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Favaretto E, Bedani F, Brancati GE, De Berardis D, Giovannini S, Scarcella L, Martiadis V, Martini A, Pampaloni I, Perugi G, Pessina E, Raffone F, Ressico F, Cattaneo CI. Synthesising 30 years of clinical experience and scientific insight on affective temperaments in psychiatric disorders: State of the art. J Affect Disord 2024; 362:406-415. [PMID: 38972642 DOI: 10.1016/j.jad.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/17/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
The concept of affective temperament has been extensively discussed throughout the history of psychopathology and represents a cornerstone in the study of mood disorders. This review aims to trace the evolution of the concept of affective temperaments (ATs) from Kraepelin's seminal work to the present day. In the 1980s, Akiskal redefined Kraepelin's concept of affective temperaments (ATs) by integrating the five recognized ATs into the broader framework of the soft bipolar spectrum. This conceptualization viewed ATs as non-pathological predispositions underlying psychiatric disorders, particularly mood disorders. Epidemiological and clinical studies have validated the existence of the five ATs. Furthermore, evidence suggests that ATs may serve as precursors to various psychiatric disorders and influence clinical dimensions such as disease course, psychopathology, and treatment adherence. Additionally, ATs appear to play a significant role in moderating phenomena such as suicide risk and stress coping. Incorporating an evaluation of temperamental bases of disorders into the multidimensional psychiatric diagnostic process could enhance treatment optimization and prognosis estimation.
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Affiliation(s)
- E Favaretto
- Department of Addiction, South Tyrol Health Care, Bressanone, Italy.
| | - F Bedani
- Mercy University Hospital, Cork, IRELAND
| | | | - D De Berardis
- Department of Psychiatry, Azienda Sanitaria Locale 4, Teramo, ITALY.
| | - S Giovannini
- Department of Addiction, South Tyrol Health Care, Bressanone, Italy
| | - L Scarcella
- Department of Psychiatry, South Tyrol Health Care, Bressanone, Italy.
| | - V Martiadis
- Department of Mental Health, Asl Napoli 1 Centro, Naples, Italy
| | - A Martini
- Department of Mental Health, ASL CN2 Alba - Bra, Italy
| | - I Pampaloni
- National OCD and BDD Unit, South West London and St Georges NHS Trust, London, United Kingdom.
| | - G Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - E Pessina
- Department of Mental Health, ASL CN2 Alba - Bra, Italy
| | - F Raffone
- Department of Mental Health, Asl Napoli 1 Centro, Naples, Italy
| | - F Ressico
- Outpatient Unit Department of Mental Health Novara, Borgomanero, Italy
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Visalli G, Longobardi G, Iazzolino AM, D'Angelo M, Stefano VD, Paribello P, Steardo L, Manchia M, Steardo L. The role of affective temperaments in self-care and medication adherence among individuals with bipolar disorder: a moderation analysis. Front Psychiatry 2024; 15:1443278. [PMID: 39323967 PMCID: PMC11422117 DOI: 10.3389/fpsyt.2024.1443278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/20/2024] [Indexed: 09/27/2024] Open
Abstract
Background Affective temperament, defined as the fundamental predisposition from which normal affective states originate or as the constitutional core of personality, play a crucial role in mood disorders, particularly bipolar disorders. Understanding the relationship between temperaments, treatment adherence, and self-care is crucial for effective management and improved clinical results. Objectives This study aims to (1) assess the correlation between affective temperaments and treatment adherence, (2) investigate the relationship between affective temperaments and self-care abilities, (3) identify predictors of treatment adherence, and (4) explore the moderating effect of self-care on the relationship between treatment adherence and depressive temperament in individuals with bipolar disorder. Methods A cross-sectional study was conducted with 231 individuals diagnosed with bipolar disorder (BD) type I (N=160) and type II (N=71). The participants were evaluated using the following psychometric tools: Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS) to assess affective temperaments, Personal and Social Performance Scale (PSP) to evaluate social functioning and self-care abilities, and Morisky Medication Adherence Scale (MMAS) to measure treatment adherence. The study involved statistical analyses to examine correlations, identify predictors, and explore moderating effects. Results The findings revealed significant correlations between affective temperaments and both treatment adherence and self-care abilities. Specifically, hyperthymic temperament was positively associated with higher treatment adherence, whereas cyclothymic and depressive temperaments were linked to lower adherence. Self-care abilities were found to mediate the relationship between depressive temperament and treatment adherence, suggesting that improved self-care can enhance adherence in individuals with depressive temperament. Conclusions Affective temperaments significantly influence treatment adherence and self-care abilities in individuals with bipolar disorder. The mediating role of self-care highlights the importance of developing targeted interventions to improve self-care practices, thereby enhancing treatment adherence and overall well-being. Personalized treatment strategies based on temperament assessments could lead to better clinical outcomes and quality of life for individuals with bipolar disorder.
