1
|
Favre S, Aubry JM, Richard-Lepouriel H. Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study. Int J Soc Psychiatry 2023; 69:378-387. [PMID: 35506642 PMCID: PMC9983048 DOI: 10.1177/00207640221093495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma impact the lives of persons living with bipolar disorder. AIM The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure. METHOD Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit. RESULTS Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component. CONCLUSION The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.
Collapse
Affiliation(s)
- Sophie Favre
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland
| | | | - Hélène Richard-Lepouriel
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland.,Department of Psychiatry, University of Geneva, Switzerland
| |
Collapse
|
2
|
Piras M, Scano A, Orrù G, Preti A, Marchese C, Kalcev G. Can an Investigation of a Single Gene be Effective in Differentiating Certain Features of the Bipolar Disorder Profile? Clin Pract Epidemiol Ment Health 2021; 17:187-189. [PMID: 35173786 PMCID: PMC8728559 DOI: 10.2174/1745017902117010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022]
Abstract
Bipolar disorder (BD) is amongst the most common heritable mental disorders, but the clarification of its genetic roots has proven to be very challenging. Many single nucleotide polymorphisms (SNPs) have been identified to be associated with BD. SNPs in the CACNA1C gene have emerged as the most significantly associated with the disease. The aim of the present study is to provide a concise description of SNP 1006737 variants identified by Real Time PCR and confirm sequencing analysis with the Sanger method in order to estimate the association with BD. The molecular method was tested on 47 Sardinian subjects of whom 23 were found to not be mutated, 1 was found to be a carrier of the homozygous A allele and 23 were found to be carriers of the heterozygous G allele. Moreover, the positive results of the preliminary application suggest that the development of the screener could be extended to the other 5 genetic variables identified as associated with BD.
Collapse
|
3
|
Holm-Hadulla RM, Hofmann FH, Sperth M, Mayer CH. Creativity and Psychopathology: An Interdisciplinary View. Psychopathology 2021; 54:39-46. [PMID: 33326984 DOI: 10.1159/000511981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
Since ancient philosophy, extraordinary creativity is associated with mental disorders, emotional and cognitive destabilization, and melancholia. We here summarize the results of empirical and narrative studies and analyze the most prominent case of a highly creative person who suffered from dysthymia and major depression with suicidality. Hereby, we focus on the interaction of different phases of the creative process with "bipolar" personality traits. Finally, we offer an interdisciplinary interpretation of the creative dialectics between order and chaos. The results show that severe psychopathology inhibits creativity. Mild and moderate disorders can inspire and motivate creative work but are only leading to new and useful solutions when creators succeed in transforming their emotional instability and cognitive incoherence into stable and coherent forms. The cultural idea that creativity emerges in dialectical processes between order and chaos, is also to be found in the psychologic interplay of coherence and incoherence, and in neuro-scientific models of the dynamics between tightening and loosening of neuronal structures. Consequences are drawn for the psychotherapeutic treatment of persons striving for creativity.
Collapse
Affiliation(s)
- Rainer M Holm-Hadulla
- Medical Department, Heidelberg University, Heidelberg, Germany, .,Universidad de Chile, Santiago, Chile,
| | - Frank-Hagen Hofmann
- Psychological Department, Heidelberg University, Heidelberg, Germany.,Counseling Service for Students, Heidelberg Student Services, Heidelberg, Germany
| | - Michael Sperth
- Counseling Service for Students, Heidelberg Student Services, Heidelberg, Germany
| | - Claude-Hélène Mayer
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
4
|
Acar S, Tadik H, Myers D, Sman C, Uysal R. Creativity and Well‐being: A Meta‐analysis. JOURNAL OF CREATIVE BEHAVIOR 2020. [DOI: 10.1002/jocb.485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Danielle Myers
- Buffalo State, State University of New York Buffalo NY USA
| | | | | |
Collapse
|
5
|
Abstract
Bipolar disorder is a lifelong mood disorder characterized by extreme mood swings between mania and depression. Despite fitness costs associated with increased mortality and significant impairment, bipolar disorder has persisted in the population with a high heritability and a stable prevalence. Creativity and other positive traits have repeatedly been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits. This suggests a model in which large doses of risk variants cause illness, but mild to moderate doses confer advantages, which serve to maintain bipolar disorder in the population. Bipolar disorder may thus be better conceptualized as a dimensional trait existing at the extreme of normal population variation in positive temperament, personality, and cognitive traits, aspects of which may reflect a shared vulnerability with creativity. Investigations of this shared vulnerability may provide insight into the genetic mechanisms underlying illness and suggest novel treatments.
