No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Affective Temperaments and Neurocognitive Functioning in Bipolar Disorder
... The ranking for psychology, neuroscience, and medicine areas in the last 7 years were considered. Twenty-one studies were published in Q1 journals (Fleck et al., 2005;Malhi et al., 2007;Thompson et al., 2007;Barrett et al., 2008;Deckersbach et al., 2008;Drapier et al., 2008;Roiser et al., 2009;Liu et al., 2010;Thermenos et al., 2010;Bertocci et al., 2011;Levy et al., 2011;Mullin et al., 2012;Gruber et al., 2013;Lee et al., 2013;Pomarol-Clotet et al., 2014;Russo et al., 2014;Bauer et al., 2015;Gvirts et al., 2015;McCormack et al., 2015;Muhtadie and Johnson, 2015;Sabater et al., 2016), one in Q2 journal (Miguélez-Pan et al., 2014), and one in Q3 journal (Dittman et al., 2008). These quartiles also indicated that the majority of selected studies were published in higher impact factor journals. ...
... Most studies evaluated the sample in just one mood episode in BD. Euthymic patients were predominant in the samples (Malhi et al., 2007;Barrett et al., 2008;Dittman et al., 2008;Drapier et al., 2008;Thermenos et al., 2010;Levy et al., 2011;Mullin et al., 2012;Gruber et al., 2013;Lee et al., 2013;Miguélez-Pan et al., 2014;Russo et al., 2014;Bauer et al., 2015;Muhtadie and Johnson, 2015;Sabater et al., 2016), few studies evaluated depressions phases of BD (Deckersbach et al., 2008;Roiser et al., 2009;Bertocci et al., 2011) and only one compared the performance in manic and euthymic episodes in relation to health controls (Fleck et al., 2005). All studies have used between-groups comparison, and only article by Pomarol-Clotet et al. (2014) also had a withinparticipants design and evaluated the same patients in three characteristics mood phases of BD. ...
... Seven studies (Malhi et al., 2007;Deckersbach et al., 2008;Drapier et al., 2008;Thermenos et al., 2010;Bertocci et al., 2011;Mullin et al., 2012;Pomarol-Clotet et al., 2014) also applied functional magnetic resonance imaging (fMRI) to measure brain activity. In relation to the cognitive instruments, 16 studies used span tasks (Malhi et al., 2007;Thompson et al., 2007;Barrett et al., 2008;Dittman et al., 2008;Roiser et al., 2009;Liu et al., 2010;Levy et al., 2011;Gruber et al., 2013;Lee et al., 2013;Miguélez-Pan et al., 2014;Russo et al., 2014;Bauer et al., 2015;Gvirts et al., 2015;McCormack et al., 2015;Muhtadie and Johnson, 2015;Sabater et al., 2016), and six studies chose n-back tasks (Deckersbach et al., 2008;Drapier et al., 2008;Thermenos et al., 2010;Bertocci et al., 2011;Mullin et al., 2012;Pomarol-Clotet et al., 2014), with two of them using the modified EFNBACK instrument. Only one article used a supra span task, the yes/no recognition memory test, based in verbal directedforgetting paradigm. ...
Working memory (WM) deficits are often reported in patients with Bipolar Disorder (BD). However, it is not clear about the nature of these WM deficits (update or serial order processes) and their association with each BD states (euthymic, mania, and depressive). This review investigated the association between BD patient's states and the functioning of WM components. For this purpose, we carried out a systematic review fulfilling a search in the databases Medline, Scopus, SciELO, and Web of Science using specific terms in the abstracts of the articles that generated 212 outcomes in the restricted period from 2005 to 2016. Twenty-three papers were selected, completely read, and analyzed using PICOS strategy. The mood episodes predicted deficits in different components of WM in BD patients (the phonological loop or visuospatial sketchpad) and were associated with different WM processes (updating and serial recall). Lower cognitive scores persist even in remission of symptoms. This result suggests that WM deficit apparently is stage-independent in BD patients. Furthermore, findings suggest that the neutral point on Hedonic Detector component of WM could be maladjusted by BD.
... Xu et al. (2014) found that symptomatic bipolar patients with a predominant hyperthymic temperament were more impaired in the tasks of set shifting and verbal working memory, and that bipolar II patients performed significantly better than bipolar I patients with the same degrees of affective temperament. In contrast, Russo et al. (2014) found a positive correlation in bipolar patients between scores on irritable and cyclothymic subscales and processing speed, working memory, reasoning, and problem solving, along with significant negative correlations in HC between hyperthymic temperament and attention and social cognition. When the HC and bipolar patients were analyzed together , a further significant negative correlation between depressive temperament and processing speed was identified (Russo et al., 2014). ...
... In contrast, Russo et al. (2014) found a positive correlation in bipolar patients between scores on irritable and cyclothymic subscales and processing speed, working memory, reasoning, and problem solving, along with significant negative correlations in HC between hyperthymic temperament and attention and social cognition. When the HC and bipolar patients were analyzed together , a further significant negative correlation between depressive temperament and processing speed was identified (Russo et al., 2014). Other studies have also informed relevant associations between cognitive functions and affective traits. ...
... This probably accounts for both the reduced cognitive deficits and the less apparent correlation between temperament and cognition in HC. It is proposed that low degrees of temperamental features, as observed in the healthy control group, likely do not interfere with cognition and may in fact benefit certain aspects of cognitive performance (Russo et al., 2014). Though verbal fluency is often found to be impaired in several psychiatric conditions, such as depression and schizophrenia (Butman et al., 2000; Higier et al., 2014; Xu, et al. 2014), we found no significant differences between the two groups in terms of verbal fluency or premorbid IQ. ...
Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains.
... Several variables can be grouped in this definition. Affective temperament (e.g., cyclothymic) refers to refer to genetically based, stable, and trait-like emotional manifestations associated with mood disorders (Russo et al., 2014). Maladaptive states of mind are the pervasive mental states laden with emotional suffering that tend to be activated when individuals experience situations that mimic past traumatic experiences (Horowitz, 1987). ...
... They concluded that it was not possible to document robust associations between working memory and Big Five personality traits. Also, affective temperament (cyclothymic and irritable) in individuals with bipolar disorder showed to be associated with processing speed, working memory, reasoning, and problem-solving (Russo et al., 2014). ...
Executive functions are described as a set of neurocognitive processes underlying human mental processing, while maladaptive cyclical patterns are the dysfunctional psychological elements associated with psychological distress and symptomatology that tend to be recurrent. Both psychological constructs tend to be studied by different scientific fields and with different methods which limits a coherent theoretical integration. Therefore, the present study aims to explore the relationships between executive functions and maladaptive cyclical patterns. A sample was gathered (N=96, Mage= 20.78, SD=4.63), and completed several self-report questionnaires along with several neuropsychological tests for the assessment of executive functions. Results showed that behavioral inhibition correlated negatively with maladaptive cyclical patterns while cognitive inflexibility correlated positively. Regression analysis showed that behavioral inhibition, psychological inflexibility, and recurring states of mind predicted emotional processing difficulties. These results emphasize previous assumptions that a difference between self-report questionnaires and behavioral tasks may limit the integrated study of psychological and neurocognitive processes.
... 3,4 In non-clinical populations, cyclothymic/irritable temperament has been associated with impaired functioning. 5 Temperament has been associated with the aspects of neurocognitive functioning; 6 irritability trait was associated with better objective performance on some cognitive domains in individuals with Bipolar Disorder, but relatively worse performance in controls. Regarding objective cognitive function, significant associations among hyperthymic temperaments and verbal memory, cyclothymic temperaments and attention, and irritable temperaments, attention, and verbal fluency in patients with euthymic bipolar disorder have been reported. ...
... A previous study suggests that trait irritability worsens objective cognitive function. 6 Therefore, an irritable temperament may worsen both subjective and objective cognitive functions. In the present study, according to the results of multiple regression analysis, depressive symptoms, subjective cognitive dysfunction, and depressive temperament predicted functional disability. ...
Purpose:
Functional disability is affected by subjective cognitive function, depressive symptoms, and affective temperaments in adults. However, the role of subjective cognitive function as a mediator of affective temperaments in functional disability remains unknown. Therefore, we aimed to determine how subjective cognitive function mediates the effect of affective temperaments on functional disability in adults.
Materials and methods:
A total of 544 participants completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), the cognitive complaints in bipolar disorder rating assessment (COBRA), and the Sheehan Disability Scale (SDS). The association among these instruments was evaluated by multiple regression and covariance structure analyses.
Results:
The structural equation model showed that the COBRA scores could be predicted directly by the four affective temperaments of the TEMPS-A (cyclothymic, depressive, irritable, and anxious) and indirectly by the PHQ-9. Moreover, the SDS score was predicted directly by these four affective temperaments and indirectly by the COBRA and PHQ-9.
Conclusion:
Subjective cognitive function mediates the effect of affective temperaments on functional disability in Japanese adults. However, the cross-sectional design may limit the identification of causal associations between the parameters. In the present study, the participants were from a specific community population; therefore, the results may not be generalizable to other communities.
... Regarding the first criterion, numerous research articles, reviews, and meta-analysis, have found several neurocognitive deficits that can be identified as suitable candidates to be endophenotypes of BD: attention, memory in general and executive functions such as cognitive flexibility, working memory, verbal fluency or response inhibition (Castañeda and Tirado, 2008;Bora et al., 2009;Maekawa et al., 2013;Bourne et al., 2013: Glahn et al., 2014Santos et al., 2014;Volkert et al., 2016b). With regard to the second criterion, to assess "clinical state-independence" in BD, several longitudinal studies comparing patients and healthy controls detected neurocognitive deficits mostly during periods of euthymia (Lee et al., 2014;Russo et al., 2014;Georgiades et al., 2016). In relation to the third criterion, despite few existing studies with relatives of patients with BD (BD-Rel), growing evidence indicates that several cognitive deficits are also present in unaffected relatives of patients with BD, (Bora et al., 2009;Arts et al., 2011;Balanzá-Martínez et al., 2008;Miskowiak et al., 2017). ...