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Affiliation(s)
- Giulia Visalli
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Grazia Longobardi
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Anna Maria Iazzolino
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Valeria Di Stefano
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Pasquale Paribello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Steardo
- Department of Clinical Psychology, University Giustino Fortunato, Benevento, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
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Li Z, Liu X, Ma R, Feng S, Zheng S, Zhu H, Yin D, Jia H. Cyclothymic Temperament, Physical Neglect, and Earlier Age of Onset Predict Poor Medication Adherence in Patients With Bipolar Disorder. J Nerv Ment Dis 2023; 211:35-39. [PMID: 36095277 DOI: 10.1097/nmd.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT Individual-level risk factors may predict poor medication adherence (PMA) in bipolar disorder (BD). This study aimed to evaluate the association between affective temperament, childhood trauma, age of first onset, and PMA in patients with BD in China. A total of 168 patients completed the eight-item Morisky Medication Adherence Scale; the Short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire; and the Childhood Trauma Questionnaire-Short Form. Scores were then compared between PMA and non-PMA groups. Binary logistic regression showed that age of first onset was negatively correlated with PMA ( β = -0.106, p = 0.002), whereas physical neglect and cyclothymic temperament were positively correlated with PMA ( β = 0.143, p = 0.029; β = 0.19, p = 0.001, respectively). These findings indicate that cyclothymic temperament, physical neglect, and earlier onset are predictors of PMA in patients with BD and that such patients may require further attention to improve medical compliance.
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Del Casale A, Lai C, Iannuccelli A, Ciacchella C, Veneziani G, Ali M, Zocchi C, Bilotta I, Pompili M. Pandemic experiences and psychopathological aspects in individuals with mood disorders and other mental disorders. Front Psychiatry 2022; 13:1039072. [PMID: 36311495 PMCID: PMC9614274 DOI: 10.3389/fpsyt.2022.1039072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with different personality traits, temperaments, and psychological symptoms have different attitudes toward the pandemic experiences and restrictive measures. The aim of the present study was to evaluate the associations between the psychological factors and the attitudes toward COVID-19, experienced during the third pandemic wave in Italy, in a sample of individuals with psychiatric disorders. Between March and September 2021, 53 patients with mood disorders and other mental disorders completed a survey composed of self-report questionnaires that assessed sleep quality, depressive and hypomanic symptoms, and temperament and personality traits. Positive and negative attitudes toward the pandemic experience were assessed using an ad hoc questionnaire. The results showed that individuals with more severe depressive symptoms were less prone to adhere to government guidelines, and were more convinced that the pandemic was not a real problem. Reduced sleep quality was associated with increased skepticism toward official explanations concerning the causes of COVID-19. Lastly, negative affect and cyclothymic temperament predicted the disposition toward COVID-19 vaccines. In conclusion, these findings highlighted that some psychological aspects and psychiatric symptoms could influence the beliefs about COVID-19 and compliance with government recommendations. Further research is needed to provide indications on how to improve the current healthcare policies.
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Affiliation(s)
- Antonio Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessia Iannuccelli
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Ciacchella
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mohamed Ali
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Clarissa Zocchi
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Irene Bilotta
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Szabo G, Fornaro M, Dome P, Varbiro S, Gonda X. A bitter pill to swallow? Impact of affective temperaments on treatment adherence: a systematic review and meta-analysis. Transl Psychiatry 2022; 12:360. [PMID: 36056016 PMCID: PMC9440110 DOI: 10.1038/s41398-022-02129-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Predominant affective temperament may affect adherence to prescribed pharmacotherapeutic interventions, warranting systematic review and meta-analysis. METHODS The Scopus, Web of Science, PubMed, and OVID MedLine databases were inquired since inception up to 31st of March 2022 for records of any study design documenting quantitative evidence about affective temperaments as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) questionnaire and treatment adherence measured by the means of major rating scales on the matter. People with low vs. high levels of treatment adherence, matched for otherwise clinically relevant variables, were deemed as cases and controls, respectively, using standardized mean differences (SMDs) in pertinent scores under random-effects meta-analysis. RESULTS Nine studies encompassing 1138 subjects pointed towards significantly higher cyclothymic (SMD = -0.872; CI: [-1.51 to -0.24]; p = 0.007), irritable (SMD = -0.773; CI: [-1.17 to -0.37]; p < 0.001) and depressive (SMD = -0.758; CI: [-1.38 to -0.14]; p = 0.017) TEMPS-A scores both for psychiatric and nonpsychiatric samples with poorer adherence. LIMITATIONS Intrinsic limitations of the present report include the heterogeneity of the operational definitions documented across different primary studies, which nonetheless reported on the sole medication-treatment adherence, thus limiting the generalizability of the present findings based on a handful of comparisons. CONCLUSIONS Though further primary studies need to systematically account for different clinical and psychosocial moderators across different clinical populations and operational definitions, cyclothymic, depressive, and irritable temperament scores may nonetheless predict treatment adherence and, thus, overall treatment outcomes.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Michele Fornaro
