Looking for bipolar spectrum psychopathology: identification and expression in daily life

A systematic review and meta-analysis of global and social functioning among people at risk of bipolar disorder

BACKGROUND

Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD.

METHODS

We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible.

RESULTS

7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples.

LIMITATIONS

Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms.

CONCLUSIONS

Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.

A critical examination of multidimensionality within the Hypomanic Personality Scale

BACKGROUND

The Hypomanic Personality Scale (HPS) assesses bipolar spectrum psychopathology and risk for bipolar disorders. Despite the developers' intent to create a scale that provides a unitary score, several studies have examined whether the HPS has a multidimensional structure. These models have been unable to identify a replicable multidimensional structure, with models varying from fairly similar to entirely dissimilar, and have suffered from theoretical and methodological concerns.

PROCEDURES

We therefore examined the multidimensional structure of the HPS in a large undergraduate and adult sample (n = 5002).

MAIN FINDINGS

We failed to reproduce factors with equal congruence to those of previously published models.

PRINCIPLE CONCLUSIONS

We concluded that the HPS lacks factorial validity in previous research as a multidimensional measure of bipolar spectrum psychopathology. We further recommend the creation of a novel multidimensional assessment of bipolar spectrum psychopathology developed from a theoretically driven, comprehensive model, rather than examining a multidimensional model of a pre-existing measure, such as the HPS.

Emotional awareness, affective dysregulation, and bipolar spectrum psychopathology: A path analysis

Affective dysregulation is present in those with subsyndromal symptoms of hypomania and mania and prospectively predicts the development of bipolar spectrum disorders. A crucial, understudied area related to the experience and regulation of emotion in this population is emotional awareness - emotional clarity (Clarity) and attention to emotion (Attention). We examined whether scores on the Hypomanic Personality Scale (HPS) were associated with deficits in emotional awareness and whether these deficits were associated with heightened intensity and instability of negative (NA) and positive affect (PA). Young adults (n=233), oversampled for high HPS scores completed self-reports and 14 days of experience sampling assessing high and low arousal NA and PA. HPS scores were associated with low Clarity and unassociated with Attention. High HPS scores were associated with greater high and low arousal NA intensity and instability only for those at low and mean levels of Attention. In contrast, there was a significant indirect association between HPS scores and intensity of high and low arousal NA and PA, as well as instability of high arousal NA, through low Clarity. Results highlighted that individual differences exist in the extent to which facets of emotional awareness differentially link scores on the HPS to emotional outcomes.

Behavioral activation system (BAS) dysregulation and bipolar spectrum psychopathology in daily life: An online-diary study

Dysregulation of the behavioral activation system (BAS) has been theorized to be a core factor underlying mood swings in bipolar disorder (BD). However, few studies have directly addressed BAS dysregulation and more research is needed to understand its dynamic expression in daily life. The aim of this study was to directly assess BAS dysregulation, and to examine its moderating effect on the relationship between life events and bipolar spectrum symptoms via multilevel modeling. Korean young adults (n = 100) were screened using the Hypomanic Personality Scale (HPS) from a large sample (N = 1,591). They completed online diaries for 7 consecutive days including the Daily Events Record as well as bipolar spectrum symptoms. BAS-activating and/or -deactivating scores were allocated to each reported life event by an expert consensus rating. Cross-level interaction analysis showed that the occurrence of BA life events contributed to a steeper increase in bipolar spectrum symptoms, particularly for individuals with high BAS dysregulation. The present study suggests that BAS dysregulation is a unique construct that deserves further exploration in BD.

Emotion dynamics concurrently and prospectively predict mood psychopathology

INTRODUCTION

Altered emotion dynamics may represent a transdiagnostic risk factor for mood psychopathology. The present study examined whether altered emotion dynamics were associated with bipolar and depressive psychopathology concurrently and at a three-year follow-up.

METHODS

At baseline (n = 138), participants completed diagnostic interviews, questionnaires, and seven days of experience sampling assessments. Four emotion dynamics were computed for negative affect (NA) and positive affect (PA) - within-person variance (variability), mean square of successive differences and probability of acute change (instability), and autocorrelation (inertia). At the three-year follow-up, participants (n = 108) were re-assessed via interviews and questionnaires.

