Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study.
ABSTRACT 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.
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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. Methods 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). Results 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%. Limitations Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report. Conclusions 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.Journal of Affective Disorders 12/2013; 151(3):932–941. DOI:10.1016/j.jad.2013.07.040 · 3.76 Impact Factor
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ABSTRACT: The current study evaluates the reliability and factor-structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Greek Version. The TEMPS-A was administered to a convenient sample of 734 subjects from the general Greek population (436 females; 59.4% and 298 males; 40.6%). Their mean age was 40.80±11.48 years (range 25-67 years). The analysis included the calculation of Chronbach's alpha, the calculation of the threshold to define dominant temperaments (+2 standard deviations or 95th percentile), confirmatory factor analysis and the calculation of Pearson correlation coefficients between the temperament scales scores. Analysis of Covariance with age as covariate and post-hoc t-test was used to search for differences in temperament scores between males and females. Also a table of percentile values corresponding to a raw score was created. Internal consistency was excellent for the various temperaments (0.72-0.88). The factor analysis confirmed the five factor solution as the best factor solution. All TEMPS items were included in the final version of the scale in the Greek language. The study sample included subjects from the general population, but it is a convenient and not representative sample. Although the authors tried to select them on the basis of being mentally healthy and without a psychiatric history, there is always a degree of uncertainty. There is also always the possibility some of them to manifest a mental disorder in the future, thus being currently in a premorbid state. The Greek version of the TEMPS-A, has good internal consistency and factor structure similar to what was found in other translations. Overall our results are in accord with the literature and in line with theoretical considerations as well as with empirical evidence.Journal of Affective Disorders 04/2014; 158:19-29. DOI:10.1016/j.jad.2013.12.030 · 3.76 Impact Factor
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ABSTRACT: Prodromal symptoms prior to first episode mania/hypomania have been reported. However, the relationship between temperament and manic/hypomanic prodromal symptoms has not been investigated. We hypothesized that subjects scoring higher on cyclothymic and irritable temperament scales show more manic/hypomanic prodromal symptoms.Method Euthymic patients diagnosed with bipolar-I or -II disorder within 8 years underwent retrospective assessments with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A) and the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R).ResultsAmong 39 subjects (36.1±9.9 years, females=59%, bipolar-I=62%) 100% and 92.3% reported subthreshold mania (mean=7.4±2.9) or subthreshold depressive symptoms (mean=2.4±1.5), and 87.2% and 43.6% reported general psychopathology (mean=3.2±2.0) or subthreshold psychotic symptoms (mean=0.7±1.0) prior to their first hypo-/manic episode. Subjects with higher cyclothymic and irritable temperament scores showed more subthreshold symptoms prior to the first manic/hypomanic episode, mainly subthreshold hypo-/manic symptoms (cyclothymic temperament r=0.430; p=0.006; irritable temperament r=0.330; p=0.040), general psychopathology symptoms (cyclothymic temperament r=0.316; p=0.05; irritable temperament r=0.349; p=0.029) and subthreshold psychotic symptoms (cyclothymic temperament r=0.413; p=0.009). In regression analyses, cyclothymic temperament explained 16.1% and 12.5% of the variance of the BPSS-R total score (p=0.045) and psychosis subscore (p=0.029).LimitationsRetrospective study, no control group, small sample size.Conclusion We present data, which indicate a relationship between cyclothymic and irritable temperament and prodromal symptoms prior to the first manic/hypomanic episode. These findings support the notion that assessing cyclothymic temperament to identify people at-risk of developing bipolar-I and -II disorder may help to increase the predictive validity of applied at-risk criteria.Journal of Affective Disorders 10/2014; 173. DOI:10.1016/j.jad.2014.10.031 · 3.71 Impact Factor