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
    • "As an example, allele frequencies in Asians were different from those of Caucasians (Murakami et al., 1999), suggesting that ethnic differences may be a confounding factor. Psychiatric diagnosis should also be considered, as it is well known that depression and anxiety disorders are associated with both higher scores of anxiety traits (Smith et al., 2005; Matsudaira and Kitamura, 2006; De Winter et al., 2007; Klein et al., 2011) and higher frequency of the S allele (Holsboer, 2008). Moreover, the fact that some of the studies reported allele frequencies not in Hardy–Weinberg equilibrium or unpublished data should be taken into account. "
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    ABSTRACT: The heritability of human personality traits is by now well established. However, since the first reports on associations between specific genetic variants and personality traits, only modest progress has been made in identifying loci that robustly support these associations. The aim of this study was to provide a summary of literature data on association studies focused on the genetic modulation of personality, according to the Cloninger, Eysenck and Costa and McCrae models. PubMed was searched for papers investigating the association between any gene variant and personality traits, which were grouped into five clusters: (a) anxiety, (b) impulsivity, (c) determination-activity, (d) socialization and (e) spirituality, in healthy individuals, populations and psychiatric patients. A total of 369 studies were included. No clear consensus on the role of any individual gene variant in personality modulation emerged, although SLC6A4 haplotypes and the DRD4 rs1800955 promoter variant seemed to be more reliably related to anxiety and impulsivity-related traits, respectively. Because conflicting results emerged from the literature, plausibly as a result of the combined influence of many loci of small effects on personality, larger sample sizes and more narrow and specific phenotype will be the minimum requirements for future genetic studies on personality. Moreover, gene×gene and gene×environment interaction studies deserve further attention.
    International clinical psychopharmacology 10/2013; 29(1). DOI:10.1097/YIC.0b013e328364590b · 2.46 Impact Factor
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