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Oh HS, Cloninger CR. The role of temperament and character in the anxiety-depression spectrum among Korean adults. J Affect Disord 2024; 359:1-13. [PMID: 38759504 DOI: 10.1016/j.jad.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Temperament and character are useful in risk assessment and therapy of individuals in the anxiety-depression spectrum but understudied in South Korea. OBJECTIVE The study aimed to identify the temperament and character features associated with anxiety and/or depression in individuals with clinical disorders and in the general population. METHODS A representative sample of 1384 Korean adults over 18 years old (58 % female) were assessed with the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Temperament and Character Inventory (TCI). Multivariate analyses, including structural equation modeling and complex systems analysis, evaluated how personality influenced risk and resilience for anxiety and/or depression. RESULTS The three groups with anxiety and/or depression were strongly distinguished by temperament and character: (i) In AD (n = 58), Harm Avoidance and Reward Dependence were higher than in DD, and Self-directedness was higher than in AD+DD; (ii) In DD (n = 90), Persistence, Self-Directedness and Cooperativeness were higher than in AD+DD; and (iii) In AD+DD (n = 101), Harm Avoidance was highest and Persistence and Self-directedness were lowest (i.e., they were lowest in Resilience). Structural equation models confirmed these risk relations with strong character development reducing the adverse effects of emotional hyperreactivity from extreme temperaments. LIMITATIONS Self-reports were measured only at one point in time, requiring collateral experimental data to support causal interpretation. CONCLUSIONS Interactions of temperament and character are strongly predictive of risk and resilience to anxiety and/or depression by regulating both positive and negative affect. Character mediates the adverse effects of extreme temperaments on affect.
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Affiliation(s)
- Hyun Sook Oh
- Department of Psychology and Childcare, College of Human Services, Hanshin University, Seoul, South Korea
| | - C Robert Cloninger
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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Tsigkaropoulou E, Michopoulos I, Porichi E, Dafnas K, Serretti A, Ferentinos P. Temperament and character dimensions explain self-reported resilience deficits in patients with affective disorders. Int Clin Psychopharmacol 2024; 39:59-69. [PMID: 37351577 DOI: 10.1097/yic.0000000000000483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
This is the first study exploring how temperament and character personality dimensions impact self-reported resilience in major depressive disorder (MDD) and bipolar disorder (BD). We included 130 euthymic patients with affective disorders (AFD; 66 MDD and 64 BD) and 134 healthy controls (HC). Connor and Davidson resilience scale and Temperament and Character Inventory (TCI-140) were administered. Multiple linear regressions and interaction analyses were performed. Mediation analyses examined if personality dimensions explained group differences in resilience. Resilience was lower in MDD and BD vs. HC and in MDD vs. BD, adjusting for sex, age and education. Higher resilience was predicted by lower harm avoidance (HA) and higher persistence (P) in AFD and MDD, lower HA in BD and higher P and self-directedness (SD) in HC. However, only HA and P had a group-specific effect on resilience in AFD vs. HC. In mediation analyses, specific TCI dimensions at least partially explained differences in resilience: HA, P and SD in AFD or MDD vs. HC; SD in BD vs. HC; P in BD vs. MDD. Concludingly, two temperament traits (HA, P) and a character trait (SD) predict resilience in AFD. Focusing on personality could identify sources of compromised resilience as potential treatment targets.
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Affiliation(s)
- Evdoxia Tsigkaropoulou
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Evgenia Porichi
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Konstantinos Dafnas
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
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Norman UA, Truijens F, Desmet M, Meganck R. Depressive personality traits and temperament and character personality traits in a clinical sample: Results from regression and network analyses. Acta Psychol (Amst) 2023; 234:103860. [PMID: 36774773 DOI: 10.1016/j.actpsy.2023.103860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Personality and psychopathology are highly relevant and easily relatable constructs. The current study investigated the relationships between dependency and self-criticism, sociotropy and autonomy depressive personality traits, and Cloninger's temperament and character personality traits postulated as vulnerability factors for depression, in relation to depressive and general psychopathology symptoms in a clinical sample of 100 patients diagnosed with major depressive disorder. The results showed that self-directedness, a character trait of the temperament and character model, was positively associated with dependency, self-criticism, sociotropy, and autonomy. Applying more in-depth analyses with regression models revealed associations between self-directedness and depressive personality styles dependency and sociotropy, and general psychopathology symptoms was a significant clinical indicator in these relationships. Going beyond the regression models, network analysis showed that self-directedness is associated with self-criticism, sociotropy, autonomy, and general psychopathology symptoms. The relationship between self-directedness and sociotropy, self-criticism and autonomy suggests that these depressive personality traits may be attributable to aspects of self-determination, maturity, responsibility, discipline, and self-acceptance. General psychopathology research informed by literature incorporating personality traits has far-reaching implications for understanding individual differences as well as increasing efforts to contribute to the amelioration of disabling psychological disorders like major depressive disorders.
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Affiliation(s)
| | - Femke Truijens
- Department of Psychology, Education & Child Studies, Department of Clinical Psychology, Erasmus University Rotterdam, Netherlands
| | - Mattias Desmet
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
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Komasi S, Jananeh M, Mahdavi S, Shademan T, Vaysi A, Shahlaee M, Mirani A, Chamandoust Z, Saeidi M. The maladaptive domains according to the alternative model of personality disorders (AMPD) criterion B in patients with affective disorders and temperamental triads related to these domains: two unique profiles. BMC Psychol 2023; 11:83. [PMID: 36978163 PMCID: PMC10053052 DOI: 10.1186/s40359-023-01122-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES The study aimed to (i) compare the maladaptive domains and facets according to the Alternative Model of Personality Disorders (AMPD) Criterion B in patients with a type II bipolar disorder (BD-II) or major depressive disorder (MDD) with healthy controls (HCs), and (ii) investigating the relationship between affective temperaments and these domains and facets in the total sample. METHODS Outpatients diagnosed with current BD-II (n = 37; female 62.2%) or MDD (n = 17; female 82.4%) based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and community HCs (n = 177; female 62.1%) in Kermanshah from July to October 2020 included this case-control study. All participants completed the Personality Inventory for DSM-5 (PID-5), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and the second version of the Beck Depression Inventory (BDI-II). Data were analyzed using analysis of variance (ANOVA), Pearson correlation, and multiple regression. RESULTS The score of patients with BD-II in all five domains and those with MDD in three domains including negative affectivity, detachment, and disinhibition are significantly higher than the HCs (p < 0.05). Depressive temperament (related to negative affectivity, detachment, and disinhibition) and cyclothymic temperament (related to antagonism and psychoticism) were the most important correlates of the maladaptive domains. CONCLUSIONS Two unique profiles are proposed, including three domains of negative affectivity, detachment, and disinhibition associated with the depressive temperament for MDD, and two domains of antagonism and psychoticism related to cyclothymic temperament for BD-II.