Collapse
Affiliation(s)
- Tiffany A Greenwood
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA;
| |
Collapse
|
6
|
Génie, créativité et bipolarité. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2013.09.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction.La créativité et le génie sont associés dans la conscience populaire, à la folie. Pourtant l’image de l’artiste a évolué toutes ces décennies, passant d’une sorte de schizophrène évidemment tourmenté à un bipolaire bienheureux et hyperactif.Objectif.Établir les mécanismes des liens unissant la créativité et l’humeur.Méthodologie.Revue de littérature en utilisant les mots clés : créativité, trouble bipolaire et tempérament.Résultats et discussion.Selon Hagop et Kareen Akiskal (1988) la prévalence des troubles bipolaires chez les créateurs est de 65 % de sujets cyclothymiques dans leur population d’artistes et d’écrivains, chanteurs de blues. British Study (1989) a établi un lien direct entre le trouble bipolaire ou cyclothymique d’artistes et d’écrivains britanniques et leur créativité : 38 % ont été traités pour des troubles de l’humeur et le 1/3 de ces artistes et écrivains font état d’oscillations sévères de l’humeur (moodswings). Elie Hantouche (2010) a souligné dans une analyse exhaustive de la littérature scientifique sur bipolarité et créativité en insistant sur le tempérament cyclothymique, que ce dernier est « un marqueur robuste de la bipolarité atténuée » et « le caractère le plus fortement lié à la créativité ». Toutefois, trop d’hypomanie tue la créativité, en effet l’hyperactivité sans période de réflexion et de contemplation ne favorise pas le processus artistique pur qui a besoin de la phase sombre de la mélancolie et de la lucidité autocritique (absente dans l’hypomanie). Bernard Granger (2004) a conclu que la bradypsychie et l’anesthésie affective de la dépression empêchent l’artiste de créer et stérilisent sa pensée. Et que dans les états maniaques les productions sont facilement débridées, inabouties et superficielles.Conclusion.Faut-il soigner les créateurs ? Faut-il privilégier l’équilibre thymique, mais respecter autant que possible la trajectoire de vie du patient sans étouffer sa créativité ?
Collapse
|
7
|
Everyday creativity and bipolar and unipolar affective disorder: preliminary study of personal and family history. Eur Psychiatry 2020. [DOI: 10.1017/s092493380000328x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SummaryPreliminary new data support the enhancement of ‘everyday’ creativity among those persons with bipolar disorders who manifest milder rather than more severe mood elevations, and among certain individuals who are likely to carry bipolar liability but themselves show no clinical mood elevations – in this case, unipolar depressives with a family history of bipolar disorder, when compared with depressives lacking this history. Creativity was assessed using the lifetime creativity scales (Richardsel al, 1988). Underlying mechanisms may be multifactorial and complex. Results suggest that both personal and family history should be considered when making predictions concerning creativity and affective disorders.
