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Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users

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Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users ORIGINAL RESEARCH published: 09 June 2021 doi: 10.3389/fpsyt.2021.660810 Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users Elena Psederska 1,2, Nicholas D. Thomson 3,4, Kiril Bozgunov 1, Dimitar Nedelchev 1, Georgi Vasilev 1 and Jasmin Vassileva 5,6* 1 Bulgarian Addictions Institute, Sofia, Bulgaria, 2 Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria, 3 Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, United States, 4 Department of Psychology, University of Durham, Durham, United Kingdom, 5 Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States, 6 Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States Background: Psychopathy and substance use disorders (SUDs) are both characterized by neurocognitive impairments reflecting higher levels of impulsivity such as reward-driven decision-making and deficient inhibitory control. Previous studies Edited by: suggest that psychopathy may exacerbate decision-making deficits, but it may be Qi Li, University of Chinese Academy of unrelated to other neurocognitive impairments among substance dependent individuals Sciences, China (SDIs). The aim of the present study was to examine the role of psychopathy Reviewed by: and its interpersonal-affective and impulsive-antisocial dimensions in moderating the Aleksander Hagen Erga, Stavanger University Hospital, Norway relationships between dependence on different classes of drugs and neurocognitive Erica Nicole Grodin, domains of impulsivity. University of California, Los Angeles, United States Method: We tested 693 participants (112 heroin mono-dependent individuals, 71 heroin *Correspondence: polysubstance dependent individuals, 115 amphetamine mono-dependent individuals, Jasmin Vassileva 76 amphetamine polysubstance dependent individuals, and 319 non-substance [email protected] dependent control individuals). Participants were administered the Psychopathy Specialty section: Checklist: Screening Version (PCL:SV) and seven neurocognitive tasks measuring This article was submitted to impulsive choice/decision-making (Iowa Gambling Task; Cambridge Gambling Task; Addictive Disorders, a section of the journal Kirby Delay Discounting Task; Balloon Analog Risk Task), and impulsive action/response Frontiers in Psychiatry inhibition (Go/No-Go Task, Immediate Memory Task, and Stop Signal Task). Received: 29 January 2021 Results: A series of hierarchical multiple regressions revealed that the Accepted: 03 May 2021 Published: 09 June 2021 interpersonal-affective dimension of psychopathy moderated the association between Citation: decision-making, response inhibition and both amphetamine and heroin dependence, Psederska E, Thomson ND, albeit differently. For amphetamine users, low levels of interpersonal-affective traits Bozgunov K, Nedelchev D, Vasilev G predicted poor decision-making on the Iowa Gambling Task and better response and Vassileva J (2021) Effects of Psychopathy on Neurocognitive inhibition on the Stop Signal task. In contrast, in heroin users high interpersonal-affective Domains of Impulsivity in Abstinent psychopathy traits predicted lower risk taking on the Cambridge Gambling Task and Opiate and Stimulant Users. Front. Psychiatry 12:660810. better response inhibition on the Go/No-Go task. The impulsive-antisocial dimension of doi: 10.3389/fpsyt.2021.660810 psychopathy predicted poor response inhibition in both amphetamine and heroin users. Frontiers in Psychiatry | www.frontiersin.org 1 June 2021 | Volume 12 | Article 660810 Psederska et al. Psychopathy and Neurocognitive Impulsivity Conclusions: Our findings reveal that psychopathy and its dimensions had both common and unique effects on neurocognitive function in heroin and amphetamine dependent individuals. Our results suggest that the specific interactions between psychopathy dimensions and dependence on different classes of drugs may lead to either deficient or superior decision-making and response inhibition performance in SDIs, suggesting that psychopathy may paradoxically play a protective role for some neurocognitive functions in specific subtypes of substance users. Keywords: opioid use disorder, stimulant use disorder, psychopathy, impulsivity, decision-making, response inhibition INTRODUCTION rapid response inhibition (13) and impulsive choice, indicating deficits in decision-making (14). This distinction is supported Impulsivity and Substance Use Disorders by findings from preclinical studies, which show that impulsive Impulsivity, defined as a “predisposition toward rapid, choice and impulsive action are differentially involved in unplanned reactions to