... In relation to the third criterion, despite few existing studies with relatives of patients with BD (BD-Rel), growing evidence indicates that several cognitive deficits are also present in unaffected relatives of patients with BD, (Bora et al., 2009;Arts et al., 2011;Balanzá-Martínez et al., 2008;Miskowiak et al., 2017). This suggests that some neurocognitive deficits may be considered endophenotype candidates for the disorder (Russo et al., 2014). These studies have shown that the cognitive performance of unaffected BD-Rel is between that of patients with BD and that of healthy controls, in cognitive functions such as processing speed, divided attention, verbal memory, set shifting and planning (Drysdale et al., 2013;Nehra et al., 2014;Volkert et al., 2016a;Tatay-Manteiga et al., 2018). ...
... However, the evaluation of QoL is mainly based on illness symptoms rather than stable patient traits. One emergent line of research is what subtype of affective temperament in euthymic BD patients may be able to predict illness course and functioning (Romero et al., 2016;Russo et al., 2014). Affective temperaments are considered temporally stable behavioural traits, with strong and characteristic affective reactivity . ...
... Secondly, we expected euthymic BD patients to have higher scores for cyclothymic, irritable, and dysthymic temperaments relative to healthy individuals (Matsumoto et al., 2005;Mendlowicz et al., 2005;Nowakowska et al., 2005). Thirdly, since affective temperament of BD patients has a negative impact on illness course and functioning (Romero et al., 2016;Russo et al., 2014), we hypothesized that certain subtypes of affective temperaments would predict the physical and mental components of HRQoL in euthymic BD patients. Specifically, we expected a negative association between cyclothymic temperament and the mental component of HRQoL (Akiskal et al., 2003;Harnic et al., 2014;Walsh et al., 2013) and between anxious temperament and the physical component related to the impact of somatic anxiety on HRQoL (Coryell et al., 2009;Sala et al., 2012). ...
Background: Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment.
Objective: Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients.
Methods: A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify the potential confounding variables and select the affective temperaments as potential predictors on the PCS and MCS of QoL in BD patients, as well as the control group.
Results: QoL scores in terms of PCS and MCS in BD patients were significantly lower than in healthy individuals. Whereas anxious temperament, anxiety disorder comorbidity, and age were the best predictors of PCS impairment in BD patients, anxious temperament, subclinical depressive symptoms, and age were the best predictors of MCS impairment.
Limitations: Further longitudinal studies with unaffected high-risk relatives are needed to examine the potential interaction between affective temperament and psychopathology.
Conclusions: Anxious temperament has an impact on QoL in BD in terms of both the physical component and the mental component. Systematic screening of temperament in BD would give clinicians better knowledge of QoL predictors. Further research should allow more individualized treatment of BD patients based on temperamental factors.
... For clinicians, it may be very important to know a BD patient's "neurocognitive destiny" to understand the impact of BD on the individual's recovery. Because of numerous studies, it is possible to affirm that these conditions are often 16 circadian rhythm disorders) may help to determine a loss of overall functioning [68][69]. It is also possible that different factors exist during the disease course, genetic and/or epigenetic, that may either protect or worsen social and cognitive functioning [69][70]. ...
... Because of numerous studies, it is possible to affirm that these conditions are often 16 circadian rhythm disorders) may help to determine a loss of overall functioning [68][69]. It is also possible that different factors exist during the disease course, genetic and/or epigenetic, that may either protect or worsen social and cognitive functioning [69][70]. ...
Introduction: This study aimed to describe the differences in global functioning in BD type I and type II patients with high premorbid functioning.
Methods: From a more extensive sample of 140 subjects, fifty euthymic bipolar outpatients with high level of premorbid social functioning measured by Premorbid Adjustment Scale were enrolled. 90 BD were excluded because they had a low premorbid social functioning. Current social and neuropsychological functioning was assessed.
Results: Cluster analysis showed that some BD patients maintain a high functioning, while other patients suffer of a loss of global functioning. Multivariate analysis showed that a lower social functioning, independently from premorbid social functioning, can be associated with a loss of executive
functions (p = .009). In this analysis the effects of bipolar type (I or II), age at onset, current social roles and duration of illness were absent or not significant (p > .05).
Discussions: This is the first study to distinguish levels of global functioning in euthymic BD patients that had the same premorbid social functioning. These important differences in the course of the BD can be assessed through psychosocial and neuropsychological assessment tools for a more appropriate
management of the variables able to modify the course of disorder, also in euthymic phase. This practice becomes crucial in the definition and implementation of specific psychosocial treatments in the short and long-term course of disease, providing a new and specific area of intervention for bipolar disorder: the cognition
... PRISMA flow diagram of study selection process. Kesebir et al., 2013, Mahon et al., 2013, de Aguiar Ferreira et al., 2014, Eich et al., 2014, Harnic et al., 2014, Kesebir et al., 2014, Dolenc et al., 2015, Innamorati et al., 2015Mendlowicz et al., 2005a, Mendlowicz et al., 2005b, Nowakowska et al., 2005, Vazquez et al., 2008, Mazzarini et al., 2009, Nilsson et al., 2010, Russo et al., 2014, Rybakowski et al., 2014, Xu et al., 2014. The included studies contained 5628 subjects, including 2025 with BD, 43 with BPD, 56 with ADHD, 1283 with MDD, 28 with ED, 1757 HC, 436 relatives of patients with BD. ...
... TEMPS-A-110, a self-administered version of TEMPS (or no further specified version of the TEMPS-A) questionnaire was used in 14 studies (Evans et al., 2005;Nowakowska et al., 2005;Benazzi, 2006;Ekinci et al., 2013;Fornaro et al., 2013b;Greenwood et al., 2013;Mahon et al., 2013;Eich et al., 2014;Harnic et al., 2014;Pompili et al., 2014;Russo et al., 2014;Rybakowski et al., 2014;Dolenc et al., 2015;Innamorati et al., 2015). The other 9 studies used the TEMPS -Rio de Janeiro in 1 study (de Aguiar Ferreira et al., 2014); TEMPS-A Rome in 1 study (Fornaro et al., 2013b); Lebanese-Arabic TEMPS-A in 1 study (Karam et al., 2010); Turkish version of TEMPS-A in 3 studies (Kesebir et al., , 2013(Kesebir et al., , 2014; Japanese version of TEMPS-A in 1 study (Matsumoto et al., 2005); Italian version of TEMPS-A in 1 study (Mazzarini et al., 2009); short version of TEMPS-A in 3 studies (Mendlowicz et al., 2005a(Mendlowicz et al., , 2005bNilsson et al., 2010); TEMPS-A Buenos Aires in 1 study (Vazquez et al., 2008); and the Chinese version of TEMPS-A in 1 study (Xu et al., 2014). ...
... One early influential study proposed the HT as a diagnostic feature of bipolar II disorder (18), resulting in what we believe a subsequent overemphasis on the role of HT as a predictor of bipolarity (19). However, a close inspection reveals that most studies found HT scores to be greater in patients with bipolarity when compared to those with MDD (20-25) but not to healthy controls (10,12,13,15,(22)(23)(24)(25)(26)(27)(28)(29). ...
Background
The aim of the present study is to evaluate the role of individual affective temperaments as clinical predictors of bipolarity in the clinical setting.
Methods
The affective temperaments of 1723 consecutive adult outpatients presenting for various symptoms to a university-based mental health clinical setting were assessed. Patients were administered the Hypomania Checklist-32 and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego – Auto-questionnaire (TEMPS-A) and were diagnosed by psychiatrists according to the DSM-5 criteria. TEMPS-A scores were studied as both continuous and normalized categorical z -scores from a previously established nationwide study on the general population of Lebanon. Simple and multiple binary logistic regressions were done on patients who have any of the DSM-5 defined bipolar types, as a combined group or separately, versus patients without any bipolar diagnosis.
Results
At the multivariable level and taking into account all temperaments, the irritable temperament is a consistent predictor of bipolar I and bipolar II disorders. Cyclothymic temperament also played a strong role in bipolarity but more decisively so in bipolar II and substance-induced bipolarity. The hyperthymic temperament had no role in bipolar I or bipolar II disorder.
... Notably, a study using the cyberball paradigm showed that individuals with cluster A personality traits were buffered against ostracism's negative impact on social pain, basic need satisfaction, and positive affect [14]. On the contrary, irritable temperament [15], defined as the tendency to experience excessive negative affect [16], has been associated with reactivity and negative interpretation in social contexts [17]. ...
Antisocial behavior involves actions that disregard the basic rights of others and may represent a threat to the social system. The neural processes associated with being subject to antisocial behavior, including social victimization, are still unknown. In this study, we used a social interaction task during functional magnetic resonance imaging to investigate the neural bases of social victimization. Brain activation and functional connectivity (FC) were estimated and correlated with the Big 5 Questionnaire, Temperament Evaluation in Memphis, Pisa and San Diego (TEMPS-M), and a Questionnaire of Daily Frustration scores. During social victimization, the right occipital and temporal cortex showed increased activation. The temporal cortex also had reduced FC with homotopic areas. Compared to the prosocial interaction, social victimization showed hyperactivation of the dorsomedial and lateral prefrontal cortex, putamen, and thalamus and increased FC of the medial-frontal–striatal–thalamic areas with the ventrolateral prefrontal cortex, insula, dorsal cingulate, and postcentral gyrus. Lastly, neuroticism, irritable temperament, and frustration scores were correlated with the magnitude of neural responses to social victimization. Our findings suggest that social victimization engages a set of regions associated with salience, emotional processing, and regulation, and these responses can be modulated by temperamental and personality traits.
... The only dimension of functioning that has been associated to affective disposition is neurocognitive functioning. Russo et al. [60] reported that the presence of cyclothymic and hyperthymic dispositions is associated to a better cognitive performance, and that depressive and anxious predominant dispositions were associated to poor cognitive skills. Considering the relationship between cognitive and psychological functioning, we can only indirectly assume that some affective dispositions can be associated with a better psychological functioning. ...
