Temperament and character in remitted and symptomatic patients with schizophrenia: modulation by the COMT Val158Met genotype

Personality traits in psychotic illness and their clinical correlates: A systematic review

This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.

Genetic contribution of catechol-O-methyltransferase in dorsolateral prefrontal cortex functional changes in the first episode schizophrenia

Catechol-O-methyltransferase (COMT) gene variants have been reported to be implicated in the pathogenesis of psychotic symptoms in schizophrenia, especially in negative symptoms. These symptoms including apathy, blunted affect, social withdrawal and motor retardation. Neuroimaging studies suggested that negative symptoms appear to be associated with impaired activities of the prefrontal cortex in particular the dorsolateral prefrontal cortex (DLPFC). Given that the COMT gene is highly expressed in the DLPFC, it is poorly understood whether the disease state and COMT val¹⁵⁸met polymorphisms have main and interactive effect on the resting state functional connectivity (RSFC) of DLPFC-related pathways. To this end, fifty-five first episode schizophrenia (FES) and fifty-three healthy controls were genotyped using blood samples and underwent magnetic resonance imaging scanning. Seed-based voxel wise functional connectivity analysis was performed by placing bilateral pairs of seeds with DLPFC in area 46 defined by Brodmann's atlas. A two-ways ANCOVA model was performed with val¹⁵⁸met genotypes and disease state as the between subjects factors. Significant disease × COMT interactive effect was found mainly in the left DLPFC with the left anterior cingulate cortex, right precuneus, right superior parietal gyrus, which were overlapped with disease main effect. And these RSFC had positive correlations with affective blunting scores in FES patients with val homozygotes, but not with met carriers. Our results showed that the disease and the genotypes in COMT gene have significant interactive effect on RSFC of DLPFC and provided evidence for a disease-dependent pattern of gene action.

Associations Of Personality Traits With The Capacity-Performance Discrepancy Of Functional Outcome In Patients With Schizophrenia

OBJECTIVE

Functional capacity, which indicates one's ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome.

METHODS

The measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group.

RESULTS

There were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group.

CONCLUSION

Lower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual's personality traits seem to be helpful for maximizing their functional performance in the community.

Karolinska Scales of Personality, cognition and psychotic symptoms in patients with schizophrenia and healthy controls

BACKGROUND

Studies on both personality dimensions and cognition in schizophrenia are scarce. The objective of the present study was to examine personality traits and the relation to cognitive function and psychotic symptoms in a sample of patients with schizophrenia and healthy controls.

METHOD

In total 23 patients with schizophrenia and 14 controls were assessed with the Karolinska Scales of Personality (KSP). A broad cognitive test programme was used, including the Wechsler Adult Intelligence Scales, the Finger-Tapping Test, the Trail Making Test, the Verbal Fluency Test, the Benton Visual Retention Test, the Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test .

RESULTS

Compared with controls, the patients exhibited prominent elevations on KSP scales measuring anxiety proneness and neuroticism (P = 0.000005-0.0001), on the Detachment scale (P < 0.00009) and lower value on the Socialization scale (P < 0.0002). The patients also scored higher on the Inhibition of Aggression, Suspicion, Guilt and Irritability scales (P = 0.002-0.03) while the remaining five scales did not differ between patients and controls. KSP anxiety-related scales correlated with the Positive and Negative Symptoms Scale (PANSS) general psychopathology subscale. Cognitive test results were uniformly lower in the patient group and correlated with PANSS negative symptoms subscale. There was no association between KSP scale scores and PANSS positive or negative symptoms.

CONCLUSION

The patients revealed a highly discriminative KSP test profile with elevated scores in neuroticism- and psychoticism-related scales as compared to controls. Results support previous findings utilizing other personality inventories in patients with schizophrenia. Cognitive test performance correlated inversely with negative symptoms.

Sensation/novelty seeking in psychotic disorders: A review of the literature

The evaluation of personality traits is important for the better understanding of the person suffering from psychosis and for treatment individualization. However literature on patients’ personality and character in such disorders is limited. The aim of this review was to summarize the literature on sensation/novelty seeking (SNS), a trait which is biologically based and highly heritable and is associated with dopamine activity, and refers to a person’s tendency to seek varied, novel, complex, and intense sensations and experiences. A total of 38 studies were included in this review, involving 2808 patients and 2039 healthy controls. There is consistent evidence that this trait is independently associated with alcohol and substance abuse in patients with schizophrenia and related disorders. The estimation of SNS would help clinicians to identify patients at risk for abuse. There is also some evidence that higher SNS levels may relate to medication non-adherence and seem to increase the risk of patients’ aggressive and violent behavior, but studies are scarce. SNS was found not to be related to suicidality, whereas in the fields of patients’ quality of life and psychopathology results are contradictory, but most studies show no possible association. Several studies suggest that SNS is lower in psychotic patients compared to controls, whereas most yield no differences. The evidence for this trait as a potential endophenotype of schizophrenia is weak. SNS may be implicated in psychotic disorders’ course and prognosis in several ways and should be always inquired for. This trait can be reliably measured with the use of easily applicable self-rated instruments, and patients’ accounts could inform clinicians when planning management and delivering individualized treatment.

The Affective and Emotional Composite Temperament Scale (AFECTS): Psychometric properties of the Spanish version in a community sample from Mexico City and comparison between remitted psychiatric patients

INTRODUCTION

AFECTS is a novel psychometric instrument that provides an integrated framework based on affective temperamental traits and their trait dimensions. It has the potential to be used in clinical and research fields to study psychopathology and mental health. It is now necessary to field-test this instrument with diverse populations and psychopathological entities.

OBJECTIVE

The primary aim was to test the construct validity and the internal consistency of the Spanish Version of the AFECTS instrument on Mexican subjects. AFECTS characteristics were then compared between general population and stable psychiatric patients.

METHODS

A cross-sectional design involving 350 subjects from the general population in México City and 91 stable patients with a bipolar disorder (BPD, n=20), major depressive disorder (MDD, n=35), or with a schizophrenia (n=36) diagnosis.

RESULTS

A six-factor structure in trait dimensions, explaining 61.4% of the variance, with a Cronbach׳s alpha of 0.93 was found. Euthymic (23%) and hyperthymic (12%) affective temperaments were the most frequent, while dysphoric (3%) and apathetic (3%) were the least. Trait dimension differences were found in Volition, Sensitivity, and the Instability Index between the groups, particularly those with a bipolar disorder.

LIMITATIONS

Use of a self report instrument, and a small sample not representative of the Mexican population or patients with psychiatric conditions.

CONCLUSIONS

The Spanish Version of the AFECTS instrument has adequate psychometric properties. This version of AFECTS will allow the use of this instrument among Spanish speaking populations and contribute to the continued research efforts on integrative models such as AFECT.