Impulsivity in schizophrenia: phenomenology and research approaches
T. A. Lepilkina,
M. A. Morozova,
G. E. Rupchev,
D. S. Burminskiy,
A. G. Beniashvili,
S. S. Potanin,
A. A. Kibitov https://doi.org/10.31363/2313-7053-2025-2-1012
Abstract
Impulsivity in schizophrenia is not a solid phenomenon either at the level of behavior or from the point of view of psychological mechanisms and underlying physiology. Some research approaches are considered in the article, and three types of impulsivity were identified based on the difference in research method and object: impulsivity as a clinical condition, impulsivity as a personality trait, and experimentally studied impulsivity. Clinical impulsivity manifests most often as the unmotivated aggression and affective outburst, or as following the psychotic symptoms. The basis for the qualification is the information from observation and interviews with the patient and family members; specific scales are used for standardized assessment. Impulsivity as a personality trait is studied mainly using self-questionnaires and describes various aspects of personality and cognitive style associated with impulsive behavior. The results of the studies in patients with schizophrenia show both higher rates of subjective impulsivity and those comparable with normative data. The third type of impulsivity reveals in controlled experiments with the conditions that provoke impulsive behavior. Data on patients with schizophrenia in the experimental paradigm are also ambiguous. The article discusses the relationships between different types of impulsivity and possible approaches to its therapy and correction in subjects with schizophrenia.
About the Authors
T. A. Lepilkina
Mental health research center
Russian Federation
Russian Federation
Taissia A. Lepilkina
Moscow
M. A. Morozova
Mental health research center
Russian Federation
Russian Federation
Margarita A. Morozova
Moscow
G. E. Rupchev
Mental health research center
Russian Federation
Russian Federation
George E. Rupchev
Moscow
D. S. Burminskiy
Mental health research center
Russian Federation
Russian Federation
Denis S. Burminskiy
Moscow
A. G. Beniashvili
Mental health research center
Russian Federation
Russian Federation
Allan G. Beniashvili
Moscow
S. S. Potanin
Mental health research center
Russian Federation
Russian Federation
Sergey S. Potanin
Moscow
A. A. Kibitov
Mental health research center
Russian Federation
Russian Federation
Andrey A. Kibitov
Moscow
References
1. Blejler E. Rukovodstvo po psihiatrii. Berlin: Izd-vo T-va «Vrach"», 1920. (In Russ.).
2. Enikolopov SN, Medvedeva TI. Approbation of the Russian-language version of the Barratt Impulsiveness Scale (BIS-11). Psikhologiia i pravo. 2015;5(3):75-89. (In Russ.). https://doi.org/10.17759/psylaw.2015050307
3. МКБ-10. Классификация психических и поведенческих расстройств. Исследовательские диагностические критерии [webmed.irkutsk.ru]. webmed; 2012. Доступно: https://webmed.irkutsk.ru/doc/pdf/icd10ps.pdf
4. Akbari M, Jamshidi S, Sheikhi S, Alijani F, Kafshchi P, Taylor D. Aripiprazole and its adverse effects in the form of impulsive-compulsive behaviors: A systematic review of case reports. Psychopharmacology (Berl). 2024;241(2):209-223. https://doi.org/10.1007/s00213-024-06529-5
5. Barkley RA. Behavioural inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin. 1997;121:65-94.
6. Barratt ES, Stanford MS, Felthous AR, Kent TA. The effects of phenytoin on impulsive and premeditated aggression: A controlled study. Journal of Clinical Psychopharmacology. 1997;17(5):341-349. https://doi.org/10.1097/00004714-199710000-00002
7. Barratt ES, Stanford MS, Kent TA, Alan F. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biological psychiatry. 1997;41(10):1045-1061. https://doi.org/10.1016/S0006-3223(96)00175-8
8. Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994;50(1-3):7-15. https://doi.org/10.1016/0010-0277(94)90018-3
9. Bellino S, Bozzatello P, Badino C, Mantelli E, Rocca P. Efficacy of polyunsaturated fatty acids (PUFAs) on impulsive behaviours and aggressiveness in psychiatric disorders. International journal of molecular sciences. 2021;22(2):620. https://doi.org/10.3390/ijms22020620
