1
|
Şair YB, Saraçoğlu İ. Exploring the role of affective temperaments: predicting major depressive disorder in the context of borderline personality disorder. Postgrad Med 2024; 136:764-769. [PMID: 39279553 DOI: 10.1080/00325481.2024.2402210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE Major depressive disorder (MDD) is a complex condition believed to arise from a multifaceted interplay of genetic, environmental, and biological factors. In the pursuit of understanding its etiology, two elements that warrant investigation are borderline personality disorder (BPD) and affective temperaments. We aim to gain deeper insights into the mechanisms underlying this debilitating mental health condition. METHOD The dataset comprises individuals who sought assistance from psychiatry outpatient clinics for diverse reasons during the period spanning from 2018 to 2022. These individuals underwent SCID-II assessments to diagnose borderline personality disorder (BPD) and also completed the TEMPS-A temperament tests. RESULTS The mean years of schooling was lower in the MDD group (p = 0.014). Two groups are compared in terms of affective temperament. Depressive (p < 0.0001), cyclothymic (p < 0.0001), anxious (p = 0.001), and irritable (p < 0.0001) temperament scores were statistically higher in the MDD group. Apart from the scale scores, the prevalence of affective temperament was evaluated and the same temperaments (depressive (p < 0.0001), cyclothymic (p < 0.0001), anxious (p = 0.001), and irritable (p < 0.0001)) were found to be significantly higher in the MDD group. Diagnosis of BPD is higher in the MDD group (p = 0.002). Binary logistic regression analysis revealed that the presence of cyclothymic temperament and marital status may be predictor factors for the development of MDD (p < 0.0001, CI: 0.001-0.121 and p = 0.002, CI: 1.550-7.172, respectively). CONCLUSION Notably, higher scores in cyclothymic temperament and experiencing loneliness have been identified as significantly associated with MDD. Interestingly, in patients with comorbid BPD-MDD, the presence of cyclothymic temperament appears to be a more critical factor than personality traits. This finding underscores the potential role of cyclothymic temperament in contributing to the co-occurrence of BPD and MDD.
Collapse
Affiliation(s)
- Yaşan Bilge Şair
- Psychiatry Department, Adnan Menderes University Hospital, Aydın, Turkey
| | - İrem Saraçoğlu
- Psychiatry Department, Adnan Menderes University Hospital, Aydın, Turkey
- Psychıatry department, Agrı Egitim ve Arastırma Hastanesi, Agrı, Turkey
| |
Collapse
|
2
|
Mauer S, Ghazarian G, Ghaemi SN. Affective Temperaments Misdiagnosed as Adult Attention Deficit Disorder: Prevalence and Treatment Effects. J Nerv Ment Dis 2023; 211:504-509. [PMID: 37040539 DOI: 10.1097/nmd.0000000000001626] [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: 04/13/2023]
Abstract
ABSTRACT Adult attention-deficit disorder (ADD) is a common diagnosis, and amphetamine medications are increasingly used. Recent reports suggest high prevalence of affective temperaments, such as cyclothymia, in adult ADD. This study reexamines prevalence rates as reflecting misdiagnosis and reports for the first time on the effects of amphetamine medications on mood/anxiety and cognition in relation to affective temperaments. Among outpatients treated at the Tufts Medical Center Mood Disorders Program (2008-2017), 87 cases treated with amphetamines were identified, versus 163 non-amphetamine-treated control subjects. Using the Temperament Scale of Memphis, Pisa, Paris and San Diego-Autoquestionnaire, 62% had an affective temperament, most commonly cyclothymia (42%). In amphetamine-treated cases, mood/anxiety symptoms worsened notably in 27% ( vs. 4% in the control group, risk ratio [RR] 6.2, confidence interval [CI], 2.8-13.8), whereas 24% had moderate improvement in cognition ( vs. 6% in the control group; RR, 3.93; CI, 1.9-8.0). Affective temperaments, especially cyclothymia, are present in persons about one-half of persons diagnosed with adult ADD and/or treated with amphetamines.