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Affiliation(s)
- Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran.
| | - Minoo Jananeh
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran.
| | - Sahar Mahdavi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Tahereh Shademan
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Anis Vaysi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Mehrnoosh Shahlaee
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Atefeh Mirani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Zahra Chamandoust
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Mozhgan Saeidi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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Ahola A, Rautio N, Timonen M, Nordström T, Jääskeläinen E, Miettunen J. Premorbid temperament as predictor of onset of depression: 23-year follow-up. Compr Psychiatry 2023; 121:152359. [PMID: 36495692 DOI: 10.1016/j.comppsych.2022.152359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Previously Cloninger's temperament traits have been researched as a risk factor for depression mostly in cross-sectional studies. In these studies, especially high harm avoidance has been associated with an increased risk of depression. The main objective of this study was to investigate how temperament traits affect the risk of the onset of depression in a previously mentally healthy adult population. METHODS This study includes a follow-up period of 23 years from the age of 31 until 54 in the Northern Finland Birth Cohort 1966 Study. Temperament was measured at the 31-year follow-up using Temperament and Character Inventory (TCI). The outcome of the study was depressive disorder diagnosis during the follow-up in both sexes. To be able to take correlations between temperament traits we also did an analysis using temperament clusters. RESULTS Our sample size was 3999 individuals, out of which 240 were diagnosed with depression. For women an increase in the TCI score for novelty seeking (NS), harm avoidance (HA) or persistence (P) increased the risk of depression during the follow-up. For men only HA was a significant predictor of depression. An increase in reward dependence (RD) was found to reduce the risk of psychotic depression. In the analysis using the temperament clusters, the cluster including shy and pessimistic individuals was associated with risk for depression diagnosis in men. CONCLUSIONS This prospective general population-based cohort study added to previous knowledge of high HA being a risk factor for depression, but it also found new associations such as higher P and NS.
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Affiliation(s)
- Aleksi Ahola
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland.
| | - Nina Rautio
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Tanja Nordström
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Kheradmand A, Amirlatifi ES, Rahbar Z. Personality traits of university students with smartphone addiction. Front Psychiatry 2023; 14:1083214. [PMID: 36846239 PMCID: PMC9945260 DOI: 10.3389/fpsyt.2023.1083214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Nowadays smartphone use is increasing drastically. There is a higher prevalence of smartphone addiction in some specific personality traits. OBJECTIVES The goal of this study is to evaluate the association of smartphone addiction with personality traits. METHODS This study is correlational research. Three hundred and eighty two students of Tehran universities were asked to answer the smartphone addiction scale (SAS) questionnaire and the Persian version of the Cloninger temperament and character inventory (TCI) questionnaire. After the smartphone addiction questionnaire assessment, individuals with smartphone addiction were identified and compared to the non-smartphone addicted group in terms of personality traits. RESULTS One hundred and ten individuals (28.8%) were prone to smartphone addiction. Mean scores of people with smartphone addiction were higher in novelty-seeking, harm avoidance, and self-transcendence than the non-addicts and were statistically significant. In persistence and self-directedness, the mean scores of the smartphone addiction group were lower than the non-addicts and were statistically significant. Individuals with smartphone addiction had higher reward dependence and lower cooperativeness however they were not statistically significant. CONCLUSIONS high novelty seeking, harm avoidance, self-transcendence, low persistence, and self-directedness which indicate narcissistic personality disorder, could have a role in smartphone addiction.
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Affiliation(s)
- Ali Kheradmand
- Department of Psychiatry, Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti Medical University, Tehran, Iran
| | - Elham Sadat Amirlatifi
- Northamptonshire Healthcare Foundation Trust, Child and Adolescent Mental Health Service, Kettering, United Kingdom
| | - Zahra Rahbar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rajewska-Rager A, Staniek M, Kucharska-Kowalczyk K, Kapelski P, Lepczynska N, Dmitrzak-Weglarz M, Pawlak J, Skibinska M. Temperament and character dimensions as psychological markers of mood disorders in Polish adolescents and young adults-A prospective study. Early Interv Psychiatry 2022; 16:1240-1248. [PMID: 35150069 DOI: 10.1111/eip.13273] [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: 11/08/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND An increasing incidence of mood disorders in adolescents and young adults is being observed. The assessment of personality traits seems to be an interesting tool in identifying early markers of major depression (MD) or bipolar disorder (BD) as well as predictors of the course of the disease. The aim of this study was to compare the personality profiles in young patients with MD and BD in acute and remitted mood states. METHODS Seventy-nine adolescents and young adults with mood disorder diagnoses (MD or BD) were included in the study. The participants were assessed based on structured diagnostic interviews and completed the Temperament and Character Inventory (TCI). The clinical evaluation was conducted during the acute episodes and after reaching the stabilized mood in the course of follow-up visits in a 2-year study observation. RESULTS At baseline, MD patients had higher scores on the harm avoidance (HA) with more pronounced anticipatory worry and fatigability subscale than BD patients. Conversely, BD patients reached higher scores in the total self-directedness (SD) character dimension and its sub-dimensions. MD patients with acute depressive symptoms had higher scores in the HA dimension and its subscale: anticipatory worry, shyness, and fatigability compared with their euthymic states. No significant differences in TCI dimensions between baseline and euthymia in the BD subgroup were found, and no differences between euthymic MD and BD patients. CONCLUSIONS Higher ST and SD sub-dimensions may constitute a personality profile specific to BD, while high HA seems to be related to major depression in both acute and remitted states in young patients.
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Affiliation(s)
- Aleksandra Rajewska-Rager
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Staniek
- Department of Adult Psychiatry, Karol Jonscher Clinical Hospital, Poznan, Poland
| | | | - Pawel Kapelski
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Lepczynska
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Dmitrzak-Weglarz
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Skibinska
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Boscutti A, Pigoni A, Delvecchio G, Lazzaretti M, Mandolini GM, Girardi P, Ferro A, Sala M, Abbiati V, Cappucciati M, Bellani M, Perlini C, Rossetti MG, Balestrieri M, Damante G, Bonivento C, Rossi R, Finos L, Serretti A, Brambilla P. The Influence of 5-HTTLPR, BDNF Rs6265 and COMT Rs4680 Polymorphisms on Impulsivity in Bipolar Disorder: The Role of Gender. Genes (Basel) 2022; 13:genes13030482. [PMID: 35328036 PMCID: PMC8954186 DOI: 10.3390/genes13030482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Impulsivity has been proposed as an endophenotype for bipolar disorder (BD); moreover, impulsivity levels have been shown to carry prognostic significance and to be quality-of-life predictors. To date, reports about the genetic determinants of impulsivity in mood disorders are limited, with no studies on BD individuals. Individuals with BD and healthy controls (HC) were recruited in the context of an observational, multisite study (GECOBIP). Subjects were genotyped for three candidate single-nucleotide polymorphisms (SNPs) (5-HTTLPR, COMT rs4680, BDNF rs6265); impulsivity was measured through the Italian version of the Barratt Impulsiveness Scale (BIS-11). A mixed-effects regression model was built, with BIS scores as dependent variables, genotypes of the three polymorphisms as fixed effects, and centers of enrollment as random effect. Compared to HC, scores for all BIS factors were higher among subjects with euthymic BD (adjusted β for Total BIS score: 5.35, p < 0.001). No significant interaction effect was evident between disease status (HC vs. BD) and SNP status for any polymorphism. Considering the whole sample, BDNF Met/Met homozygosis was associated with lower BIS scores across all three factors (adjusted β for Total BIS score: −10.2, p < 0.001). A significant 5-HTTLPR x gender interaction was found for the SS genotype, associated with higher BIS scores in females only (adjusted β for Total BIS score: 12.0, p = 0.001). Finally, COMT polymorphism status was not significantly associated with BIS scores. In conclusion, BD diagnosis did not influence the effect on impulsivity scores for any of the three SNPs considered. Only one SNP—the BDNF rs6265 Met/Met homozygosis—was independently associated with lower impulsivity scores. The 5-HTTLPR SS genotype was associated with higher impulsivity scores in females only. Further studies adopting genome-wide screening in larger samples are needed to define the genetic basis of impulsivity in BD.
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Affiliation(s)
- Andrea Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
| | - Matteo Lazzaretti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
| | - Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (P.G.); (L.F.)
