Impaired Impulse Control in Patients with Paranoid Schizophrenia in a State of Long-Term Drug Remission (Exploratory Research)

Background: Currently, many researchers suggest that for patients with schizophrenia, impulsivity more often manifests in the form of impairment of the control of the impulse of action. The most widely used instrument for research of this disorder is the Go/No-Go test. There is evidence that the indicator of this test in patients with schizophrenia shows not only increased impulsivity, but also increased auto- and heteroaggression. In this regard, the study of this aspect of impulsivity seems relevant in patients with schizophrenia. The aim of the study: to assess the severity of violations of impulse control of action in patients suffering from an episodic form of schizophrenia in a state of prolonged drug remission and their association with residual psychopathological manifestations. Patients and Methods: the study group made up 16 patients (14 men and 2 women), average age 48.2 ± 8.8 years, mean duration of disease 25 ± 10.6 years, age of manifestation 20.7 ± 4,0 years, duration of stable condition averaged 7,0 ± 5,0 years, duration of stable therapeutic regimen 5.6 ± 3.2 years, total score according to the PANSS scale was 64 ± 17. The control group consisted of healthy subjects (average age 44.5 ± 10.5 years) who did not consult a psychiatrist. The assessment of the patients’ condition was carried out using PANSS, the Barratt scale and the Go/No-Go test. Results: patients were less likely to give correct answers in the Go/No-Go test, especially in relation to relevant stimuli, while the indicators of correct responses to an irrelevant stimulus did not differ between the groups, though the reaction time was longer in patient’s group. The overall average reaction time was longer in the group of patients. This result may show the complexity of any type of signal for patients and a greater amount of resource for processing all types of stimuli relative to a healthy group. The indicator of the motor component of the Barratt scale was correlated with the average reaction time (R = 0.58) and the average reaction time to the relevant stimulus (R = 0.59). There were no links between any indicators of the Go/No-Go test and psychometric indicators on the PANSS scale. Conclusion: the hypothesis of a violation of the control of the impulse of action and its connection between motor impulsivity and residual mental disorders in this study was only partially confirmed: violations were detected, but they were not associated with residual psychopathological manifestations. Significantly greater mutual influence was found in the study of patients’ self-assessment of impulsivity, cognitive test scores and psychometric indicators of psychopathological disorders. 

1. Blejler E. Rukovodstvo po psihiatrii. Berlin, Izd-vo T-va «Vrach”», 1920

2. Rukovodstvo po psixiatrii v 2 tomax pod redakciej akademika RAMN A.S. Tiganova, tom 1, chast2, glava 1. Moskva “Medicina”19407-554.

3. Li W, Yang Y, Hong L, An FR, Ungvari GS, Ng CH, Xiang YT. Prevalence of aggression in patients with schizophrenia: A systematic review and meta-analysis of observational studies. Asian J Psychiatr. 2020;47:101846. doi: 10.1016/j.ajp.2019.101846. Epub 2019 Oct 16. PMID: 31715468.

4. Wu Y, Kang R, Yan Y, Gao K, Li Z, Jiang J, Chi X, Xia L. Epidemiology of schizophrenia and risk factors of schizophrenia-associated aggression from 2011 to 2015. J Int Med Res. 2018;46(10):4039-4049. doi: 10.1177/0300060518786634

5. Stahl SM. Deconstructing violence as a medical syndrome: mapping psychotic, impulsive, and predatory subtypes to malfunctioning brain circuits. CNS Spectr. 2014;19(5):357-365. doi: 10.1017/S109285291400052

6. Hoptman MJ. Impulsivity and aggression in schizophrenia: a neural circuitry perspective with implications for treatment. CNS Spectr. 2015 Jun;20(3):280-286. doi: 10.1017/S1092852915000206. Epub 2015 Apr 22. PMID: 25900066; PMCID: PMC4441843.

7. McDermott BE, Holoyda BJ. Assessment of aggression in inpatient settings. CNS Spectr. 2014 Oct;19(5):425-431. doi: 10.1017/S1092852914000224. PMID: 25296966.

8. Ahmed AO, Richardson J, Buckner A, Romanoff S, Feder M, Oragunye N, Ilnicki A, Bhat I, Hoptman MJ, Lindenmayer JP. Do cognitive deficits predict negative emotionality and aggression in schizophrenia? Psychiatry Res. 2018; 259:350-357. doi: 10.1016/j.psychres.2017.11.003. Epub 2017 Nov 7. PMID: 29120842.

9. Gomez P, Ratcliff R, Perea M. A model of the go/nogo task. J Exp Psychol Gen. 2007;136(3):389-413. doi: 10.1037/0096-3445.136.3.389. PMID: 17696690; PMCID: PMC2701630.

10. 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. doi: 10.1111/jnp.12126. Epub 2017 May 8. PMID: 28485076.

11. Strauss GP, Thaler NS, Matveeva TM, Vogel SJ, Sutton GP, Lee BG, Allen DN. Predicting psychosis across diagnostic boundaries: Behavioral and computational modeling evidence for impaired reinforcement learning in schizophrenia and bipolar disorder with a history of psychosis. J Abnorm Psychol. 2015;124(3):697-708. doi: 10.1037/abn0000039. PMID: 25894442

12. Woolard AA, Kose S, Woodward ND, Verbruggen F, Logan GD, Heckers S. Intact associative learning in patients with schizophrenia: evidence from a Go/ NoGo paradigm. Schizophr Res. 2010;122(1-3):131-135. doi: 10.1016/j.schres.2010.02.1057. Epub 2010 Mar 11. PMID: 20226631; PMCID: PMC2902634.