Collapse
Affiliation(s)
- Sivan Mauer
- Department of Psychiatry, Tufts University Medical School
| | - Garo Ghazarian
- Department of Psychiatry, Tufts University Medical School
| | | |
Collapse
|
3
|
Ghaemi SN, Angst J, Vohringer PA, Youngstrom EA, Phelps J, Mitchell PB, McIntyre RS, Bauer M, Vieta E, Gershon S. Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity. Int J Bipolar Disord 2022; 10:23. [PMID: 36227452 DOI: 10.1186/s40345-022-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the 1970 s, scientific research on psychiatric nosology was summarized in Research Diagnostic Criteria (RDC), based solely on empirical data, an important source for the third revision of the official nomenclature of the American Psychiatric Association in 1980, the Diagnostic and Statistical Manual, Third Edition (DSM-III). The intervening years, especially with the fourth edition in 1994, saw a shift to a more overtly "pragmatic" approach to diagnostic definitions, which were constructed for many purposes, with research evidence being only one consideration. The latest editions have been criticized as failing to be useful for research. Biological and clinical research rests on the validity of diagnostic definitions that are supported by firm empirical foundations, but critics note that DSM criteria have failed to prioritize research data in favor of "pragmatic" considerations. RESULTS Based on prior work of the International Society for Bipolar Diagnostic Guidelines Task Force, we propose here Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC-BP) for use in research studies, with the hope that these criteria may lead to further refinement of diagnostic definitions for other major mental illnesses in the future. New proposals are provided for mixed states, mood temperaments, and duration of episodes. CONCLUSIONS A new CRDC could provide guidance toward an empirically-based, scientific psychiatric nosology, and provide an alternative clinical diagnostic approach to the DSM system.
Collapse
Affiliation(s)
- S Nassir Ghaemi
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA. .,Department of Psychiatry, Harvard Medical School, Boston, USA.
| | | | - Paul A Vohringer
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA.,Department of Psychiatry, University of Chile, Santiago, Chile
| | - Eric A Youngstrom
- Departments of Psychology, Neuroscience, and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - James Phelps
- Department of Psychiatry, Good Samaritan Regional Medical Center, Corvallis, OR, USA
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuel Gershon
- Department of Psychiatry, University of Miami, Miami, USA
| |
Collapse
|
4
|
Mauer S, de Siqueira ASS, Borges MK, Biella MM, Voshaar RCO, Aprahamian I. Relationship between affective temperament and major depressive disorder in older adults: A case-control study. J Affect Disord 2020; 277:949-953. [PMID: 33065837 DOI: 10.1016/j.jad.2020.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/27/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. METHODS A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. RESULTS In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1-7.2). LIMITATIONS The sample was relatively small, and their educational level was very low. CONCLUSION A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.
Collapse
Affiliation(s)
- Sivan Mauer
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Department of Psychiatry, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
| | | | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| |
Collapse
|
5
|
Mauer S. The relationship between affective temperament and remission. Bipolar Disord 2020; 22:537. [PMID: 32558005 DOI: 10.1111/bdi.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sivan Mauer
- Tufts Medical Center, Department of Psychiatry, Boston, MA, USA
| |
Collapse
|
6
|
Silva RDAD, Mograbi DC, Camelo EVM, Amadeo LN, Santana CMT, Landeira-Fernandez J, Cheniaux E. The relationship between insight and affective temperament in bipolar disorder: an exploratory study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:210-215. [PMID: 30304117 DOI: 10.1590/2237-6089-2017-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/29/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far. OBJECTIVE To evaluate the relationship between affective temperament and insight in bipolar disorder. METHOD A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales. RESULTS In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder. CONCLUSION In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.
Collapse
Affiliation(s)
- Rafael de Assis da Silva
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Daniel C Mograbi
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Evelyn V M Camelo
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luiza Nogueira Amadeo
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Cristina M T Santana
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | | | - Elie Cheniaux
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
7
|
Ghaemi SN, Dalley S, Catania C, Barroilhet S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand 2014; 130:99-108. [PMID: 24571137 DOI: 10.1111/acps.12257] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the empirical literature on diagnostic validators in borderline personality and bipolar illness. METHOD Using principles of evidence-based medicine, the highest levels of evidence were emphasized in interpretation of similarities or differences between bipolar illness and borderline personality on the five standard diagnostic validators in psychiatric nosology: symptoms, course, genetics, treatment response, and neurobiology. RESULTS Bipolar illness and borderline personality were found to be similar in the nosological validator of symptoms of mood lability and impulsivity, but differed notably on all other diagnostic validators, especially the course validator of past sexual abuse and the genetic validator of a bipolar family history. They also differ notably in the symptom validator of parasuicidal self-harm. Treatment response and neurobiological differences were also present and consistent. CONCLUSION This review of the literature indicates that these two conditions, bipolar illness and borderline personality, are different and can be distinguished. The much stronger biological and genetic evidence for bipolar illness in particular suggests that the two conditions can be reasonably seen as different kinds of clinical entities, namely a biological disease versus a psychosocially caused clinical picture. If this interpretation is correct, similarities between the two conditions, such as mood lability and impulsivity, are superficial, while differences are profound. Further, true comorbidity may be much less common than often presumed.
