Affective temperaments across the bipolar-unipolar spectrum: examination of the TEMPS-A in 927 patients and controls

White and gray matter alterations in bipolar I and bipolar II disorder subtypes compared with healthy controls - exploring associations with disease course and polygenic risk

Patients with bipolar disorder (BD) show alterations in both gray matter volume (GMV) and white matter (WM) integrity compared with healthy controls (HC). However, it remains unclear whether the phenotypically distinct BD subtypes (BD-I and BD-II) also exhibit brain structural differences. This study investigated GMV and WM differences between HC, BD-I, and BD-II, along with clinical and genetic associations. N = 73 BD-I, n = 63 BD-II patients and n = 136 matched HC were included. Using voxel-based morphometry and tract-based spatial statistics, main effects of group in GMV and fractional anisotropy (FA) were analyzed. Associations between clinical and genetic features and GMV or FA were calculated using regression models. For FA but not GMV, we found significant differences between groups. BD-I patients showed lower FA compared with BD-II patients (ptfce-FWE = 0.006), primarily in the anterior corpus callosum. Compared with HC, BD-I patients exhibited lower FA in widespread clusters (ptfce-FWE < 0.001), including almost all major projection, association, and commissural fiber tracts. BD-II patients also demonstrated lower FA compared with HC, although less pronounced (ptfce-FWE = 0.049). The results remained unchanged after controlling for clinical and genetic features, for which no independent associations with FA or GMV emerged. Our findings suggest that, at a neurobiological level, BD subtypes may reflect distinct degrees of disease expression, with increasing WM microstructure disruption from BD-II to BD-I. This differential magnitude of microstructural alterations was not clearly linked to clinical and genetic variables. These findings should be considered when discussing the classification of BD subtypes within the spectrum of affective disorders.

TEMPS-A (short version) plays a supplementary role in the differential diagnosis between major depressive disorder and bipolar disorder

AIM

Early differential diagnosis between patients with major depressive disorder (MDD) and bipolar disorder (BD), and subsequently providing appropriate treatments are essential. There has been increased interest regarding the association between affective temperaments and mood disorder diagnosis. Our aim was to analyze the diagnostic validity of affective temperaments assessed by the short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), in mood disorder patients.

METHODS

Inpatients with MDD (n = 146) or BD (n = 128) completed the short version of TEMPS-A, and their depressive and manic symptom severities were evaluated. Data of MDD and BD patients were compared by univariable and multivariable analyses.

RESULTS

Of the five affective temperament dimensions, substantially higher hyperthymic, irritable, and cyclothymic temperament scores were found in BD patients than in MDD patients. Using a multivariable logistic regression model built using the severities of depressed and manic conditions, and the five affective temperament subscale scores as independent variables, we identified two factors statistically associated with BD diagnosis (anxious temperament and cyclothymic temperament). The recommended cutoff point for the 12 items evaluating cyclothymic temperament to differentiate BD from MDD was 8 or more 'True' items (sensitivity: 35.9%, specificity: 87.7%).

LIMITATIONS

Our design was cross-sectional, and therefore, there was a possibility of longitudinal diagnostic conversion of patients from MDD to BD.

CONCLUSION

Cyclothymic and anxious temperaments on the short version of TEMPS-A, identified as diagnostic differentiating factors between MDD and BD, may play supplementary roles in the early identification of BD.

Developmental trajectories in psychiatric disorders: does substance/alcohol use moderate the effects of affective temperaments as moderators of age at onset? A study in post-acute, hospitalized patients with psychotic or DSM-5 bipolar or major depressive disorders

