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Avaliação de personalidade em transtorno afetivo bipolar por meio do estudo de pares de irmãos

Source: OAI

ABSTRACT Estudos comparando temperamento, caráter e impulsividade entre portadores de transtorno afetivo bipolar eutímicos e controles saudáveis têm mostrado escores mais elevados de busca de novidade, esquiva ao dano, autotranscendência e impulsividade, e escores mais baixos de autodirecionamento e cooperatividade entre os portadores de transtorno bipolar. Entretanto, não está claro se esses achados são resultado de um efeito cicatriz dos episódios ou representam marcadores de vulnerabilidade ao transtorno. O objetivo deste estudo foi avaliar traços de personalidade como prováveis marcadores de vulnerabilidade ao transtorno afetivo bipolar por meio da comparação de escores de temperamento, caráter e impulsividade entre portadores de transtorno afetivo bipolar, seus irmãos sem este transtorno e controles saudáveis. Foram avaliados 67 portadores eutímicos de transtorno afetivo bipolar tipo I, 67 irmãos e 70 controles saudáveis utilizando-se o Inventário de Temperamento e Caráter e a Escala de Impulsividade de Barratt. Foram considerados eutímicos os portadores de transtorno afetivo bipolar que apresentavam escores 7 na Escala de Avaliação de Depressão de Hamilton e na Escala de Avaliação de Mania de Young. As comparações das médias dos escores de impulsividade e das dimensões de temperamento e caráter entre os três grupos foram realizadas por meio de análise de variância. Testes post-hoc de Games-Howell ou Tukey (em função da homogeneidade de variância das variáveis dependentes) foram utilizados para análises posteriores par a par. O nível de significância alfa foi estabelecido em 5%. O resultados mostraram que portadores de transtorno afetivo bipolar eutímicos apresentaram, em relação aos controles saudáveis, escores significativamente mais elevados de busca de novidade, esquiva ao dano e autotranscendência, bem como de impulsividade motora, atencional e de não planejamento, e escores significativamente mais baixos de autodirecionamento e cooperatividade. Os irmãos não afetados por transtorno afetivo bipolar apresentaram, em relação aos controles saudáveis, escores significativamente mais elevados de esquiva ao dano e impulsividade motora, e escores significativamente mais baixos de autodirecionamento. O subgrupo de 32 irmãos sem qualquer diagnóstico psiquiátrico apresentou escores significativamente mais baixos de esquiva ao dano em relação aos controles. Esses resultados sugerem que escores elevados de esquiva ao dano e impulsividade motora e escores baixos de autodirecionamento podem representar marcadores de vulnerabilidade ao transtorno afetivo bipolar, sendo que a dimensão esquiva ao dano destaca-se por ter permanecido elevada mesmo entre os irmãos sem qualquer transtorno psiquiátrico. Esses dados podem contribuir para o avanço no conhecimento sobre os mecanismos neurobiológicos subjacentes ao transtorno afetivo bipolar, bem como para o desenvolvimento de estratégias de tratamento e prevenção desse transtorno Recent studies have shown that euthymic patients with bipolar disorder present higher scores on impulsivity, novelty seeking, harm avoidance and selftranscendence and lower scores on self-directedness and cooperativeness than healthy controls. However it is unclear whether specific personality traits are vulnerability markers for bipolar disorder or represent a scarring effect of the affective episodes. The aim of this study was to compare temperament, character and impulsivity among patients with bipolar disorder, their unaffected siblings and healthy controls. We assessed 67 euthymic outpatients with bipolar disorder type I, 67 full siblings and 70 healthy controls using the Temperament and Character Inventory and the Barratt Impulsiveness Scale. Patients were euthymic if they present a Hamilton depression rating scale score and a Young mania rating scale score less than 8. Analysis of variance was used to compare mean scores of temperament, character and impulsivity among the three groups, and the Games- Howell test and the Tukey test were used as post-hoc tests for pairwise comparisons. The level of significance was set at 5%. Euthymic patients with bipolar disorder showed higher scores on impulsivity, novelty seeking, harm avoidance, and selftranscendence, and lower scores on self-directedness and cooperativeness than healthy controls. Their siblings without bipolar disorder diagnosis showed higher scores on harm avoidance and motor impulsivity and lower scores on selfdirectedness than healthy controls. A subset of 32 siblings who never have developed any psychiatric disorder during lifetime showed higher harm avoidance scores than healthy controls. Our results suggest that higher scores on harm avoidance and motor impulsivity, and lower scores no self-directedness may represent vulnerability markers for bipolar disorder. The harm avoidance dimension stands out since it remained higher even among siblings without any axis I psychiatric diagnosis. These data may contribute to further improve preventive strategies in subjects at high risk for bipolar disorder

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