Thus, it has been proposed that patients across psychiatric diagnostic categories that express high impulsivity levels may benefit from preventive and therapeutic strategies targeting impulsivity. Impulsivity has been linked to severe clinical expression, including suicidality, aggression, and early onset of the disorder. Elevated impulsivity has been demonstrated in bipolar and schizophrenia spectrum disorders as well as in a range of other mental disorders such as attention-deficit hyperactivity disorder, borderline and antisocial personality disorders, and intermittent explosive disorder. Impulsivity can be conceptualized as a tendency to react without considering the consequences. The development of a severe mental disorder affects quality of life and functioning, although illness course varies substantially between individuals. Schizophrenia and bipolar disorder are severe mental disorders with overlapping clinical presentations, environmental risk factors, and polygenic architectures. Future studies are warranted to determine the causal directionality of the observed associations with psychopharmacotherapy. The present study reveals associations between impulsivity in severe mental disorders and treatment with lithium and antidepressants, with opposite directions. We report elevated impulsivity across SCZ and BD but no associations to systemic immune dysregulation based on the current immune marker selection. Among patients, impulsivity was negatively associated with lithium treatment ( p = 0.003) and positively associated with antidepressant treatment ( p = 0.011) after controlling for diagnosis, psychotropic co-medications, manic symptoms, and depressive symptoms. Impulsivity was positively associated with SCZ ( p < 0.001) and BD ( p < 0.001) diagnosis and negatively associated with age ( p < 0.05), but not significantly associated with any of the circulating immune markers independently of diagnostic status. Associations were assessed using linear regressions. Patients underwent thorough clinical assessment, including evaluation of psychotropic medication. Plasma levels of systemic immune markers (RANTES, IL-1RA, IL-18, IL-18BP, sTNFR-1) were measured by enzyme immunoassays. Impulsivity was assessed in a sample ( N = 657) of patients with schizophrenia or schizophreniform disorder (SCZ) ( N = 116) or bipolar disorder (BD) ( N = 159) and healthy participants ( N = 382) using the Barratt Impulsiveness Scale (BIS-11) questionnaire. We investigated if impulsivity was associated with circulating immune marker levels and with a range of psychopharmacological treatment regimens in severe mental disorders. Biological underpinnings are largely unknown, but involvement of immune dysregulation has been indicated, and the effects of psychopharmacological agents vary. Impulsivity is a transdiagnostic feature linked to severe clinical expression and a potential target for psychopharmacological strategies.
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