BACKGROUND

Age-at-onset (AAO) affects psychiatric disorder outcome; substance (SUDs) or alcohol use disorders (AUDs) may influence their onset. Affective temperaments may affect early AAO and drug-use proneness. Objectives: To investigate whether SUD/AUD moderated temperamental effects in determining AAO of mental disorders. Methods: We included 300 post-acute inpatients with schizophrenia-spectrum and other psychotic (SSOPDs), major depressive (MDD) or bipolar (BD) disorders (168 men; mean age, 40.63 years ± 11.82 men, 43.21 years ± 12.69 women) with (N = 110) or without (N = 190) SUD/AUD. Patients completed cross-sectionally TEMPS-A. We carried moderation analysis with each regression-significant TEMPS temperament as independent variable, SUD/AUD presence/absence as dichotomous moderator, and AAO as dependent variable. Significance was set at p < 0.05. Results: AAO was lower in patients with SUD/AUD diagnosis than in patients without (23.74 ± 10.09 vs. 27.73 ± 10.35, respectively, p = 0.001, η2 = 0.034). SUD/AUD patients scored higher on the hyperthymic (10.22 ± 4.08, p < 0.001, η2 = 0.069) and irritable (8.26 ± 4.69, p < 0.01, η2 = 0.026) temperaments than nonSUD/AUD patients. Moderation analysis showed only direct effects of irritable (β = -0.55, p < 0.005) and hyperthymic (β = -0.95, p < 0.001) temperaments on AAO and no significant SUD/AUD and interaction effects. Limitations. Cross-sectional design. Conclusions: When irritable and hyperthymic traits prevail over other temperaments, AAO is earlier in SSOPDs, MDD, and BD. SUD/AUD presence/absence does not moderate the relationship between temperament and AAO.

Utility of TEMPS-A in differentiation between major depressive disorder, bipolar I disorder, and bipolar II disorder

Background

The association between temperament characteristics and mood disorders has gained much attention in recent years. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) is a self-rating scale measuring 5 affective temperament dimensions. In this study, we aimed to clarify whether each affective temperament of TEMPS-A is a differentiating factor between major depressive disorder (MDD), bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and analyzed the utility of TEMPS-A in their differential diagnosis in a clinical setting.

Methods

A total of 346 patients (MDD, n = 176; BD-II, n = 112; BD-I, n = 58) filled out TEMPS-A. To assess the patients’ mood state at the time of temperament assessment, Patient Health Questionnaire-9 (PHQ-9) and Young Mania Rating Scale (YMRS) were also conducted.

Results

Multivariate logistic regression analysis demonstrated that cyclothymic and anxious temperament scores were significant factors differentiating the diagnosis of BD-I and BD-II from the diagnosis of MDD, and hyperthymic temperament score was a specific factor for the differential diagnosis of BD-I versus the diagnosis of BD-II.

Limitations

All of the patients included in our study received treatment in large general hospitals. Because the nature of the present study was cross-sectional, some MDD subjects in this study might have unrecognized BD-I/BD-II.

Conclusions

Cyclothymic and anxious temperament scores assessed by TEMPS-A might enable differentiation between MDD and BD, and hyperthymic temperament score on TEMPS-A might be useful in distinguishing between BD-I and BD-II.

Postpartum psychosis in bipolar disorder: no evidence of association with personality traits, cognitive style or affective temperaments

BACKGROUND

Bipolar disorder has been associated with several personality traits, cognitive styles and affective temperaments. Women who have bipolar disorder are at increased risk of experiencing postpartum psychosis, however little research has investigated these traits and temperaments in relation to postpartum psychosis. The aim of this study is to establish whether aspects of personality, cognitive style and affective temperament that have been associated with bipolar disorder also confer vulnerability to postpartum psychosis over and above their known association with bipolar disorder.

METHODS

Personality traits (neuroticism, extraversion, schizotypy and impulsivity), cognitive styles (low self-esteem and dysfunctional attitudes) and affective temperaments (including cyclothymic and depressive temperaments) were compared between two groups of parous women with DSM-IV bipolar I disorder: i) 284 with a lifetime history of postpartum psychosis within 6 weeks of delivery (PP group), ii) 268 without any history of mood episodes with onset during pregnancy or within 6 months of delivery (no perinatal mood episode, No PME group).

RESULTS

After controlling for current mood state, and key demographic, clinical and pregnancy-related variables, there were no statistically significant differences between the PP and No PME groups on any of the personality, cognitive style or affective temperament measures.

CONCLUSIONS

Personality traits, cognitive styles and affective temperaments previously shown to be associated with bipolar disorder in general were not specifically associated with the occurrence of postpartum psychosis. These factors may not be relevant for predicting risk of postpartum psychosis in women with bipolar disorder.