Background
The present study aims to assess clinical and psychological correlates of psychological functioning in patients with mood disorders, in a naturalistic setting. In particular, we aimed to describe which sociodemographic, clinical, and temperamental dispositions are more frequently associated with poor psychological functioning, and to describe the association between cognitive and psychological functioning in euthymic patients with major depression and bipolar disorder.
Methods
Inclusion criteria were as follows: (1) diagnosis of major depression, or bipolar disorder type I or II; (2) age between 18 and 65 years; and (3) being in a stable phase of the disorder. Patients’ psychiatric symptoms, quality of life, affective temperaments, and impulsivity were investigated with validated assessment instruments.
Results
166 patients have been recruited, mainly female (55.4%), whose mean age was 47.1 ± 14.2 years. 42.6% of individuals reported a diagnosis of major depression. According to regression analyses, poor cognitive performance ( p < 0.05), reduced perceived quality of life (p < .0001), lifetime suicide attempts ( p < 0.01), and increased trait-related impulsivity ( p <0 .001) strongly correlated with poor psychological functioning. Moreover, cyclothymic and irritable dispositions were also associated with poor social functioning ( p < 0.01), whereas hyperthymic affective disposition was associated to a better psychological performance (p < 0.01).
Conclusions
Our results support the evidence that patients with mood disorders should be assessed for psychological functioning and affective dispositions, to identify patients at higher risk to develop worse long-term outcomes and to develop targeted interventions.
... Characterizing endophenotypic profiles associated with MIs could be useful for identifying individuals at risk, increasing the effectiveness of early diagnosis, improving disease subtyping, and proposing therapeutic strategies to reduce the negative effects of the symptoms, in addition to serving as a scientific basis for the physiopathology of the disease [33][34][35]. Thus, the identification of suitable cognitive endophenotypes for MIs is a potentially useful strategy to improve the understanding of MIs [36][37][38][39]. ...
Background
Characterizing neurocognitive endophenotypes of mental illnesses (MIs) could be useful for identifying at-risk individuals, increasing early diagnosis, improving disease subtyping, and proposing therapeutic strategies to reduce the negative effects of the symptoms, in addition to serving as a scientific basis to unravel the physiopathology of the disease. However, a standardized algorithm to determine cognitive endophenotypes has not yet been developed. The main objective of this study was to present a method for the identification of endophenotypes in MI research.
Methods
For this purpose, a 14-expert working group used a scoping review methodology and designed a method that includes a scoring template with five criteria and indicators, a strategy for their verification, and a decision tree.
Conclusions
This work is ongoing since it is necessary to obtain external validation of the applicability of the method in future research.
... The concept of affective temperament was also created. This temperament style is characterized by one or more of five main affective dimensions: anxious, irritable, cyclothymic, hyperthymic and depressive (11). ...
Alcohol consumption among older adults is becoming an increasing public health problem due to the rapidly growing elderly population. There is a theory that Type D personality is positively correlated with alcohol dependence. The study aimed to assess the style of coping with stress, emotions and anxiety in elder men addicted to alcohol and the relationship between the above. The study included 170 men aged 60 years and older (mean age - 63 ± 3.1 years) addicted to alcohol staying in the Department of Alcohol Addiction Therapy for Men. They were tested with the questionnaire sheet and the following scales: Perceived Family Wealth (PFW), Family Affluence Scale (FAS), Cantril's Ladder of Life Scale, Satisfaction with Life Scale, Type D Personality Scale-14 (DS14), and the 10-item Perceived Stress Scale (PSS-10). The respondents' wealth on a scale of 1–5 points was assessed on avg. 3.1 ± 0.2. The above was confirmed by the results of the FAS scale study, where the respondents obtained an average of 3.9 ± 1.9 (min. 1, max. 8), which proves their average level of affluence. The evaluation of the satisfaction with life using Cantril's Ladder showed that the respondents were also satisfied with life on average (on average 5.5 ± 1.9). The assessment of life satisfaction using the Satisfaction with Life Scale (SWLS) scale allowed for the conclusion that the respondents were very dissatisfied with their lives (mean 17.2 ± 4.9). The evaluation of the measurement of perceived stress (PSS-10 scale) showed that the respondents obtained an average of 23.5 ± 3.7, and on the sten scale, a mean of 7.7 ± 0.98, which proves a high level of perceived stress. The study using the DS14 scale showed that the respondents were in the negative emotionality (NE) subscale - 17.4 ± 4.5 points, and in the HS scale - 16.2 ± 3.2, which proves that they can be classified as a Type D personality. The participants were very dissatisfied with their lives, with a high perceived stress and Type D personality.
... 44 Similarly, we previously reported gender-specific effects of emotional abuse on several measures of affective processing in patients with bipolar disorder. 20 In another study, the presence of trauma in males with psychosis was significantly correlated with impaired performance across multiple cognitive domains, compared with males with no reported trauma. 16 Our study is consistent with prior work that suggests that participants with mood disorders are exposed to multiple traumas over their life course. ...
Background
Studies have shown that over half of individuals with bipolar disorder experience early-life trauma, which may influence clinical outcomes, including suicidality and presence of psychotic features. However, studies report inconsistent findings regarding the effect of trauma on cognitive outcomes in bipolar disorder.
Aims
Our study explores the effect of lifetime trauma on the level of vulnerability to psychosis and cognitive performance in participants with bipolar disorder.
Method
We evaluated lifetime trauma history in 236 participants with a diagnosis of bipolar disorder type 1 or 2, using the Structured Clinical Interview for DSM-IV and the Childhood Trauma Questionnaire. We classified trauma types based on the Substance Abuse and Mental Health Services Administration's concept of trauma, which characterises the type of experienced trauma (e.g. interpersonal and intentional, accidental or naturally occurring). Our primary outcome measures of interest were vulnerability to psychosis (Schizotypal Personality Questionnaire), cognitive performance (MATRICS Consensus Cognitive Battery) and social functioning (Social Adjustment Scale Self-Report).
Results
Multivariate analysis of covariance showed a significant effect of trauma type on the Schizotypal Personality Questionnaire cognitive–perceptual domain (F(3) = 6.7, P < 0.001). The no-trauma group had lower cognitive–perceptual schizotypal features compared with the accidental and intentional trauma ( P < 0.001) and interpersonal and intentional trauma ( P = 0.01) groups.
Conclusions
Our results highlight the need for careful trauma inquiry in patients with bipolar disorder, and consideration of how trauma-focused or -informed treatments may be an integral part of treatment planning to improve outcomes in bipolar disorder.
... Temperament determines one's response to internal and external stimuli and remains mostly unchanged throughout life [16]. Therefore, problems with self-care behaviors attributed to temperament are difficult to change and can lead to long-term poor glycemic control. ...
IntroductionPoor medication adherence and disordered eating are major self-care problems in patients with type 2 diabetes that worsen glycemic control and increase the risk of developing severe diabetes complications. Affective temperament, which remains mostly unchanged throughout life, is speculated to predict poor treatment response and high comorbidity. The aim of this study was to explore the link between affective temperament and poor glycemic control due to insufficient self-care.Methods
This single-center case–control study involved 77 outpatients divided into the ‘poor glycemic control’ group (n = 52) and the ‘better glycemic control’ group (n = 25) based on their mean glycated hemoglobin (HbA1c) levels over the past 12 months. All participants underwent one-on-one interviews during which they completed the following psychometric questionnaires: (1) the Mini-International Neuropsychiatric Interview 5.0.0; (2) the Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire; (3) a researcher-designed single question for assessing subclinical stress-induced overeating; and (4) the Morisky Medication Adherence Scale. The difference between two continuous independent variables was determined using Student’s t test. Discrete variables were compared using the Chi-square (χ2) or Fisher’s exact test. Multiple testing corrections were performed using the false discovery rate.ResultsThose outpatients in the poor glycemic control group exhibited significantly more stress-induced overeating (χ2 = 1.14, q statistic = 0.040) and poor medication adherence (t = 3.70, q = 0.034) than those in the better glycemic control group. However, there were no significant differences between the two groups in terms of affective temperaments, clinical eating disorders, or diabetes-specific distress. Patients with stress-induced overeating (t = − 2.99, p = 0.004) and poor medication adherence (t = − 4.34, p = 0.000) exhibited significantly higher scores for cyclothymic temperament than their counterparts.Conclusion
Cyclothymic temperament is significantly associated with disordered eating and/or poor medication adherence in patients with type 2 diabetes and is possibly linked to poor glycemic control.
... All rights reserved. gence and clinical evolution of mood disorders and important disease characteristics, including predominant polarity, symptomatic expression, neurocognitive performance [112][113][114][115][116][117][118][119][120][121][122][123][124] , long-term course and outcome, as well as response and adherence to treatment 119 . Temperament may also mediate such features of BD, such as impulsivity, suicidal risk, and functional capacity 125 . ...
Objectives:
To clarify the clinical features preceding the onset of Bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years.
Methods:
We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies.
Methods:
The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective and prospective studies.
Results:
Cyclothymic features, a family history of BD, retrospectively-reported attenuated manic symptoms, prospectively-identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention.
Conclusions:
The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment. This article is protected by copyright. All rights reserved.
... More recently, a relationship between temperamental subtype and neurocognition has been reported. In particular, high ratings of cyclothymia and irritability in BD patients have been associated with better processing speed, working memory, reasoning and problem-solving (Russo et al., 2014). On the other hand, BD patients with hyperthymic temperament showed greater cognitive deficits in set shifting and verbal working memory than BD patients with non-predominant temperaments (Xu et al., 2014). ...
Background:
Affective temperaments have been shown to impact on the clinical manifestations and the course of bipolar disorder. We investigated their influence on clinical features and functional outcome of manic episode.