Collapse
|
8
|
Jaracz M, Borkowska A. Creativity and Affective Temperament in Artistic and Non‐artistic Students: Different Temperaments are Related to Different Aspects of Creativity. JOURNAL OF CREATIVE BEHAVIOR 2019. [DOI: 10.1002/jocb.426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marcin Jaracz
- Chair of Clinical Neuropsychology, Faculty of Health Sciences Nicolaus Copernicus University in Torun, Poland
| | - Alina Borkowska
- Chair of Clinical Neuropsychology, Faculty of Health Sciences Nicolaus Copernicus University in Torun, Poland
| |
Collapse
|
9
|
Acar S, Chen X, Cayirdag N. Schizophrenia and creativity: A meta-analytic review. Schizophr Res 2018; 195:23-31. [PMID: 28867517 DOI: 10.1016/j.schres.2017.08.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 02/04/2023]
Abstract
The present study investigated the relationship between creativity and schizophrenia with a 3-level multilevel meta-analytic approach. Analyses with 200 effect sizes obtained from 42 studies found a mean effect size of r=-0.324, 95%CI [-0.42, -0.23]. Further analyses focused on moderators and indicated that the relationship between schizophrenia and creativity is moderated by type of creativity measure, the content of creativity measure, the severity of schizophrenia, and patient status. The negative mean effect size was stronger with semantic-category or verbal-letter fluency tasks than the divergent thinking or associational measures. Performance on verbal measures of creativity was significantly lower than the nonverbal measures. When effect sizes were compared at different levels of severity, a stronger and more negative mean effect size was obtained at chronic schizophrenia than acute and early onset levels. Studies that involved inpatients had a significantly higher (more negative) mean effect size than those involving outpatients. When these findings are considered along with previous meta-analyses on the link between creativity and psychoticism and schizotypy, creativity and psychopathology seem to have an inverted-U relationship. A mild expression of schizophrenia symptoms may support creativity but a full demonstration of the symptoms undermines it.
Collapse
Affiliation(s)
- Selcuk Acar
- International Center for Studies in Creativity, Buffalo State - State University of New York, United States.
| | - Xiao Chen
- International Center for Studies in Creativity, Buffalo State - State University of New York, United States.
| | - Nur Cayirdag
- International Center for Studies in Creativity, Buffalo State - State University of New York, United States.
| |
Collapse
|
10
|
Vellante F, Sarchione F, Ebisch SJH, Salone A, Orsolini L, Marini S, Valchera A, Fornaro M, Carano A, Iasevoli F, Martinotti G, De Berardis D, Di Giannantonio M. Creativity and psychiatric illness: A functional perspective beyond chaos. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:91-100. [PMID: 28689007 DOI: 10.1016/j.pnpbp.2017.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/14/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Federica Vellante
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy; Institute of Advanced Biomedical Technologies, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy; NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Asl 4, Teramo, Italy
| | - Fabiola Sarchione
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Sjoerd J H Ebisch
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Anatolia Salone
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Laura Orsolini
- Polyedra Research Group, 64100 Teramo, Italy.; Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Stefano Marini
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Michele Fornaro
- New York State Psychiatric Institute (NYPSI), Columbia University, NYC, NY, USA
| | - Alessandro Carano
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy; NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Maria SS del Soccorso", San Benedetto del Tronto, Italy
| | - Felice Iasevoli
- Polyedra Research Group, 64100 Teramo, Italy.; Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatogical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Giovanni Martinotti
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Asl 4, Teramo, Italy; Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
| | - Massimo Di Giannantonio
- Department of Neurosciences Clinical Imaging, Chair of Psychiatry, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
11
|
Nowacka O, Welcz H, Karakuła-Juchnowicz H. Review paper. Does genius border on insanity? Part I: A relationship between creativity and the presence of psychopathological symptoms in bipolar disorder. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The theory linking the development of mental disorders with the processes of human evolution assumes that these disorders may be the result of a side effect of natural and sexual selection processes. Creativity is one of the adaptive features associated with the increased incidence of psychopathological symptoms (as compared to the general population).
In this review paper, the definition of creativity has been characterized, and contemporary existing theories on its background, have been presented. Also, the paper describes the relationship between creativity and the presence of psychopathological symptoms. Special attention has been paid to the relationship between creativity and bipolar disorder.
The research results prove the existence of a correlation between a high level of creativity and a higher prevalence of psychopathological symptoms, particularly concerning the symptoms of bipolar disorder spectrum.