Temperament and Character Inventory in Bipolar Disorder versus Healthy Controls and Modulatory Effects of 3 Key Functional Gene Variants

BACKGROUND

Bipolar disorder (BD) has been associated with temperamental and personality traits, although the relationship is still to be fully elucidated. Several studies investigated the genetic basis of temperament and character, identifying catechol-O-methyltransferase (COMT), brain derived neurotrophic factor (BDNF), and serotonin transporter (5-HTT) gene variants as strong candidates.

METHODS

In the GECO-BIP study, 125 BD patients and 173 HC were recruited. Subjects underwent to a detailed assessment and the temperament and character inventory 125 items (TCI) was administrated. Three functional genetic variants within key candidate genes (COMT rs4680, BDNF rs6265, and the serotonin-transporter-linked polymorphic region (5-HTTLPR)) were genotyped. Univariate and multivariate analyses were performed.

RESULTS

Compared to HC, BD patients showed higher scores in novelty seeking (NS; p = 0.001), harm avoidance (HA; p < 0.001), and self transcendence (St; p < 0.001), and lower scores in self directness (p < 0.001) and cooperativeness (p < 0.001) TCI dimensions. Concerning the genetic analyses, COMT rs4680 was associated with NS in the total sample (p = 0.007) and in the male subsample (p = 0.022). When performing the analysis in the HC and BD samples, the association was confirmed only in HC (p = 0.012), and in the HC male subgroup in particular (p = 0.004). BDNF rs6265 was associated with St in the BD group (p = 0.017).

CONCLUSION

COMT rs4680 may modulate NS in males in the general population. This effect was not detected in BD patients, probably because BD alters the neurobiological basis of some TCI dimensions. BDNF rs6265 seems to modulate St TCI dimension only in BD patients, possibly modulating the previously reported association between rs6265 and BD treatment response. Further studies are needed to confirm our findings.

Phenotypical characteristics of postpartum psychosis: A clinical cohort study

OBJECTIVES

Postpartum psychosis (PP) is known for its clear onset but its phenotype has never been clearly described in a cohort. The aim of this study was to describe PP symptomatology, and to identify subgroups of patients based on symptom profiles.

METHODS

We prospectively assessed a wide range of symptoms in cases of PP in a cohort of women (N=130) admitted to the Mother-Baby inpatient unit. Using a person-centered analytic approach, we distinguished mutually exclusive subgroups of women. Subgroups were related to demographic and clinical characteristics.

RESULTS

The most prevalent symptoms of PP were irritability (73%), abnormal thought content (72%), and anxiety (71%). Suicidal and infanticidal ideation was present in 19% and 8% of patients, respectively. Delusions and hallucinations often had a negative content. Latent class analysis revealed three symptom profiles, a manic (34%), depressive (41%) and atypical (25%) profile, respectively. The manic profile is characterized by manic symptoms and agitation, the depressive profile by depressive and anxiety symptoms, and the atypical profile by disturbance of consciousness and disorientation. In women with a depressive profile, treatment was started 2 weeks later (P=.049), and more often voluntarily, than in manic and atypical women (P=.037).

CONCLUSIONS

We distinguished subgroups of PP patients with a manic, depressive, and atypical profile. Disturbance of consciousness, disorientation, and depersonalization/derealization were less prevalent than previously suggested in the literature. Instead, the depressive profile was the most prevalent, but the depressive profile can easily remain undetected, which could lead to treatment delay and risk of suicide/infanticide. Within the manic profile, irritability was highly prevalent and occurred more often than elevated mood.

A comparative meta-analysis of TEMPS scores across mood disorder patients, their first-degree relatives, healthy controls, and other psychiatric disorders

BACKGROUND

The Temperament Evaluation Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS) is validated to assess temperament in clinical and non-clinical samples. Scores vary across bipolar disorder (BD), major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), borderline personality disorder (BPD) and healthy controls (HCs), but a meta-analysis is missing.

METHODS

Meta-analysis of studies comparing TEMPS scores in patients with mood disorders or their first-degree relatives to each other, or to a psychiatric control group or HCs.