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
| | - Michela Sala
- Mental Health Department, Azienda Sanitaria Locale Alessandria, 15121 Alessandria, Italy;
| | - Vera Abbiati
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Marco Cappucciati
- Department of Mental Health and Substance Abuse, Azienda Sanitaria Locale Piacenza, 29121 Piacenza, Italy;
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Maria Gloria Rossetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Matteo Balestrieri
- Psychiatry Unit, Department of Medicine, University of Udine, 33100 Udine, Italy;
| | - Giuseppe Damante
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
| | - Carolina Bonivento
- IRCCS “E. Medea”, Polo Friuli-Venezia Giulia, San Vito al Tagliamento, 33078 Pordenone, Italy;
| | - Roberta Rossi
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio FBF, 25125 Brescia, Italy;
| | - Livio Finos
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (P.G.); (L.F.)
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40123 Bologna, Italy;
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.P.); (G.D.); (M.L.); (G.M.M.); (A.F.); (M.G.R.)
- Correspondence:
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Effect of vortioxetine in subjects with major depressive and alcohol use disorders: a 6-month retrospective analysis. CNS Spectr 2022; 27:73-81. [PMID: 32772956 DOI: 10.1017/s109285292000173x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and alcohol use disorder (AUD) are highly comorbid, with greater clinical complexity and psychosocial impairment. Several antidepressants have been used in this population, with mixed results. This preliminary study aims to investigate the effects of the multimodal antidepressant vortioxetine in MDD + AUD subjects. METHODS We retrospectively evaluated 57 MDD + AUD and 56 MDD outpatients, matched for baseline characteristics. Patients were assessed after 1, 3, and 6 months treatment with vortioxetine (10-20 mg/d, flexibly dosed) in combination with continuous psychosocial support. The primary outcome was improvement in depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale. We also investigated changes in anxiety, anhedonia, cognition, functioning, quality of life, and clinical global severity using the following instruments: Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Digit Symbol Substitution Test, Perceived Deficits Questionnaire-Depression, Functioning Assessment Short Test, Quality of Life Index, and Clinical Global Impression-Severity Scale. RESULTS Vortioxetine significantly improved mood in MDD + AUD patients (P < .001), with no differences when compared to MDD (P = .36). A substantial rate (45.6%) of comorbid subjects obtained clinical remission at endpoint (P = .36 vs MDD). We additionally observed baseline to endpoint improvements on all secondary outcomes (P < .001), with no significant difference between groups. Overall, vortioxetine was safe and well tolerated. CONCLUSIONS Given its effectiveness on mood, cognition, and functioning, its good safety and tolerability profile, and low potential for abuse, vortioxetine could represent a valid pharmacological intervention in MDD + AUD patients as part of an integrated therapeutic-rehabilitation program.
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Miola A, Baldessarini RJ, Pinna M, Tondo L. Relationships of affective temperament ratings to diagnosis and morbidity measures in major affective disorders. Eur Psychiatry 2021; 64:e74. [PMID: 34812134 PMCID: PMC8715280 DOI: 10.1192/j.eurpsy.2021.2252] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ratings of affective temperament types show promise in helping to differentiate diagnostic groups among major affective disorders as well as to predict associations with important aspects of morbidity including suicidal risk. METHODS The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-rating (TEMPS-A) questionnaire was completed by 858 unselected, consecutive, consenting adults diagnosed with a DSM-5 major affective disorder (173 bipolar-1 [BD-1]), 250 BD-2, 435 major depressive disorder [MDD]) to score for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp), and irritable (irr) affective temperaments. We tested their associations with diagnosis and selected clinical factors, including diagnosis, depression scores, suicidal ideation or acts, substance abuse, episodes/year, and %-time ill. RESULTS Scores for cyc ranked: BD-2 > BD-1 > MDD; anx ranked: MDD > BD-2 > BD-1; irr was greater in BD than MDD; dys was greater in MDD than BD; hyp did not differ by diagnosis. We confirmed associations of suicidal risk with higher scores of all temperament types except lower hyp scores. Higher cyc and irr scores and lower anx scores were associated with substance abuse. Several scores were higher with measures of greater affective morbidity: cyc with current depression, episodes/year, and %-time ill; irr with more episodes and depressions/year and greater %-time manic. Some of these associations were selective for BD or MDD. CONCLUSIONS The findings indicate that TEMPS-A ratings of affective temperament types can contribute to differential diagnoses and predict types and amounts of affective morbidity, as well as detecting suicidal risks.
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Affiliation(s)
- Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Pinna
- Lucio Bini Mood Disorders Centers, Cagliari, Italy
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Lucio Bini Mood Disorders Centers, Cagliari, Italy
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11
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Suen PJC, Goerigk S, Razza LB, Padberg F, Passos IC, Brunoni AR. Classification of unipolar and bipolar depression using machine learning techniques. Psychiatry Res 2021; 295:113624. [PMID: 33307387 DOI: 10.1016/j.psychres.2020.113624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/28/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Paulo J C Suen
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, Hospital of the University of Munich, Munich, Germany; University of Applied Sciences, Hochschule Fresenius, Munich, Germany; Dept. of Psychological Methodology and Assessment, University of Munich, Munich, Germany
| | - Lais B Razza
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000 São Paulo, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Hospital of the University of Munich, Munich, Germany
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000, São Paulo, Brazil.
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12
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Yang T, Lam RW, Huang J, Su Y, Liu J, Yang X, Yang L, Zhu N, Zhao G, Mao R, Zhou R, Xia W, Liu H, Wang Z, Chen J, Fang Y. Exploring the Effects of Temperament on Gray Matter Volume of Frontal Cortex in Patients with Mood Disorders. Neuropsychiatr Dis Treat 2021; 17:183-193. [PMID: 33519204 PMCID: PMC7837575 DOI: 10.2147/ndt.s287351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with bipolar disorder (BD) and patients with major depressive disorder (MDD) have relatively specific temperament and structural abnormalities of brain regions related to emotion and cognition. However, the effects of temperament factors on the structure of frontal and temporal cortex is still unclear. The aims of this study were to explore the differences and relationships between temperament characteristics and the gray matter volume of frontal and temporal cortex in patients with BD or MDD. METHODS T1-weighted magnetic resonance imaging (MRI) data, demographic and clinical information were obtained from 279 depressed patients (90 patients with BD, 189 patients with MDD) and 162 healthy controls (HC). Temperament was assessed with the Chinese short version of Temperament Evaluation of Memphis, Pisa and San Diego - Auto questionnaire (TEMPS-A). The Desikan-Killiany atlas was used for yielding gray matter volume by FreeSurfer 6.0 software suite. A total of 22 frontal and temporal regions were chosen as regions of interest (ROIs). RESULTS Compared with patients with MDD, patients with BD had higher TEMPS-A total scores and scores on cyclothymic, irritable and hyperthymic subscales. The gray matter volume in bilateral rostral middle frontal gyrus (RMFG), left temporal pole and right superior frontal gyrus were reduced in patients with BD. Patients with MDD only had lower gray matter volume in bilateral temporal pole. In the pooled patients, there were negative associations between hyperthymia and gray matter volume in right RMFG. CONCLUSION Patients with BD and MDD had different temperament characteristics. The prominent temperament subscales in patients with BD were cyclothymia, irritable and hyperthymia. Patients with greater hyperthymia had lower gray matter volume in right frontal gyrus. Temperament may reflect an endophenotype in patients with mood disorders, especially in BD.