Collapse
Affiliation(s)
- Olga Nowacka
- Student Research Group at the Department of Clinical Neuropsychiatry at the Chair of Psychiatry Medical University of Lublin , Poland
| | - Henryk Welcz
- I Department of Psychiatry, Psychotherapy end Early Intervention, Medical University of Lublin , Poland
| | - Hanna Karakuła-Juchnowicz
- I Department of Psychiatry, Psychotherapy end Early Intervention, Medical University of Lublin, Lublin , Poland
- Department of Clinical Neuropsychiatry, Medical University of Lublin , Poland
| |
Collapse
|
12
|
Barbato G, Piemontese S, Pastorello G. Seasonal Changes in Mood and Creative Activity among Eminent Italian Writers. Psychol Rep 2016; 101:771-7. [DOI: 10.2466/pr0.101.3.771-777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A sample of 33 eminent Italian writers was studied. They were nominees of three of the most important literary Italian awards (Strega, Campiello, and Viareggio). The Seasonal Pattern Assessment Questionnaire was mailed to 105 writers during the period October 2003 and January 2004, of whom 39 replied. 33 ( M age = 54.5 yr., SD=12.5; 8 women and 25 men) completed the questionnaire. Among respondents, spring and summer months showed highest ratings of “feel best.” During the summer a decline in creativity was not significant; respondents also reported sleeping least. Scores on the Global Seasonality Score suggested writers appeared to show higher seasonal sensitivity than the general population. Seasonal changes were considered as a problem by a majority of them. Although writers showed high seasonal sensitivity, no significant relationship was found between the seasonal pattern of mood and self-reported creativity.
Collapse
|
13
|
Mania risk and creativity: a multi-method study of the role of motivation. J Affect Disord 2015; 170:52-8. [PMID: 25233239 DOI: 10.1016/j.jad.2014.08.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Substantial literature has linked bipolar disorder and risk for bipolar disorder with creative accomplishment, but few multimodal studies of creativity are available, and little is known about mechanisms. METHODS We use a multi-method approach to test the association of bipolar risk with several creativity measures, including creative accomplishments, creative personality traits, and a laboratory index of insight. We also examined whether multiple facets of motivation accounted for the links of bipolar risk with creativity. Among 297 undergraduates, mania risk, as measured with the Hypomanic Personality Scale was related to lifetime creativity and creative personality, but not to performance on the insight task. Motivational traits appeared to mediate the links of mania risk with both lifetime creative accomplishments and self-rated creativity. LIMITATIONS The study relied on a cross-sectional design and a convenience sample. CONCLUSIONS Future studies would benefit from exploring motivation as a positive aspect of manic vulnerability that may foster greater creativity.
Collapse
|
14
|
Parker G, Fletcher K. Differentiating bipolar I and II disorders and the likely contribution of DSM-5 classification to their cleavage. J Affect Disord 2014; 152-154:57-64. [PMID: 24446541 DOI: 10.1016/j.jad.2013.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Current diagnostic criteria define bipolar I (BP I) and bipolar II (BP II) disorders as distinct conditions, differing only slightly by clinical features. This review seeks to identify commonalities and differentiating features across the two sub-types, and emphasize that differences in causes and treatments are likely to be highly dependent on the diagnostic criteria used to define and differentiate the two conditions. We undertake a literature review of candidate clinical features that might be anticipated to vary or be shared across BP I and BP II disorders, and consider the impact of DSM definition on such applied findings. Studies respecting DSM-IV differentiation of BP I and BP II disorders have generated relatively few differences across the conditions, which may reflect definitional similarity or commonalities across the two conditions. As DSM-5 decision rules are similar to those used by DSM-IV to differentiate BP I and BP II disorders, we argue for application studies employing DSM-5 decisions to examine the differential impact of three features that weight BP I assignment (i.e. psychosis, hospitalization and/or impairment) and examine other sets of differentiating criteria.