10. Buss AH, Plomin R. A temperament theory of personality development. New York: Wiley-Interscience; 1975.
11. Cheng GL, Tang JC, Li FW, Lau EY, Lee TM. Schizophrenia and risk-taking: impaired reward but preserved punishment processing. Schizophrenia research. 2012;136(1-3): 122-127. https://doi.org/10.1016/j.schres.2012.01.002
12. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Archives of General Psychiatry. 1993;50:975-990. https://doi.org/10.1001/archpsyc.1993.01820240059008
13. Dawd AM. Delay of Gratification: Predictors and Measurement Issues. Acta Psychopathol. 2017;3(6):81. https://doi.org/10.4172/2469-6676.100153
14. Dervaux A, Baylé FJ, Laqueille X, Bourdel MC, Le Borgne MH, Olié JP, Krebs MO. Is substance abuse in schizophrenia related to impulsivity, sensation seeking, or anhedonia? American Journal of Psychiatry. 2001;158(3):492-494. https://doi.org/10.1176/appi.ajp.158.3.492
15. Dhillon R, Bastiampillai T, Cao CZ, Eckert TG, Tibrewal P. Aripiprazole and Impulse-Control Disorders: A Recent FDA Warning and a Case Report. Prim Care Companion CNS Disord. 2017;12;19(1). https://doi.org/10.4088/PCC.16l02003
16. Dougherty DM, Bjork JM, Harper AR, Marsh DM, Moeller GF, Mathias CW, Swann AC. Behavioral impulsivity paradigms: a comparison in hospitalized adolescents with disruptive behavior disorders. Journal of Child Psychology and Psychiatry. 2003;44(8):1145-1157. https://doi.org/10.1111/1469-7610.00197
17. Dougherty DM, Mathias CW, Marsh DM, Jagar AA. Laboratory behavioral measures of impulsivity. Behavior research methods. 2005;37(1):82-90. https://doi.org/10.3758/BF03206401
18. Dougherty DM, Mathias CW, Marsh-Richard DM, Furr RM, Nouvion SO, Dawes MA. Distinctions in behavioral impulsivity: implications for substance abuse research. Addictive disorders & their treatment. 2009;8(2):61-73. https://doi.org/10.1097/ADT.0b013e318172e488
19. Dursun SM, Szemis A, Andrews H, Whitaker P, Reveley MA. Effects of clozapine and typical antipsychotic drugs on plasma 5-HT turnover and impulsivity in patients with schizophrenia: a cross-sectional study. Journal of Psychiatry and Neuroscience. 2000;25(4):347-352.
20. Enticott PG, Ogloff JR, Bradshaw JL. Response inhibition and impulsivity in schizophrenia. Psychiatry research. 2008;157(1-3):251-254. https://doi.org/10.1016/j.psychres.2007.04.007
21. Ettinger U, Aichert DS, Wöstmann N, Dehning S, Riedel M, Kumari V. Response inhibition and interference control: Effects of schizophrenia, genetic risk, and schizotypy. J Neuropsychol. 2018;12(3):484-510. https://doi.org/10.1111/jnp.12126
22. Evenden JL. Varieties of impulsivity. Psychopharmacology. 1999;146(4):348-361. https://doi.org/10.1007/PL00005481
23. Eysenck SB, Eysenck HJ. The place of impulsiveness in a dimensional system of personality description. British Journal of Social and Clinical Psychology. 1977;16(1):57-68. https://doi.org/10.1111/j.2044-8260.1977.tb01003.x
24. Eysenck SB, Pearson PR, Easting G, Allsopp JF. Age norms for impulsiveness, venturesomeness and empathy in adults. Personality and Individual Differences. 1985;6:613-619. https://doi.org/10.1016/0191-8869(85)90011-x
25. Fortgang RG, Hultman CM, van Erp TG, Cannon TD. Multidimensional assessment of impulsivity in schizophrenia, bipolar disorder, and major depressive disorder: testing for shared endophenotypes. Psychological medicine. 2016;46(7):1497-1507. https://doi.org/10.1017/S0033291716000131
26. Golden C.J., Freshwater S.M. Stroop color and word test. A manual for clinical and experimental uses. Illinois: Stoelting Co., 2002.
27. Gut-Fayand A, Dervaux A, Olié JP, Lôo H, Poirier MF, Krebs MO. Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity. Psychiatry research. 2001;102(1):65-72. https://doi.org/10.1016/S0165-1781(01)00250-5
28. Haden SC, Shiva A. Trait impulsivity in a forensic inpatient sample: An evaluation of the Barratt Impulsiveness Scale. Behavioral sciences & the law. 2008;26(6);675-690. https://doi.org/10.1002/bsl.820
29. Hamilton KR, Mitchell MR, Wing VC, Balodis IM, Bickel WK, Fillmore M et al. Choice impulsivity: Definitions, measurement issues, and clinical implications. Personality Disorders: Theory, Research, and Treatment. 2015;6(2):182. https://doi.org/10.1037/per0000099
30. Herman AM, Critchley HD, Duka T. Risk-Taking and Impulsivity: The Role of Mood States and Interoception. Front. Psychol. 2018;9:1625. https://doi.org/10.3389/fpsyg.2018.01625
31. Hjell G, Rokicki J, Szabo A, Holst R, Tesli N, Bell C et al. Impulsivity across severe mental disorders: a cross-sectional study of immune markers and psychopharmacotherapy. BMC Psychiatry. 2023;7;23(1):659. https://doi.org/10.1186/s12888-023-05154-4.