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Affiliation(s)
- Tao Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jia Huang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yousong Su
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jing Liu
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaorui Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lu Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Na Zhu
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Guoqing Zhao
- Department of Psychology, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Ruizhi Mao
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rubai Zhou
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Weiping Xia
- Department of Medical Psychology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Hongmei Liu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou District Mental Health Center, Shanghai, People's Republic of China
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People's Republic of China
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13
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Immature defense mechanisms mediate the relationship between childhood trauma and onset of bipolar disorder. J Affect Disord 2021; 278:672-677. [PMID: 33125910 DOI: 10.1016/j.jad.2020.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accumulating evidence has converged to suggest that childhood trauma may contribute to bipolar disorder (BD). This study aimed to investigate the patterns of childhood trauma among patients with bipolar I (BD-I) and bipolar II (BD-II) disorders, according to DSM-IV and in contrast with healthy volunteers. We also explored whether the relationship between childhood trauma and onset of bipolar disorder is mediated by immature defense mechanisms. METHODS Participants were patients with BD-I (n=44) and BD-II (n = 42), and healthy controls (HCs, n = 43). Childhood traumatic experiences and defense mechanisms were assessed by the Childhood Trauma Questionnaire (CTQ) and the Defense Style Questionnaire (DSQ), respectively. RESULTS BD patients experienced more severe childhood trauma than HCs. Physical neglect sub-score and total score of the CTQ had both direct and indirect effects on the diagnosis of BD-I, and an immature defense style mediated the indirect effects. The diagnosis of BD-II was mainly related to the physical neglect and emotional abuse subs-core and total score of the CTQ, as mediated by the immature defense mechanisms. BD-I and BD-II significantly differed in the emotional abuse sub-score of the CTQ. CONCLUSIONS Physical neglect sub-score and total score of the CTQ were associated with the diagnosis of BD (both BD-I and BD-II), as mediated by an immature defense style. Furthermore, emotional abuse might be an important risk factor for BD-II compared to BD-I. These findings may inform risk reduction and psychosocial intervention strategies to prevent and treat patients with bipolar disorders.
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14
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The dual-system theory of bipolar spectrum disorders: A meta-analysis. Clin Psychol Rev 2020; 83:101945. [PMID: 33217713 DOI: 10.1016/j.cpr.2020.101945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 01/05/2023]
Abstract
Bipolar spectrum disorders are characterized by alternating intervals of extreme positive and negative affect. We performed a meta-analysis to test the hypothesis that such disorders would be related to dysregulated reinforcement sensitivity. First, we reviewed 23 studies that reported the correlation between self-report measures of (hypo)manic personality and measures of reinforcement sensitivity. A large relationship was found between (hypo)manic personality and BAS sensitivity (g = .74), but not with BIS sensitivity (g = -.08). This stands in contrast to self-reported depression which has a small, negative relationship with BAS sensitivity and a large positive one with BIS sensitivity (Katz et al., 2020). Next, we reviewed 33 studies that compared reinforcement sensitivity between euthymic, bipolar participants and healthy controls. There, bipolar disorder had a small, positive relationship with BAS sensitivity (g = .20) and a medium, positive relationship with BIS sensitivity (g = .64). These findings support a dualsystem theory of bipolar disorders, wherein BAS sensitivity is more closely related to mania and BIS sensitivity more closely to bipolar depression. Bipolar disorders show diatheses for both states with euthymic participants being BAS- and BIS- hypersensitive. Implications for further theory and research practice are expounded upon in the discussion.
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15
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Temperament, Character, and Defense Mechanism Changes With Treatment in Depression: A 9-Month Naturalistic Follow-up. J Nerv Ment Dis 2020; 208:403-412. [PMID: 32079864 DOI: 10.1097/nmd.0000000000001142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the changes in temperament, character, and defense mechanisms with the treatment and remission in patients with major depressive disorder. The study was designed as a longitudinal observational follow-up study of patients with repeated measures at 0, 12, and 36 weeks. In baseline comparisons, the major depression group showed higher harm avoidance and novelty seeking scores and lower self-directness and mature defense styles scores compared with healthy controls. In the follow-up, temperament dimensions and neurotic defenses remained unchanged, mature defense styles and self-directness revealed significant increase, and immature defense styles revealed significant decrease. Although there was no significant difference in the defense styles, harm avoidance and novelty seeking scores remained higher in MDD patients compare with healthy controls in 36 weeks. Our findings regarding continuation of hierarchically upward improvement in defense mechanism after the remission may support importance of treatment after remission.
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16
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Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model. Clin Psychol Rev 2020; 77:101842. [PMID: 32179341 DOI: 10.1016/j.cpr.2020.101842] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/06/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges' g = .99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = -.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (β = .37) and anxiety (β = .35), with reward sensitivity only predicting depression (β = -.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.
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17
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Fornaro M, Fusco A, Novello S, Mosca P, Anastasia A, De Blasio A, Iasevoli F, de Bartolomeis A. Predictors of Treatment Resistance Across Different Clinical Subtypes of Depression: Comparison of Unipolar vs. Bipolar Cases. Front Psychiatry 2020; 11:438. [PMID: 32670098 PMCID: PMC7326075 DOI: 10.3389/fpsyt.2020.00438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Treatment-resistant depression (TRD) and treatment-resistant bipolar depression (TRBD) poses a significant clinical and societal burden, relying on different operational definitions and treatment approaches. The detection of clinical predictors of resistance is elusive, soliciting clinical subtyping of the depressive episodes, which represents the goal of the present study. METHODS A hundred and thirty-one depressed outpatients underwent psychopathological evaluation using major rating tools, including the Hamilton Rating Scale for Depression, which served for subsequent principal component analysis, followed-up by cluster analysis, with the ultimate goal to fetch different clinical subtypes of depression. RESULTS The cluster analysis identified two clinically interpretable, yet distinctive, groups among 53 bipolar (resistant cases = 15, or 28.3%) and 78 unipolar (resistant cases = 20, or 25.6%) patients. Among the MDD patients, cluster "1" included the following components: "Psychic symptoms, depressed mood, suicide, guilty, insomnia" and "genitourinary, gastrointestinal, weight loss, insight". Altogether, with broadly defined "mixed features," this latter cluster correctly predicted treatment outcome in 80.8% cases of MDD. The same "broadly-defined" mixed features of depression (namely, the standard Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition-DSM-5-specifier plus increased energy, psychomotor activity, irritability) correctly classified 71.7% of BD cases, either as TRBD or not. LIMITATIONS Small sample size and high rate of comorbidity. CONCLUSIONS Although relying on different operational criteria and treatment history, TRD and TRBD seem to be consistently predicted by broadly defined mixed features among different clinical subtypes of depression, either unipolar or bipolar cases. If replicated by upcoming studies to encompass also biological and neuropsychological measures, the present study may aid in precision medicine and informed pharmacotherapy.