RESULTS

NA variability was associated with bipolar spectrum disorders at baseline and follow-up. NA instability predicted depressive symptoms and hypomanic personality at baseline, and bipolar spectrum disorders at the follow-up. NA inertia did not predict diagnoses or symptoms at either assessment. PA inertia predicted hyperthymic temperament at baseline but not follow-up. Notably, NA variability and instability predicted the development of new bipolar spectrum disorders at the follow-up.

LIMITATIONS

Consistent with the recruitment strategy and young age of the participants, only 50% had developed diagnosable psychopathology by the time of the follow-up assessment.

CONCLUSIONS

The present study provided a unique demonstration that altered emotion dynamics differentially predicted bipolar and depressive psychopathology concurrently and prospectively. Emotion dynamics are important to both digital phenotyping and mobile-based interventions as emotional instability offers a measurable risk factor that is identifiable prior to illness onset.

Affective dynamics in bipolar spectrum psychopathology: Modeling inertia, reactivity, variability, and instability in daily life

BACKGROUND

Bipolar psychopathology is characterized by affective dysregulation independent of mood episodes. However, previous research has relied on laboratory-based emotion-eliciting tasks or retrospective questionnaires that do not take into account temporal dynamics of affect. Thus, the present study examined affective dynamics (reactivity, variability, instability, and inertia) of low and high arousal negative affect (NA) and positive affect (PA) in daily life in those at risk for bipolar psychopathology.

METHODS

Undergraduates (n = 135) completed the Hypomanic Personality Scale and experience sampling surveys assessing affective experiences 8 times daily for 7 days.

RESULTS

HPS scores were associated with greater reactivity of NA when experiencing negative or stressful events, variability of NA (high and low arousal) and PA (high arousal), and instability of NA and PA (high and low arousal) in daily life. HPS scores were associated with a high probability of acute increases in NA and PA and were unassociated with levels of inertia.

LIMITATIONS

This study only examined short-term dynamics over 7 days. Future studies should model both short- and long-term dynamics and whether these dynamics predict behavioral outcomes.

CONCLUSIONS

These results provide evidence that bipolar spectrum psychopathology is characterized by reactivity of NA as well as variability, instability, and acute increases in NA and PA in daily life over-and-above mean levels of affect. Modeling affective dynamics may provide context-relevant information about the course and trajectory of bipolar spectrum psychopathology and should facilitate the use of experience sampling methodology to study and intervene in mood lability in patients with bipolar disorders.

Validation of the Hypomanic Personality Scale (HPS) in Iranian adolescents

BACKGROUND

The main purpose of the current study was to examine the psychometric properties of the Hypomanic Personality Scale (HPS) in Iranian adolescents.

METHODS

A number of 805 high school and freshman students answered the HPS, the Hypomania scale of the MMPI-2, the Borderline Traits Questionnaire (STB) and the Schizotypal Personality Questionnaire-Brief. Data were analysed using explanatory factor analysis, Pearson correlation coefficient as well as independent t-test.

RESULTS

Principal component analysis led to the extraction of two factors namely mood volatility/excitement and social vitality. Convergent validity coefficients were equal to 0.71, 0.57 and 0.74 for the total scale, mood volatility/excitement and social vitality subscales respectively. Test-retest reliability of the total scale and its subscales were equal to 0.61, 0.67 and 0.57 respectively. Internal consistency and the split-half reliability of the total scale and the two subscales showed the same coefficients. The results showed that the female group gained higher scores on the total scale and the social vitality subscale.

DISCUSSION

The results supported the multi-dimensional structure and psychometric properties of the HPS among Iranian adolescents.

CONCLUSIONS

The findings of this study confirm the use of HPS as a valid scale in investigating hypomanic characteristics, particularly among Iranian adolescents. © 2018 John Wiley & Sons, Ltd.