Collapse
|
15
|
McCraw S, Parker G, Fletcher K, Friend P. Self-reported creativity in bipolar disorder: prevalence, types and associated outcomes in mania versus hypomania. J Affect Disord 2013; 151:831-6. [PMID: 24084622 DOI: 10.1016/j.jad.2013.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bipolar (BP) disorder has been linked to creativity following investigation of prominent artists and controlled trials of creativity in BP disorder patients. However, it is unclear whether creativity is differentially expressed across the BP I and BP II subtypes. METHODS 219 patients (aged 19-63 years) diagnosed with BP disorder by clinical interview and DSM-IV criteria were asked whether they tended to be more creative during hypo/manic episodes, and answered five questions about personality styles associated with creativity. Qualitative analyses were performed on a smaller subset of 69 BP patients (n=19 BP I, n=50 BP II) who provided written responses of the types of creative activities engaged in when hypo/manic and any perceived advantages or disadvantages of their creative pursuits. RESULTS 82% of BP patients affirmed being creative when hypo/manic, with comparable results for the BP I and BP II subtypes (84% and 81% respectively). Both BP subtypes engaged mostly in writing, painting, work or business ideas and 'other' forms of art; however BP II patients were more likely to draw and be musical. Both subgroups reported the consequences of feeling good, being productive or quitting their project. BP I patients were more likely to overspend during their creative highs while BP II patients were more likely to experience improved focus and clarity. BP patients affirming creative highs were significantly more likely to report creative personality styles more generally outside of a mood episode. LIMITATIONS BP patients' self-reported creative activities were not retrospectively judged for quality or originality and so may reflect common creative abilities rather than exceptional quality. The impact of depressive episodes on creativity was not assessed. Uneven sample sizes in the BP I and BP II subgroups may have compromised statistical power. CONCLUSION Creativity during hypo/manic episodes was extremely common in both BP subtypes. While some nuances in activity type and outcomes were observed, no significant creative phenotype specific to BP I or BP II disorder emerged.
Collapse
Affiliation(s)
- Stacey McCraw
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
| | | | | | | |
Collapse
|
16
|
Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder. J Affect Disord 2011; 135:292-7. [PMID: 21767880 DOI: 10.1016/j.jad.2011.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/23/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Creativity is a complex construct involving affective and cognitive components. Bipolar Disorder (BD) has been associated with creativity and is characterized by a wide range of affective and cognitive symptoms. Although studies of creativity in BD have tended to focus on creativity as a trait variable in medicated euthymic patients, it probably fluctuates during symptomatic states of BD. Since creativity is known to involve key affective and cognitive components, it is plausible to speculate that cognitive deficits and symptoms present in symptomatic BD could interfere with creativity. MATERIAL AND METHODS Sixty-seven BD type I patients medication free, age 18-35 years and experiencing a maniac, mixed, or depressive episodes, were assessed for creativity, executive functioning, and intelligence. RESULTS Manic and mixed state patients had higher creativity scores than depressive individuals. Creativity was influenced by executive function measures only in manic patients. Intelligence did not influence creativity for any of the mood episode types. CONCLUSION We propose that creativity in BD might be linked to the putative hyperdopaminergic state of mania and be dependent on intact executive function. Future studies should further explore the role of dopaminergic mechanisms in creativity in BD.
Collapse
|
17
|
Vellante M, Zucca G, Preti A, Sisti D, Rocchi MBL, Akiskal KK, Akiskal HS. Creativity and affective temperaments in non-clinical professional artists: an empirical psychometric investigation. J Affect Disord 2011; 135:28-36. [PMID: 21820743 DOI: 10.1016/j.jad.2011.06.062] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Manic-depression/bipolar disorder was linked to creativity, with affective temperaments allegedly favoring creative expression and achievement, but a few studies only empirically tested the link. METHODS 152 undergraduate students attending preparatory courses for creative artistic professions and 152 students in areas expected to lead to a profession mostly requiring the application of the learned rules were invited to fill in the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire), the General Health Questionnaire (GHQ) and the Creative Achievement Questionnaire (CAQ). Latent class analysis (LCA) was used to investigate the links between creativity scores and measures of psychopathology. RESULTS Creative participants and controls did not differ in terms of sex (males=47%), age (24.5 years, SD=3.8), or socioeconomic status. Creative people scored higher than controls on the CAQ and on the cyclothymic, hyperthymic and irritable subscales of the TEMPS-A, but not on the GHQ. Greater involvement in creative activities rather than being a creative achiever best differentiated those into the "risk for bipolar spectrum" class from the other two classes extracted by the LCA from the TEMPS-A. LIMITATIONS The use of self-report measures to evaluate both creative involvement and the risk of psychopathology, and the exclusive focus on artistic creativity limit the generalizability of the findings. CONCLUSIONS This study confirms that the cyclothymic dimension of the bipolar spectrum is linked to creativity, and this link is likely to result from increased involvement into pleasurable activities, including creative ones.