13. Krakowski MI, De Sanctis P, Foxe JJ, Hoptman MJ, Nolan K, Kamiel S, Czobor P. Disturbances in Response Inhibition and Emotional Processing as Potential Pathways to Violence in Schizophrenia: A High-Density Event-Related Potential Study. Schizophr Bull. 2016;42(4):963-974. doi: 10.1093/schbul/sbw005. Epub 2016 Feb 19. PMID: 26895845; PMCID: PMC4903062.

14. Slavutskaya MV, Lebedeva IS, Karelin SA, Оmelchenko MA. Neurobiological markers of cognitive control impairment in patients with ultra-high risk of schisophrenia. Meditsinskaia psikhologiia v Rossii. 2020;12(3):4. doi: 10.24412/2219-8245-2020-3-4 [in Russian, abstract in English]

15. van Erp TG, Baker RA, Cox K, Okame T, Kojima Y, Eramo A, Potkin SG. Effect of brexpiprazole on control of impulsivity in schizophrenia: A randomized functional magnetic resonance imaging study. Psychiatry Res Neuroimaging. 2020 Jul 30;301:111085. doi: 10.1016/j.pscychresns.2020.111085. Epub 2020 May 5. PMID: 32450497.

16. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-276. doi: 10.1093/schbul/13.2.261. PMID: 3616518.

17. Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry. 1997 Dec;58(12):538-546. doi: 10.4088/jcp.v58n1205. Erratum in: J Clin Psychiatry 1998 Apr;59(4):200. PMID: 9448657.

18. Enikolopov SN, Medvedeva TI. Approbation of the Russian-language version of the Barratt Impulsiveness Scale (BIS-11) [Elektronnyi resurs]. Psikhologiia i pravo [Psychology and Law]. 2015;5(3):75-89. (In Russ.)

19. Patton JH, Stanford MS, Barratt ES. Factor structure of the barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–774. doi: 10.1002/1097-4679(199511)51:63.0.CO;2

20. Lejuez CW, Read JP, Kahler CW, Richards JB, Ramsey SE, Stuart GL, Strong DR, Brown RA. Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). J Exp Psychol Appl. 2002;8(2):75-84. doi: 10.1037//1076-898x.8.2.75. PMID: 12075692.

21. Morozova MA, Potanin SS, Burminsky DS, Beniashvili AG, Rupchev GE, Lepilkina TA, Sorokin MYu, Kasyanov ED, Mazo GE, Tarumov DA, Trufanov AG, Markin KV, Beybalaeva TZ, Katok AA, Tsapko DS. Low doses of quetiapine (Seroquel) as an impulsivity corrector in patients with bipolar affective disorder in remission. S.S. Korsakov Journal of Neurology and Psychiatry. 2022;122(8):120-127. (In Russ.). doi: 10.17116/jnevro2022122081120

22. Sánchez-Kuhn A, León JJ, Gôngora K, Pérez-Fernández C, Sánchez-Santed F, Moreno M, Flores P. Go/NoGo task performance predicts differences in compulsivity but not in impulsivity personality traits. Psychiatry Res. 2017;257:270-275. doi: 10.1016/j.psychres.2017.07.064. Epub 2017 Jul 31. PMID: 28783574.

23. Myers CE, Dave CV, Callahan M, Chesin MS, Keilp JG, Beck KD, Brenner LA, Goodman MS, Hazlett EA, Niculescu AB, St. Hill L, Kline A, Stanley BH, Interian A. Improving the prospective prediction of a nearterm suicide attempt in veterans at risk for suicide, using a go/no-go task. Psychol Med. 2023;53(9):4245-4254. doi: 10.1017/S0033291722001003

24. Araki T, Kirihara K, Koshiyama D, Nagai T, Tada M, Fukuda M, Kasai K. Intact neural activity during a Go/No-go task is associated with high global functioning in schizophrenia. Psychiatry Clin Neurosci. 2016; 70(7):278-285. doi: 10.1111/pcn.12389. Epub 2016 May 2. PMID: 26991316.

25. Sumich A, Kumari V, Dodd P, Ettinger U, Hughes C, Zachariah E, Sharma T. N100 and P300 amplitude to Go and No-Go variants of the auditory oddball in siblings discordant for schizophrenia. Schizophr Res. 2008;98(1-3):265-277. doi: 10.1016/j.schres.2007.09.018. Epub 2007 Nov 19. PMID: 18022352.

26. Fortier A, Dumais A, Athanassiou M, Tikàsz A, Potvin S. Dysconnectivity between the anterior insula and the dorsal anterior cingulate cortex during an emotion go/no go paradigm is associated with aggressive behaviors in male schizophrenia patients. Psychiatry Res Neuroimaging. 2023; 328:111579. doi: 10.1016/j.pscychresns.2022.111579. Epub 2022 Nov 30. PMID: 36469978.

27. Gigaux J, Le Gall D, Jollant F, Lhuillier JP, Richard-Devantoy S. Cognitive inhibition and quality of life in schizophrenia: A pilot study. Schizophr Res. 2013;143(2-3):297-300. doi: 10.1016/j.schres.2012.11.019

28. Omelchenko MA, Zinkevich AS, Vares AYu. Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode. S.S. Korsakov Journal of Neurology and Psychiatry. 2023; 123(12):83-92. (In Russ.). doi: 10.17116/jnevro202312312183.