Psychopathology, everyday behaviors, and autonomic activity in daily life: An ambulatory impedance cardiography study of depression, anxiety, and hypomanic traits

Discrepancies regarding the link between autonomic nervous system (ANS) activity and psychopathology may be due in part to inconsistent measurement of non-psychological factors, including eating, drinking, activity, posture, and interacting with others. Rather than sources of noise, behaviors like being active and being with others may be the behavioral pathways that connect psychopathology symptoms to autonomic activity. The present study examined whether behaviors mediate the association of depression, anxiety, and hypomanic traits with ANS by using experience sampling methodology and ambulatory impedance cardiography. Participants (n = 49) completed measures of affect and one day of experience sampling and ambulatory impedance cardiography. The association of hypomanic traits with heart rate variability and heart rate was mediated by physical activity, and social activity mediated the association of depressive symptoms and respiration. These results highlight the importance of considering the pathways between psychopathology and ANS and the mediating role that everyday behaviors play.

What can daily life assessment tell us about the bipolar spectrum?

Evidence suggests that bipolar psychopathology is better characterized as a spectrum than by categorical diagnoses. The examination of symptoms and impairment associated with bipolar spectrum psychopathology is important and can be enhanced by methods that examine affect, thoughts, and behavior in daily life. The present study extended findings that provide validation of a continuum of bipolar psychopathology in daily life. Young adults (n=294) completed the Hypomanic Personality Scale (HPS) and experience sampling using smartphones. Participants were signaled eight times daily for one week to complete surveys in their normal daily environment. Bipolar spectrum psychopathology was characterized by increased positive and negative affect, confidence, racing thoughts, energy, and impulsivity in daily life. The HPS moderated the association of stress with trouble concentrating, irritability with dysphoria and impulsivity, and confidence with feeling like one's emotions were out of control. This study demonstrated that bipolar spectrum psychopathology is associated with disruptions in affect, thoughts, and behaviors and provided further evidence for a continuum of bipolar psychopathology. ESM is a promising method for examining dynamic constructs such as bipolar spectrum psychopathology and has the potential to be a strong research and clinical tool.

Extreme cognitions are associated with diminished ability to use disconfirming evidence

OBJECTIVES

An Integrative Cognitive Model of mood swings and bipolar disorder proposes that cognitive styles characterized by extreme self-referent appraisals of internal states (e.g., 'If I have a bad night's sleep it means that I am about to have a breakdown') interfere with mood regulation. The aim of this study is to determine whether strong endorsement of such appraisals is predicted by a diminished ability to access disconfirming counterexamples.

DESIGN

We examined whether the ability to access two different categories of counterexample (known as Disabling Conditions and Alternative Causes) would predict endorsement of extreme appraisals (measured by the Hypomanic Attitudes and Positive Predictions Inventory; HAPPI) and mania risk (measured by the Hypomanic Personality Scale; HPS).

METHOD

A non-clinical sample of 150 students completed the HAPPI, the HPS and a conditional reasoning task that indexed the ability to access Disabling Conditions and Alternative Causes. Current mood was controlled for using the Internal States Scale.

RESULTS

The ability to make use of disabling counterexamples during the reasoning task was inversely related with scores on the HAPPI (r = -.19, p < .05); participants that were less able to make use of disabling counterexamples endorsed extreme self-referent appraisals to a greater extent. There was no association between the use of alternative cause counterexamples and the HAPPI, and no association between either measure of counterexample generation and the HPS.

CONCLUSIONS

A diminished ability to use disconfirming evidence when reasoning about the world may reinforce problematic cognitive styles such as extreme, personalized appraisals of experience, which can interfere with mood regulation.

PRACTITIONER POINTS

Problematic cognitive styles such as extreme, personalized appraisals of experience may be reinforced by the inability to produce or access evidence that disconfirms these maladaptive beliefs. This reasoning bias may be associated with cognitive styles underlying psychopathology. There may be clinical utility in exploring the use of disabler generation in psychological interventions, to help disconfirm maladaptive beliefs.

A web-based study of bipolarity and impulsivity in athletes engaging in extreme and high-risk sports

BACKGROUND

We hypothesised that men and women who engage in extreme or high-risk sports would score higher on standardised measures of bipolarity and impulsivity compared to age and gender matched controls.

METHODS

Four-hundred and eighty extreme or high-risk athletes (255 males and 225 females) and 235 age-matched control persons (107 males and 128 females) were enrolled into the web-based case-control study. The Mood Disorder Questionnaire (MDQ) and Barratt Impulsiveness Scale (BIS-11) were administered to screen for bipolarity and impulsive behaviours, respectively.