Method:
In a naturalistic, multicenter, national study, a sample of 194 BD I patients that initated or changed pharmacological treatment for DSM-IV-TR manic episode underwent a comprehensive evaluation including briefTEMPS-M, CTQ, YMRS, MADRS, FAST, and CGI-BP. Factorial, correlation and comparative analyses were conducted on different temperamental subtypes.
Results:
Depressive, cyclothymic, irritable and anxious temperaments resulted significantly correlated with each other. On the contrary, hyperthymic temperament scores were not correlated with the other temperamental dimensions. The factorial analysis of the briefTEMPS-M sub-scales total scores allowed the extraction of two factors: the Cyclothymic-Depressive-Anxious (Cyclo-Dep-Anx) and the Hyperthymic. At final evaluation Dominant Cyclo-Dep-Anx patients reported higer scores in MADRS and in CTQ emotional neglect and abuse subscale scores than Dominant Hyperthymic patients. The latter showed a greater functional outcome than Cyclo-Dep-Anx patients.
Conclusions:
Affective temperaments seem to influence the course of mania. Childhood emotional abuse and neglect were related to the cyclothymic disposition. Cyclothymic subjects showed more residual depressive symptoms and Hyperthymic temperament is associated with a better short-term functional outcome.
... Our database search identified 750 references, yielding 15 potentially eligible studies. Three studies were excluded because the authors did not use the MCCB, five studies were excluded because there were overlaps in participants, [19][20][21][22][23] and one study was excluded because the authors did not report data for patients with BD separately. 24 In addition, we excluded one article reporting results from the Veterans Affairs (VA) Cooperative Studies Program, 25 Finally, we included five studies in our analyses, [9][10][11][12]26 comprising 361 patients with BD (female: 51.4%) and 293 HC (female: 58.2%). ...
Aim:
Neurocognitive impairment is one of the core symptoms of bipolar disorder. The MATRICS Cognitive Consensus Battery (MCCB) is a potential consensus assessment tool to evaluate cognitive function in patients with bipolar disorder. Here, we report on cognitive deficits evaluated using the MCCB Japanese version (MCCB-J) in euthymic Japanese patients with bipolar disorder, and compare them with scores in previous studies.
Methods:
We compared neurocognitive function in 25 patients with euthymic bipolar disorder and 53 healthy controls. Additionally, we searched all available databases for studies that evaluate cognitive function in bipolar disorder using the MCCB, and conducted a meta-analysis.
Results:
Canonical discriminant analysis revealed significant differences in MCCB-J domain scores between bipolar disorder and healthy controls. Patients with bipolar disorder performed significantly worse on visual learning, social cognition, speed of processing, and MCCB composite scores. Our meta-analysis revealed that patients with bipolar disorder performed worse than healthy controls, as reflected by MCCB composite scores and scores on all seven cognitive domains. However, there are differences in the cognitive deficits identified in previous studies compared with our participants, particularly social cognition.
Conclusions:
As reported in previous studies, neurocognitive deficits were observed in Japanese euthymic bipolar disorder patients assessed using the MCCB-J. Further study is needed to clarify whether differences in social cognition between this study and previous studies are a result of coping mechanisms for social settings in Japanese populations.
... These findings may suggest that the link between cognition and neuroticism differs between HC and BD. . Support for this hypothesis comes from a previous study showing that while in HC irritability -a facet of neuroticism -correlated negatively with attention, in BD, high irritability was associated with faster processing speed (31). Therefore, the faster response times could indicate increased "impulsivity" or high responsiveness to emotional stimuli in patients with BD. ...
Background:
Bipolar disorder (BD) is characterized by affective processing bias and variations in personality traits. It is still unknown whether these features are linked to the same structural brain alterations. The aim of this study was to investigate relationships between specific personality traits, white matter (WM) properties, and affective processing in BD and HC.
Methods:
24 healthy controls (HC) and 38 adults with BDI (HC: 29.47 ± 2.23 years, 15 females; BDI: 32.44 ± 1.84 years, 20 females) completed clinical scales and the Big Five Inventory. They were also administered the Affective Go/No-Go (AGN) and the Rapid Visual Processing (RVP) tasks of the Cambridge Neuropsychological Test Automated Battery. Diffusion Tensor Imaging (DTI) assessed the microstructure of WM tracts.
Results:
In BDI measures of WM properties were reduced across all major brain white matter tracts. As expected, individuals with BDI reported greater neuroticism, lower agreeableness and conscientiousness, and made a greater number of errors in response to affective stimuli in the AGN task compared to HC. High neuroticism scores were associated with faster AGN latency, and overall reduced AGN accuracy in both HC and BDI. Elevated FA values were associated with reduced neuroticism and increased cognitive processing in HC but not in BDI.
Conclusions:
Our findings showed important potential links between personality, affective processing and WM integrity in BD. In the future therapeutic interventions for BD using brain stimulation protocols might benefit from the use of DTI to target pathways underlying abnormal affective processing.
... 32 Our findings are in partial agreement with the findings of a recent study that showed a strong negative correlation between the depressive temperament and processing speed in a combined sample of healthy controls and bipolar patients. 21 The authors of the same study also reported associations between the cyclothymic temperament and better performance on a range of executive tests in bipolar patients and in the combined sample. As P300 is often correlated with cognitive functioning, these findings are generally consistent with the results of our study. ...
Affective temperaments are the subclinical manifestations or phenotypes of mood states and hypothetically represent one healthy end of the mood disorder spectrum. However, there is a scarcity of studies investigating the neurobiological basis of affective temperaments. One fundamental aspect of temperament is the behavioral reactivity to environmental stimuli, which can be effectively evaluated by use of cognitive event-related potentials (ERPs) reflecting the diversity of information processing. The aim of the present study is to explore the associations between P300 and the affective temperamental traits in healthy individuals. We recorded the P300 ERP waves using an auditory oddball paradigm in 50 medical student volunteers (23 females, 27 males). Participants’ affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego–auto questionnaire version (TEMPS-A). In bivariate analyses, depressive temperament score was significantly correlated with P300 latency (rs = 0.37, P < .01). In a multiple linear regression analysis, P300 latency showed a significant positive correlation with scores of depressive temperament (β = 0.40, P < .01) and a significant negative one with scores of cyclothymic temperament (β = −0.29, P = .03). Affective temperament scores were not associated with P300 amplitude and reaction times. These results indicate that affective temperaments are related to information processing in the brain. Depressive temperament may be characterized by decreased physiological arousal and slower information processing, while the opposite was observed for cyclothymic temperament.
Background: To our knowledge, there have been no studies that have examined affective temperament traits in offspring of parents with bipolar disorder (BD). The aim of this study was to identify affective temperamental characteristics and their relationships with cognitive functions in BD offspring.
Methods: A group of BD offspring were enrolled in this study. Subthreshold symptoms were used to categorize participants as either symptomatic offspring (SO) (n=60) or asymptomatic offspring (AO) (n=52). Healthy controls (HCs; n=48) were also enrolled for comparison. We used the Chinese Short Version of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire (TEMPS-A) to measure temperament traits, and MATRICS Consensus Cognitive Battery (MCCB) to measure cognitive functions.
Results: We observed higher cyclothymic, irritable, depressive and anxious temperament scores in SO than AO when compared to HCs. In BD offspring (SO and AO), cyclothymic individuals performed better in processing speed and verbal learning than depressive individuals and better in attention/vigilance than irritable and anxious individuals; hyperthymic individuals performed better in processing speed than depressive individuals. We also observed that a higher cyclothymic score was associated with better verbal learning and verbal fluency, a higher hyperthymic score was associated with better processing speed and verbal learning; while a higher depressive score was associated with worse processing speed, verbal learning and verbal fluency and a higher irritable score was associated with worse attention/vigilance.
Conclusions: The relationships between cognitive functions and measures of temperament suggest that these features may share neurobiological substrates and appear to be heritable.
Background
Correlations between depressive symptoms and affective temperaments or quality of childhood parenting have been investigated previously; however, how childhood parenting and affective temperaments affect cognitive complaints remains unknown. Thus, we evaluated correlations among childhood parenting, affective temperaments, depressive symptoms, and cognitive complaints in adults.
Methods
Participants (N=490) completed the Parental Bonding Instrument (PBI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire version (TEMPS-A), the Patient Health Questionnaire-9 (PHQ-9), and the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Multiple regression analyses and structural equation modeling were performed to evaluate scale correlations.
Results
As per structural equation modeling, the direct effect of PHQ-9 and four subscales (cyclothymic, depressive, irritable, and anxious temperament) of TEMPS-A on COBRA were significant; the indirect effect of the four subscales of TEMPS-A on COBRA via PHQ-9 was significant; the direct effect of the three subscales (paternal care, maternal care, and maternal overprotection) of PBI on PHQ-9 and four subscales of TEMPS-A were significant; the indirect effect of the three subscales of PBI on PHQ-9 via the four subscales of TEMPS-A was significant.
Limitations
Cross-sectional designs cannot identify causal relationships between parameters. As participants were adult volunteers from the community, results may not be generalizable to individuals with psychiatric disorders.
Conclusions
Childhood parenting affects cognitive complaints indirectly via affective temperaments and depressive symptoms in adult community volunteers. An important role of affective temperaments and depressive symptoms in the effects of childhood parenting on cognitive complaints is suggested.
Background:
Emotion regulation (ER) applies behavioral and cognitive strategies to modify the appearance and intensity of emotions. Working memory capacity (WMC) plays an important role in the ER process, particularly through its influence on the efficiency of ER strategies.
Methods:
We investigated interactions between WMC and three ER strategies, namely cognitive reappraisal, expressive suppression, and rumination, in 43 euthymic patients with bipolar I disorder and 48 healthy control subjects. We used the Korean versions of the Operation Span Task, Emotion Regulation Questionnaire, Ruminative Response Scale, and Difficulties in Emotion Regulation Scale.
Results:
WMC modulated the efficacy of cognitive reappraisal in healthy controls with high WMC, but not in patients with bipolar disorder. There were no significant interactions between WMC and expressive suppression or rumination in either group.
