Character and temperament in major depressive disorder and a highly anxious-retarded subtype derived from melancholia

Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.
Comprehensive Psychiatry (Impact Factor: 2.25). 09/2007; 48(5):426-35. DOI: 10.1016/j.comppsych.2007.04.002
Source: PubMed


An anxious-retarded subtype of major depressive disorder, defined by high scores for both anxiety and retardation, has been derived from melancholia and appeared to have higher external validity in terms of poor outcome and vasopressinergic stress hormone regulation. A specific personality could enhance the validity of this subtype, and the association with melancholia suggested the absence of a personality disorder. As 2 character dimensions of the Temperament and Character Inventory (TCI), self-directedness (SD) and cooperativeness, parsimoniously predict the presence of a personality disorder, the primary aim was to test whether patients with the highly anxious-retarded subtype of depression have both normal SD and normal cooperativeness. A secondary aim was to optimally account for the general personality characteristics of patients with a major depressive disorder.
Eighty-six patients with major depressive disorder and matched healthy controls were selected. Seventy patients were eventually recruited for a 2-year follow-up encompassing 5 assessments of personality (TCI) and psychopathology (Comprehensive Psychopathological Rating Scale). Full remission of depression was defined by the presence of less than 3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition items of depression during 2 weeks.
State-dependent changes of SD and harm avoidance (HA) scores were found in all depressed patients. Fully remitted patients had only high HA compared with healthy controls. Unexpectedly, fully remitted patients with the highly anxious-retarded subtype, in addition, had low SD.
The temperament of high HA may be the predisposing TCI trait for major depressive disorder in general. Low SD may be a specific presumably premorbid character trait for the highly anxious-retarded subtype derived from melancholia.

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Available from: Jaap G Goekoop, May 12, 2014
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    • "Of course, former studies evaluating HA scores as clinical predictor were based on an AD treatment in non-TRD samples, making it difficult to compare. Moreover, because personality features, such as HA, have been reported to be different between depressed melancholic and non-melancholic patients (Sato et al., 2001; de Winter et al., 2007; Rubino et al., 2009), the inclusion of only melancholic TRD patients may have influenced our results. Conform to other AD studies evaluating also the other temperament dimensions, NS and RD were also no predictor to response in refractory MDD, neither the other character scales CO and ST (Mulder, 2002). "
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    ABSTRACT: Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
    Psychiatry Research 08/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.084 · 2.47 Impact Factor
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    • "The Temperament and Character Inventory (TCI) has been used in general population studies and in studies including patients with major depressive disorder (MDD) to assess how different temperament dimensions are associated with this disorder.1 HA has reportedly been higher in MDD patients than in general population3-9 and has been state dependent in MDD.5,6 HA has also been associated with depressive symptoms in general population.10-12 HA, RD and NS have been found to have trait-like characteristics that are related to the familial occurrence of depression.4 "
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    ABSTRACT: Not enough is known about which patients suffering from major depressive disorder benefit from antidepressant drug treatment. Individual temperament is relatively stable over a person's lifespan and is thought to be largely biologically predefined. We assessed how temperament profiles are related to depression and predict the efficacy of antidepressant treatment. We recruited one hundred Finnish outpatients (aged 19 to 72) suffering from major depressive disorder, of whom 86 completed the 6-week study. We assessed their temperament features with the Temperament and Character Inventory and used cluster analysis to determine the patient's temperament profile. We also categorized the patients according to the vegetative symptoms of major depressive disorder. There was an association between skewed temperament profile and severity of major depressive disorder, but the temperament profiles alone did not predict antidepressant treatment response. Those with higher baseline vegetative symptoms score had modest treatment response. Our model with baseline Montgomery Åsberg Depression Rating Scale (MADRS) vegetative symptoms, age and temperament clusters as explanatory variables explained 20% of the variance in the endpoint MADRS scores. The temperament clusters were associated both with severity of depression and antidepressive treatment response of depression. The effect of the temperament profile alone was modest but, combined with vegetative symptoms of depression, their explanatory power was more marked suggesting that there could be an association of these two in the biological basis of MDD.
    Psychiatry investigation 01/2014; 11(1):18-23. DOI:10.4306/pi.2014.11.1.18 · 1.28 Impact Factor
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    • "The exact definition of temperament is still a topic of discussion, but in general, temperament refers to individual differences that have a genetic basis, are manifested early in life and are relatively stable over time [10]. The association between psychopathology and temperament has been explained by four different models: (1) the scar model proposes that psychopathology would modify pre-existing temperament traits; (2) the vulnerability model proposes that certain traits would raise the likelihood of developing a determined type of psychopathology; (3) the spectrum model supposes that psychiatric disorders would be the extreme end of a temperament; and (4) the pathoplastic model hypothesizes that specific temperament combinations could interfere with some characteristics of psychiatric disorders like their course and presentation [11] [12] [13] [14]. Therefore, temperament traits could play a role in determining vulnerability to depression, either predisposing individuals to or protecting them from developing the disorder. "
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    ABSTRACT: OBJECTIVES: To evaluate temperament and character traits using the Junior Temperament and Character Inventory (JTCI) in children and adolescents with major depressive disorder (MDD) in comparison with healthy control subjects (HC), and to verify if comorbidity with disruptive behavioral disorders and being currently depressed influence JTCI scores. METHODS: A case-control study comprising 41 MDD children/adolescents matched to 40 HC by gender and age (8-17years). All participants were assessed diagnostically with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL). Temperament and character traits were measured with the parent and child versions of JTCI, and depression was evaluated with the Children's Depression Rating Scale (CDRS). RESULTS: According to child and parent data, MDD subjects had significantly higher scores on harm avoidance and novelty seeking, and lower scores on reward dependence, persistence, self-directedness and cooperativeness compared with HC. According to parent data only, MDD subjects significantly differed from HC on self-transcendence (lower spirituality scores and higher fantasy scores). Comorbidity with disruptive behavioral disorders exerted influence on almost all dimensions, in general increasing the mean differences between MDD and HC subjects. Also, being currently depressed did not influence the results, except for reward dependence according to parent data. LIMITATIONS: The cross-sectional nature of the study and its limited sample size. CONCLUSIONS: MDD children/adolescents have a different temperament and character profile compared to HC subjects. This study supports previous findings of trait-like characteristics of harm avoidance and self-directedness.
    Comprehensive psychiatry 12/2012; 54(4). DOI:10.1016/j.comppsych.2012.10.009 · 2.25 Impact Factor
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