RESULTS

Results indicated that extreme or high-risk athletes had significantly higher scores of bipolarity and impulsivity, and lower scores on cognitive complexity of the BIS-11, compared to controls. Further, there were positive correlations between the MDQ and BIS-11 scores.

CONCLUSION

These results showed greater rates of bipolarity and impulsivity, in the extreme or high-risk athletes, suggesting these measures are sensitive to high-risk behaviours.

Factor structure of the French version of the Hypomanic Personality Scale (HPS) in non-clinical young adults

BACKGROUND

Hypomanic Personality Scale (HPS) is a self-report questionnaire designed to identify vulnerable individuals at high risk of bipolar disorders in non-clinical samples. Our aim was to identify the factorial structure of HPS in a French non-clinical sample and to compare this with different factor solutions described in the literature. We carried out a survey in a French population using a French version of HPS.

METHODS

A total of 698 participants were included in the study. They completed the HPS, the Schizotypal Personality Questionnaire-Brief (SPQ-B), the Positive And Negative Affect Schedule (PANAS), and the Beck Depression Inventory (BDI-II). We tested the 1, 3 and 4-factor solutions and used a Confirmatory Factor Analysis to compare these with the factor solutions suggested by Rawling et al. and Schalet et al.

RESULTS

Goodness-of-fit indices showed that Schalet et al.'s solution "fits" our data better than Rawling et al.'s factorial solutions. HPS scores correlated with the PANAS Positive score and the SPQ-B total score. We confirmed the 3-factor structure of the HPS in a large non-clinical population of young adults and found consistent correlations with BDI, affectivity and schizotypal traits.

Ecological momentary assessment (EMA) of depression-related phenomena

Ecological momentary assessment (EMA) is one research method increasingly employed to better understand the processes that underpin depression and related phenomena. In particular, EMA is well suited to the study of affect (e.g., positive and negative affect), affective responses to stress (e.g., emotion reactivity), and behaviors (e.g., activity level, sleep) that are associated with depression. Additionally, EMA can provide insights into self-harm behavior (i.e. suicide and non-suicidal self-injury), and other mood disorders (e.g. bipolar disorder) commonly associated with depressive episodes. Given the increasing availability and affordability of handheld computing devices such as smartphones, EMA is likely to play an increasingly important role in the study of depression and related phenomena in the future.

The independence of schizotypy from affective temperaments--a combined confirmatory factor analysis of SPQ and the short TEMPS-A

Sparse evidence of a co-aggregation of the risk of schizophrenia and bipolar disorder provides support for a shared but nonspecific genetic etiology of bipolar disorder and schizophrenia. Temperaments are conceptualized as trait sub-syndromic conditions of major pathologies. This study set out to test the hypothesis of a continuum between schizotypy and affective temperaments versus the alternative hypothesis of their independence based on a cross-sectional, survey design involving 649 (males: 47%) college students. The short 39-item TEMPS-A and the SPQ were used as measures of the affective temperaments and of schizotypy, respectively. Confirmatory factor analyses were applied to a unidimensional model, to a standard correlate traits model, to second-order representations of a common latent structure, and to a bifactor model. Confirmatory bifactor modeling provided evidence against a complete independence of the dimensions subsumed by the affective and the schizotypal traits. The best solution distinguished between two sub-domains grouping positive symptoms and negative symptoms as measured by the SPQ subscales, and a sub-domain related to the affective temperaments as measured by the TEMPS-A. Limitations due to the use of subscales from two different tools should be taken into account.

Temperamental dimensions of the TEMPS-A in male and female subjects engaging in extreme or/and high risk sports

OBJECTIVES

We investigated temperamental dimensions of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) as well as bipolarity features in male and female subjects engaging in extreme or/and high risk sports.

METHODS

The web-based case-control study was performed in 480 subjects engaging in extreme or/and high risk sports (255 male, 225 female) aged 26 ± 6 years and in 235 age- and sex-matched healthy controls subjects (107 male, 128 female), aged 28 + 9 years. The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. The Mood Disorder Questionnaire (MDQ) was employed for the assessment of bipolarity.

