Impulsivity as a key to transdiagnostic understanding of mental disorders

Impulsivity has established itself as a key transdiagnostic construct in psychiatry, rethinking ideas about the etiopathogenesis, clinical course, and approaches to the treatment of mental disorders. Epidemiological data indicate its high prevalence and a role as a key pathogenetic factor affecting severity, comorbidity, and suicide risk. This review systematizes the current view on impulsivity. We searched for relevant publications in PubMed, Scopus, ScienceDirect, and Mendeley. Convergent neuroimaging data (structural and functional MRI), genetics, and neuropsychology reveal a common neurobiological substrate, dysfunction of prefrontal-striatal-thalamic control networks and impaired monoaminergic (dopamine, serotonin, norepinephrine) modulation, underlining impulsivity in attention deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), addictive, and affective disorders. Psychometric models and neurobehavioral studies confirm the heterogeneity of the construct (motor, cognitive, affective impulsivity, sensation-seeking) with differentiated neurocorrelates. High levels of impulsivity are a powerful predictor of adverse outcomes: relapses in dependence, self-injurious, and suicidal behavior in BPD and functional deficits in patients with ADHD. Effective correction requires multilevel strategies tailored to specific features of the phenotype: psychotherapy, neuromodulation, and targeted pharmacotherapy. The review substantiates the need to shift from syndrome-oriented to transdiagnostic models, integrating neuroscience advances to enable a personalized approach and overcome the crisis of traditional diagnostics.