scholarly journals Interactions of immediate and long-term action regulation in the course and complications of bipolar disorder

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180132 ◽  
Author(s):  
Marijn Lijffijt ◽  
Brittany O'Brien ◽  
Ramiro Salas ◽  
Sanjay J. Mathew ◽  
Alan C. Swann
Keyword(s):  
Bipolar Disorder ◽  
Risk Taking ◽  
Treatment Strategies ◽  
Behavioural Disorders ◽  
Theme Issue ◽  
Impulsive Behaviour ◽  
Behavioural Sensitization ◽  
Theoretical Perspectives ◽  
Clinical Consequences

Immediate and long-term mechanisms interact in the regulation of action. We will examine neurobiology and practical clinical consequences of these interactions. Long-term regulation of immediate behavioural control is based on analogous responses to highly rewarding or stressful stimuli: (i) impulsivity is a failure of the balance between activation and inhibition in the immediate regulation of action. (ii) Sensitization is a persistently exaggerated behavioural or physiological response to highly salient stimuli, such as addictive stimuli or inescapable stress. Sensitization can generalize across classes of stimuli. (iii) Impulsivity, possibly related to poor modulation of catecholaminergic and glutamatergic functions, may facilitate development of long-term sensitized responses to stressful or addictive stimuli. In turn, impulsivity is prominent in sensitized behaviour. (iv) While impulsivity and sensitization are general components of behaviour, their interactions are prominent in the course of bipolar disorder, emphasizing roles of substance-use, recurrent course and stressors. (v) Suicide is a complex and severe behaviour that exemplifies the manner in which impulsivity facilitates behavioural sensitization and is, in turn, increased by it, leading to inherently unpredictable behaviour. (vi) Interactions between impulsivity and sensitization can provide targets for complementary preventive and treatment strategies for severe immediate and long-term behavioural disorders. Progress along these lines will be facilitated by predictors of susceptibility to behavioural sensitization. This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications’.

scholarly journals Conquering the inner couch potato: precommitment is an effective strategy to enhance motivation for effortful actions

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180131 ◽  
Author(s):  
Bettina Studer ◽  
Carolin Koch ◽  
Stefan Knecht ◽  
Tobias Kalenscher
Keyword(s):  
Risk Taking ◽  
Small Reward ◽  
Computational Modelling ◽  
Self Control ◽  
Clinical Implications ◽  
Theme Issue ◽  
Choice Behaviour ◽  
Impulsive Behaviour ◽  
Theoretical Perspectives ◽  
Regulatory Measure

Letting effort-free gratification derail us from effort-requiring goals is one reason why we fail to realize health-relevant intentions like ‘exercise regularly’. We tested the effectiveness of the self-control strategy precommitment in such effort-related conflicts, using a novel laboratory choice paradigm, where participants could precommit to an effort-requiring large reward by pre-eliminating an effort-free small reward from their choice set. Our participants used precommitment frequently and effectively, such that they reached effort-requiring large rewards more often. Using computational modelling and Bayesian model comparisons, we assessed whether participants employed precommitment to avoid anticipated willpower failures (i.e. as a self-regulatory measure) or to maximize their motivation to choose the effort-requiring option (i.e. as a self-motivational measure). Observed choices and precommitment decisions were consistent with the motivation maximization hypothesis, but not the willpower hypothesis. Our findings show that offering precommitment is effective in helping individuals optimize their motivation and choice behaviour and thereby achieve effort-requiring goals, and strongly encourage application of precommitment schemes in exercise and rehabilitation interventions. This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications’.

scholarly journals Why has evolution not selected for perfect self-control?

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180139 ◽  
Author(s):  
Benjamin Y. Hayden
Keyword(s):  
Cognitive Control ◽  
Risk Taking ◽  
Decision Makers ◽  
Self Control ◽  
Subjective Feeling ◽  
Theme Issue ◽  
Theoretical Perspectives ◽  
Obvious Reason ◽  
Control Failures

Self-control refers to the ability to deliberately reject tempting options and instead select ones that produce greater long-term benefits. Although some apparent failures of self-control are, on closer inspection, reward maximizing, at least some self-control failures are clearly disadvantageous and non-strategic. The existence of poor self-control presents an important evolutionary puzzle because there is no obvious reason why good self-control should be more costly than poor self-control. After all, a rock is infinitely patient. I propose that self-control failures result from cases in which well-learned (and thus routinized) decision-making strategies yield suboptimal choices. These mappings persist in the decision-makers’ repertoire because they result from learning processes that are adaptive in the broader context, either on the timescale of learning or of evolution. Self-control, then, is a form of cognitive control and the subjective feeling of effort likely reflects the true costs of cognitive control. Poor self-control, in this view, is ultimately a result of bounded optimality. This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications.

