from a list provided by the Lebanese Order of Pharmacists in a convenient way. The questionnaire included the Teruel Orthorexia Scale (TOS) to measure HeOr, Big Five Inventory (BFI) to assess adaptive personality traits, and the I-8 scale for impulsivity. Higher extraversion (B = -4.31) was significantly associated with lower healthy orthorexia. The interaction perseverance by extraversion was associated with higher healthy orthorexia; in those with higher perseverance, higher extraversion was associated with more healthy orthorexia. Our study presents findings that could be of significant clinical relevance in the future, especially with the interest increase in Orthorexia Nervosa prevalence, which subsequently prompts more research and intrigue about HeOr. Furthermore, it places healthy eating and consistent commitment to a healthy diet within a clearly defined scientific frame, on which further investigation can be based.

Impulsivity is a central concept for many psychological models and interventions. Despite extensive research, the concept of impulsivity lacks clarity due to the diversity of definitions provided. The aims of this study were to conduct a concept analysis of impulsivity to provide a clear and workable definition of impulsivity for future nursing research. This study used Rodgers' evolutionary concept analysis approach to analyze 37 articles from various disciplines. Our analysis offers promising direction in refining the concept. The findings can drive future research and enhance nurse researchers' ability to attend and explore health-related issues associated with the concept.

Objective Attention-deficit/hyperactivity disorder (ADHD) is an established risk factor for developing alcohol use disorder (AUD), and AUD-ADHD comorbidity is associated with additional psychiatric diagnoses. Several lines of evidence support the role of impulsivity as a pathway of these relationships; however, impulsivity is not a unitary construct. Thus, we sought to explore whether separate aspects of impulsivity may explain the relationship between ADHD symptoms and psychiatric comorbidity among inpatients (N = 136) with AUD. Methods: We assessed ADHD symptoms (childhood ADHD [Wender Utah Rating Scale], adult ADHD [Adult ADHD self-report scale]), health-related quality of life (HRQL; EQ-5D-5L), psychiatric comorbidity (Mini International Neuropsychiatric Interview), and impulsive personality traits (Urgency, Premeditation, Perseverance, Sensation seeking [UPPS] scale). Results: 19% of patients screened positive in the retrospective assessment of childhood ADHD, and 17% for adult ADHD. Participants reported moderate levels of problem severity in the HRQL dimensions, and 65% had ≥1 current psychiatric disorders other than AUD and ADHD. Multiple mediation indicated that there was a significant direct effect of childhood ADHD symptoms on psychiatric comorbidity (β = 0.224, 95% CI [0.080, 1.114]), and indirect effects of both reacting impetuously when experiencing negative emotions (negative urgency; β = 0.999, 95% CI [0.043, 0.461]) and the tendency to not finish tasks (lack of perseverance; β = 0.075, 95% CI [0.002, 0.297]). Conclusions: The subcomponents of impulsivity to react rashly when experiencing negative emotions and the tendency to not persist in activities seem to contribute to the relationship between ADHD symptoms (particularly those in childhood) and psychiatric comorbidity among patients with severe AUD.

Mindfulness has been associated with fewer negative mental health symptoms during adolescence, but fewer studies have examined longitudinal associations between mindfulness and symptoms in conjunction with two vulnerability factors for psychopathology with mindfulness: rumination and impulsivity. This study examined longitudinal associations between internalizing symptoms (depression, anxiety, stress), mindfulness, rumination, and impulsivity over a one-year period among 352 Spanish adolescents (57.4% girls; M = 14.47, SD = 1.34). Participants completed self-reported measures of symptoms, mindfulness, rumination, and impulsivity at two time points. Mindfulness negatively predicted stress and depressive symptoms, and a bidirectional negative association was found between mindfulness and impulsivity. Impulsivity positively predicted stress, and anxiety positively predicted depressive symptoms, stress, and rumination. This study highlights the importance of mindfulness as a protective factor and impulsivity and anxiety as risk factors for internalizing symptoms throughout adolescence. These findings build on previous studies that examined longitudinal associations between mindfulness and symptoms by including rumination and impulsivity’s roles.