RESULTS

Twenty-six studies were meta-analyzed with patients with BD (n= 2025), MDD (n=1283), ADHD (n=56) and BPD (n=43), relatives of BD (n=436), and HCs (n=1757). Cyclothymic (p<0.001) and irritable TEMPS scores (p<0.001) were higher in BD than MDD (studies=12), and in MDD vs HCs (studies=8). Cyclothymic (p<0.001), irritable (p<0.001) and anxious (p=0.03) scores were higher in BD than their relatives, who, had higher scores than HCs. No significant differences emerged between ADHD and BD (studies=3);

CONCLUSION

Affective temperaments are on a continuum, with increasing scores ranging from HCs through MDD to BD regarding cyclothymic and irritable temperament, from MDD through BD to HC regarding hyperthymic temperament, and from HC through BD relatives to BD regarding cyclothymic, irritable and anxious temperament. Depressive and anxious temperaments did not differ between BD and MDD, being nonetheless the lowest in HCs. BD did not differ from ADHD in any investigated TEMPS domain.

LIMITATIONS

Different TEMPS versions, few studies comparing BD with ADHD or BPD, no correlation with other questionnaires.

Comparative analysis of affective temperament in patients with difficult-to-treat and easy-to-treat major depression and bipolar disorder: Possible application in clinical settings

BACKGROUND

Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder.

METHODS

Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis.

RESULTS

Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively.

CONCLUSIONS

MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.

Relationships between chronotypes and affective temperaments in healthy young adults

BACKGROUND

Chronotype, an individual׳s preferred time for activity and sleep, has been known to be associated with affective disorders. Affective temperaments may be subclinical manifestations that represent a biological diathesis for affective disorders. Therefore, the aim of this study is to investigate the relationships between circadian preferences and affective temperaments.

METHODS

Six hundred and forty one healthy young adults (376 male, 265 female) completed the Korean Translation of Composite Scale of Morningness to measure diurnal preferences and the Temperament Scale of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A) to measure cyclothymic, depressive, hyperthymic, irritable, and anxious affective temperaments. Multivariate analyses of covariance were computed with the five affective temperaments as dependent variables, chronotype and gender as an independent variable, and age as a covariate.

RESULTS

One hundred and sixteen subjects were classified as having morning-type (18.1%), 402 as intermediate-type (62.7%), and 123 as evening-type (19.2%) circadian preferences. Evening-type was significantly associated with greater depressive, cyclothymic, irritable, and anxious temperaments, while morning-type was significantly associated with hyperthymic temperament.

LIMITATIONS

The present study only used self-report questionnaires to measure diurnal preference.

CONCLUSIONS

Evening-type subjects were more likely to have depressive, cyclothymic, irritable and anxious temperaments, whereas morning-types were more likely to have hyperthymic temperament. This relationship between chronotype and affective temperament might be important for vulnerability to affective disorders.

Validation of the Chinese Version of the Short TEMPS-A and its application in patients with mood disorders

BACKGROUND

The short version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) is a useful instrument to measure affective temperaments. Aims of the present study are to validate the Chinese Version of the Short TEMPS-A, and to explore whether it could be useful to distinguish patients with mood disorders from healthy controls or differentiate patients with bipolar disorder (BPD) from those with major depressive disorder (MDD) in Chinese population.

METHODS

A sample of 715 participants, including 387 patients with MDD, 143 with BPD and 185 healthy controls, was recruited. All participants completed The Chinese Version of the Short TEMPS-A. Standard psychometric tests of reliability and validation were performed. ANOVA, non-parameter test and Multiple Logistic Regression were used to test the association between TEMPS-A scores and mood disorders.

RESULTS

The originally proposed five factors of the Chinese Version of the Short TEMPS-A were upheld. The Chronbach-Alpha coefficients of it varied from 0.70 to 0.89 and test-retest Spearman׳s Correlation Coefficients varied from 0.52 to 0.85. Significant differences were found across the three groups on all five TEMPS-A subscales (P<0.001). Multiple Logistic Regression showed that hyperthymic temperament distinguished patients with BPD from those with MDD (OR 1.28, 95% CI 1.14-1.45, P<0.001) after controlling for age, gender and the severity of depression.

LIMITATIONS

The cross-sectional self-report design, unbalanced demographic characteristics and undifferentiated subtypes of bipolar disorders might limit the generalizability of the results.

CONCLUSION

The Chinese Version of the Short TEMPS-A shows good reliability and validity. It might be used as a screening tool in the general population to identify the vulnerability for developing a mood disorder and the potential risk for bipolar disorder among those who only have depressive symptoms.

