Study On The Relationship Between Emotion-triggered Impulsivity,response Inhibition And Aggressive Behavior In Bipolar Disorder Patients

BackgroundImpulsivity is one of the criteria for diagnosing a manic/hypomanic episode.Even when the symptoms are relieved after taking the drug,the possibility of obvious impulsive behavior in patients with bipolar disorder is still very high,and the impulsive behavior is characterized by emotional stimulation,intolerable,and uncontrollable,which further increases the rsk of self-injury suicide,violence and even criminal behaviors of patients,affecting the individual's social function,and increasing the burden on the family and society.PurposeStudy 1:to understand the status quo of emotion-triggered impulsivity and aggressive behavior in patients with bipolar disorder and healthy people,explore the social and psychological high-risk factors affecting aggressive behavior in BD patients and healthy people,and further establish the potential impact path model of aggressive behavior.Study 2:to discusses the characteristics and differences of BD students and healthy students' response inhibition in the context of emotional induction,to explore the relationship between self-assessment of emotion-triggered impulsivity and response inhibition related behavioral indicators and EEG indicators,try to explain the cognitive neural mechanism of impulsive aggressive behavior in BD patients from the perspective of reaction inhibition.Subject and methodsIn the first study,505 patients with bipolar disorder and 451 healthy control samples were randomly selected for a multi-center cross-sectional survey,which mainly involved general demographic sociology information,childhood trauma scale,eysenck personality questionnaire(Chinese version),upps-p impulsive behavior scale(Chinese version),and Buss&Perry aggression questionnaire(Chinese version).In the second study,28 students with bipolar disorder in a medical university and 29 healthy college students in a medical university in Guangdong province were selected as research objects.Under the evoked state of positive/negative/neutral emotion picture cues,the subjects completed the classic sound stop signal task to investigate the individual's response inhibition ability.Results1)The cross-sectional survey results show that,in addition to matching gender,age,and educational level between the two samples of BD patients and healthy individuals(t/?2=0.39?2.17,ps>0.05),there is no significant difference in the composition ratio of residence,subjective family economic level,parental educational level,whether they are employed,and whether they stay behind differences(?2=1.47?7.46,ps>0.05),the respondents have significant differences in marriage and love situation(?2=26.87,p<0.05).2)Childhood trauma,neuroticism,emotion-triggered impulsivity and aggressive behavior were positively correlated in BD patients and healthy individuals,and the correlation coefficient was between 0.21 and 0.87(p<0.01).Compared with other dimensions of impulsivity,such as sensation seeking,positive urgency and negative urgency are more correlated with aggressive behavior(r=0.39?0.51).Compared with healthy individuals,BD patients experienced more childhood trauma,and scored higher on neuroticism,emotion-triggered impulsivity and aggressive behavior,with significant differences(t=5.35?12.75,ps<0.01).3)In bipolar and healthy people,the direct effect from childhood trauma to aggressive behavior is significant,with the standardized direct effect value(c')ranging from 0.119 to 0.247,and the proportion of direct effect is 51.74%to 72.65%,and the 95%interval did not include 0.4)In bipolar and healthy people,neuroticism and emotion-triggered impulsivity had significant chain mediating effects between childhood trauma and aggression,with chain mediating effects ranging from 0.022 to 0.035.The proportion of mediating effect was between 6.47%and 15.22%,and the 95%interval did not include 0.5)In the stop signal task,the interaction effect between group and emotion and the main effect of emotion were not significant in the response signal accuracy rate(go ACC),response signal response time(go RT)and stop signal response time(SSRT)(F=0.02-3.87,ps>0.05).Compared with the healthy control group,the BD group had lower go ACC(F=4.60,p=0.03).Go RT has a longer trend(F=3.29,p=0.08).Based on the control of go RT and go ACC,the main effects of the groups were not significantly different on SSRT(BDssRT=201.87ms,CONssRT=212.80ms,F=0.05,p=0.83).BD patients with lower go ACC and slower go RT had shorter SSRT and significant difference(F=2.46,p<0.05).6)For the EEG idicators of the stop signal task,the interaction effect of group and emotion on emotion P300 and LPP and the main effect of group are not significant(F=0.01?0.59,ps>0.05),the main effect of emotion is significant(F=48.13,71.30,ps<0.01),compared with In neutral conditions,the average amplitude of individual emotions P300 and LPP is greater in the positive and negative emotional picture induced states.7)On the average volatility of stop N1 induced by the sound signal,there was no significant interaction between group,emotion and task performance(F=0.60?2.48,ps>0.05),and the main effect of emotional nature and task performance was significant(F=10.05,29.49,ps<0.01).Compared with the neutral and negative conditions,the average amplitude of N1 in the state of positive emotion pictures is smaller,and the average differences are 1.077?V and 1.522?V,respectively(p<0.01).Compared with the failed trials,the average amplitude of N1 was greater under the successful suppression,with an average difference of 2.239?V,p<0.01.Compared with the healthy control group,the overall