Collapse
Affiliation(s)
- Marcello Vellante
- Department of Psychology, University of Cagliari, via Is Mirrionis 1, 09123 Cagliari, Italy
| | | | | | | | | | | | | |
Collapse
|
18
|
Eőry A, Gonda X, Torzsa P, Kalabay L, Rihmer Z. Affective temperaments: from neurobiological roots to clinical application. Orv Hetil 2011; 152:1879-86. [DOI: 10.1556/oh.2011.29245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) has grown to be a clinically important outcome measure in the diagnosis and the clinical course of mood disorders. However, temperaments, which represent the biologically stable core of personality, are not just antecedents of major affective disorders, but also serve as a reservoir of genetically advantageous traits for the survival of different cultures. The rapidly growing body of research in psychiatric and non-psychiatric fields even raises the question of temperament as a common root in psychiatric and somatic disorders, providing a new meaning for the construct of psychosomatic disorders. In this review we aim to summarize current knowledge on both the neurobiological background and clinical importance of affective temperaments including implications for future research. Orv. Hetil., 2011, 152, 1879–1886.
Collapse
Affiliation(s)
- Ajándék Eőry
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Xénia Gonda
- Semmelweis Egyetem, Általános Orvostudományi Kar Klinikai és Kutatási Mentálhigiénés Osztály Budapest
| | - Péter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - László Kalabay
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Zoltán Rihmer
- Semmelweis Egyetem, Általános Orvostudományi Kar Klinikai és Kutatási Mentálhigiénés Osztály Budapest
- Semmelweis Egyetem, Általános Orvostudományi Kar Pszichiátriai és Pszichoterápiás Klinika Budapest
| |
Collapse
|
19
|
Holm-Hadulla RM, Roussel M, Hofmann FH. Depression and creativity - the case of the German poet, scientist and statesman J. W. v. Goethe. J Affect Disord 2010; 127:43-9. [PMID: 20605219 DOI: 10.1016/j.jad.2010.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/10/2010] [Accepted: 05/11/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Goethe was one of the most creative poets, scientists and statesmen ever existing. Since the age of fourteen, he suffered from severe mood swings. His descriptions of feelings, emotions, and mental states related to temperamental and poetic melancholy, depressive episodes, dysthymic phases, and creativity are unique in respect to their phenomenological precision and richness. Furthermore, his (self-) therapeutic strategies and his self transformation in literature remain interesting until today for psychopathology, psychotherapy and creativity research. METHODS Goethe's self-assessments in his works and letters as well as the description of him by others are analysed by phenomenological and hermeneutic methods from the perspective of current psychiatric classification and psychotherapeutic knowledge. RESULTS From a modern scientific perspective Goethe's mood swings are not to be regarded as expressions of a "poet's melancholy" in fashion at his time but as symptoms of depressive episodes. Several distinctive depressive episodes can be diagnosed which were characterized by long lasting depressive mood, lack of drive, interests and self-esteem combined with social retreat and physical illness. Moreover, Goethe described a mood disorder which fits into the modern concept of "driven dysthymia" or Bipolar II disorder. Goethe's depressive moods were associated with eminent poetic creativity whereas in times of scientific and political productivity Goethe seemed to be protected against depressive episodes. LIMITATIONS Phenomenological and hermeneutic analysis cannot offer causal explanations but only reasons for understanding and communicative action. CONCLUSIONS In Goethe's life poetic incubation, illumination and elaboration seemed to be associated with psychic labilisation and dysthymia, sometimes with depressive episodes in a clinical sense. Thus, creative work was on the one hand triggered by depressive and dysthymic moods and served on the other hand to cope with depressive moods as well as with suicidal tendencies. In line with modern empirical results Goethe's scientific and social activities and achievements were associated with personal well-being, but also with lack of poetic inspiration.
