Elevated impulsivity in psychosis is associated with mood, anxiety, and general symptoms

Impulsivity is a trans-diagnostically relevant construct which includes five separable domains: negative urgency, (lack of) perseverance, (lack of) premeditation, sensation seeking, and positive urgency. Impulsivity may be elevated in psychosis, and has been associated with increased aggression, suicidality, and substance use in this population. However, profiles of specific domains of impulsivity across the psychoses and their association with clinical symptoms and functioning has not been well-described. We aimed to examine impulsivity profiles across the psychosis spectrum, and the extent to which impulsivity correlates with clinical symptoms and functioning. Participants included 186 individuals with schizophrenia spectrum disorders (SSD; n = 93) or mood disorders with psychosis (MDP n = 93), and healthy controls (n = 50). Findings revealed elevated impulsivity across the psychosis spectrum, which was more pronounced in the MDP group. Linear regression revealed that positive and general symptoms of psychosis, depressive, manic, and anxiety symptoms were associated with impulsivity. When other domains were controlled, negative urgency, positive urgency, and lack of perseverence emerged as predictors of clinical symptoms across the psychosis spectrum. Results suggest that state clinical symptoms are associated with trait markers of impulsivity, and that individuals on the psychosis spectrum who report high levels of emotional urgency may be at risk for more severe mood, anxiety, and general psychosis symptoms. Understanding the role of the impulsivity domains in relation to clinical symptoms has clinical implications, both in understanding outcomes and identifying treatment targets. Mechanisms of these associations should be explored.