Criminal conviction, impulsivity, and course of illness in bipolar disorder

Abstract

Objective Criminal behavior in bipolar disorder may be related to substance use disorders, personality disorders, or other comorbidities potentially related to impulsivity. We investigated relationships among impulsivity, antisocial personality disorder (ASPD) or borderline personality disorder symptoms, substance use disorder, course of illness, and history of criminal behavior in bipolar disorder. Methods A total of 112 subjects with bipolar disorder were recruited from the community. Diagnosis was by Structured Clinical Interview for DSM-IV (SCID-I and SCID-II); psychiatric symptom assessment by the Change version of the Schedule for Affective Disorders and Schizophrenia (SADS-C); severity of Axis II symptoms by ASPD and borderline personality disorder SCID-II symptoms; and impulsivity by questionnaire and response inhibition measures. Results A total of 29 subjects self-reported histories of criminal conviction. Compared to other subjects, those with convictions had more ASPD symptoms, less education, more substance use disorder, more suicide attempt history, and a more recurrent course with propensity toward mania. They had increased impulsivity as reflected by impaired response inhibition, but did not differ in questionnaire-measured impulsivity. On logit analysis, impaired response inhibition and ASPD symptoms, but not substance use disorder, were significantly associated with criminal history. Subjects convicted for violent crimes were not more impulsive than those convicted for nonviolent crimes. Conclusions In this community sample, a self-reported history of criminal behavior is related to ASPD symptoms, a recurrent and predominately manic course of illness, and impaired response inhibition in bipolar disorder, independent of current clinical state.

Genetic and environmental determinants of violence risk in psychotic disorders: a multivariate quantitative genetic study of 1.8 million Swedish twins and siblings

“…Clinical studies have demonstrated that impulsivity and risk-taking behaviours are stronger in bipolar disorder than in schizophrenia (30) and the rates of aggression and violence tend to be more pronounced in patients diagnosed with bipolar disorder who exhibit higher rates of impulsivity (31). Second, it has also been established that the risk of aggression in bipolar disorder increases substantially during acute manic episodes (31, 32), which are characterised by elevated levels of irritability, impatience and impaired insight (33). Genetically informative longitudinal clinical studies are therefore warranted to further explore the ways in which symptoms of mania interplay with substance misuse to generate increased levels of aggression and violence.…”

Análise de Teoria de Resposta ao Item de um Instrumento Breve de Avaliação de Comportamentos Antissociais

“…Esses comportamentos envolvem tanto aspectos sutis de falta de reciprocidade nas interações interpessoais quanto comportamentos de natureza agressiva, sendo explicados por múltiplas trajetórias desenvolvimentais (Frick e Viding, 2009). Comportamentos socialmente desviantes são comuns a diversas condições psicopatológicas; por exemplo, ocupam um papel central no Transtorno da Personalidade Antissocial (American Psychiatric Association, 2013), e são também correlatos de traços de psicopatia (Cooke, Michie, Hart e Clark, 2004), e de Transtorno da Personalidade Borderline (Chabrol, Valls, Leeuwen e Bui, 2012), Transtorno da Personalidade Narcisista (Reidy, Zeichner, Foster e Martinez, 2008), e Transtorno Bipolar (Swann et al, 2011), além de outras categorias nosográficas. De um ponto de vista neurobiológico, comportamentos antissociais, especialmente aqueles agressivos, são influenciados por uma baixa ativação das estruturas cerebrais frontais (e.g., orbitofrontal) e das amígdalas (Blair, 2004), bem como por uma alta razão testosterona/cortisol (Terburg, Morgan e Van Honk, 2009).…”

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

“…Gender has no effect on impulsivity [5,28] or conviction history in bipolar disorder [36]. Approximately 90% of individuals with ASPD are men, but half of those with comorbid ASPD and bipolar disorder were women [37].…”

“…In a crime-registry study of subjects discharged from hospitalization for an affective disorder, propensity toward mania predicted subsequent conviction [109]. The number of manic episodes no longer contributed significantly to conviction history when ASPD symptoms and rapid-response impulsivity were taken into account [36]. …”

“…ASPD symptom count and rapid-response impulsivity contributed independently to criminal conviction [36]. Impulsivity may interact with factors related to voluntary behavior or earlier experience [116], including: Psychopathy [117], consistent with increased, but not borderline, ASPD symptom scores with conviction history [36]. Elements of psychopathy and impulsivity may cut across ASPD and bipolar disorder and contribute differentially to their severity;…”