internal or external stimuli without distinct stages of the addiction cycle and are mediated by regards to the negative consequences of these reactions” (1) is different neural circuits (15). Impulsive action reflects response considered a key etiological factor in current conceptualizations disinhibition and is typically measured by Stop Signal Tasks of substance use disorders (SUDs) (2). Deficits in impulse [SST; (16)], which examine the ability to cancel an already control are considered both as vulnerability factors that initiated motor response, and/or Go/No-Go type of paradigms increase the risk of initiation and maintenance of SUDs (17, 18), measuring the ability to inhibit a prepotent or (3, 4), as well as consequences of chronic drug use reflecting dominant behavioral response. Impulsive choice reflects a long-term neuroadaptive changes in the brain linked to reward-driven decision-making style associated with higher risk- specific neurocognitive impairments (5, 6). Despite the strong taking and preference for immediate over delayed rewards. associations of impulsivity with SUDs, recent advances in the Common tasks of impulsive choice include delay discounting literature have drawn attention to the multifactorial nature tasks (19, 20) such as the Monetary Choice Questionnaire of impulsivity and the heterogeneity of SUDs, suggesting [MCQ; (21)] and simulated gambling tasks measuring sensitivity that specific impulsivity dimensions might be differentially to risk and reward, such as the Iowa Gambling Task [IGT; implicated in distinct types of SUDs and in different stages of the (22)] measuring decision-making under ambiguity or the addiction cycle (2, 4, 7). Cambridge Gambling Task [CGT; (23)] and the Balloon Impulsivity is a multidimensional construct comprised of a Analog Risk Task [BART; (24)], measuring decision-making variety of characteristics reflecting the personality dimensions under risk. of trait impulsivity, as well as a number of neurobehavioral manifestations, reflecting more fluctuating neurocognitive dimensions of state impulsivity (8). Trait impulsivity is a Neurocognitive Impulsivity in Substance stable personality dimension, widely acknowledged as a Use Disorders general risk factor for SUDs (9), which is usually measured by Impairments in neurocognitive impulsivity have long been self-report questionnaires such as the Barratt Impulsiveness implicated in SUDs. Increased response disinhibition and Scale-11 [BIS-11; (10)] and the UPPS Impulsive Behavior aberrant decision-making are some of the most common findings Scale [UPPS; (11)]. Trait impulsivity is considered to be in people with SUDs (23, 25–31). Deficits in neurocognitive on a continuum between lower, more adaptive levels and dimensions of impulsivity have gained increased research interest higher, more extreme and maladaptive levels, which feature in the addiction literature as predictors of drug initiation and prominently in externalizing psychiatric disorders that originate poor treatment outcomes. Studies reveal that higher delay in childhood and are commonly comorbid with SUDs, discounting and compromised decision-making are predictive such as attention deficit hyperactivity disorder (ADHD), of post-treatment relapse and can negatively affect one’s ability oppositional defiant disorder (ODD), conduct disorder, and to achieve and maintain abstinence from substance use (32–37). antisocial personality disorder (ASPD) (12). In contrast to trait Although response disinhibition on Stop Signal and Go/No-Go impulsivity, neurocognitive dimensions of impulsivity are more tasks has not been consistently related to treatment retention and fluctuating and dependent on environmental influences and the abstinence (34, 35), it has proven to be among the most reliable current state of the individual (9). Therefore, neurocognitive predictors of drug use initiation (38–41). domains of impulsivity reflect more imminent risk and are Though individuals with SUDs manifest marked impairments typically measured in the laboratory with performance-based on virtually all tasks of impulsive choice and impulsive action computerized tasks. (23, 25, 28, 30, 31), recent studies suggest that the type of Neurocognitive impulsivity is additionally subdivided into deficits demonstrated by individuals with SUDs might also be two broad domains: impulsive action, involving deficits in affected by the unique properties of the type of substance Frontiers in Psychiatry | www.frontiersin.org 2 June 2021 | Volume 12 | Article 660810 Psederska et al. Psychopathy and Neurocognitive Impulsivity they are using. In line with the precision medicine approach, Effects of Psychopathy on Neurocognitive current models of addiction emphasize the increasing need Impulsivity
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