average amplitude of N1 in the inhibition task of the BD experimental group was smaller,-8.15?V and-7.30?V,respectively;8)On the average volatility of stop P3,there was no significant interaction between group,emotional nature and task performance(F=0.20?1.41,p>0.05),and the main effect of task performance was significant(p<0.01),compared with the number of failed trials When the subjects were successfully suppressed,the average amplitude of stop P3 was smaller,with an average difference of 2.789?V,p<0.01.The main effect of emotion was not significant(F=0.33,p=0.72).The average amplitude of stop P3 was 12.68?V,12.55?V and 12.46?V,respectively,induced by positive,negative and neutral pictures.The main effect of the group was not significant(F=0.21,p=0.65).Compared with the healthy control group,the average amplitude of the stop P3 average amplitude on the inhibition task of the BD experimental group and the healthy control group was 8.118?V and 7.470?V,respectively.9)In the bipolar disorder experimental group and the healthy control combination set,N1 was significantly positively correlated with SSRT and negatively correlated with go RT,and P3 was significantly negatively correlated with SSRT(r=0.40,-0.270,-0.29,p<0.05).10)In the bipolar disorder experimental group and the healthy control combination set,there was no significant correlation between positive urgency and negative urgency scores with go ACC,go RT,SSRT,and successful suppression of N1 and P3(r=-0.187?0.131,ps>0.05).Aggressive behavior was significantly positively correlated with go RT(r=0.28,p<0.05)and significantly negatively correlated with SSRT(r=-0.30,p<0.05).In the BD experimental group,Yang's mania and Hamilton depression scores were not significantly correlated with BD students' go ACC,go RT,SSRT,and successful suppression of N1 ??and P3.The correlation coefficients ranged from-0.18 to 0.29,p>0.05.There was no significant difference in the above indicators of BD students whether they took medication and whether they took mood stabilizers,antipsychotics,and antidepressants(F=0.010?2.335,ps>0.05).Conclusions1)Compared with the healthy population,patients with bipolar disorder experienced more childhood trauma,had lower levels of emotional stability,showed higher levels of emotion-triggered impulsivity and aggressive behavior,and their impulsivity was characterized by being triggered by emotions.2)In BD patients and healthy individuals,childhood trauma not only directly affects aggressive behavior,but also indirectly affects individual's aggressive behavior through the chain intermediary of neuroticism and emotion-triggered impulsivity.3)Compared with the healthy control group,the BD experimental group performed worse on the go task in the stop signal paradigm,and had nothing to do with the clinical symptoms and whether the medication was taken,suggesting that BD students' general cognitive control ability was impaired.4)The stop task performance of BD students is similar to that of healthy individuals.There is no obvious damage when stopping the signal response,which may be affected by the secondary performance of the go task.5)The stop N1 induced by the stop signal is greater under the condition of successful suppression,and the stop P3 is greater under the condition of failed suppression,indicating that both components are related to the reaction inhibition.6)Emotional picture cues in the stop signal task were effectively processed.Emotion affects the amplitude of stop N1,reflecting the effect of emotion on response inhibition.Research innovation1)The survey includes two large samples of BD patients and healthy individuals that are well matched in demographic variables such as gender,age,and education level.On the basis of objectively presenting an overview of the clinical and general population's emotion-triggered impulsivity and aggressive behaviors,from the perspective of the interaction between the individual,the situation and the internal psychological state,an influence path that affects the occurrence of aggressive behaviors is established.It expands the application of general attack theory model and provides further empirical data support for the theory assumption.2)The experimental study combined emotional picture induction,classic stop signal paradigm and event-related potential technology.The results of the study strictly controlled the influence of other depression and manic scores and medication conditions on the response inhibition performance of BD patients,which improves the unity of research methods on the same subject and the lack of control over unrelated clinical variables.Limitations and future recommendation1)The cross-sectional design prevents us from drawing firm conclusions about the causal relationship between childhood trauma,neuroticism,emotional impulsivity,and aggressive behaviors in BD patients and healthy individuals.This study strictly follows the three principles of classical inference causality,and performs statistical control on covariates such as gender,left-behind,age at onset,etc.Subsequent research can make full use of the advantages of tracking design such as cross-lag design,determine the order between different variables and analyze the time-varying development changes.2)The investigation and experimental research under did not differentiate the diagnosis or clinical stage of BD samples,such as biphasic type ?,biphasic type ?,or manic phase,depression phase,and remission phase,and the promotion of the research conclusions was limited.Subsequent studies will benefit from the inclusion of a wider range of clinical variables that affect the emotion-triggered impulsivity and response inhibition of BD patients.