Affective temperament profiles and clinical correlates in patients with epilepsy: a link from mood disorders

BACKGROUND

The current study sought to investigate the affective temperaments of patients with epilepsy and possible relationships between disease characteristics and temperament profiles.

METHODS

A total of 70 adults with epilepsy and 70 healthy volunteers completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A).

RESULTS

Patients with epilepsy had higher scores on these three scales than healthy controls. With respect to temperaments, irritable temperament alone was significantly higher in patients than controls. Irritable temperament also had a significant positive correlation with psychiatric history, whereas depressive temperament had a significant positive correlation with illness and treatment duration. Patients who had suffered simple partial and complex partial seizures had higher anxious temperament scores than patients with generalized epilepsy.

LIMITATIONS

Because the study group was recruited through consecutive patients seen in a single neurology clinic, our findings may not be representative of PWE in general.

CONCLUSIONS

Because irritability is one of the key symptoms of interictal dysphoric disorder and because TEMPS-A irritable temperament and BDI scores were found to be significantly related, the high rate of irritable temperament in our patient sample may be associated with depressive mood. We may suggest that at least some of the affective symptoms in patients with epilepsy and the historical concept of "epileptic personality" may be explained by affective temperaments.

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.

Affective temperaments in alcohol and opiate addictions

Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.05-1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95% CI 1.36-7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95% CI 0.42-0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.

Affective temperaments: unique constructs or dimensions of normal personality by another name?

BACKGROUND

Current models theorize that affective temperaments underlie the development and expression of mood psychopathology. Recent studies support the construct validity of affective temperaments in clinical and non-clinical samples. However, one concern is that affective temperaments may be describing characteristics that are better captured by models of normal personality. We conducted two studies examining: (a) the association of affective temperaments with domains and facets of normal personality, and (b) whether affective temperaments accounted for variance in mood symptoms and disorders, impairment, and daily-life experiences over-and-above variance accounted for by normal personality.

METHODS

Study 1 included 522 young adults who completed the TEMPS-A and the NEO-PI-3. Study 2 included 145 participants who were administered the TEMPS-A, NEO-FFI, interviews assessing psychopathology and impairment, and an assessment of daily life experiences.

RESULTS

Study 1 revealed that personality domains and facets accounted for one-third to one-half of the variance in affective temperaments. However, study 2 demonstrated that affective temperaments accounted for unique variance in measures of psychopathology, impairment, and daily-life experiences after partialling variance associated with personality domains. Specifically, cyclothymic/irritable temperament predicted bipolar disorders, impairment, borderline personality traits, urgency, and anger in daily life. Hyperthymic temperament predicted hypomanic episodes, grandiosity, sensation seeking, and increased activity in daily life.

LIMITATIONS

The study was limited by the fact that only domain, not facet-level, measures of FFM were available in study 2.

CONCLUSIONS

The findings support the validity of hyperthymic and cyclothymic/irritable temperaments as indicators of clinical psychopathology and indicate that they provide information beyond normal personality.

Heritability and genome-wide SNP linkage analysis of temperament in bipolar disorder

BACKGROUND

The many attempts to identify genes for bipolar disorder (BD) have met with limited success, which has generally been attributed to genetic heterogeneity and small gene effects. However, it is also possible that the categorical phenotypes used in genetic studies of BD are not the most informative or biologically relevant. We have explored aspects of temperament as quantitative phenotypes for BD through the use of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A), which is designed to assess lifelong, milder aspects of bipolar symptomatology and defines five temperaments: hyperthymic, dysthymic, cyclothymic, irritable, and anxious.

METHODS

We compared temperament scores between diagnostic groups and assessed heritability in a sample of 101 families collected for genetic studies of BD. A genome-wide SNP linkage study was then performed in the subset of 51 families for which genetic data was available.

RESULTS

Significant group differences were observed between BD subjects, their first-degree relatives, and independent controls, and all five temperaments were found to be significantly heritable, with heritabilities ranging from 21% for the hyperthymic to 52% for the irritable temperaments. Suggestive evidence for linkage was observed for the hyperthymic (chromosomes 1q44, 2p16, 6q16, and 14q23), dysthymic (chromosomes 3p21 and 13q34), and irritable (chromosome 6q24) temperaments.