scholarly journals Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180128 ◽  
Author(s):  
Anthony R. Isles ◽  
Catharine A. Winstanley ◽  
Trevor Humby
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Risk Taking ◽  
Neurodegenerative Disorders ◽  
Human Population ◽  
Clinical Implications ◽  
Theme Issue ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Impulsive Behaviour ◽  
Theoretical Perspectives

Our willingness to take risks, our ability to wait or the speed with which to make decisions are central features of our personality. However, it is now recognized that impulsive and risk-taking behaviours are not a unitary construct, and different aspects can be both psychologically and neurally dissociated. The range of neurochemicals and brain systems that govern these behaviours is extensive, and this may be a contributing factor to the phenotypic range seen in the human population. However, this variety can also be pathological as extremes in risk-taking and impulsive behaviours are characteristics of many neuropsychiatric and indeed neurodegenerative disorders. This spans obsessive–compulsive disorder, where behaviour becomes ridged and non-spontaneous, to the nonsensical risk-taking seen in gambling and drug taking. This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

scholarly journals Computational psychiatry of impulsivity and risk: how risk and time preferences interact in health and disease

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180135 ◽  
Author(s):  
Silvia Lopez-Guzman ◽  
Anna B. Konova ◽  
Paul W. Glimcher
Keyword(s):  
Risk Taking ◽  
Temporal Discounting ◽  
Time Preferences ◽  
Clinical Implications ◽  
Mathematical Relationship ◽  
Theme Issue ◽  
Impulsive Behaviour ◽  
Theoretical Perspectives ◽  
Subjective Value ◽  
Health And Disease

Choice impulsivity is an important subcomponent of the broader construct of impulsivity and is a key feature of many psychiatric disorders. Choice impulsivity is typically quantified as temporal discounting , a well-documented phenomenon in which a reward's subjective value diminishes as the delay to its delivery is increased. However, an individual's proclivity to—or more commonly aversion to— risk can influence nearly all of the standard experimental tools available for measuring temporal discounting. Despite this interaction, risk preference is a behaviourally and neurobiologically distinct construct that relates to the economic notion of utility or subjective value. In this opinion piece, we discuss the mathematical relationship between risk preferences and time preferences, their neural implementation, and propose ways that research in psychiatry could, and perhaps should, aim to account for this relationship experimentally to better understand choice impulsivity and its clinical implications. This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications’.

scholarly journals Feeding behaviour, risk-sensitivity and response control: effects of 5-HT2Creceptor manipulations

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180144 ◽  
Author(s):  
Trevor Humby ◽  
Yateen Patel ◽  
Jenny Carter ◽  
Laura-Jean G. Stokes ◽  
Robert D. Rogers ◽  
...  
Keyword(s):  
Risk Taking ◽  
Impulse Control ◽  
Delay Condition ◽  
Risk Sensitivity ◽  
Variable Delay ◽  
Theme Issue ◽  
The Past ◽  
Theoretical Perspectives ◽  
Developed World ◽  
The Impact

People, like animals, tend to choose the variable option when given the choice between a fixed and variable delay to reward where, in the variable delay condition, some rewards are available immediately (Laura-Jeanet al. 2019Phil. Trans. R. Soc. B374, 20180141. (doi:10.1098/rstb.2018.0141)). This bias has been suggested to reflect evolutionary pressures resulting from food scarcity in the past placing a premium on obtaining food quickly that can win out against the risks of sometimes sustaining longer delays to food. The psychologies mediating this effect may become maladaptive in the developed world where food is readily available contributing, potentially, to overeating and obesity. Here, we report our development of a novel touchscreen task in mice allowing comparisons of the impact of food delay and food magnitude across species. We show that mice exhibit the typical preference, as shown by humans, for variable over fixed delays to rewards but no preference when it comes to fixed versus variable reward amounts and further show that this bias is sensitive to manipulations of the 5-HT2Creceptor, a key mediator of feeding and impulse control. We discuss the data in terms of the utility of the task to model the psychologies and underlying brain mechanisms impacting on feeding behaviours.This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications’.

scholarly journals Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans

2018 ◽  
Vol 374 (1766) ◽  
pp. 20180129 ◽  
Author(s):  
Robert F. Leeman ◽  
Bonnie H. P. Rowland ◽  
Nioud Mulugeta Gebru ◽  
Marc N. Potenza
Keyword(s):  
Sexual Behaviour ◽  
Risk Taking ◽  
Empirical Support ◽  
International Classification Of Diseases ◽  
Impulsive Behaviour ◽  
Sexual Behaviours ◽  
Theoretical Perspectives ◽  
Wide Range ◽  
Classification Of Diseases