Limitations:
These include the small sample size, use of neutral words to evaluate negative emotion, use of self-administered questionnaires, and relatively high cut-off for the definition of euthymic states. A number of uncontrolled factors may have influenced our results including patients' duration of remission, number of episodes, psychiatric family history, and current psychiatric medications.
Conclusions:
Our findings suggest that working memory does not function effectively in the reappraisal process during ER in patients with bipolar disorder. This may indicate that top-down regulation of emotion is impaired in bipolar disorder. Cognitive interventions aimed at improving ER in such patients may be ineffective.
Introduction:
In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far.
Objective:
To evaluate the relationship between affective temperament and insight in bipolar disorder.
Method:
A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales.
Results:
In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder.
Conclusion:
In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.
Background
The Measurement and Treatment Research to Improve Cognition Schizophrenia Consensus Cognitive Battery (MCCB) has also been proposed for use in clinical trials to assess cognitive deficits in patients with bipolar disorder (BD). The aim of this study was to evaluate cognitive function assessed by the MCCB in BD.
Methods
A literature search of the PubMed, Embase, PsycINFO, SCI, Cochrane Library databases and the Cochrane Controlled Trials Register was conducted. Case reports, reviews and meta-analyses were excluded and a systematic review of the remaining studies of cognitive function in BD was carried out. The cognitive outcome measure was the MCCB, including 7 domains and overall cognition. A random-effects model was applied.
Results
Eighty eight studies were initially identified. Seven clinical studies comprising a total of 487 patients and 570 healthy controls (HC) were included in the meta-analysis. Patients with BD performed worse than HC in overall cognition and processing speed with a large effect size of >0.8; with a medium effect size (0.5–0.8) in attention, working memory, verbal learning and visual learning; and with a small effect size (0.2–0.5) in reasoning and problem solving and social cognition.
Conclusion
Patients with BD performed worse than HC in overall cognition and all cognitive domains of the MCCB. Cognitive deficits in domains of processing speed and working memory are prominent in patients with BD. Our findings suggest that MCCB can be usefully applied in BD.
Pamięć operacyjna stanowi podstawę dobrze działającego systemu mózgowego i zapewnia właściwy przebieg złożonych
procesów poznawczych. Zdaniem wielu badaczy na jakość funkcjonowania pamięci operacyjnej wpływają emocje,
w szczególności te negatywne. Pacjenci z zaburzeniami depresyjnymi charakteryzują się nieprawidłowym działaniem pamięci operacyjnej: występują u nich trudności w wygaszaniu negatywnych emocji i utrzymywaniu pozytywnych informacji.
Zmiany w zakresie sprawności pamięci operacyjnej obecne u osób zmagających się z zaburzeniami afektywnymi mają swoje
korelaty neurobiologiczne. W piśmiennictwie dotyczącym badań, w których zastosowano metody neuroobrazowe, nie ma
zgodności co do wspólnego wzorca dysfunkcji czynnościowej mózgu u pacjentów z zaburzeniami afektywnymi.
Z zaburzeniami nastroju najczęściej wiązane są nieprawidłowości w aktywności zarówno obszarów korowych, jak i obszarów
podkorowych mózgu w trakcie wykonywania zadań angażujących pamięć operacyjną. Dysfunkcje tej pamięci odgrywają
ważną rolę w generowaniu i utrzymywaniu symptomów zaburzeń afektywnych. Co więcej, deficyty neuropsychologiczne
występujące u osób ze zdiagnozowaną chorobą afektywną dwubiegunową uważane bywają za charakterystyczną cechę
funkcjonowania tych pacjentów. W niniejszej pracy przedstawione zostaną najważniejsze aktualne doniesienia związane ze
wskazaną tematyką. Należy prowadzić dalsze badania tego zagadnienia, z dodatkowym uwzględnieniem wpływu przebiegu
i obrazu klinicznego choroby na działanie pamięci operacyjnej. Poszukiwania te mogłyby się przyczynić do poprawy jakości
procesu diagnostyczno-terapeutycznego.
Objectives:
Although it is well established that euthymic patients with bipolar disorder can have cognitive impairment, substantial heterogeneity exists and little is known about the extent and severity of impairment within the bipolar II disorder subtype. Therefore, the main aim of this study was to analyze cognitive variability in a sample of patients with bipolar II disorder.
Methods:
The neuropsychological performance of 116 subjects, including 64 euthymic patients with bipolar II disorder and 52 healthy control subjects, was examined and compared by means of a comprehensive neurocognitive battery. Neurocognitive data were analyzed using a cluster analysis to examine whether there were specific groups based on neurocognitive patterns. Subsequently, subjects from each cluster were compared on demographic, clinical, and functional variables.
Results:
A three-cluster solution was identified with an intact neurocognitive group (n = 29, 48.3%), an intermediate or selectively impaired group (n = 24, 40.0%), and a globally impaired group (n = 7, 11.6%). Among the three clusters, statistically significant differences were observed in premorbid intelligence quotient (p = 0.002), global functional outcome (p = 0.021), and leisure activities (p = 0.001), with patients in the globally impaired cluster showing the lowest attainments. No differences in other clinical characteristics were found among the groups.
Conclusions:
These results confirm that neurocognitive variability is also present among patients with bipolar II disorder. Approximately one-half of the patients with bipolar II disorder were cognitively impaired, and among them 12% were severely and globally impaired. The identification of different cognitive profiles may help to develop cognitive remediation programs specifically tailored for each cognitive profile.
Kraepelin and Kretschmer hypothesized a continuum between full-blown affective pathology and premorbid temperaments. More recently Akiskal proposed a putative adaptive role for the four fundamental temperaments: the hyperthymic one characterized by emotional intensity, the cyclothymic one by emotional instability, the depressive one by a low energy level, and the irritable one by an excessive response to stimuli. Today it is widely debated whether affective temperaments belong to the domain of pathology or to that of normality.
To make clear, by applying an integrated model, the position of affective temperaments within the continuum between normality and pathology.
We reviewed several papers that explore the distribution of affective temperaments among the general population, and their involvement both in pathological conditions (somatic and psychiatric) and in human activities (professions and other occupations).
Far from being intrinsically pathological conditions, affective temperaments seem to represent adaptive dispositions whose dysregulation can lead to full-blown affective pathology. All the temperamental types display some impact on people's lives by influencing personal skills and professional choices over a wide field of human activities.
Affective temperaments are not problematic when they appear in a mild form, but when they occur in extreme form we have observed a gap between the hyperthymic temperament, which represents the most functional and desirable, and the cyclothymic, depressive, irritable and phobic anxious ones, which are closer to mood, anxiety, and substance use disorders, and imply a component of somatic diseases and life stressors.
Background
Affective temperaments such as cyclothymia, which may be the fundamental substrates for bipolar disorder and bipolar II in particular, have been reported to be associated with abnormalities in the regions that are related to cognitive deficits in bipolar disorder. However, few studies have examined the effects of affective temperaments on neuropsychological performance in individuals with bipolar disorder.
Method
In a six-week prospective study, we administered Chinese version of TEMPS-A (Temperament Evaluation of Memphis, Pisa, San Diego-Autoquestionnair) to 93 patients with bipolar I depression, 135 patients with bipolar II depression, and 101 healthy controls. Cognitive function was assessed with a battery of neuropsychological tasks, including attention, processing speed, set shifting, planning, verbal working memory, verbal fluency, and visual spatial memory. Mixed-effects statistical models were used to assess the effects of affective temperaments on cognitive function.
Results
Bipolar patients with hyperthymic temperament showed greater cognitive deficits in set shifting (p=0.05) and verbal working memory (p=0.026) than did bipolar patients with non-predominant temperaments (predominant temperament was defined as one standard deviation above the mean). The differences in estimated marginal means were −0.624 (95% CI, −1.25 to 0) and −0.429 (95% CI, −0.81 to −0.05), respectively. Significant temperament X bipolar subtype interaction effects were observed for set shifting (Wald X2=18.161, p<0.001), planning (Wald X2=7.906, p=0.048), and visual spatial memory (Wald X2=16.418, p=0.001).
Limitation
The anxious temperament was not evaluated.
Conclusion
Our data suggest that hyperthymic temperament may be associated with cognitive deficits in some specific domains in bipolar disorder; and that the effect of temperaments may be different across subtypes of bipolar disorder.
Efforts to identify genetic loci for bipolar disorder (BPD) have thus far proved elusive. The identification of processes mediating between genotype and phenotype (endophenotypes) may help resolve the carrier status of family members in genetic studies of polygenetic disorders with imperfect penetrance, such as BPD. We reviewed the literature to determine if neuropsychological measures could be used as effective endophenotypes to aid molecular genetic studies searching for genes predisposing to BPD.
Four prerequisites for endophenotypic markers are described, and a critical review of relevant literature was undertaken to determine if neurocognitive measures satisfy these four requirements in BPD.
We found evidence that executive functions and declarative memory may be candidate neurocognitive endophenotypes for BPD. However, we cannot exclude other areas of cognition as being affected by BPD susceptibility genes, given the limits of the current knowledge of the neuropsychology of BPD. In particular, the paucity of studies measuring cognition in healthy relatives of BPD patient limits conclusion regarding familial aggregation of particular neurocognitive deficits (i.e. attention). Furthermore, the effects of clinical state and/or medication usage on cognitive functioning in BPD probands should be further explored.
Molecular genetic studies of BPD may benefit from the application of select neuropsychological measures as endophenotypic markers. The use of these markers, once defined, may improve power for detecting genes predisposing to BPD and may help to better define diagnostic criteria.