RESULTS

Both male and female athletes had significantly higher scores of hyperthymic temperaments compared with control male and female subjects who had declared themselves as not involved into the activities of extreme or/and high risk sports. In addition, compared with controls, male sportsmen had lower scores of depressive and anxious temperaments, and female athletes had higher scores of cyclothymic and irritable temperaments. Both male and female athletes obtained significantly higher scores of bipolarity as measured by the MDQ, than control men and women.

LIMITATIONS

Web-based study involving a risk of selection and recall bias, problematic homogeneity of the experimental group.

CONCLUSIONS

Subjects engaged into extreme or/and high risk sports have significantly higher scores of hyperthymic temperament, measured by the TEMPS-A and present sex-specific features of other temperaments. Such subjects obtain also greater bipolarity scores as measured by the MDQ.

A three-year longitudinal study of affective temperaments and risk for psychopathology

BACKGROUND

Affective temperaments are presumed to underlie bipolar psychopathology. The TEMPS-A has been widely used to assess affective temperaments in clinical and non-clinical samples. Cross-sectional research supports the association of affective temperaments and mood psychopathology; however, longitudinal research examining risk for the development of bipolar disorders is lacking. The present study examined the predictive validity of affective temperaments, using the TEMPS-A, at a three-year follow-up assessment.

METHODS

The study interviewed 112 participants (77% of the original sample) at a three-year follow-up of 145 non-clinically ascertained young adults psychometrically at-risk for bipolar disorders, who previously took part in a cross-sectional examination of affective temperaments and mood psychopathology.

RESULTS

At the reassessment, 29 participants (26%) met criteria for bipolar spectrum disorders, including 13 participants who transitioned into disorders during the follow-up period (14% of the originally undiagnosed sample). Cyclothymic/irritable and hyperthymic temperaments predicted both total cases and new cases of bipolar spectrum disorders at the follow-up. Cyclothymic/irritable temperament was associated with more severe outcomes, including DSM-IV-TR bipolar disorders, bipolar spectrum psychopathology, major depressive episodes, and substance use disorders. Hyperthymic temperament was associated with bipolar spectrum psychopathology and hypomania, whereas dysthymic temperament was generally unassociated with psychopathology and impairment.

LIMITATIONS

The present sample of young adults is still young relative to the age of onset of mood psychopathology.

CONCLUSIONS

These results provide the first evidence of the predictive validity of affective temperaments regarding risk for the development of bipolar psychopathology. Affective temperaments provide a useful construct for understanding bipolar psychopathology.

Personality, Emotions, and the Emotional Disorders

We examined symptom-level relations between the emotional disorders and general traits within the five-factor model of personality. Neuroticism correlated strongly with the general distress/negative affectivity symptoms (depressed mood, anxious mood, worry) that are central to these disorders; more moderately with symptoms of social phobia, affective lability, panic, posttraumatic stress disorder, lassitude, checking, and obsessive intrusions; and more modestly with agoraphobia, specific phobia, and other symptoms of depression and obsessive-compulsive disorder. Extraversion was negatively correlated with symptoms of social anxiety/social phobia and was positively related to scales assessing expansive positive mood and increased social engagement in bipolar disorder. Conscientiousness, agreeableness, and openness showed weaker associations and generally added little to the prediction of these symptoms. It is noteworthy, moreover, that our key findings replicated well across (a) self-rated versus (b) interview-based symptom measures. We conclude by discussing the diagnostic and assessment implications of these data.

The dynamics of mood and coping in bipolar disorder: longitudinal investigations of the inter-relationship between affect, self-esteem and response styles

BACKGROUND

Previous research has suggested that the way bipolar patients respond to depressive mood impacts on the future course of the illness, with rumination prolonging depression and risk-taking possibly triggering hypomania. However, the relationship over time between variables such as mood, self-esteem, and response style to negative affect is complex and has not been directly examined in any previous study--an important limitation, which the present study seeks to address.