Collapse
|
20
|
Toward interaction of affective and cognitive contributors to creativity in bipolar disorders: a controlled study. J Affect Disord 2010; 125:27-34. [PMID: 20085848 DOI: 10.1016/j.jad.2009.12.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 12/21/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Enhanced creativity in bipolar disorder patients may be related to affective and cognitive phenomena. METHODS 32 bipolar disorder patients (BP), 21 unipolar major depressive disorder patients (MDD), 22 creative controls (CC), and 42 healthy controls (HC) (all euthymic) completed the Revised Neuroticism Extraversion Openness Personality Inventory (NEO), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), the Myers-Briggs Type Inventory (MBTI); the Barron-Welsh Art Scale (BWAS), the Adjective Check List Creative Personality Scale, and the Figural and Verbal Torrance Tests of Creative Thinking. Mean scores were compared across groups, and relationships between temperament/personality and creativity were assessed with bivariate correlation and hierarchical multiple linear regression. RESULTS BP and CC (but not MDD) compared to HC had higher BWAS-Total (46% and 42% higher, respectively, p<0.05) and BWAS-Dislike (83% and 93% higher, p<0.02) scores, and higher MBTI-Intuition preference type rates (78% vs. 50% and 96% vs. 50%, p<0.05). BP, MDD, and CC, compared to HC, had increased TEMPS-A-Cyclothymia scores (666%, 451% and 434% higher, respectively, p<0.0001), and NEO-Neuroticism scores (60%, 57% and 51% higher, p<0.0001). NEO-Neuroticism and TEMPS-A Cyclothymia correlated with BWAS-Dislike (and BWAS-Total), while MBTI-Intuition continuous scores and NEO-Openness correlated with BWAS-Like (and BWAS-Total). LIMITATIONS Relatively small sample size. CONCLUSIONS We replicate the role of cyclothymic and related temperaments in creativity, as well as that of intuitive processes. Further studies are needed to clarify relationships between creativity and affective and cognitive processes in bipolar disorder patients.
Collapse
|
21
|
Rihmer Z, Gonda X, Rihmer A, Fountoulakis KN. Suicidal and violent behaviour in mood disorders: A major public health problem. A review for the clinician. Int J Psychiatry Clin Pract 2010; 14:88-94. [PMID: 24922467 DOI: 10.3109/13651501003624712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Suicide attempt, and particularly completed suicide are relatively rare events in the community, but they are very common among psychiatric patients. Since over 90% of suicide victims suffer from (mostly untreated) current major mental disorders (particularly from major depressive episode), psychiatric risk factors are the clinically most useful predictors, especially if psychosocial and demographic risk factors are also pesent. Violent behaviours associated with mood disorders constitute a related yet independently also important aspect of this illness, and assessment and management of violence is a key component of everyday psychiatric practice. While most people with current mental disorder are not violent, violence is more common among seriously mentally ill individuals than in healthy persons. This is particularly true for untreated schizophrenics and untreated patients with major mood disorders, first of all in the cases of comorbid substance use disorders, mainly among those with current mania or postpartum depression. Although specific clinical studies are lacking, it is very lilely that successful acute and long-tem treatment of mood disorders can reduce the risk of violent behaviour in this patient population.
