One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions.
Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity.
PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity.
These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.
"In the TCI, both the temperament category of reward dependence (related to warm social affiliations, separation distress, sympathy, and social sensitivity ), and the character component cooperativeness (ability to accept of others, listen and cooperate), describe social and relational proclivities. Concerning the TEMPS-A, although its questions are devoid of specific relational language or context, Akiskal's list of the survival-related events that elicit and reflect affective proclivities (i.e., being enamored and jilted, dominance-submission hierarchies, tendency toward fealty, territoriality), are inherently relational (Akiskal et al., 2005a). Furthermore, from a neurobiological vantage, both of these scales ultimately reflect the function of underlying socioemotional brain systems, and components of each scale have been associated with central systems related to social reward (Bachner-Melman et al., 2005; Gerretsen et al., 2010; Lebreton et al., 2009), including the oxytocin system (Bell et al., 2006; Cloninger, 1994; Groppe et al., 2013; Kawamura et al., 2011; Tost et al., 2010a). "
[Show abstract][Hide abstract] ABSTRACT: Background
As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients.
We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD).
Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%.
Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report.
Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.
"Among the personality variables studied, neuroticism was independently associated with self-reported somatic symptoms in large community samples (Rosmalen et al., 2007; Neeleman et al., 2004). Akiskal and collaborators (Akiskal et al., 2005a, 2005b) operationalized the concept of affective temperaments for use in research based on theoretical and clinical observations from the seminal works of Kraepelin (1921) and Kretschmer (1936). Recently, Lara et al. (2012a) extended the concept of affective temperaments to include 12 predominant types, namely euthymic, depressive, anxious, apathetic, obsessive, cyclothymic, dysphoric, irritable, volatile , disinhibited, hyperthymic and euphoric. "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown. METHODS: We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable. RESULTS: Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense. LIMITATIONS: The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness. CONCLUSIONS: Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.
Journal of Affective Disorders 05/2013; DOI:10.1016/j.jad.2013.04.043 · 3.38 Impact Factor
"Hyperthymic personality, atypical depressive symptoms, psychotic major depressive episodes, postpartum depression, and antidepressant ‘wear-off’ are other criterion D items which did not reach a significant level in predicting BSD on logistic regression. The literature includes some evidence in support of and/or against the relationship between each above indices and bipolar disorder.27826–35 However, despite lack of significant role for each remained criterion D items in predicting the BSD in the present study, the findings are not able to rule out the contribution of each mentioned BSD indices in developing a BSD, because of some methodological limitations that will be pointed out. "
[Show abstract][Hide abstract] ABSTRACT: A bipolar spectrum definition presented to help the designation of more appropriate diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is Ghaemi et al. Bipolar Spectrum Disorder (BSD). The present study evaluates the BSD frequency among inpatients with major depressive disorder (MDD) and tries to elucidate the contribution of second degree diagnostic items of BSD in the BSD definition.
One hundred individuals aged 18-65 with current MDD consecutive admitted in three university affiliated psychiatric center were clinically interviewed. The patients with mental retardation or the history of substance dependence/ abuse were excluded. The interviews were carried out by a trained general practitioner according to an 11-item checklist comprised of criteria C (2 items) and D (9 items) of Ghaemi et al. BSD.
Fifty three males and 47 females entered the study. Patients' mean age was 34.16 ± 9.58. Thirty eight patients (39.2%: 18 males and 20 females) met the complete diagnostic criteria of BSD. Early onset depression (53.0%), recurrent depression (40.0%) and treatment resistant depression (38.8%) were the most frequent accessory items of BSD, but using logistic regression three items recurrent major depressive episodes (MDEs), treatment resistant depression, and brief MDE- had the significant weight to predict the BSD. Then, three mentioned items were simultaneously entered the logistic regression model: brief MDE (β = 1.5, EXP (β) = 4.52, p = 0.007), treatment resistant depression (β = 1.28, EXP (β) = 3.62, p = 0.01), and recurrent MDEs (β = 1.28, EXP (β) = 3.62, p = 0.01) had the highest strength in predicting BSD and account for 21-30% of BSD diagnosis variance in sum.
Regarding the greater diagnostic strength of some accessory items - especially brief MDE - to predict the BSD, it is suggested that these items were considered as the main ones in the BSD criterion C.
Journal of research in medical sciences 03/2009; 14(1):29-35. · 0.65 Impact Factor
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