Progress in identifying the genetic basis of bipolar affective disorder has been disappointing, most probably because of the genetic and phenotypic heterogeneity of the condition. These setbacks have led to the adoption of alternative strategies such as the use of endophenotypes or intermediate traits to identify those individuals at genetic risk for developing the disorder. Gottesman and Gould [Am J Psychiatry (2003), 160:636], in a review of the endophenotypic concept, have suggested five criteria that should be characteristic of a trait in order for it to qualify as an endophenotype. These five criteria are used in order to assess the viability of using personality traits as endophenotypes for genetic analyses of bipolar disorder. A review of the literature suggests that certain personality traits or temperaments are associated with the illness in a state independent manner, that personality is at least partly heritable, and that various temperaments aggregate in the non-affected relatives of bipolar probands. Nevertheless, it is unclear whether specific personality traits co-segregate with affectively ill individuals. We conclude that personality profiling of probands and their relatives may facilitate molecular genetic work, but given the fact that personality is itself a complex trait, its use as an endophenotype has certain limitations.
There is growing interest to research neurocognition as a putative endophenotype for subjects with bipolar disorders (BD). The authors sought to review the available literature focused on relatives of subjects with bipolar disorder (BD-Rels) and identify suitable cognitive candidates to endophenotypes or endophenocognitypes.
A systematic review was conducted in Medline, EMBASE and PsycINFO databases (1980-July 2007), supplemented with a manual search of reference lists.
Twenty-three cross-sectional papers of discordant twins (4 studies), genetic high-risk subjects (7), and different BD-Rel groups (12) met the inclusion criteria and evaluated 532 BD-Rels. Impairments on the broad domain of verbal learning/memory were found in 6 out of 11 studies (54%), as well as in 3 of 9 reports (33%) of working memory. Moreover, BD-Rels showed deficits in visual-spatial learning and memory (1/6 reports; 17%), alternating attention (1/8; 12.5%), psychomotor speed (2/10; 20%), and abstraction/cognitive flexibility, sustained attention and selective attention (2/8 each; 25%). Scores of general intelligence were lower than those of controls in 2/16 (12.5%) reports, but fell well within the average range in all studies. No study that assessed immediate memory or verbal fluency (6 each) reported impairments in BD-Rels. Finally, language, social cognition, and motor and planning skills are neglected areas of research.
Overall, the neurocognitive profile in BD-Rels is still unclear, and the evidence in support of the presence of cognitive deficits seems quite sparse. Verbal learning/memory and verbal working memory seem to be the most suitable endophenocognitypes for BD. Conversely, healthy family members would have an intact performance on immediate memory, verbal fluency, and probably on general intelligence. The possibility that BD-Rels show less cognitive efficiency compared to healthy controls also on other functions must be addressed by future studies with larger samples, comprehensive neuropsychological assessments, and, ideally, longitudinal designs.
Bipolar disorder is an episodic affective illness, once believed to involve complete inter-episode remission. More recent data have highlighted the presence of persistent symptoms during purported periods of Wellness, including subsyndromal affective symptoms and neurocognitive impairment. These unremitting symptoms are of extreme clinical importance, as they are directly related to a worsening of clinical course, functional impairments and psychosocial difficulties in patients with bipolar disorder. Although there is now substantial evidence demonstrating the prevalence of neurocognitive impairment during euthymia, there have been few studies, to date, targeting this disabling aspect of the illness using pharmacological strategies.
While treatment approaches have previously focused on primary affective and psychotic symptoms of the disease, it is important to consider the debilitating impact that impaired cognition has on patients with bipolar disorder. A recent focus has been placed on the significant need for large-scale clinical trials designed to specifically target cognitive impairment in patients with schizophrenia, with a parallel need existing in the field of bipolar research.
There is now early evidence for the presence of neurocognitive deficits in patients with bipolar disorder and a relationship between these impairments and functional disability, making this a symptom domain that requires immediate clinical attention. Convergent data indicate a compelling need for formal assessment of cognition in patients with bipolar disorder, and for researchers and clinicans alike to consider the necessity for treatment specific to cognition in this population. Although limited data exist from cognitive enhancement trials in this population, there are a number of potential pharmacotherapy targets based on evidence from neuroimaging, molecular genetic, pharmacological and animal studies related to the pathophysiology of bipolar disorder. Future directions for potential cognitive enhancement strategies in bipolar disorder may include medications that influence dopaminergic or glutamatergic neurotransmission; however, urther work is needed to adequately assess the safety and effectiveness of these agents in bipolar patients. Finally, psychosocial intervention and/or cognitive remediation should be considered as alternatives to medications, although these techniques will also require additional systematic study.
10.1176/appi.ajp.160.4.636
The clinical phenotype of bipolar disorder (BPD) is heterogeneous and the genetic architecture of the disorder is complex and not well understood. Given these complications, it is possible that the identification of intermediate phenotypes ("endophenotypes") will be useful in elucidating the complex genetic mechanisms that result in the disorder. The examination of unaffected relatives is critical in determining whether a particular trait is genetically-relevant to BPD. However, few dimensional traits related to BPD have been assessed in unaffected relatives of patients.
We assessed affective temperament and schizotypy in 55 discordant sibling pairs and 113 healthy controls (HCs) using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire version (TEMPS-A) to assess affective temperament and the Schizotypal Personality Questionnaire (SPQ) to assess schizotypy.
BPD patients scored significantly higher than HCs on all subscales of the SPQ and on all but one subscale (hyperthymic) of the TEMPS-A (all p<0.01). Siblings demonstrated scores that were significantly intermediate to patients and HCs on the anxious subscale of the TEMPS-A and on the interpersonal deficits and disorganized subscales of the SPQ.
We did not investigate the BPD spectrum as most patients were diagnosed with BPD I (n=47). Most of the patients had experienced psychosis (n=42) and so we were unable to examine whether psychosis status impacted upon affective temperament or schizotypy in patients or their siblings.
These data suggest that schizotypy and affective temperament represent dimensional traits that are likely to underlie the genetic risk for BPD.
Associations between symptom dimensions and cognition have been mainly studied in non-affective psychosis. The present study investigated whether previously reported associations between cognition and four symptom dimensions (reality distortion, negative symptoms, disorganisation and depression) in non-affective psychosis generalise to a wider spectrum of psychoses. It also extended the research focus to mania, a less studied symptom dimension.
Linear and non-linear (quadratic, curvilinear or inverted-U-shaped) associations between cognition and the above five symptom dimensions were examined in a population-based cohort of 166 patients with first-onset psychosis using regression analyses.
Negative symptoms showed statistically significant linear associations with IQ and processing speed, and a significant curvilinear association with verbal memory/learning. Significant quadratic associations emerged between mania and processing speed and mania and executive function. The contributions of mania and negative symptoms to processing speed were independent of each other. The findings did not differ between affective and non-affective psychoses, and survived correction for multiple testing.
Mania and negative symptoms are associated with distinct patterns of cerebral dysfunction in first-onset psychosis. A novel finding is that mania relates to cognitive performance by a complex response function (inverted-U-shaped relationship). The associations of negative symptoms with cognition include both linear and quadratic elements, suggesting that this dimension is not a unitary concept. These findings cut across affective and non-affective psychoses, suggesting that different diagnostic entities within the psychosis spectrum lie on a neurobiological continuum.
The objective of this study was to assess psychomotor functioning and attention in individuals with bipolar disorder during the depressed phase of illness. Measures of attention and psychomotor functioning were administered to a sample of 24 bipolar I and II patients and a matched sample of healthy controls. Relative to the healthy controls, the bipolar sample demonstrated evidence of psychomotor slowing and revealed deficits on measures of effortful attention, yet demonstrated comparable performance on measures of automatic attention. In the bipolar sample, we detected significant correlations among measures of psychomotor functioning and some aspects of attention and a strong relationship between the severity of depression and psychomotor functioning, but no direct relationship between attention deficits and depressive symptomatology. These results suggest an attentional impairment during the depressed phase of bipolar disorder that may be specific to effortful processing, while automatic processes remain relatively intact. Associations among indices of attention deficits and psychomotor slowing may be indicative of similarities in the underlying neurobiology of these frequently co-occurring symptom domains in depressed individuals with bipolar disorder.
Our aim was to delineate neuropsychological deficits related to genetic susceptibility, illness process and iatrogenic factors in bipolar disorder (BD).
Following an extensive publication search on several databases, meta-analyses were conducted for 18 cognitive variables in studies that compared performances of euthymic BD patients (45 studies; 1423 subjects) or first-degree relatives of BD patients (17 studies; 443 subjects) with healthy controls. The effect of demographic variables and confounding factors like age of onset, duration of illness and medication status were analysed using the method of meta-regression.
While response inhibition, set shifting, executive function, verbal memory and sustained attention deficits were common features for both patient (medium to large effect sizes) and relative groups (small to medium effect sizes), processing speed, visual memory and verbal fluency deficits were only observed in patients. Medication effects contributed to psychomotor slowing in BD patients. Earlier age of onset was associated with verbal memory impairment and psychomotor slowing.
Data related to some confounding variables was not reported in a substantial number of extracted studies.
Response inhibition deficit, a potential marker of ventral prefrontal dysfunction, seems to be the most prominent endophenotype of BD. The cognitive endophenotype of BD also appears to involve fronto-temporal and fronto-limbic related cognitive impairments. Processing speed impairment is related, at least partly, to medication effects indicating the influence of confounding factors rather than genetic susceptibility. Patterns of sustained attention and processing speed impairments differ from schizophrenia. Future work in this area should differentiate cognitive deficits associated with disease genotype from impairments related to other confounding factors.
This paper has drawn attention to a large and neglected universe of a soft bipolar spectrum characterized by abrupt biphasic shifts in mood, cognition, behavior, and circadian rhythms. The ease with which tricyclic anti-depressants induced changes in the cyclic nature of the illness is a special instance of these patients' vulnerability to abrupt shifts from depression to hypomania and vice versa or from euthymia to one of the affective phases and vice versa. Such shifts can also be brought about by influences possibly involving catecholaminergic excess, e.g., object loss, rapid eye movement sleep deprivation, and seasonal variation in daylight. Such vulnerability has important implications in the treatment of mood disorders and suggests caution in the overzealous use of tricyclic antidepressants in instances where subtle indicators of bipolarity can be demonstrated. Criteria for the precise clinical delineation of these elusive bipolar categories are presented.
