Article

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

Leiden University, Leyden, South Holland, Netherlands
Comprehensive Psychiatry (Impact Factor: 2.25). 09/2007; 48(5):426-35. DOI: 10.1016/j.comppsych.2007.04.002
Source: PubMed

ABSTRACT

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

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Available from: Jaap G Goekoop, May 12, 2014
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    • "Fourteen papers were excluded because of overlapping samples with other studies. Although there was a partial overlap of the inclusion/exclusion criteria between this study and the meta-analysis by Miettunen and Raevuori (Miettunen and Raevuori, 2012), the different selection procedures resulted in the exclusion of some papers (Abrams et al., 2004; Bahceci, 2010; Ball et al., 2002; de Winter et al., 2007; Richter et al., 2000; Wilson, 2010). Altogether, 57 studies were finally included in this meta-analysis (table 1). "
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    ABSTRACT: Background: Cloninger's psychobiological model of personality has been extensively applied to subjects affected by mood disorders (MOOD). However, most studies are widely heterogeneous in terms of sample size, methods of assessment, and selection of participants. Methods: We conducted a systematic review of literature and a random effects meta-analysis of studies comparing at least two of the following groups: (a) adults with a primary MOOD diagnosis (Bipolar Disorder (BP) or major depressive disorder (MDD)), (b) their unaffected siblings (SIB) or (c) healthy subjects (HS), and reporting quantitative results from the Tridimensional Personality Questionnaire (TPQ) or the Temperament and Character Inventory (TCI). Subgroup, sensitivity and meta-regression analyses were also conducted. Results: High Harm Avoidance and low Self-Directedness were consistently associated with MOOD and SIB samples. BP was characterized by higher scores in Novelty Seeking and Self-Transcendence than HS, SIB and MDD. Age seemed to have a negative effect on Novelty Seeking and a positive effect on Harm Avoidance, Cooperativeness and Self-Transcendence. An euthymic mood state was associated with reduced Harm Avoidance, but increased Reward Dependence, Self-Directedness and Cooperativeness. Limitations: The quality of the included studies varied and was relatively low. Moreover, publication bias and heterogeneity in the distribution of effect sizes may also have limited our results. Conclusion: High Harm Avoidance and Low Self-Directedness may be trait markers for MOOD in general, while high Novelty Seeking and high Self-Transcendence may be specific to BP. Future studies are needed to disentangle the state-trait effect of each personality dimension.
    Full-text · Article · Jan 2016 · Journal of Affective Disorders
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    • "Fourteen papers were excluded because of overlapping samples with other studies. Although there was a partial overlap of the inclusion/exclusion criteria between this study and the meta-analysis by Miettunen and Raevuori (Miettunen and Raevuori, 2012), the different selection procedures resulted in the exclusion of some papers (Abrams et al., 2004;Bahceci et al., 2010;Ball et al., 2002;de Winter et al., 2007;Richter et al., 2000;Wilson et al., 2010). Altogether, 57 studies were finally included in this meta-analysis (Table 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cloninger's psychobiological model of personality has been extensively applied to subjects affected by mood disorders (MOOD). However, most studies are widely heterogeneous in terms of sample size, methods of assessment, and selection of participants. Methods: We conducted a systematic review of literature and a random effects meta-analysis of studies comparing at least two of the following groups: (a) adults with a primary MOOD diagnosis (Bipolar Disorder (BP) or Major Depressive Disorder(MDD)), (b) their unaffected siblings (SIB) or (c) healthy subjects (HS), and reporting quantitative results from the Tridimensional Personality Questionnaire (TPQ) or the Temperament and Character Inventory (TCI). Subgroup, sensitivity and meta-regression analyses were also conducted. Results: High Harm Avoidance and low Self-Directedness were consistently associated with MOOD and SIB samples. BP was characterized by higher scores in Novelty Seeking and Self-Transcendence than HS, SIB and MDD. Age seemed to have a negative effect on Novelty Seeking and a positive effect on Harm Avoidance, Cooperativeness and Self-Transcendence. An euthymic mood state was associated with reduced Harm Avoidance, but increased Reward Dependence, Self-Directedness and Cooperativeness. Limitations: The quality of the included studies varied and was relatively low. Moreover, publication bias and heterogeneity in the distribution of effect sizes may also have limited our results. Conclusion: High Harm Avoidance and Low Self-Directedness may be trait markers for MOOD in general, while high Novelty Seeking and high Self-Transcendence may be specific to BP. Future studies are needed to disentangle the state-trait effect of each personality dimension.
    Full-text · Article · Jan 2016 · Journal of Affective Disorders
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    • "Of course, former studies evaluating HA scores as clinical predictor were based on an AD treatment in non-TRD samples, making it difficult to compare. Moreover, because personality features, such as HA, have been reported to be different between depressed melancholic and non-melancholic patients (Sato et al., 2001; de Winter et al., 2007; Rubino et al., 2009), the inclusion of only melancholic TRD patients may have influenced our results. Conform to other AD studies evaluating also the other temperament dimensions, NS and RD were also no predictor to response in refractory MDD, neither the other character scales CO and ST (Mulder, 2002). "
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    ABSTRACT: Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
    Full-text · Article · Aug 2014 · Psychiatry Research
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