LIMITATIONS

The relatively small size of our linkage sample likely limited our ability to reach genome-wide significance in this study.

CONCLUSIONS

While not genome-wide significant, these results suggest that aspects of temperament may prove useful in the identification of genes underlying BD susceptibility.

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.

Psychometric properties of the Slovenian version of temperament evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A): temperament profiles in Slovenian university students

BACKGROUND

TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a self-rated instrument that measures five affective temperaments: depressive, cyclothymic, hyperthymic, irritable, and anxious. The aim of our study was to examine the psychometric characteristics of the Slovenian TEMPS-A and to ascertain if temperament profile is related to the professions chosen by Slovenian students.

METHODS

892 Slovenian university students in six different professional fields (economics, geography, engineering, law, sports pedagogy and nursing) were included in our study.

RESULTS

Cronbach's reliability coefficients denoted acceptable internal consistency of the subscales. Principal component analysis revealed relatively good internal structure of the instrument. Nursing and geography students scored the highest on depressive temperament. Sports pedagogues as well as engineers demonstrated the most firm personality structure with distinctive hyperthymic temperament. Law students revealed the most irritable temperament, while nursing and law students scored the highest on anxious temperament.

LIMITATIONS

Sample of Slovenian students is not representative for general population. The structure of the sample was crucial as well, as it comprised mainly of younger students who just started their study.

CONCLUSIONS

The Slovenian version of the TEMPS-A proved to have relatively good internal consistency and internal structure. The questionnaire verified as a reliable and valid instrument and generally in line with previous studies. This study strengthens the perspective that professional areas could be associated with distinct affective temperament profile that could influence career decisions. The findings in students of economics, geography, and sport pedagogy are new as they have not been previously investigated by TEMPS researchers. The results open new possibilities for future research.

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.

Cyclothymia

Over the last three decades, cyclothymia has been positioned in one of two principal ways: formally classified as a mood disorder, and less formally categorized at a "cyclothymic temperament" (CT) level. This review considers its historic evolution and provides five models for conceptualizing independence or interdependence between cyclothymia as a temperament style and as a formal mood disorder. Findings argue for CT to be conceded and appropriately defined. Secondly, it is recommended that cyclothymia's expression as a mood disorder should be positioned within the bipolar II disorder class-albeit perhaps having briefer mood swings and fewer episodes, more rapid cycling, and greater reactivity to environmental factors than is conceptualized currently for bipolar II disorders. By allowing cyclothymia both axis I and axis II status (although necessitating differing terminology), research evaluating any shared biological underpinnings and any predisposition provided by the CT temperament style to a later formalized bipolar II condition would be advanced.

Temperaments mediate suicide risk and psychopathology among patients with bipolar disorders

BACKGROUND

Several studies have demonstrated that bipolar II (BD-II) disorder represents a quite common, distinct form of major mood disorders that should be separated from bipolar I (BD-I) disorder. The aims of this cross-sectional study were to assess temperament and clinical differences between patients with BD-I and BD-II disorders and to assess whether temperament traits are good predictors of hopelessness in patients with bipolar disorder, a variable highly associated with suicidal behavior and ideation.

METHOD

Participants were 216 consecutive inpatients (97 men and 119 women) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), BD who were admitted to the Sant'Andrea Hospital's psychiatric ward in Rome (Italy). Patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego--Autoquestionnaire, the Beck Hopelessness Scale (BHS), the Mini International Neuropsychiatric Interview (MINI), and the Gotland Scale of Male Depression.

RESULTS

Patients with BD-II had higher scores on the BHS (9.78 ± 5.37 vs 6.87 ± 4.69; t(143.59) = -3.94; P < .001) than patients with BD-I. Hopelessness was associated with the individual pattern of temperament traits (ie, the relative balance of hyperthymic vs cyclothymic-irritable-anxious-dysthmic). Furthermore, patients with higher hopelessness (compared with those with lower levels of hopelessness) reported more frequently moderate to severe depression (87.1% vs 38.9%; P < .001) and higher MINI suicidal risk.