32. Hoptman MJ. Impulsivity and aggression in schizophrenia: a neural circuitry perspective with implications for treatment. CNS spectrums. 2015;20(3):280-286. https://doi.org/10.1017/S1092852915000206
33. Iancu I, Bodner E, Roitman S, Piccone Sapir A, Poreh A, Kotler M. Impulsivity, aggression and suicide risk among male schizophrenia patients. Psychopathology. 2010;43(4):223-229. https://doi.org/10.1159/000313520
34. Kaladjian A, Jeanningros R, Azorin JM, Anton JL, Mazzola-Pomietto P. Impulsivity and neural correlates of response inhibition in schizophrenia. Psychological medicine. 2011;41(2):291-299. https://doi.org/10.1017/S0033291710000796
35. Kavoor AR, Mitra S, Kumar S, Sisodia AK, Jain R. Lipids, aggression, suicidality and impulsivity in drug-naïve/drug-free patients of schizophrenia. Asian journal of psychiatry. 2017;27:129-136. https://doi.org/10.1016/j.ajp.2017.03.002
36. Kay S.R., Opler L.A., Fiszbein A., Ramirez P.M., Opler M., White L. Positive and negative syndrome scale (PANSS): Technical manual. NY: Multi-Health Systems Inc, 2006.
37. Kaya S, Taşcı G, Kılıç N, Karadayı H, Özsoy F, Atmaca M. Examination of the Relationship between Peripheral Inflammation Markers and Impulsivity and Aggression in Schizophrenia Patients Involved and Not Involved in Crime. Journal of Personalized Medicine. 2023;13(3):475. https://doi.org/10.3390/jpm13030475
38. Kenemans JL, Bekker EM, Lijffijt M, Overtoom CCE., Jonkman LM, Verbaten MN. Attention deficit and impulsivity: selecting, shifting, and stopping. International Journal of Psychophysiology. 2005;58(1):59-70. https://doi.org/10.1016/j.ijpsycho.2005.03.009
39. Khan A, Lindenmayer JP, Insel B, Seddo M, Demirli E, DeFazio K et al. Computerized cognitive and social cognition training in schizophrenia for impulsive aggression. Schizophrenia research. 2023;256:117-125. https://doi.org/10.1016/j.schres.2022.11.004
40. Lau JH, Jeyagurunathan A, Shafie S, Chang S, Samari E, Cetty L et al. The factor structure of the Barratt Impulsiveness Scale (BIS-11) and correlates of impulsivity among outpatients with schizophrenia and other psychotic disorders in Singapore. BMC Psychiatry. 2022;22(1):226. https://doi.org/10.1186/s12888-022-03870-x
41. Lejuez CW, Read JP, Kahler CW, Richards JB, Ramsey SE, Stuart GL et al. Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied. 2002;8(2):75-84. https://doi.org/10.1037/1076-898X.8.2.75
42. Logan GD, Schachar RJ, Tannock R. Impulsivity and inhibitory control. Psychological science. 1997;8(1):60-64. https://doi.org/10.1111/j.1467-9280.1997.tb00545.x
43. McDermott BE, Holoyda BJ. Assessment of aggression in inpatient settings. CNS spectrums. 2014;19(5):425-431. https://doi.org/10.1017/S1092852914000224
44. Miller E, Joseph S, Tudway J. Assessing the component structure of four self-report measures of impulsivity. Personality and Individual differences. 2004;37(2):349-358. https://doi.org/10.1016/j.paid.2003.09.008
45. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. American journal of psychiatry. 2001;158(11):1783-1793. https://doi.org/10.1176/appi.ajp.158.11.1783
46. Moeller F.G., Swann A.C. Pharmacotherapy of clinical aggression in individuals with psychopathic disorders. In Felthous AR, Saß H (Eds.). International handbook on psychopathic disorders and the law. Chichester, UK: Wiley; 2007.