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Affiliation(s)
- Michele Fornaro
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy
| | - Andrea Fusco
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
| | - Stefano Novello
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
| | - Pierluigi Mosca
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
| | | | - Antonella De Blasio
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, University of Naples Federico II, Naples, Italy
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18
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Bartova L, Dold M, Kautzky A, Fabbri C, Spies M, Serretti A, Souery D, Mendlewicz J, Zohar J, Montgomery S, Schosser A, Kasper S. Results of the European Group for the Study of Resistant Depression (GSRD) - basis for further research and clinical practice. World J Biol Psychiatry 2019; 20:427-448. [PMID: 31340696 DOI: 10.1080/15622975.2019.1635270] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The overview outlines two decades of research from the European Group for the Study of Resistant Depression (GSRD) that fundamentally impacted evidence-based algorithms for diagnostics and psychopharmacotherapy of treatment-resistant depression (TRD). Methods: The GSRD staging model characterising response, non-response and resistance to antidepressant (AD) treatment was applied to 2762 patients in eight European countries. Results: In case of non-response, dose escalation and switching between different AD classes did not show superiority over continuation of original AD treatment. Predictors for TRD were symptom severity, duration of the current major depressive episode (MDE), suicidality, psychotic and melancholic features, comorbid anxiety and personality disorders, add-on treatment, non-response to the first AD, adverse effects, high occupational level, recurrent disease course, previous hospitalisations, positive family history of MDD, early age of onset and novel associations of single nucleoid polymorphisms (SNPs) within the PPP3CC, ST8SIA2, CHL1, GAP43 and ITGB3 genes and gene pathways associated with neuroplasticity, intracellular signalling and chromatin silencing. A prediction model reaching accuracy of above 0.7 highlighted symptom severity, suicidality, comorbid anxiety and lifetime MDEs as the most informative predictors for TRD. Applying machine-learning algorithms, a signature of three SNPs of the BDNF, PPP3CC and HTR2A genes and lacking melancholia predicted treatment response. Conclusions: The GSRD findings offer a unique and balanced perspective on TRD representing foundation for further research elaborating on specific clinical and genetic hypotheses and treatment strategies within appropriate study-designs, especially interaction-based models and randomized controlled trials.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , United Kingdom
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy
| | | | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | | | - Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria.,Zentrum für seelische Gesundheit Leopoldau, BBRZ-MED , Vienna , Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
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19
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Perugi G, Pacchiarotti I, Mainardi C, Verdolini N, Menculini G, Barbuti M, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Vieta E. Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis. Eur Neuropsychopharmacol 2019; 29:825-834. [PMID: 31227264 DOI: 10.1016/j.euroneuro.2019.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Resistance and worsening of depression in response to antidepressants (ADs) are major clinical challenges. In a large international sample of patients with major depressive disorder (MDD), we aim to explore the possible associations between different patterns of response to ADs and bipolarity. A total of 2811 individuals with a major depressive episode (MDE) were enrolled in the BRIDGE-II-MIX study. This post-hoc analysis included only 1329 (47%) patients suffering from MDD. Patients with (TRD-MDD, n = 404) and without (NTRD-MDD, n = 925) history of resistance to AD treatment and with (n = 184) and without (n = 1145) previous AD-induced irritability and mood lability (AIM) were compared using Chi-square, t-Student's test and logistic regression models. TRD-MDD patients resulted significantly associated with higher rates of AIM, psychotic features, history of suicide attempts, emotional lability and impulsivity, comorbid borderline personality disorder and polipharmacological treatment, compared to NTRD-MDD group. In comparison to NAIM-MDD patients, subjects in the AIM-MDD group showed significantly higher rates of first-degree family history for BD, previous TRD, atypical features, mixed features, psychiatric comorbidities, lifetime suicide attempts and lower age at first psychiatric symptoms. In addition, patients with AIM presented more often almost all the hypomanic symptoms evaluated in this study. Among these latter symptoms, logistic regressions showed that distractibility, impulsivity and hypersexuality were significantly associated with AIM-MDD. In conclusion, in MDD patients, a lifetime history of resistance and/or irritability/mood lability in response to ADs was associated with the presence of mixed features and a possible underlying bipolar diathesis.
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Affiliation(s)
- Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cecilia Mainardi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy; Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy; FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Giulia Menculini
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Jules Angst
- Psychiatric Hospital, University of Zurich, Switzerland
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London SE5 8AZ, United Kingdom
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
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20
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Balestri M, Porcelli S, Souery D, Kasper S, Dikeos D, Ferentinos P, Papadimitriou GN, Rujescu D, Martinotti G, Di Nicola M, Janiri L, Caletti E, Mandolini GM, Pigoni A, Paoli RA, Lazzaretti M, Brambilla P, Sala M, Abbiati V, Bellani M, Perlini C, Rossetti MG, Piccin S, Bonivento C, Fabbro D, Damante G, Ferrari C, Rossi R, Pedrini L, Benedetti F, Montgomery S, Zohar J, Mendlewicz J, Serretti A. Temperament and character influence on depression treatment outcome. J Affect Disord 2019; 252:464-474. [PMID: 31005789 DOI: 10.1016/j.jad.2019.04.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND personality features have been repeatedly associated with depression treatment outcome in Major Depressive Disorder (MDD), however conclusive results are still lacking. Moreover, as for Bipolar Disorder (BD), results are only few and preliminary. AIM the aim of the present study was to perform an exploratory investigation of the influence of personality traits as assessed by the Temperament and Character Inventory (TCI), on principal depression treatment outcomes (non remission, non response and resistance). METHODS 743 mood disorders patients (455 MDD (61.24%) and 288 BD (38.76%)) were recruited in the context of 6 European studies. Generalized logit models were performed to test the effects of TCI dimensions on treatment outcomes, considering possible confounders such as age, gender and education. Positive results were controlled for comorbidities (anxiety and substance use disorders) as well. RESULTS MDD Non-Remitters showed high Harm Avoidance (HA) and Self Transcendence (ST) (p = 0.0004, d = 0.40; p = 0.007, d = 0.36 respectively) and low Persistence (P) and Self Directedness (SD) (p = 0.05; d = 0.18; p = 0.002, d = 0.40, respectively); MDD Non-Responders showed a slightly different profile with high HA and low Reward Dependence (RD) and SD; finally, MDD Resistants showed low RD, P and Cooperativeness (C). In BD patients, only higher HA in non response was observed. LIMITATIONS the retrospective cross-sectional design, the TCI assessment regardless of the mood state and the small number of bipolar patients represent the main limitations. CONCLUSION specific TCI personality traits are associated with depression treatment outcome in MDD patients. The inclusion of such personality traits, together with other socio-demographic and clinical predictors, could ameliorate the accuracy of the prediction models available to date.
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Affiliation(s)
- Martina Balestri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dimitris Dikeos
- Department of Psychiatry, Athens University Medical School, Athens, Greece
| | | | | | - Dan Rujescu
- University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg, Germany
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Scienze Cliniche, University "G.d'Annunzio", Chieti, Italy
| | - Marco Di Nicola
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Janiri
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Elisabetta Caletti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Riccardo Augusto Paoli
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Lazzaretti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michela Sala
- Department of Mental Health, Azienda Sanitaria Locale Alessandria, Alessandria, Italy
| | - Vera Abbiati
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Sara Piccin
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Carolina Bonivento
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Dora Fabbro
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Giuseppe Damante
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Francesco Benedetti
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Joseph Zohar
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy.
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Liu T, Zhong S, Wang B, Liao X, Lai S, Jia Y. Similar profiles of cognitive domain deficits between medication-naïve patients with bipolar II depression and those with major depressive disorder. J Affect Disord 2019; 243:55-61. [PMID: 30227315 DOI: 10.1016/j.jad.2018.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/26/2018] [Accepted: 05/27/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bipolar disorder (BD) II is more likely to be misdiagnosed as major depressive disorder (MDD) than other types of BD, leading to incorrect treatment and poor outcomes. Previous studies have shown inconsistent results regarding the differences in cognitive deficits between the two disorders. To eliminate the compounding effects of medication and aging, we sought to investigate changes in cognitive function in medication-naïve, non-late-life patients with BDII and MDD. METHODS Three subject groups were enrolled: 30 depressed BDII patients, 30 depressed MDD patients and 30 healthy controls. All subjects underwent a battery of cognitive tests to assess 8 cognitive domains. The cognitive domains were compared between the three subject groups. In BDII and MDD, the effect sizes were computed as evaluation parameters, weighing the degree of the cognitive deficits and the correlations between cognitive test deficits and clinical variables were also computed. RESULTS Compared with the controls, the BDII and MDD patients were characterized by similar deficits in psychomotor speed, working memory, visual memory, attention switching and verbal fluency. Moderate to severe deficits in the majority of cognitive tests were observed in the BDII and MDD patients. Furthermore, correlations between the modified Wisconsin Card Sorting Test total errors and age of onset in the BDII patients and between correct digit span responses (backward and total) and depressive severity were found in the MDD patients. CONCLUSIONS Our findings suggest that BDII and MDD patients may suffer from similar profiles of cognitive domain deficits that may not assist in distinguishing between the two disorders. In addition, cognitive deficits may be correlated with the age of onset and depressive severity in mood disorders.