CONCLUSION

Temperaments are important predictors both of suicide risk and psychopathology and may be used in clinical practice for better delivery of appropriate care to patients with bipolar disorders.

Prospective predictors of mood episodes in bipolar disorder

BACKGROUND

: Bipolar disorder (BD) is associated with alterations in mood, personality, cognition and event-related potential (ERP) measures. The relationship between these multidimensional measures of state and subsequent course of the illness is not well understood. Therefore, this study aimed to prospectively identify factors that predicted the course of mood episodes.

METHODS

: Sixty-five participants with BD were administered the auditory P300 oddball task, clinical assessment instruments and cognitive tests at baseline, and were subsequently administered the SCID interview once a month by telephone for 12 months.

RESULTS

: Hierarchical regression analyses indicated that the Montgomery-Asberg Depression Rating Scale (MADRS) predicted the number of months spent in a depressed state (p<.001) and in a mixed state (p=.001), while both the MADRS (p<.001) and time to complete Trails A (p=.033) predicted total number of months in a mood episode (across all mood states). Among euthymic patients at entry, Cox regression analyses indicated that higher ratings on both the MADRS (p=.017) and Hypomanic Personality Scale (HPS; p<.001) were associated with both increased likelihood of a mood episode and less time until the onset of a mood episode.

LIMITATIONS

: The sample size is relatively small, not all participants completed 12 months, and follow-up assessments were conducted via telephone.

CONCLUSIONS

: Our results suggest that affective and cognitive measures, and personality factors, especially the MADRS and HPS, serve as important predictors of the course of mood episodes or relapse in BD patients. These prospective markers of acute mood states may be used to guide treatment decisions.

Personality traits in bipolar disorder type I: a sib-pair analysis

OBJECTIVE

The aim of this study was to compare temperament and character traits among patients with bipolar disorder (BD), their siblings, and healthy controls (HCs) in order to examine whether personality traits are related to the genetic vulnerability to develop BD.

METHODS

Using the Temperament and Character Inventory, we assessed 204 subjects: 67 euthymic outpatients with bipolar disorder type I, 67 siblings without BD, and 70 HCs.

RESULTS

Scores on harm avoidance, novelty seeking, and self-transcendence were significantly higher among patients with BD than among HCs, whereas those on self-directedness and cooperativeness were significantly lower. Siblings showed higher scores on harm avoidance and lower scores on self-directedness than did HCs. As some of the siblings presented at least one lifetime psychiatric disorder other than BD (n = 35), we examined the subset of siblings who had no lifetime psychiatric disorder (n = 32). This group showed statistically higher harm avoidance scores than HCs.

CONCLUSIONS

Our results suggest that the harm avoidance temperament trait and, to a lesser extent, the self-directedness character trait may represent vulnerability factors for BD.

Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients

BACKGROUND

Recent studies have suggested that clinicians may under diagnose bipolarity in a substantial proportion of depressive patients, and proposed that affective temperaments particularly cyclothymic temperament (CT), may predict bipolarity in these patients. The objectives of this study were to assess CT in patients with recurrent depressive disorder (RDD) and to explore its associations with clinical predictors of bipolarity.

METHODS

98 patients (43 men and 55 women, mean age=46.8±9.9years), followed for RDD according to DSM-IV-TR criteria, were recruited. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale with the threshold score of 10/21.

RESULTS

The mean score of CT was 6.5±5.2. One-third of patients (33.7%) had a CT score ≥10. These patients with high CT scores had significantly early age at onset of first depressive episode and high number of previous depressive episodes, and had more psychotic and melancholic features and suicidal ideations and attempts during the last depressive episode compared to patients with low CT scores. The multiple regression analysis showed an association between CT scores and psychotic, melancholic and atypical features and suicide attempts during the last depressive episode.

LIMITATIONS

This is a cross-sectional study with a relatively small number of patients. The Tunisian version of the CT subscale was not yet validated.

CONCLUSIONS

CT was associated with some clinical predictive factors of bipolarity. These results suggest the relevance of the CT screening in RDD, considering the change of polarity risk and misdiagnosis of unipolar depression.