47. Mohan T, Dolan S, Mohan R, Dawson J. Aripiprazole and impulse-control disorders in high-risk patients. Asian J Psychiatr. 2017;27:67-68. https://doi.org/10.1016/j.ajp.2017.02.015
48. Nolan KA, D'Angelo D, Hoptman MJ. Self-report and laboratory measures of impulsivity in patients with schizophrenia or schizoaffective disorder and healthy controls. Psychiatry Res. 2011;15;187(1-2):301-303. https://doi.org/10.1016/j.psychres.2010.10.032
49. Ouzir M. Impulsivity in schizophrenia: a comprehensive update. Aggression and Violent Behavior. 2013;18(2):247-254. https://doi.org/10.1016/j.avb.2012.11.014
50. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51:768-774. https://doi.org/10.1002/1097-4679(199511)51:63.0.CO;2-1
51. Prelog PR, Palandacic AK. (2023) Hypersexuality during treatment with cariprazine in a patient with schizophrenia? A case report. BMC Psychiatry. 11;23(1):935. https://doi.org/10.1186/s12888-023-05432-1
52. Puljic K, Herceg M, Tudor L, Pivac N. The association between prolactin concentration and aggression in female patients with schizophrenia. World J Biol Psychiatry. 2021;22(4):301-309. https://doi.org/10.1080/15622975.2020.1795254
53. Reddy LF, Lee J, Davis MC, Altshuler L, Glahn DC, Miklowitz DJ, Green MF. Impulsivity and risk taking in bipolar disorder and schizophrenia. Neuropsychopharmacology. 2014;39(2):456-463. https://doi.org/10.1038/npp.2013.218
54. Reynolds B, Ortengren A, Richards JB, De Wit H. Dimensions of impulsive behavior: Personality and behavioral measures. Personality and individual differences. 2006;40(2):305-315. https://doi.org/10.1016/j.paid.2005.03.024
55. Sagayadevan V, Satghare P, Jeyagurunathan A, Koh YS, Shafie S, Chang S, Samari E, Subramaniam M. Mediating effect of symptom severity on the relationship between aggression, impulsivity and quality of life outcomes among patients with schizophrenia and related psychoses. Frontiers in psychiatry. 2023;14:1154083. https://doi.org/10.3389/fpsyt.2023.1154083
56. Sepede G, Spano MC, Lorusso M, De Berardis D, Salerno RM, Di Giannantonio M, Gambi F. Sustained attention in psychosis: Neuroimaging findings. World J Radiol. 2014;28;6(6):261-273. https://doi.org/10.4329/wjr.v6.i6.261
57. Spivak B, Mester R, Wittenberg N, Maman Z, Weizman A. Reduction of aggressiveness and impulsiveness during clozapine treatment in chronic neuroleptic-resistant schizophrenic patients. Clinical neuropharmacology. 1997;20(5):442-446. https://doi.org/10.1097/00002826-199710000-00009
58. Stahl C, Voss A, Schmitz F, Nuszbaum M, Tüscher O, Lieb K, Klauer KC. Behavioral components of impulsivity. Journal of Experimental Psychology: General. 2014;143(2):850-886. https://doi.org/10.1037/a0033981
59. Strassnig MT, Nascimento V, Deckler E, Harvey PD. Pharmacological treatment of violence in schizophrenia. CNS Spectr. 2020;25(2):207-215. https://doi.org/10.1017/S1092852919001226
60. Strickland JC, Johnson MW. Rejecting impulsivity as a psychological construct: A theoretical, empirical, and sociocultural argument. Psychological Review. 2021;128(2):336-361. https://doi.org/10.1037/rev0000263
61. Tiplady B. Continuous attention: Rationale and discriminant validation of a test designed for use in psychopharmacology. Behavior Researchсh Methods, Instruments, and Computers. 1992;(1):16-21.
62. Turiaco F, Bruno A, Mento C, Cedro C, Pandolfo G, Muscatello MRA. Impulsivity and Metacognition in a Psychiatric Population. Clin Neuropsychiatry. 2022;19(2):97-102. https://doi.org/10.36131/cnfioritieditore20220203
63. van Erp TGM, Bakerc RA, Coxc K, Okamed T, Kojimad Y, Eramoe A, Potkin SG. Effect of brexpiprazole on control of impulsivity in schizophrenia: A randomized functional magnetic resonance imaging study. Psychiatry Research: Neuroimaging. 2020;301:111085. https://doi.org/10.1016/j.pscychresns.2020.111085
64. Whiteside SP, Lynam DR. The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and individual differences. 2001;30(4):669-689. https://doi.org/10.1016/S0191-8869(00)00064-7
65. Xu S, Korczykowski M, Zhu S, Rao H. Assessment of risk-taking and impulsive behaviors: A comparison between three tasks. Soc Behav Pers. 2013;41(3):477-486. https://doi.org/10.2224/sbp.2013.41.3.477
66. Zermatten A, Van der Linden M, d'Acremont M, Jermann F, Bechara A. Impulsivity and decision making. The Journal of nervous and mental disease. 2005;193(10):647-650. https://doi.org/10.1097/01.nmd.0000180777.41295.65
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Lepilkina T.A., Morozova M.A., Rupchev G.E., Burminskiy D.S., Beniashvili A.G., Potanin S.S., Kibitov A.A. Impulsivity in schizophrenia: phenomenology and research approaches. V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. 2025;59(2):20-29. (In Russ.) https://doi.org/10.31363/2313-7053-2025-2-1012
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