Collapse
Affiliation(s)
- S N Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | | | | | | |
Collapse
|
8
|
Abstract
OBJECTIVE This review aims to address concerns about the potential overinclusiveness and vagueness of bipolar spectrum concepts, and also, concerns about the overlap between bipolar illness and borderline personality. METHOD Narrative review based on historical and empirical studies. RESULTS Bipolar disorder (BD) and major depressive disorder (MDD) came to be separate entities with the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III), in contrast to the Kraepelinian manic-depressive insanity (MDI) concept, which included both. The bipolar spectrum concept is a return to this earlier Kraepelinian perspective. Further, very different features differentiate the disease of bipolar illness (family history of bipolar illness, severe recurrent mood episodes with psychomotor activation) from the clinical picture of borderline personality (dissociative symptoms, sexual trauma, parasuicidal self-harm). The term 'disorder' obfuscates an ontological difference between diseases, such as manic-depressive illness, and clinical pictures, such as hysteria/post-traumatic stress disorder/dissociation/borderline personality. CONCLUSIONS Bipolar spectrum concepts are historically rooted in Kraepelin's manic-depressive illness concept, are scientifically testable, and can be clearly formulated. Further, they differ in kind from traumatic/dissociative conditions in ways that can be both historically and scientifically established.
Collapse
Affiliation(s)
- S Nassir Ghaemi
- 1Mood Disorders Program, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | | |
Collapse
|
9
|
Preti A, Vellante M, Gabbrielli M, Lai V, Muratore T, Pintus E, Pintus M, Sanna S, Scanu R, Tronci D, Corrias I, Petretto DR, Carta MG. Confirmatory factor analysis and measurement invariance by gender, age and levels of psychological distress of the short TEMPS-A. J Affect Disord 2013; 151:995-1002. [PMID: 24054919 DOI: 10.1016/j.jad.2013.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A) is a widely used self-reported tool aimed at measuring the affective temperaments that define the bipolar spectrum, with cyclothymic, depressive, irritable, hyperthymic, and anxious subscales. Confirmatory factor analysis (CFA) was rarely used to confirm the expected five-factor model. Measurement invariance was never tested. METHODS Cross-sectional, survey design involving 649 Italian college students (males: 47%). The short 39-item TEMPS-A and the 12-item General Health Questionnaire (GHQ-12) were used as measures of the affective temperaments and of psychological distress, respectively. CFA was applied to the TEMPS-A. Measurement invariance by gender, age and levels of psychological distress on the GHQ-12 was calculated with the establishment of subsequent equivalence constraints in the model parameters across groups. RESULTS The expected five-factor model had the best fit for all CFA indexes. Configural, metric and scalar invariance of the five-factor model of the TEMPS-A was proved across gender, age and levels of psychological distress of the participants. The hyperthymic temperament subscale has low or no links with the other affective temperament subscales, which were interrelated with medium to large effect sizes. LIMITATIONS College students might be not representative of the general population. No information on the clinical status of the students was available beyond self-report data. CONCLUSION The study proved the measurement invariance of the (short) TEMPS-A, which is a pre-requisite to compare groups or individuals in cross-sectional and longitudinal surveys. Generalizability cannot be assumed without replication of the findings in clinical samples.
Collapse
Affiliation(s)
- Antonio Preti
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Italy; Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hantouche E, Perugi G. Should cyclothymia be considered as a specific and distinct bipolar disorder? ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Abstract
BACKGROUND Temperament is the stable core of personality and it may represent the underlying continuity between how the person typically is (trait) and how the person temporarily changes (state). Comorbid depression in patients with Type 2 diabetes is important because of the negative consequences on the prognosis of diabetes. Little research has explored the relationships between temperament, depression and type 2 diabetes. The aims of the present paper are first to describe current research that has examined the relationship between temperament, diabetes and depression, and second to make recommendations for future research. METHODS Literature search from Medline and references in published papers. RESULTS Current research has described the relationship of temperament with cyclothymia, bipolar disorder, mood instability and suicidality. Studies on the relationship between temperament and depressive disorders are scarce. Nevertheless, there is likely a continuum between depressive temperament and related personality traits and subthreshold and clinical depressive states and disorders and diabetes outcomes. LIMITATIONS The greatest limitation concerns the scarcity of papers on this issue. There are also methodological limitations in accurately assessing depressive temperament versus current depressive disorders and residual symptoms from these disorders. CONCLUSION Depressive temperament may be a promising construct to understand better the interplay between depression and diabetes.
Collapse
|