Majör Depresyonun Dürtüselliğin Farklı Boyutları ile İlişkisi

Abstract

Objectives: Impulsivity is a multidimentional construct involving diverse neuropsychological and neurobiological processes. Impulsivity is particularly important in major depression due to its influence on suicidality and medication compliance. The aim was to study impulsive features in depressed patients and their relationship to suicidality. Method: Participants were recruited between March 2016 and September 2016 in Hacettepe University Hospitals Psychiatry Clinic. Hundred and three outpatients diagnosed as major depression, with Structured Clinical Interview for DSM-IV (SCID-I) were recruited. Two groups were constituted as ‘remitted major depression’ (RMD, n=32) and ‘major depression’ (MD, n=71) based on Hamilton Depression Rating Scale (HDRS) scores ≤ 7 and ≥ 8, respectively. ‘Control group’ (C) consisted of 30 healthy individuals who were never diagnosed with any psychiatric disorder. Comorbid Axis I mental diagnosis other than remitted anxiety disorders were excluded. Subthreshold bipolarity was assessed with Mood Disorder Questionnaire (MDQ), suicidal ideation and behaviour history were recorded. Impulsivity was evaluated with self-report scales and behavioral tasks: Barratt Impulsivity Scale (BIS), UPPS Impulsive Behaviour Scale (UPPS), Go/no-go Task, Iowa Gambling Task (IGT), Balloon Analogue Risk Task ( BART). Data were analyzed with Mann-Whitney U test, Kruskal-Wallis test, Spearman test with SPSS Statistics 17.0. Significance level was set as p <0.05. Results: Barratt Impulsivity Scale non-planning subscale and UPPS urgency subscale scores in MD group was higher than controls, and MD group had higher UPPS urgency subscale scores than RMD group. There was no significant difference between groups in behavioral task scores. There were weak positive correlations between depression symptom severity and lack of premeditation, urgency, non-planning, and attention impulsivity, and ommision errors in Go/no-go Task reflecting attention deficit, when analysed in all participants. MD group with suicidal ideation had higher BIS total and attention impulsivity scores, UPPS total, lack of premeditation and urgency scores, and comission errors in Go/no-go Task reflecting failure in response inhibition, compared to those without suicidal ideation. In addition to these differences, MD group with lifetime history of suicide attempt had higher scores for all subscales of BIS, however there was no difference in behavioral task performances. Conclusion: Higher impulsivity found only in self-report scales during depressive episode suggests that the impulsivity is state dependent, rather than being a trait feature. Impulsivity needs to be investigated by follow up studies including dimensions that were not assessed in this study. Various dimensions of impulsivity assessed by self-report scales and behavioral tasks were found to be related to suicide risk. The relationship between impulsivity and suicidality in depressed patients should be investigated in further studies in order to be able to predict the risk of suicide, improve management according to this risk, and to develop more effective treatment approaches.