#98 - Impulsivity Flashcards
What are the 4 key components of impulsivity?
UPPS -
Urgency/emotion driven behaviors ((eg, running through red light (dangerous) when you are stressed.)
(lack of) Premeditation
(lack of) Perseverance (grit)
Sensation seeking (sky-diving)
Which psychiatric diagnoses are associated with impulsivity?
TLDR - Tons of disorders. They often occur together (significant comorbidity.)
Classic Impulsivity disorders = disruptive, impulse control, and conduct disorders (eg, pyromania, defiant disorder, conduct disorder)
ADHD involves impulsivity but not “impulsivity disorder” - it is a neurodevelopmental disorder.
Personality Disorders - borderline, antisocial disorder,
mania
substance abuse,
Characterize the growth of the PFC (pre-frontal cortex) from childhood to adulthood.
Period before puberty - marked by progressive events- increasing synaptic density/ myelination
Period post puberty – marked by regressive events - synaptic/dendritic pruning
Both periods equally important…
What are the two sub regions of the PFC (prefrontal cortex) that are crucial to impulsivity? (extra credit: components of each)
Ventromedial PFC (including the orbitofrontal cortex and the anterior cingulate gyrus)
Dorsolateral PFC
What is the role of the ventromedial PFC (prefrontal cortex) in impulsivity?
Ventromedial PFC plays a strong role in stimulus-reward associations / representation of reward value (eg, lesion resulted in trouble recognizing that a different deck was now beneficial)
Which part of the PFC is involved in the limbic loop? What are the other important players?
vmPFC. limbic loop includes the nucleus accumbens and the ventral striatum…
What is the role of the dorsolateral PFC in impulsivity?
dlPFC plays a vital role in working memory.
How does the dlPFC relate to treatment of impulsivity?
Enhancement of dlPFC function (working memory function) via cognitive training (strengthening working memory) and magnetic stimulation may reduce impulsivity.
Why is working memory relevant to impulsivity ?
It is a part of the executive control system.
“working memory is involved in the ongoing, moment to moment, regulation of behavior.”
“delay discounting” experiments (eg, 1 dollar now or 100 dollars 6 months from now) involves which area of the PFC?
dlPFC - working memory
these areas light up during imaging studies performed during these questions.
Substance use disorders are associated with (increased/decreased) working memory?
decreased.
What is one specific treatment which targets the dlPFC, which is not clinically ready yet, but promising?
Repetitive transcranial magnetic stimulation (rTMS)
- reduces impulsivity
- modifies drug craving
- reduces substance use.
definition of impulsivity
A predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to themselves or others.”