4 current approaches to understanding temperament are discussed in the roundtable. In an introductory overview, Goldsmith outlines some of the major convergences and divergences in the understanding of this concept. Theorists representing 4 positions--Goldsmith, Buss and Plomin, Rothbart, and Thomas and Chess--outline their views by responding to each of 6 questions: How do you define temperament and explain the boundaries of the concept? What are the elements of temperatment? How does the construct of temperament permit you to approach issues or organize data in ways that are possible only if this construct is invoked? How does temperament develop? To what extent do you consider temperament to be a personological versus a relational or an interactional construct? and How does your approach deal with issues of temperamental "difficulty"? In 2 commentaries on the theorists' answers, Hinde highlights differences among their positions and indicates issues that current theories of temperament must take into consideration, and McCall draws on common aspects to propose a synthesizing definition that draws on all 4 approaches.
There are currently seven rating scales available to assess manic symptomatology. All, however, have some limitations that could restrict their clinical and research utility. To resolve these deficiencies the Clinician-Administered Rating Scale for Mania (CARS-M) was developed and normed on 96 patients with mixed diagnoses during baseline and following treatment. Interrater reliability was established across multiple raters viewing 14 videotaped interviews and comparing agreement among individual items and total scores. Test-retest reliability was assessed on 36 patients twice during baseline. The mean intraclass correlation coefficient among five raters across items for each of the 14 patients was 0.81, and for total scores 0.93. Principal components analysis of items revealed two factors: mania, and psychosis. Test-retest reliability was significant for both factors (range = 0.78 to 0.95). Internal validity, comparing each item with its respective total factor score, revealed significant correlations for all items. Correlation of CARS-M total scores with mania rating scale (MRS) total scores was 0.94. Results indicate the CARS-M is both a reliable and valid measure of the severity of manic symptomatology, which incorporates a number of methodological improvements leading to greater precision and clinical utility.
The purpose of this study was to evaluate the reliability and psychometric properties of the Semistructured Affective Temperament Interview, and determine cut-offs for each temperament.
1010 Italian students aged between 14 and 26 were evaluated by means of the Akiskal and Mallya criteria in a Semistructured Interview for depressive, cyclothymic, hyperthymic, and irritable temperaments.
This instrument has very good reliability and internal consistency. The percentage of subjects with a z-score higher than the second positive standard deviation ( + 2 SD) on the scales of depressive and cyclothymic temperaments are 3.6% and 6.3% (reaching scores of 7/7 and 9/10), respectively. Hyperthymic traits, on the other hand, are widespread in our sample: most subjects are included within the second positive standard deviation ( + 2 SD), and 8.2% of these reach a 7/7 score; therefore, the problem of defining a cut-off for this temperament is still open. By contrast, the irritable temperament is rare, conforming to a non-gaussian distribution, with 2.2% of cases above the second positive standard deviation ( + 2 SD).
The data are based on subject report without collateral information and external validation.
This study contributes to more accurate definition of cut-offs for individual temperament scales. The standardization of the interview thus makes it possible to compare three out of four temperamental scales, showing the dominant temperamental characteristics for each subject. Prospective studies are needed to demonstrate the stability of these traits over time.
Generalized anxiety disorder (GAD) is defined as an uncontrollable disposition to worry about one's welfare and that of one's immediate kin. Associated manifestations include arousal, vigilance, tension, irritability, unrestful sleep and gastrointestinal distress. There is growing evidence for the lifelong nature of this condition among many of its sufferers. This and other evidence reviewed in the present paper provide further support for the thesis that the chronic disposition to worry should probably be classified under constitutional or trait anxiety. GAD is best considered an exaggeration of a normal personality disposition that can be named 'Generalized anxious temperament' (GAT). Despite some overlap with anxious-phobic, inhibited and avoidant-sensitive temperaments, GAT seems to have a distinct profile with altruistic overtones; on the other hand, GAT is less easily distinguished from harm-avoidant and obsessive traits. That worrying would increase upon relaxation is not a paradox at all, and is understandable in an ethological perspective as subserving the defensive function of being vigilant of ever present yet uncertain external dangers--to oneself and one's kin--in day-to-day living. GAT can thus be considered as 'altruistic anxiety', subserving hypothetically the survival of one's extended phenotype in a 'kin selection' paradigm. Only when extreme does worrying manifest in a clinical context, impairing one's interpersonal life and functioning at work, and increasing use of general health care resources. Furthermore, generalized anxiety appears to predispose to and is often associated with depression, and a spectrum of phobic disorders, as well as alcohol and sedative use. These considerations place GAD (and the putative GAT) in the limelight and underscore the need for more research into its fundamental characteristics. Towards this aim, a self-rated GAT measure under development in our center is provided in an appendix to this paper.
Endophenotypes, measurable components unseen by the unaided eye along the pathway between disease and distal genotype, have emerged as an important concept in the study of complex neuropsychiatric diseases. An endophenotype may be neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, or neuropsychological (including configured self-report data) in nature. Endophenotypes represent simpler clues to genetic underpinnings than the disease syndrome itself, promoting the view that psychiatric diagnoses can be decomposed or deconstructed, which can result in more straightforward-and successful-genetic analysis. However, to be most useful, endophenotypes for psychiatric disorders must meet certain criteria, including association with a candidate gene or gene region, heritability that is inferred from relative risk for the disorder in relatives, and disease association parameters. In addition to furthering genetic analysis, endophenotypes can clarify classification and diagnosis and foster the development of animal models. The authors discuss the etymology and strategy behind the use of endophenotypes in neuropsychiatric research and, more generally, in research on other diseases with complex genetics.
Cognitive impairment in bipolar disorder may be a stable characteristic of the illness, although discrepancies have emerged with regard to what dysfunctions remain during remission periods. The aim of this study was to ascertain whether euthymic bipolar patients would show impairment in verbal learning and memory and in executive functions compared with healthy controls. Secondly, to establish if there was a relationship between clinical data and neuropsychological performance.
Forty euthymic bipolar patients were compared with 30 healthy controls through a battery of neuropsychological tests assessing estimated premorbid IQ, attention, verbal learning and memory, and frontal executive functioning. The effect of subsyndromal symptomatology was controlled.
Remitted bipolar patients performed worse than controls in several measures of memory and executive function, after controlling for the effect of subclinical symptomatology, age and premorbid IQ. Verbal memory impairment was related to global assessment of function scores, as well as to a longer duration of illness, a higher number of manic episodes, and prior psychotic symptoms.
Results provide evidence of neuropsychological impairment in euthymic bipolar patients, after controlling for the effect of subsyndromal depressive symptoms, suggesting verbal memory and executive dysfunctions. Cognitive impairment seems to be related to a worse clinical course and poor functional outcome.
The array of different diagnoses and clinical presentations seen in the family members of bipolar probands suggests a quantitative or spectrum phenotype. Consistent with this idea, it has been proposed that an underlying quantitative variation in temperament may be the primary phenotype that is genetically transmitted and that it in turn predisposes to bipolar disorder (BP). Choosing the appropriate phenotypic model for BP is crucial for success in genetic mapping studies. To test this theory, various measures of temperament were examined in the family members of bipolar probands. We predicted that a gradient of scores would be observed from those with BP to those with major depression to unaffected relatives to controls.
Members of 85 bipolar families and 63 control subjects were administered clinical interviews for diagnosis (SCID) and two temperament assessments, the TEMPS-A and TCI-125. Subjects with BP, major depressive disorder, unaffected relatives, and controls were compared on each temperament scale and on eight factors extracted from a joint factor analysis of the TEMPS-A and TCI-125.
The four groups were found to be significantly different and with the expected order of average group scores for four of the TEMPS-A scales, three of the TCI-125 scales, and one of the extracted factors. On the fifth TEMPS-A scale, hyperthymic, controls scored higher than the other three subject groups contrary to expectations. Significant differences were seen between unaffected relatives and controls on the hyperthymic scale and on the first extracted factor, anxious/reactive.
Controls were mainly recruited through advertisements, which may have introduced an ascertainment bias. It is also possible that mood state at the time of completing the questionnaire influenced subject's rating of their temperament. Additionally, bipolar I and bipolar II subjects were placed in the same group even though they had some differing clinical features.
Our data support the theory that some dimensions of temperament are transmitted in families as quantitative traits that are part of a broader bipolar spectrum. In particular, the hyperthymic scale of the TEMPS-A and the anxious/reactive extracted factor distinguished unaffected relatives from controls. The hyperthymic scale yielded results opposite to expectation with controls higher than any family group. This may be an artifact of the self-rated form of the questionnaire, a consequence of our grouping bipolar I and II subjects together, or the result of a "protective" factor and bears further study. Nevertheless, both of these scales may be useful quantitative traits for genetic mapping studies.
To investigate the presence of temperament dysregulation in healthy relatives of bipolar probands (RBP), a population at high risk for developing mood disorders, by comparing them with clinically recovered bipolar patients (BP) and normal controls (NC).
52 RBP and 23 BP were originally recruited for a multicenter genetic study in bipolar disorders. NC (n=102) were also recruited by newspaper advertisement, radio and television announcements, flyers, newsletters, or word of mouth. All volunteers were asked to complete the TEMPS-A Scale, a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. In scoring temperaments, we relied upon the short validated version of the TEMPS-A [J. Affect. Disord. (2004)], from which traits with loadings <0.035 had been deleted.
To examine differences in temperament dimensions among the three groups, a MANCOVA model was constructed using diagnostic group as the fixed factor (BP vs. RBP vs. NC); effects of age and gender were adjusted as covariates. MANCOVA showed overall group effect on the dependent variables (Hotelling's F5,175=6.64, p<0.001). Four dependent variables (dysthymic, cyclothymic, irritable, and anxious temperaments) showed significant between-group differences. RBP showed lower cyclothymic temperament scores than BP, but higher scores than NC. BP and RBP showed higher anxious temperament scores than NC. Hyperthymic scores were significantly highest in the NC.