- Department of Psychiatry, Federico II University of Naples, Naples, Italy
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
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In Patients with Obesity, Are Affective Temperaments Associated with Attrition? An Evaluation during and before the SARS-CoV-2 Pandemic. J Clin Med 2022; 11:jcm11030862. [PMID: 35160313 PMCID: PMC8836900 DOI: 10.3390/jcm11030862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/04/2023] Open
Abstract
Timely data on attrition from weight loss programs for patients with obesity during the SARS-CoV-2 pandemic are lacking, so we aimed to contribute to filling this gap in the literature by comparing attrition during or outside of the SARS-CoV-2 pandemic and its possible association with patients' affective temperaments, psychopathology, and clinical variables. Two-hundred and eleven outpatients with obesity were recruited and completed the Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire, Binge Eating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Those who dropped out during the pandemic period were mostly men, with younger age of weight gain, and with a larger waist circumference than completers. Patients with obesity who dropped out outside of the SARS-CoV-2 pandemic showed marked levels of depression, anxiety, binge eating episodes, and higher affective temperaments (but the hyperthymic one) when compared to their counterparts. The cyclothymic temperament slightly increased attrition (OR = 1.13, 95% CI 1.00-1.27 p = 0.05) outside the pandemic, while during the pandemic, male gender (OR = 3.50, 1.04-11.7, p = 0.04) was associated with attrition. These findings suggested that male patients with obesity are at particular risk of drop-out from weight-loss treatment during the SARS-CoV-2 pandemic; contrariwise, outside the pandemic, affective temperaments could be a useful baseline assessment for defining the attrition risk in these patients.
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Lesiewska N, Kamińska A, Junik R, Michalewicz M, Myszkowski B, Borkowska A, Bieliński M. Affective Temperament and Glycemic Control - The Psychological Aspect of Obesity and Diabetes Mellitus. Diabetes Metab Syndr Obes 2021; 14:4981-4991. [PMID: 35002270 PMCID: PMC8722534 DOI: 10.2147/dmso.s342185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/09/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Affective temperament shows innate predisposition to affective disorders and has been studied in patients with type 2 diabetes mellitus (T2DM) and obesity. Studies describing connections between depressive disorders, obesity and T2DM, show a bidirectional way in which these disorders affect each other. Given that obesity, depression, and T2DM are still growing health problems of our times, the improvement of therapeutic strategies is required. The aim of our study was to evaluate affective temperament in obese individuals with T2DM and pre-diabetes and to investigate the correlations between affective temperaments and glycemic control. MATERIALS AND METHODS The study enrolled 185 obese individuals (146 females; 39 males) who were diagnosed with pre-diabetes, diabetes or without any carbohydrate disorder. For affective temperament evaluation, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was utilized; for glycemic control, the assessment of hemoglobin A1c (HbA1c) was performed. RESULTS We did not observe any significant differences of affective temperament between studied groups. In the group of patients with diabetes, depressive, cyclothymic and anxious temperaments positively correlated with HbA1c values indicating worse glycemic control. Inversly, hyperthymic dimension showed negative correlation with HbA1c values. CONCLUSION Affective temperaments may affect glycemic control in obese individuals with carbohydrate disorders. Individuals with stronger expression of cyclothymic, depressive and anxious temperaments may need more medical aid for better self-management. Hence, TEMPS-A is an easy and useful tool which may significantly improve the compliance in obese patients with carbohydrate disorders.
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Affiliation(s)
- Natalia Lesiewska
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Correspondence: Natalia Lesiewska Tel/Fax +48 52 585 37 03 Email
| | - Anna Kamińska
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Magdalena Michalewicz
- Department of Pulmonology, Allergology and Pulmonological Oncology, Military Clinical Hospital No. 10 with Policlinic in Bydgoszcz, Bydgoszcz, Poland
| | - Bartłomiej Myszkowski
- Department of Obstetrics, Women’s Diseases and Oncological Gynecology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Alina Borkowska
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Maciej Bieliński
- Chair and Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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