Observations of elevated impulsivity in bipolar disorder raise the issue of whether behavioral control is further compromised by state factors in manic episodes of the illness or the more frequently experienced periods of depression. Psychometric assessments suggest that attentional and motor impulsivity, as measured by the BIS-11 (Barratt, 1993), are increased in manic episodes and show a significant association with SADS-C Mania factor scores (Swann et al., 2008). The symptoms correlating most strongly with impulsivity may be visible hyperactivity > increased energy > accelerated speech; with no correlation involving subjective mood. Manic symptoms are also often present during predominately depressive episodes. Manic symptom ratings in bipolar depressive episodes correlate with impulsivity and with clinical indices of a severe course of illness including early onset, histories of alcohol-use disorders, and suicide attempts, bridging state-related and trait-related aspects of the disorder (Swann et al., 2008).