METHODS

In order to maximize ecological validity, individuals diagnosed with bipolar disorder (N = 48) reported mood, self-esteem and response styles to depression, together with contextual information, up to 60 times over a period of six days, using experience sampling diaries. Entries were cued by quasi-random bleeps from digital watches. Longitudinal multilevel models were estimated, with mood and self-esteem as predictors of subsequent response styles. Similar models were then estimated with response styles as predictors of subsequent mood and self-esteem. Cross-sectional associations of daily-life correlates with symptoms were also examined.

RESULTS

Cross-sectionally, symptoms of depression as well as mania were significantly related to low mood and self-esteem, and their increased fluctuations. Longitudinally, low mood significantly predicted rumination, and engaging in rumination dampened mood at the subsequent time point. Furthermore, high positive mood (marginally) instigated high risk-taking, and in turn engaging in risk-taking resulted in increased positive mood. Adaptive coping (i.e. problem-solving and distraction) was found to be an effective coping style in improving mood and self-esteem.

CONCLUSIONS

This study is the first to directly test the relevance of response style theory, originally developed to explain unipolar depression, to understand symptom changes in bipolar disorder patients. The findings show that response styles significantly impact on subsequent mood but some of these effects are modulated by current mood state. Theoretical and clinical implications are discussed.

The expression of affective temperaments in daily life

BACKGROUND

Numerous validation studies have examined the TEMPS-A in both clinical and nonclinical samples. However, the majority of these studies utilized cross-sectional assessments in laboratory or clinical settings. The present study is the first to examine the expression of affective temperaments in daily life using experience sampling methodology (ESM).

METHODS

138 participants completed the TEMPS-A and received a personalized digital assistant that signaled them eight times daily for one week to complete questionnaires that assessed affect, cognition, behavior, sense of self, and social interaction.

RESULTS

As expected, cyclothymic/irritable temperament was positively associated with negative affect, risky behavior, and restlessness, and was negatively associated with positive affect and preference to be with others in daily life. In contrast, hyperthymic temperament was associated with positive affect, fullness of thought, doing many and exciting things, grandiosity, and preference to be with others in daily life. Dysthymic temperament was modestly associated with worry, and was positively associated with trouble concentrating, fullness of thought, and a preference for social contact. Cross-level interactions indicated that cyclothymic/irritable temperament was associated with elevated stress reactivity in daily life.

LIMITATIONS

ESM data collection was limited to one week. Longer assessment periods might better capture the cyclical nature of affective temperaments.

CONCLUSIONS

This was the first study to examine affective temperaments in daily life. The findings offer further validation of the TEMPS-A, as well as the maladaptive nature of the cyclothymic/irritable temperament.

The association of affective temperaments with impairment and psychopathology in a young adult sample

BACKGROUND

Previous research has examined the association of affective temperaments, as measured by the TEMPS-A, with DSM bipolar disorders. However, the relation of the TEMPS-A with risk for bipolar disorder remains unclear. The present study examined the association of affective temperaments with psychopathology, personality, and functioning in a nonclinically ascertained sample of young adults at risk for bipolar disorder.

METHODS

One hundred forty-five participants completed the TEMPS-A, as well as interview and questionnaire measures of psychopathology, personality, and functioning.

RESULTS

Cyclothymic/irritable temperament was associated with a range of deleterious outcomes, including mood disorders and impaired functioning. It was negatively associated with agreeableness and conscientiousness, and positively associated with current depressive symptoms, neuroticism, borderline symptoms, impulsivity, and grandiosity. Dysthymic temperament was positively associated with current depressive symptoms, neuroticism and agreeableness, but was unrelated to mood psychopathology. Hyperthymic temperament was associated with bipolar spectrum disorders, hypomania or interview-rated hyperthymia, extraversion, openness, impulsivity, and grandiosity.

LIMITATIONS

The present study was cross-sectional. Longitudinal studies utilizing the TEMPS-A are needed to better understand the predictive validity of the TEMPS-A for the development of bipolar disorder.

CONCLUSIONS

Early identification of individuals who fall on the bipolar spectrum may hasten appropriate intervention or monitoring, and prevent misdiagnosis. The TEMPS-A appears to be a useful tool for assessing affective temperaments and bipolar spectrum psychopathology. The results support previous research documenting the association of cyclothymic/irritable temperament with bipolar psychopathology and other negative outcomes.