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Affiliation(s)
- Tao Liu
- Guangzhou Huiai Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Bing Wang
- Department of Affective Disorder, Shenzhen Mental Health Center, Shenzhen, China
| | - Xiaoxiao Liao
- Department of Psychology, Jiangmen Central Hospital, Jiangmen, China
| | - Shunkai Lai
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Lima CNDC, da Silva FER, Chaves Filho AJM, Queiroz AIDG, Okamura AMNC, Fries GR, Quevedo J, de Sousa FCF, Vasconcelos SMM, de Lucena DF, Fonteles MMDF, Macedo DS. High Exploratory Phenotype Rats Exposed to Environmental Stressors Present Memory Deficits Accompanied by Immune-Inflammatory/Oxidative Alterations: Relevance to the Relationship Between Temperament and Mood Disorders. Front Psychiatry 2019; 10:547. [PMID: 31428001 PMCID: PMC6689823 DOI: 10.3389/fpsyt.2019.00547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022] Open
Abstract
Low-exploratory (LE) and high-exploratory (HE) rodents mimic human depressive and hyperthymic temperaments, respectively. Mood disorders (MD) may be developed by the exposure of these temperaments to environmental stress (ES). Psychiatric symptoms severity in MD patients is related to the magnitude of memory impairment. Thus, we aimed at studying the consequences of the exposure of LE and HE male Wistar rats, during periadolescence, to a combination of ES, namely, paradoxical sleep deprivation (PSD) and unpredictable stress (US), on anxiety-related behavior in the plus maze test, working (WM) and declarative memory (DM) performance. We also evaluated hippocampal immune-inflammatory/oxidative, as consequences of ES, and prevention of ES-induced alterations by the mood-stabilizing drugs, lithium and valproate. Medium exploratory (ME) control rats were used for comparisons with HE- and LE-control rats. We observed that HE-controls presented increased anxiolytic behavior that was significantly increased by ES exposure, whereas LE-controls presented increased anxiety-like behavior relative to ME-controls. Lithium and valproate prevented anxiolytic alterations in HE+ES rats. HE+ES- and LE+ES-rats presented WM and DM deficits. Valproate and lithium prevented WM deficits in LE-PSD+US rats. Lithium prevented DM impairment in HE+ES-rats. Hippocampal levels of reduced glutathione (GSH) increased four-fold in HE+ES-rats, being prevented by valproate and lithium. All groups of LE+ES-rats presented increased levels of GSH in relation to controls. Increments in lipid peroxidation in LE+ES- and HE+ES-rats were prevented by valproate in HE+ES-rats and by both drugs in LE+ES-rats. Nitrite levels were increased in HE+ES- and LE+ES-rats (five-fold increase), which was prevented by both drugs in LE+ES-rats. HE+ES-rats presented a two-fold increase in the inducible nitric oxide synthase (iNOS) expression that was prevented by lithium. HE+ES-rats showed increased hippocampal and plasma levels of interleukin (IL)-1β and IL-4. Indoleamine 2, 3-dioxygenase 1 (IDO1) was increased in HE+ES- and LE+ES-rats, while tryptophan 2,3-dioxygenase (TDO2) was increased only in HE+ES-rats. Altogether, our results showed that LE- and HE-rats exposed to ES present distinct anxiety-related behavior and similar memory deficits. Furthermore, HE+ES-rats presented more brain and plasma inflammatory alterations that were partially prevented by the mood-stabilizing drugs. These alterations in HE+ES-rats may possibly be related to the development of mood symptoms.
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Affiliation(s)
- Camila Nayane de Carvalho Lima
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil.,Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Francisco Eliclécio Rodrigues da Silva
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Adriano José Maia Chaves Filho
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Ana Isabelle de Gois Queiroz
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Adriana Mary Nunes Costa Okamura
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Gabriel Rodrigo Fries
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - João Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Francisca Cléa F de Sousa
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Silvania Maria Mendes Vasconcelos
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - David F de Lucena
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Marta Maria de França Fonteles
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Danielle S Macedo
- Neuropharmacology Laboratory, Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceara, Fortaleza, Brazil.,National Institute for Translational Medicine (INCT-TM, CNPq), Neurosciences and Behavior Department, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, Brazil
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23
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Saigo T, Hayashida M, Tayama J, Ogawa S, Bernick P, Takeoka A, Shirabe S. Prevention of depression in first-year university students with high harm avoidance: Evaluation of the effects of group cognitive behavioral therapy at 1-year follow-up. Medicine (Baltimore) 2018; 97:e13009. [PMID: 30383656 PMCID: PMC6221729 DOI: 10.1097/md.0000000000013009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 10/05/2018] [Indexed: 11/26/2022] Open
Abstract
High harm avoidance (HA) scores on the temperament and character inventory appear to be a risk factor for depressive disorders and suicide. Since 2012, we have conducted group cognitive behavioral therapy (G-CBT) interventions for students at Nagasaki University with high HA and without depressive disorders, with the aim of preventing depression. Here, we report on the effects of the G-CBT at 1-year follow-up for the 2012 to 2015 period.Forty-two participants with high HA were included in the final analysis. Outcomes were measured with the Beck Depression Inventory II, Manifest Anxiety Scale, 28-item General Health Questionnaire, and Brief Core Schema Scales at baseline, and at 6-month, and 1-year follow-ups.Repeated-measures analyses of variance revealed a significant decrease in mean depressive symptom scores at the 6-month follow-up point; this decrease was maintained at 1 year. Improvements in cognitive schemas were also seen at 6 months and 1 year.We observed improvements in cognitive schemas associated with depression as a result of the G-CBT intervention, with effects maintained at 1 year post-intervention. This intervention may be effective in positively modifying the cognitions of students with HA and preventing future depression.
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Affiliation(s)
- Tatsuo Saigo
- Department of Preventive Medicine, Graduate School of Biomedical Sciences
| | - Masaki Hayashida
- Department of Preventive Medicine, Graduate School of Biomedical Sciences
- Center for Health and Community Medicine
| | - Jun Tayama
- Center for Health and Community Medicine
- Graduate School of Education
| | - Sayaka Ogawa
- Department of Preventive Medicine, Graduate School of Biomedical Sciences
- Center for Health and Community Medicine
| | - Peter Bernick
- Center for Health and Community Medicine
- Student Accessibility Office, Nagasaki University, Nagasaki, Japan
| | | | - Susumu Shirabe
- Department of Preventive Medicine, Graduate School of Biomedical Sciences
- Center for Health and Community Medicine
- Student Accessibility Office, Nagasaki University, Nagasaki, Japan
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Dell’Orco S, Sperandeo R, Moretto E, Maldonato NM. Revision on Psychometric Properties of the Temperament and Character Inventory in a Clinical Sample. Front Psychol 2018; 9:1951. [PMID: 30369898 PMCID: PMC6194178 DOI: 10.3389/fpsyg.2018.01951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Cloninger's Temperament and Character Inventory (TCI) although elaborated on the general population, is frequently used in clinical samples. The study evaluates the psychometric characteristics of TCI in clinical populations with the aim of creating a reduced version of the test suitable for these subjects. This research was conducted on two groups of mental health outpatients. In the first study, 44 items, correlated with the psychiatric disorders, was selected. These items, divided in four dimensions utilizing both statistic and psychopathological criteria, show good internal consistency and external validity and constitute a Reduced Version (TR-TCI) of the test. In the second study, the predictive validity of the TR-TCI was evaluated through the ROC curves and a logistic regression model. The results show a good predictive validity of TR-TCI, that allows us to use this instrument in order to identify the personality structures that make people sensitive to psychiatric pathologies.
