Cognitive Neuropsychiatry
ISSN: 1354-6805 (Print) 1464-0619 (Online) Journal homepage: http://www.tandfonline.com/loi/pcnp20
Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition Marvi K. Cheema, Glenda M. MacQueen & Stefanie Hassel To cite this article: Marvi K. Cheema, Glenda M. MacQueen & Stefanie Hassel (2015) Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition, Cognitive Neuropsychiatry, 20:5, 424-437, DOI: 10.1080/13546805.2015.1076722 To link to this article: https://doi.org/10.1080/13546805.2015.1076722
Published online: 05 Oct 2015.
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Cognitive Neuropsychiatry, 2015 Vol. 20, No. 5, 424–437, http://dx.doi.org/10.1080/13546805.2015.1076722
Assessing personal financial management in patients with bipolar disorder and its relation to impulsivity and response inhibition Marvi K. Cheemaa, Glenda M. MacQueenb and Stefanie Hasselb,c* a
b
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; cDepartment of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK (Received 15 October 2014; accepted 21 July 2015) Introduction: Impulsivity and risk-taking behaviours are reported in bipolar disorder (BD). We examined whether financial management skills are related to impulsivity in patients with BD. Methods: We assessed financial management skills using the Executive Personal Finance Scale (EPFS), impulsivity using the Barratt Impulsiveness Scale (BIS) and response inhibition using an emotional go/no-go task in bipolar individuals (N = 21) and healthy controls (HC; N = 23). Results: Patients had fewer financial management skills and higher levels of impulsivity than HC. In patients and controls, increased impulsivity was associated with poorer personal financial management. Patients and HC performed equally on the emotional go/no-go task. Higher BIS scores were associated with faster reaction times in HC. In patients, however, higher BIS scores were associated with slower reaction times, possibly indicating compensatory cognitive strategies to counter increased impulsivity. Conclusions: Patients with BD may have reduced abilities to manage personal finances, when compared against healthy participants. Difficulty with personal finance management may arise in part as a result of increased levels of impulsivity. Patients may learn to compensate for increased impulsivity by modulating response times in our experimental situations although whether such compensatory strategies generalize to real-world situations is unknown. Keywords: bipolar disorder; personal financial management; impulsivity; response inhibition
Introduction Bipolar disorder (BD) affects up to 3% of the population (Bebbington & Ramana, 1995). It is characterized by disruptions of mood and behavior and associated with impaired cognitive functioning. Impulsivity is considered a core trait of BD that negatively impacts illness course (Swann, Lijffijt, Lane, Steinberg, & Moeller, 2009a). Impulsive and disinhibited behaviors, e.g., buying sprees or gambling, may occur particularly, but not only, during (hypo)manic episodes, leading to psychological, social and economic problems. Such behaviors arise from failures to resist an impulse, drive or temptation to perform tasks, or actions that have such negative repercussions. *Corresponding author. Email:
[email protected] © 2015 Taylor & Francis
Cognitive Neuropsychiatry
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Anecdotal evidence suggests that uncontrolled spending is amongst the most frequent risk-taking behavior in BD; over 70% of patients reported spending large amounts of money when hypomanic (Fletcher, Parker, Paterson, & Synnott, 2013). Compulsive buying (CB) is present in 8% of BD patients, a significantly higher prevalence than that reported for the general population (Kesebir, Isitmez, & Gundogar, 2012). CB severity is also linked to depression (Lawrence, Ciorciari, & Kyrios, 2014; Muller et al., 2014). Poor financial functioning is associated with high impulsivity in patients with BD (Jimenez et al., 2012). Patients with BD and high levels of risk-taking behaviors (e.g., excessive spending) also have high levels of impulsivity and low self-directedness (Di Nicola et al., 2010). Impulsivity is linked to preferences for immediate rewards when weighing options, or reduced sensitivity to negative ramifications from choices (Martin & Potts, 2009; Potts, George, Martin, & Barratt, 2006). We examined whether increased impulsivity is associated with poor personal financial management and whether there are differences between healthy controls (HC) and BD patients on personal financial management using the Executive Personal Finance Scale (EPFS) (Spinella, Yang, & Lester, 2007). The EPFS is a convenient (short and easy) selfreport measure of personal financial management behaviours, comprising 4 subscales (impulse control, organization, planning and motivational drive) and two higher-order factors that encompass cognitive (e.g., planning, organizing) and emotional elements (e.g., anxiety, impulse-spending, prestige) of personal finance (Spinella et al., 2007). Validity has been confirmed in correlations with income, credit card debt and investments, and with established measures assessing financial behaviors and attitudes, the Compulsive Buying Scale (Faber & O’Guinn, 1992) and the Money Attitude Scale (Yamauchi & Templer, 1982). Impulsivity & Response Inhibition Aspects of trait impulsivity are measured by the Barratt Impulsiveness Scale (BIS; Patton, Stanford, & Barratt, 1995)). Previous work using the BIS has shown that impulsiveness may vary between mood states, but even euthymic BD patients typically show higher trait impulsivity than HC, suggesting that impulsivity is a core trait of the disorder, e.g., (Najt et al., 2007; Peluso et al., 2007; Strakowski et al., 2010; Swann, Anderson, Dougherty, & Moeller, 2001; Swann, Bjork, Moeller, & Dougherty, 2002; Swann, Lijffijt, Lane, Steinberg, & Moeller, 2009b), but see also (Lewis, Scott, & Frangou, 2009). Deficits in various inhibitory processes have been observed in BD patients, even when in remission (Hummer et al., 2013; Swann, Pazzaglia, Nicholls, Dougherty, & Moeller, 2003; Wright, Lipszyc, Dupuis, Thayapararajah, & Schachar, 2014) and problems with impulse control – specifically relating to executive function and attention – are reported in depressed and manic patients (Swann et al., 2007; Swann, Steinberg, Lijffijt, & Moeller, 2008). Response inhibition as a concept related to impulsivity has been assessed with the go/ no-go task (Hummer et al., 2013; Murphy et al., 1999). The emotional variant of the task uses emotional stimuli, e.g., emotional faces (Murphy et al., 1999), and incorporates emotional modulation of response inhibition (e.g., (Schulz et al., 2007); (Messerotti Benvenuti, Sarlo, Buodo, Mento, & Palomba, in press)). Deficits in response inhibition to emotive stimuli may be related to exaggerated, or biased, responses to the emotional content, to impaired emotion regulatory processes, or to both (Hummer et al., 2013).
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Findings from studies using an emotional go/no-go task in remitted patients with BD are variable. Euthymic patients were less accurate than HC in one study (Degabriele, Lagopoulos, & Ward, 2011) but others report no difference in accuracy between patients and HC (Elliott et al., 2004; Gopin, Burdick, Derosse, Goldberg, & Malhotra, 2011; Hummer et al., 2013; Rubinsztein, Michael, Paykel, & Sahakian, 2000; Rubinsztein, Michael, Underwood, Tempest, & Sahakian, 2006; Wessa et al., 2007). Similarly discrepant results are seen for reaction time (RT); some studies report no differences between BD patients and HC (Degabriele et al., 2011; Elliott et al., 2004; Hummer et al., 2013; Wessa et al., 2007), while others show that patients are slower than HC on the emotional go/no-go task (Gopin et al., 2011; Roiser et al., 2009; Rubinsztein et al., 2000; et al., 2006). Slowed reaction times may be the result of a compensatory mechanism to allow adequate time for stimulus processing (Swann et al., 2009b). We hypothesized that there would be an association between impulsivity, as assessed by self-report and the go/no-go task, and elements of personal financial management as assessed by the EPFS. In exploratory analyses we examined relations between these variables and clinical measures (medication load, illness duration, age-of-illness onset and number of illness episodes). Methods Participants We recruited twenty-one patients with BD Subtype-I from outpatient clinics at the Department of Psychiatry, University of Calgary. Twenty-three age- and genderratio matched HC were recruited from the community. Ethical approval was obtained from the Conjoint Health Research Ethics Board at the University of Calgary. Informed consent was obtained from all participants. Participants were between 18– 60 years old. The MINI-PLUS (Lecrubier et al., 1997) was used to determine illness duration, number of illness episodes, number of previous psychotic episodes, history of alcohol and illicit substance abuse and comorbid psychiatric conditions (Table 1). Participants were excluded if they met the following criteria: self-reported history of head injury/neurological disease, assessed by self-report or patient file, or a premorbid IQ estimate