Impulsivity's relationships to addictive and sexual behaviours raise questions regarding the extent impulsivity may constitute a vulnerability factor for subsequent addictive and sexual behaviours and/or results from each of these. Here, we systematically reviewed empirical support for impulsivity as a precipitating factor or a consequence of addictive or sexual behaviours. We restricted ourselves to recent, human studies with assessments over time, including at least one measure of impulsivity, addictive and sexual behaviours, yielding a review including 29 published reports from 28 studies. Findings point to generalized, self-reported impulsivity as a predictor of addictive and sexual behaviours at a wide range of severity, with elements of both impulsivity and compulsivity to these acts. Alcohol consumption often increases impulsive behaviour, including inclinations towards impulsive and potentially compulsive sexual acts. Research using the Sexual Delay Discounting Task has yielded findings linking impulsivity, addictive and sexual behaviour and as such is a valuable research tool that should be used more extensively. The present review identified gaps to be addressed in further research that concurrently examines facets of impulsivity, addictive and sexual behaviours, especially because criteria for compulsive sexual behaviour disorder have been included in the eleventh edition of the International Classification of Diseases . This article is part of the theme issue ‘Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications’.

Stabilization in the treatment of mania, depression and mixed states

2000 ◽  
Vol 12 (3) ◽  
pp. 110-114 ◽  
Author(s):  
D.J. Kupfer ◽  
E. Frank ◽  
V.J. Grochocinski ◽  
J.F. Luther ◽  
P.R. Houck ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Acute Phase ◽  
Treatment Strategies ◽  
Manic Episode ◽  
Term Treatment ◽  
Therapeutic Approaches ◽  
Mixed States ◽  
Long Term Treatment ◽  
Time To Stabilization

ABSTRACTWhile one major need for improved therapeutic approaches in bipolar disease is the development of long-term treatment strategies, a systematic approach during the acute phase of bipolar disorder is also required. In our own studies we have arbitrarily divided the initial treatment of subjects by the predominant polarity for which they are treated acutely: manic, depressed, or mixed/cycling.1 In this larger investigation of over 150 patients with bipolar disorder, we now demonstrated again that the time to initial stabilization is generally the shortest with a manic episode and the longest with a mixed/cycling episode with the depressed episode in the middle (although almost as long as the mixed/cycling episode). These findings indicate the difficulty of treating both the depressed phase and mixed/cycling episodes in bipolar disorder. It is also noteworthy that gender does not have a significant effect on time to stabilization. Such findings in the acute phase have profound implications in designing and carrying out long-term therapeutic strategies for this disorder.

Antipsychotic combination strategies in patients with bipolar disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S615-S615
Author(s):  
R. Molina Ruiz ◽  
M. de Castro Oller ◽  
V. Gomez Macías ◽  
M. Roncero Rodriguez ◽  
F. Montañes Rada
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Treatment Strategies ◽  
Efficacy And Safety ◽  
Long Term Effects ◽  
Combination Strategies ◽  
Affective Symptoms ◽  
Meta Analyses

IntroductionTreatment strategies in bipolar disorder (BPD) has changed in the last decades and polypharmacy including antipsychotics has become extremely common compared to monotherapy with mood stabilisers. Clinicians tend to use 2 or more atypical antipsychotics despite the lack of evidence to support safety, tolerability and efficacy of this practice.ObjectiveTo determine most frequently used treatment strategies in a sample of bipolar disorder patients and review of the literature.MethodologyAnalysis of a sample of 35 patients with BPD from Madrid and review of recent literature for evidence arising from international guidelines recommendations and meta-analyses.ResultsMost frequently used treatment approach in our sample was polytherapy, including at least 1 atypical antipsychotic (31%) and polytherapy, including at least 2 antipsychotics (47%) together with mood stabilisers. Only 11% were in monotherapy with mood stabilisers and another 11%were in monotherapy with one atypical antipsychotic but without mood stabilisers. Aripiprazol and olanzapine were among the most preferred atypical antipsychotics. Efficacy and safety of such combinations have not been systematically compared with monotherapy in the literature. Previous data indicate that polytherapy in BPD may incur in important disadvantages [1].ConclusionsTreatment of BPD remains challenging. Polytherapy seem to have replaced monotherapy due to less relapses and better results in treatment of affective symptoms. However, compliance and secondary long-term effects should be taken into account. Superiority in terms of efficacy in polytherapy needs to be balanced with tolerability issues. More studies on combination therapy, long-term efficacy and safety are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

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