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Affiliation(s)
- Silvia Dell’Orco
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | | | - Enrico Moretto
- School of Integrated Gestalt Psychotherapy, Torre Annunziata, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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25
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Ferentinos P, Fountoulakis KN, Lewis CM, Porichi E, Dikeos D, Papageorgiou C, Douzenis A. Validating a two-dimensional bipolar spectrum model integrating DSM-5's mixed features specifier for Major Depressive Disorder. Compr Psychiatry 2017. [PMID: 28647613 DOI: 10.1016/j.comppsych.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The literature on DSM-5's 'Major Depressive Disorder with lifetime mixed features' (MDD-MF) is limited. This study investigated MDD-MF's potential inclusion into a bipolar spectrum. METHODS We recruited 287 patients with Bipolar I disorder (BD-I), BD-II, MDD-MF or 'MDD without lifetime mixed features' (MDD-noMF); most (N=280) were stabilized for at least one year on medication. Sixteen validators (clinical features, psychiatric family history, temperament, stabilizing treatment) were compared across groups and subjected to trend analyses. Two discriminant function analyses (DFA; primary and secondary), excluding or including, respectively, treatment-related predictors, explored latent dimensions maximizing between-group discrimination; mahalanobis distances between group 'centroids' were calculated. RESULTS Eleven validators differed significantly across groups; nine varied monotonically along a bipolar diathesis gradient with significant linear trends; two peaked at MDD-MF and displayed significant quadratic trends. In the primary DFA, apart from a classic bipolarity dimension, correlating with hospitalizations, early age at onset, lifetime psychosis and lower anxious temperament scores, on which groups ranked along a bipolar propensity gradient, a second dimension was also significant, peaking at BD-II and MDD-MF (challenging the classic bipolar ranking), which correlated with lifetime psychiatric comorbidities, suicidality, lower lifetime psychosis rates, female gender, higher cyclothymic and lower depressive temperament scores; MDD-MF was equipoised amidst BD-II and MDD-noMF. After including treatment-related predictors (secondary DFA), discrimination improved overall but BD-II and MDD-MF were closest than any other pair, suggesting similar treatment patterns for these two groups at this naturalistic setting. CONCLUSIONS To our knowledge, this is the first time a two-dimensional bipolar spectrum based on classic external validators is proposed, fitting the data better than a unidimensional model. Additional predictors are warranted to improve BD-II/MDD-MF discrimination.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece; Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic and Development Psychiatry Center, London, United Kingdom.
| | | | - Cathryn M Lewis
- Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic and Development Psychiatry Center, London, United Kingdom.
| | - Evgenia Porichi
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.
| | - Dimitris Dikeos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece.
| | - Charalambos Papageorgiou
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece.
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.
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Janiri D, Di Nicola M, Martinotti G, Janiri L. Who's the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders. Curr Neuropharmacol 2017; 15:409-416. [PMID: 28503113 PMCID: PMC5405613 DOI: 10.2174/1570159x14666160607101400] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Predominant polarity characterises patients who mainly manifest recurrences of depression or mania/hypomania. Alcohol use disorder (AUD) and polysubstance use (PSU), which often complicate bipolar disorder (BD) and affect its clinical course, can influence predominant polarity. Nevertheless, previous studies have not clarified if BD patients differ in predominant polarity from BD patients with substance use disorder (SUD) comorbidity. OBJECTIVE The aim of this study was to compare predominant polarity between BD without SUD, BD with AUD and BD with PSU. We also investigated the association between predominant polarity and first episode polarity in each diagnostic group. METHOD We evaluated predominant polarity (≥2:1 lifetime depressive vs. manic/hypomanic episodes) in 218 DSM-IV-TR BD patients. Specifically, data were obtained from 86 patients with BD without SUD, 69 patients with BD and AUD, and 63 patients with BD and PSU with alcohol as the primary substance abused. RESULTS The three groups significantly differed for predominant polarity. The most common predominant polarity in BD without SUD was manic, while in BD with AUD and in BD with PSU it was depressive. Uncertain predominant polarity was the least common in BD without SUD and BD with PSU, whereas in BD with AUD, manic predominant polarity was least common. Predominant polarity matched onset polarity in all groups. CONCLUSION BD without SUD, BD with AUD, and BD with PSU have different predominant polarities. The correspondence between predominant polarity and polarity at the onset may impact diagnosis and treatment of BD.
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Affiliation(s)
- Delfina Janiri
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Martinotti
- Department of Neuroscience and Imaging, Institute of Psychiatry, “G. D’Annunzio” University of Chieti, Pescara, Italy
- Clinica Villa Maria Pia, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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Park H, Suh BS, Lee HK, Lee K. Temperament and characteristics related to attention deficit/hyperactivity disorder symptoms. Compr Psychiatry 2016; 70:112-7. [PMID: 27624430 DOI: 10.1016/j.comppsych.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/18/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Adult attention deficit/hyperactivity disorder (ADHD) exhibits symptoms, such as attention deficit and impulsivity, that make it difficult for patients to manage social activities. In this study, we investigated the association of adult ADHD symptoms with temperament and character dimensions, taking into account possible sex interactions. METHOD A total of 2917 (1462 males and 1455 females) college students completed the 140 5-point Likert items on the Temperament and Character Inventory-Revised Short version (TCI-RS) and the Attention Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS). According to the ASRS score, subjects were classified into the control group, the inattentive ADHD symptom (IA) group, or the hyperactive/impulsive ADHD symptom (HI) group. Additionally, the scores of the four temperament dimensions and the three character dimensions were compared. RESULTS In the IA and HI groups, the NS and HA levels of the temperament dimension were high and the PS level was low compared with the control group. In the character dimension, the levels of SD and CO were significantly lower in the ADHD groups than in the control group (P<0.001). Meanwhile, the ST level in the HI group was significantly higher than in the control group. In the regression analysis after age and gender correction, NS and SD in the IA group and NS, CO, and ST in the HI group were associated with adult ADHD symptoms. CONCLUSION The current findings suggest that high novelty seeking may be related to adult ADHD symptoms in the temperament dimension. Furthermore, some character dimensions were associated with adult ADHD symptoms.
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Affiliation(s)
- Hwanjin Park
- Department of Occupational & Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medicine, Graduate school, Hanyang University, Seoul, Republic of Korea
| | - Byung Seong Suh
- Department of Occupational & Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye-Kyung Lee
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea
| | - Kounseok Lee
- Department of Medicine, Graduate school, Hanyang University, Seoul, Republic of Korea; Department of Psychiatry, St. Andrew's Hospital, Icheon, Republic of Korea.
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Investigating the Impact of a Genome-Wide Supported Bipolar Risk Variant of MAD1L1 on the Human Reward System. Neuropsychopharmacology 2016; 41:2679-87. [PMID: 27184339 PMCID: PMC5026735 DOI: 10.1038/npp.2016.70] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 01/22/2023]
Abstract
Recent genome-wide association studies have identified MAD1L1 (mitotic arrest deficient-like 1) as a susceptibility gene for bipolar disorder and schizophrenia. The minor allele of the single-nucleotide polymorphism (SNP) rs11764590 in MAD1L1 was associated with bipolar disorder. Both diseases, bipolar disorder and schizophrenia, are linked to functional alterations in the reward system. We aimed at investigating possible effects of the MAD1L1 rs11764590 risk allele on reward systems functioning in healthy adults. A large homogenous sample of 224 young (aged 18-31 years) participants was genotyped and underwent functional magnetic resonance imaging (fMRI). All participants performed the 'Desire-Reason Dilemma' paradigm investigating the neural correlates that underlie reward processing and active reward dismissal in favor of a long-term goal. We found significant hypoactivations of the ventral tegmental area (VTA), the bilateral striatum and bilateral frontal and parietal cortices in response to conditioned reward stimuli in the risk allele carriers compared with major allele carriers. In the dilemma situation, functional connectivity between prefrontal brain regions and the ventral striatum was significantly diminished in the risk allele carriers. Healthy risk allele carriers showed a significant deficit of their bottom-up response to conditioned reward stimuli in the bilateral VTA and striatum. Furthermore, functional connectivity between the ventral striatum and prefrontal areas exerting top-down control on the mesolimbic reward system was reduced in this group. Similar alterations in reward processing and disturbances of prefrontal control mechanisms on mesolimbic brain circuits have also been reported in bipolar disorder and schizophrenia. Together, these findings suggest the existence of an intermediate phenotype associated with MAD1L1.