Objective:To evaluate the associations between cannabis use and neurocognitive functioning, including self-reported attention deficit hyperactivity disorder (ADHD) symptoms, in a large sample of emerging adults (ages 21–25) using a cross-sectional design. A secondary objective was to examine age of cannabis initiation as a moderator.Methods:Participants were high-risk drinking emerging adults (n = 598) reporting past-month cannabis use in the following categories: 1) non-users (i.e., never or not in the past month; n = 276), 2) occasional users (i.e., monthly or weekly users; n = 201), and 3) daily users (n = 121). Categorical comparisons were conducted on working memory, attention, behavioral inhibition, delay and probability discounting, verbal intelligence, and ADHD symptoms. Complementary dimensional analyses examined cannabis severity in relation to neurocognition using regressions. Covariates were age, race, sex, income, years of education, tobacco use, and alcohol use.Results:Frequency of cannabis use was significantly associated with poorer working memory performance, more impulsive delay discounting, and greater endorsement of ADHD symptoms, but not other domains. Effect sizes were small and poorer performance was selectively present among daily, not occasional, cannabis users. Earlier age of initiation was not independently or interactively associated with neurocognitive performance.Conclusions:Daily cannabis use was selectively adversely associated with aspects of memory, impulsivity, and subjective attentional functioning, but most cognitive indicators were not implicated, and evidence of amplification by earlier age of initiation was not observed. Ascertaining causal versus consequential roles of cannabis in neurocognitive functioning is an important priority.

Background University students are at a greater risk of gaining weight compared to others. We explored associations between changes in weight and a set of dispositional constructs related to eating behaviour: motivation, impulsivity, social comparison, and eating styles. We predicted that increases in controlled motivation, impulsivity, uncontrolled eating, emotional eating, and physical appearance comparison would be related to increased weight and body fat. Methods First year students at a British university completed baseline (n = 196) and three-month (n = 163) measures of impulsivity, physical appearance comparison, motivation for following a healthy diet, eating styles, weight and body fat. Baseline-follow-up changes in these constructs were computed and subjected to cluster analysis. Results Four participant groups were identified according to similarities in the way these constructs evolved over time. The Losing and Gaining groups tended to show opposing changes in key variables (physical appearance comparison, uncontrolled eating, motivation, weight, and percentage of body fat). Interestingly, two groups showed no change in weight and body fat but evidenced unique changes in key variables, indicating that individuals can have different psychological profiles but still maintain their weight. Conclusions The study highlighted how stable weight maintenance arises from sets of interdependent constructs rather than variables in isolation, as well as emphasizing a need to take a person-centred approach to examining those at risk of weight gain and in developing interventions.

RATIONALE: Reward-associated cues can promote maladaptive behavior, including risky decision-making in a gambling setting. A propensity for sign tracking over goal tracking—i.e., interaction with a reward-predictive cue rather than the site of reward—demonstrates an individual’s tendency to transfer motivational value to a cue. However, the relationship of sign tracking to risky decision-making remains unclear. OBJECTIVES: To determine whether sign tracking predicts risky choice, we used a Pavlovian conditioned approach task to evaluate the tendency of male rats to sign track to a lever cue and then trained rats on a rodent gambling task (rGT) with win-associated cues. We also tested the effects of D-amphetamine, quinpirole (a D(2)/D(3) receptor agonist), and PD128907 (a D(3) receptor agonist) on gambling behavior in sign tracker and goal tracker individuals. RESULTS: Increased sign tracking relative to goal tracking was associated with suboptimal performance on the rGT, including decreased selection of the optimal choice, increased selection of a high-risk/high-reward option, and increased impulsive premature choices. Amphetamine increased choices of a low-risk/low-reward option at the expense of optimal and high-risk choices, whereas quinpirole and PD128907 had little effect on choice allocation, but reduced impulsivity. Drug effects were similar across sign tracker and goal tracker individuals. CONCLUSIONS: Cue reactivity, as measured by sign tracking, is predictive and may be an important driver of risky and impulsive choices in a gambling setting laden with salient audiovisual cues. Evaluating an individual’s sign tracking behavior may be an avenue to predict vulnerability to pathological gambling and the efficacy of treatments.