In view of the small cell sizes, bipolar I vs. bipolar II subanalyses could not be conducted.
Methodologic strengths of the present analyses is that the BP group had clinically recovered, and we used the validated short version of the TEMPS-A for the present analyses. Our findings suggest that some clinically healthy relatives of bipolar probands exhibit a subclinical cyclothymic instability in mood, interest, self-confidence, sleep, and/or energy as well as anxiety proneness that is not observed among normal controls. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar spectrum disorders, or specific clinical subtypes (e.g., bipolar I, bipolar II) within this spectrum. This is a conceptual perspective with many unanswered questions. Resolution of these questions will require innovative definitions of phenotypes to be included in the analyses of the temperament subscales in different populations. The temperament subscales themselves need to be calibrated properly, to find out which traits or specific combinations of trains are most promising. More extensive and complex quantitative trait analyses of these temperaments in a much expanded sample are reported elsewhere in this issue [J. Affect. Disord. (2004)].
The modern concept of affective disorders focuses increasingly on the study of subthreshold conditions on the border of manic or depressive episodes. Indeed, a spectrum of affective conditions spanning from temperament to clinical episodes has been proposed by the senior author. As bipolar disorder is a familial illness, an examination of cyclothymic temperament (CT) in controls and relatives of bipolar patients is of major relevance.
We recruited a total sample of 177 healthy symptom-free volunteers. These controls were divided into three groups. The first one is comprised of 100 normal subjects with a negative familial affective history (NFH); the second of 37 individuals, with positive affective family history (PFH); and a third of 40 subjects, with at least one sib or first-degree kin with bipolar disorder type I according to the DSM-IV (BPR). The last two groups defined at risk individuals. We interviewed all subjects with CT, as described by the senior author.
We found a statistically significant difference in the rates of CT between the subjects in BPR versus others. CT was also more prevalent in the PFH compared with NFH. Additionally, the simple numeration of the CT traits exhibited gradation in the distribution of individuals inside the NFH, PFH and BPR. Finally, categorically defined CT and CT traits predominated in females. LIMITATION and
Although not all relatives of bipolar probands were studied, our results exhibit an aggregation of CT in families with affective disorder-and more specifically those with bipolar background. These results allow us to propose the importance of including CT for phenotypic characterization of bipolar disorder. Furthermore, our results support a spectrum concept of bipolar disorder, whereby CT is distributed in ascending order in the well-relatives of those with depressive and bipolar disorders. We submit that this temperament represents a behavioral endophenotype, serving as a link between molecular and behavioral genetics.
Our aim was to validate the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) in a clinical population.
The study was conducted in two Memphis mood clinics involving 398 affectively ill patients with young to middle index age (42 years+/-13 S.D.), who were 95% white, 62% female, and 51% bipolar spectrum. A subset of 157 of the entire sample were retested in 6-12 months, and the entire sample was then subjected to factor analysis (PCA extraction method with varimax rotation).
We obtained high test-retest reliability ranging from 0.58 for the irritable, to 0.68, 0.69 and 0.70, respectively, for the cyclothymic, dysthymic and hyperthymic. The hypothesized four-factor structure of the TEMPS-A was upheld, with the cyclothymic explaining 14% of the variance, followed by the irritable, hyperthymic, and dysthymic together accounting for another 14%. Internal consistency was excellent, with Chronbach alphas ranging from 0.76 for the dysthymic to 0.88 for the cyclothymic. Exploratory factor analysis revealed 2 super factors, Factor I loading on cyclothymic, irritable, and dysthymic temperaments, and Factor II loading heavily on the hyperthymic. The 50-item TEMPS-A-Clinical Version was constructed by using a cutoff of alpha > or =0.4 for traits loading exclusively on their original temperaments. We also proposed a longer 69-item version for future study, in which we permitted a greater number of traits based on clinical considerations (alpha cutoff 0.30).
The sample was preponderantly white, and may not generalize to other U.S. ethnic groups. This earlier version of TEMPS-A did not include the anxious temperament.
We psychometrically validated the TEMPS-A in affectively ill outpatients, leading to an instrument suitable for use in psychiatric, especially affectively ill, populations. It is noteworthy that in this clinically ill population we succeeded in measuring traits which could make subjects vulnerable to affective episodes, as well as those of adaptive nature. For instance, the dysthymic emerged as bound to routine, self-blaming, shy-nonassertive, sensitive to criticism, yet self-denying, dependable, and preferring to work for someone else rather than be the boss. The hyperthymic had the highest number of "positive" traits: upbeat, fun-loving, outgoing, jocular, optimistic, confident, full of ideas, eloquent, on the go, short-sleeper, tireless, who likes to be the boss, but single-minded, risk-taker, and unlikely to admit to his/her meddlesome nature. The cyclothymic emerged as labile with rapid shifts in mood; unstable in energy, self-esteem and socialization; unevenly gifted and dilettante; yet keen in perception, intense in emotions, and romantic. The irritable emerged as skeptical and critical (which might be considered intellectual virtues), but otherwise having the "darkest" nature of all temperaments: grouchy, complaining, dissatisfied; anger- and violence-prone, and sexually jealous. The foregoing temperament attributes, observed in a moderately severe group of patients with affective disorders, nonetheless testify to the evolutionary context of these disorders-"submissive" behavior, territoriality, romantic charm, and last, but not least, sexually jealous with its associated specter of violence. We hypothesize that the putative social and limbic mechanisms underlying mood disorders appear to have archaic origins on an evolutionary scale. We finally submit that the traits underlying affective disorders are very much part of human nature.
A number of studies have reported evidence of cognitive deficits in euthymic bipolar patients. Qualitative reviews of the literature have indicated impairments in executive functions and declarative memory are most consistently reported. However, not all primary studies conducted to date have had sufficient power to detect statistically significant differences and there have been few attempts to quantify the magnitude of impairments. This review aims to combine data from available studies to identify the profile of neuropsychological deficits in euthymic bipolar patients and quantify their magnitude.
Systematic literature review and meta-analysis.
Large effect sizes (d>or=0.8) were noted for aspects of executive function (category fluency, mental manipulation) and verbal learning. Medium effect sizes (0.5<or=d<0.8) were found for aspects of immediate and delayed verbal memory, abstraction and set-shifting, sustained attention, response inhibition, and psychomotor speed. Small effect sizes (0.2<or=d<0.5) were reported for verbal fluency by letter, immediate memory, and sustained attention.
Sufficient data were not available to investigate all domains. For example analyses did not include measures of visuospatial function.
Euthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function and verbal memory. It is not yet clear whether these are two discrete areas of impairment or are related to one another. Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions.
Although cognitive deficits are prominent in symptomatic patients with bipolar disorder, the extent and pattern of cognitive impairment in euthymic patients remain uncertain.
Neuropsychological studies comparing euthymic bipolar patients and healthy controls were evaluated. Across studies, effect sizes reflecting patient-control differences in task performance were computed for the 15 most frequently studied cognitive measures in the literature.
Across the broad cognitive domains of attention/processing speed, episodic memory, and executive functioning, medium-to-large performance effect size differences were consistently observed between patients and controls, favoring the latter. Deficits were not observed on measures of vocabulary and premorbid IQ.
Meta-analytic findings provide evidence of a trait-related neuropsychological deficit in bipolar disorder involving attention/processing speed, memory, and executive function. Findings are discussed with regard to potential moderators, etiologic considerations, limitations, and future directions in neuropsychological research on bipolar disorder.
Previous work suggests that impairments in executive function and verbal memory in particular may persist in euthymic bipolar patients and serve as an indicator of genetic risk (endophenotype).
A systematic review of the literature was undertaken. Effects sizes were extracted from selected papers and pooled using meta-analytical techniques.
In bipolar patients, large effect sizes (d>0.8) were noted for executive functions (working memory, executive control, fluency) and verbal memory. Medium effect sizes (0.5<d<0.8) were reported for aspects of executive function (concept shifting, executive control), mental speed, visual memory, and sustained attention. Small effect sizes (d<0.5) were found for visuoperception. In first-degree relatives, effect sizes were small (d<0.5), but significantly different from healthy controls for executive function and verbal memory in particular.
Executive function and verbal memory are candidate bipolar endophenotypes given large deficits in these domains in bipolar patients and small, but intermediate, cognitive impairments in first-degree relatives.
Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians Roundtable: what is temperament? Four approaches
- T E Goldberg
- K E Burdick
- Va Goldsmith
- H H Buss
- A H Plomin
- R Rothbart
- M K Thomas
- A Chess
- S Hinde
- R A Mccall
Goldberg, T.E., Burdick, K.E., 2008. Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians. American Psychiatric Publishing, Inc., Arlington, VA. Goldsmith, H.H., Buss, A.H., Plomin, R., Rothbart, M.K., Thomas, A., Chess, S., Hinde, R.A., McCall, R.B., 1987. Roundtable: what is temperament? Four approaches. Child Dev. 58, 505–529.
Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians
- T E Goldberg
- K E Burdick
- Inc
- V A Arlington
- H H Goldsmith
- A H Buss
- R Plomin
- M K Rothbart
- A Thomas
- S Chess
- R A Hinde
- R B Mccall
Goldberg, T.E., Burdick, K.E., 2008. Cognitive Dysfunction in Bipolar Disorder: A
Guide for Clinicians. American Psychiatric Publishing, Inc., Arlington, VA.
Goldsmith, H.H., Buss, A.H., Plomin, R., Rothbart, M.K., Thomas, A., Chess, S., Hinde,
R.A., McCall, R.B., 1987. Roundtable: what is temperament? Four approaches.
Child Dev. 58, 505-529.
MATRICS Consensus Cognitive Battery
- K H Nuechterlein
- M F Green
Nuechterlein, K.H., Green, M.F., 2006. MATRICS Consensus Cognitive Battery.
MATRICS Assessment, Inc., Los Angeles, CA.