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Deguchi Y, Iwasaki S, Konishi A, Ishimoto H, Ogawa K, Fukuda Y, Nitta T, Inoue K. The Usefulness of Assessing and Identifying Workers' Temperaments and Their Effects on Occupational Stress in the Workplace. PLoS One 2016; 11:e0156339. [PMID: 27227771 PMCID: PMC4881989 DOI: 10.1371/journal.pone.0156339] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/12/2016] [Indexed: 12/29/2022] Open
Abstract
The relationship between temperaments and mental disorders has been reported in previous studies, but there has been little attention to temperaments in the occupational safety and health research. The aim of this study was to clarify the effects of temperaments on occupational stress among local government employees. The subjects were 145 Japanese daytime workers in local government. Temperaments were assessed by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire (TEMPS-A). Occupational stress was assessed using the Generic Job Stress Questionnaire (GJSQ). Hierarchical multiple linear regression analysis was used. Hyperthymic temperament predicted a higher level of job control, and a lower level of role ambiguity and job future ambiguity. Irritable temperament predicted a lower level of social support from supervisors and a higher level of role conflict, variance in workload and intragroup conflict. Anxious temperament predicted a lower level of social support from coworkers and a higher level of job future ambiguity. The sample size was small. Only Japanese local government employees were surveyed. Hyperthymic temperament played a protective role, and irritable, anxious temperament played a vulnerable role against one's own occupational stress and recognizing the roles they play in work life would lead to self-insight. Additionally, recognition of the temperaments and temperament-related stressors by one's supervisors or coworkers would facilitate provision of social support.
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Affiliation(s)
- Yasuhiko Deguchi
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
- * E-mail:
| | - Shinichi Iwasaki
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Akihito Konishi
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hideyuki Ishimoto
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichiro Ogawa
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yuichi Fukuda
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoko Nitta
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koki Inoue
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Use of the Temperament and Character Inventory to Predict Response to Repetitive Transcranial Magnetic Stimulation for Major Depression. J Psychiatr Pract 2016; 22:193-202. [PMID: 27123799 PMCID: PMC4852279 DOI: 10.1097/pra.0000000000000150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goal of this study was to investigate the utility of the Temperament and Character Inventory (TCI) in predicting antidepressant response to repetitive transcranial magnetic stimulation (rTMS). BACKGROUND Although rTMS of the dorsolateral prefrontal cortex is an established antidepressant treatment, little is known about predictors of response. The TCI measures multiple personality dimensions (harm avoidance, novelty seeking, reward dependence, persistence, self-directedness, self-transcendence, and cooperativeness), some of which have predicted response to pharmacotherapy and cognitive-behavioral therapy. A previous study suggested a possible association between self-directedness and response to rTMS in melancholic depression, although this was limited by the fact that melancholic depression is associated with a limited range of TCI profiles. METHODS Nineteen patients with a major depressive episode completed the TCI before a clinical course of rTMS over the dorsolateral prefrontal cortex. Treatment response was defined as ≥50% decrease in scores on the Hamilton Rating Scale for Depression (Ham-D). Baseline scores on each TCI dimension were compared between responders and nonresponders through analysis of variance. Pearson correlations were also calculated for temperament/character scores in comparison with percentage improvement in Ham-D scores. RESULTS Eleven of the 19 patients responded to rTMS. T-scores for persistence were significantly higher in responders than in nonresponders (P=0.022). Linear regression revealed a correlation between persistence scores and percentage improvement in Ham-D scores. CONCLUSIONS Higher persistence scores predicted antidepressant response to rTMS. This may be explained by rTMS-induced enhancement of cortical excitability, which has been found to be decreased in patients with high persistence. Personality assessment that includes measurement of TCI persistence may be a useful component of precision medicine initiatives in rTMS for depression.
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Nemes B, Cozman D. The relevance of personality assessment in estimating the risk of onset and the outcome of major depressive disorder. ACTA ACUST UNITED AC 2016; 89:212-5. [PMID: 27152070 PMCID: PMC4849377 DOI: 10.15386/cjmed-563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 09/22/2015] [Accepted: 10/06/2015] [Indexed: 01/07/2023]
Abstract
In the past two decades, numerous studies have focused on the relationship between the psychobiological model of temperament and character and the development and evolution of major depressive disorder. This interest has been generated primarily because this particular model was developed as a tool for a comprehensive diagnosis of mental disorders. Such a diagnosis model, based on fewer diagnostic categories and a more phenomenological and person oriented approach seems to be supported by more recent research. The aim of this paper was to review the latest developments in this area, but in the context of the initial development of the psychobiological model of temperament and character, i.e. as a tool for the comprehensive diagnosis of depressed individuals. Data published so far supports the following observations: (1) high harm avoidance and low self-directedness are risk factors for the development of major depressive disorder, but further research is needed to clearly establish the role of the other dimensions or their facets as predictors for the development of a depressive episode; (2) although some evidence has been obtained so far regarding the use of harm avoidance, novelty seeking, reward dependence and cooperativeness in predicting treatment response in major depressive disorder, further research is needed to clarify and/or to replicate these findings; and (3) data on temperament and character dimensions related to relapse in major depressive disorder are insufficient, although some evidence has been brought to support the hypothesis that high harm avoidance scores, and low self-directedness and novelty seeking scores might serve as predictors; further prospective studies need to be carried out to establish their utility in this respect.
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Affiliation(s)
- Bogdan Nemes
- Department of Medical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Cozman
- Department of Medical Psychology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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A meta-analysis of temperament and character dimensions in patients with mood disorders: Comparison to healthy controls and unaffected siblings. J Affect Disord 2016; 194:84-97. [PMID: 26803780 DOI: 10.1016/j.jad.2015.12.077] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/30/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cloninger's psychobiological model of personality has been extensively applied to subjects affected by mood disorders (MOOD). However, most studies are widely heterogeneous in terms of sample size, methods of assessment, and selection of participants. METHODS We conducted a systematic review of literature and a random effects meta-analysis of studies comparing at least two of the following groups: (a) adults with a primary MOOD diagnosis (Bipolar Disorder (BP) or major depressive disorder (MDD)), (b) their unaffected siblings (SIB) or (c) healthy subjects (HS), and reporting quantitative results from the Tridimensional Personality Questionnaire (TPQ) or the Temperament and Character Inventory (TCI). Subgroup, sensitivity and meta-regression analyses were also conducted. RESULTS High Harm Avoidance and low Self-Directedness were consistently associated with MOOD and SIB samples. BP was characterized by higher scores in Novelty Seeking and Self-Transcendence than HS, SIB and MDD. Age seemed to have a negative effect on Novelty Seeking and a positive effect on Harm Avoidance, Cooperativeness and Self-Transcendence. An euthymic mood state was associated with reduced Harm Avoidance, but increased Reward Dependence, Self-Directedness and Cooperativeness. LIMITATIONS The quality of the included studies varied and was relatively low. Moreover, publication bias and heterogeneity in the distribution of effect sizes may also have limited our results. CONCLUSION High Harm Avoidance and Low Self-Directedness may be trait markers for MOOD in general, while high Novelty Seeking and high Self-Transcendence may be specific to BP. Future studies are needed to disentangle the state-trait effect of each personality dimension.
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