Emotional modulation of response inhibition in stable patients with bipolar I disorder: a comparison with healthy and schizophrenia subjects

OBJECTIVES

Bipolar disorder (BD) has been associated with impairment in affective processing during depressive and manic states; however, there are limited data as to whether this population exhibits such difficulty during stable periods. We examined the pattern of affective processing in stable BD patients and compared their profile to that of healthy controls (HC) and patients diagnosed with schizophrenia (SZ).

METHODS

A total of 336 subjects were administered an Affective Go/No-go test to evaluate target detection of negatively valenced, positively valenced, and neutral stimuli. Accuracy and response bias served as dependent variables in a series of multivariate analyses of covariance to test for group differences.

RESULTS

The BD group relative to the HC group exhibited response biases toward negatively valenced information (p<0.01). Deficits were also evident in discrimination of and accurate responses to positively valenced information in the BD group versus the HC group (p<0.05). In contrast to the controls, the SZ group performed poorly on all task components and was less accurate across all conditions regardless of affective valence (p<0.01). Patients with SZ evidenced reverse biases for positive information, as they were less likely to respond to positive words (p<0.05) despite comparable response bias on neutral and negative conditions.

CONCLUSIONS

Affective processing impairment evident in BD is a feature of the disorder that is present even during stable periods. Prior studies comparing BD with SZ have highlighted clear quantitative but inconsistent qualitative differences in cognitive functioning. Our data suggest that a response bias toward negative stimuli may be a critical and relatively specific feature of BD.

Clinical endophenotypes for bipolar disorder

Although twin, family, and adoption studies demonstrate that bipolar disorder (BPD) is substantially heritable, the molecular genetic basis for this illness remains elusive. Given evidence that genes predisposing to BPD may be transmitted without expression of the clinical phenotype, interest has arisen in developing endophenotypes - indicators of processes mediating between genotype and phenotype. Patients with BPD have subtle neuropsychological abnormalities, even during periods of symptom remission. Some of these neurocognitive deficits are present in unaffected family members of probands with BPD, suggesting that these measures may be quantitative endophenotypes for the disorder. Similarly, BPD is associated with specific personality traits (e.g., reduced inhibition, increased risk-taking) that have been observed in both affected individuals and their family members. In this chapter, we review the evidence for candidate neurocognitive and personality endophenotypes for BPD. We conclude that neurocognitive and personality traits appear to be appropriate endophenotypes for BPD, suggesting that these measures share some genetic factors with the illness.

[Temperament traits associated with bipolar affective disorder: an integrative literature review]

Studies have suggested an association between temperament characteristics and adjustment and psychiatric disorders, describing them as different manifestations of vulnerability to psychopathology. The objective of this study was to conduct an integrative review of the literature on temperament traits typical of bipolar patients in relation to the general population. A systematic search was conducted on the MEDLINE, PsycINFO and LILACS databases, using the headings bipolar disorder, temperament and/or personality, between January 2000 and December 2010. The search was performed in January 2011. A total of 199 articles were identified for potential inclusion in the review. After application of the exclusion criteria, a total of 15 articles were selected and their full texts analyzed. Review of the selected studies revealed heterogeneity in terms of sample profile and specific temperament traits assessed with the appropriate instruments. Temperament traits in bipolar patients are identified based on different theoretical models. The results of five studies consistently showed that neuroticism is a distinct personality trait in the temperament profile of bipolar patients. Future reviews should use more specific keywords and limit the search to studies with a longitudinal design.

The link between bipolar disorders and creativity: evidence from personality and temperament studies

Although extensive literature supports connections between bipolar disorder and creativity, possible mechanisms underlying such relationships are only beginning to emerge. Herein we review evidence supporting one such possible mechanism, namely that personality/temperament contribute to enhanced creativity in individuals with bipolar disorder, a theory supported by studies showing that certain personality/temperamental traits are not only common to bipolar disorder patients and creative individuals but also correlate with measures of creativity. Thus, we suggest based on studies using three important personality/temperament measures-the Neuroticism, Extraversion, and Openness Personality Inventory (NEO); the Myers-Briggs Type Indicator (MBTI); and the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A)-that changeable (increased TEMPS-A-cyclothymia) and at times negative (increased NEO-neuroticism) affect and open-minded (increased NEO-openness) and intuitive (increased MBTI-intuition) cognition may contribute importantly to enhanced creativity in individuals with bipolar disorder.