Collapse
Affiliation(s)
- Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | | | | | | |
Collapse
|
22
|
Schizotypy and affective temperament: Relationships with divergent thinking and creativity styles. PERSONALITY AND INDIVIDUAL DIFFERENCES 2009. [DOI: 10.1016/j.paid.2009.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
23
|
Murphy C. The link between artistic creativity and psychopathology: Salvador Dalí. PERSONALITY AND INDIVIDUAL DIFFERENCES 2009. [DOI: 10.1016/j.paid.2009.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Abstract
Music has soothed the souls of human beings for centuries and it has helped people recover from ailments since ancient times. Today, there is still a widespread interest in the relationship between music, affect and mental illness. This article is aimed at reviewing these complex relationships, starting from a wide perspective on the neurobiology of emotions, perceptions and music language to a detailed analysis of psychopathology in famous musicians.
Collapse
Affiliation(s)
- Marco Mula
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University, Novara, Italy
| | | |
Collapse
|
25
|
Pies R. The historical roots of the "bipolar spectrum": did Aristotle anticipate Kraepelin's broad concept of manic-depression? J Affect Disord 2007; 100:7-11. [PMID: 17224187 DOI: 10.1016/j.jad.2006.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 08/29/2006] [Indexed: 11/17/2022]
Abstract
The construct of bipolar disorder, or bipolar spectrum disorders, has been a source of controversy in recent years. Some have argued that subtle variants within the putative bipolar spectrum are merely the creation of overzealous clinicians, perhaps encouraged by various special interest groups. In reality, the concept of a bipolar spectrum may be inferred from numerous classical sources, dating back to the 19th century and even into antiquity. The Greek philosopher Aristotle, usually considered the author of a work called Problemata, appears to have recognized some form of the bipolar spectrum, more than two millennia ago. This recognition continues throughout the 19th century, and into our own time. Such transcultural findings across many centuries have implications for the "objective" nature of psychiatric disease.
Collapse
Affiliation(s)
- Ronald Pies
- Tufts University School of Medicine, Boston, MA 01730, USA.
| |
Collapse
|
26
|
Akiskal HS, Akiskal KK. In search of Aristotle: temperament, human nature, melancholia, creativity and eminence. J Affect Disord 2007; 100:1-6. [PMID: 17499855 DOI: 10.1016/j.jad.2007.04.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 04/18/2007] [Indexed: 11/24/2022]
Abstract
Is suffering associated with melancholia and "madness" necessary for artistic creativity and eminence? Or do creativity and leadership have something to do with the temperaments associated with affective disease? We integrate concepts dating back to Greek psychological medicine and philosophy--especially work attributed to Aristotle--with modern data-based examination of the role of cyclothymic and related temperaments in the interface between mixity, the bipolar spectrum and normality. We place our query within the general framework of evolutionary biology and human nature. In doing so, we propose that affective disease--including mania and associated psychotic states--exist because they serve as the genetic reservoir for adaptive temperaments and the genes for genius. Affective disorder can therefore be regarded as the price of exceptional greatness. Thus, creative and eminent individuals, by virtue of their being exceptional, occupy a somewhat unstable terrain between temperament and affective disease.
Collapse
|
27
|
Strong CM, Nowakowska C, Santosa CM, Wang PW, Kraemer HC, Ketter TA. Temperament-creativity relationships in mood disorder patients, healthy controls and highly creative individuals. J Affect Disord 2007; 100:41-8. [PMID: 17126408 DOI: 10.1016/j.jad.2006.10.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/02/2006] [Accepted: 10/13/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate temperament-creativity relationships in euthymic bipolar (BP) and unipolar major depressive (MDD) patients, creative discipline controls (CC), and healthy controls (HC). METHODS 49 BP, 25 MDD, 32 CC, and 47 HC (all euthymic) completed three self-report temperament/personality measures: the Revised NEO Personality Inventory (NEO-PI-R), the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and the Temperament and Character Inventory (TCI); and four creativity measures yielding six parameters: the Barron-Welsh Art Scale (BWAS-Total, BWAS-Like, and BWAS-Dislike), the Adjective Check List Creative Personality Scale (ACL-CPS), and the Torrance Tests of Creative Thinking--Figural (TTCT-F) and Verbal (TTCT-V) versions. Factor analysis was used to consolidate the 16 subscales from the three temperament/personality measures, and the resulting factors were assessed in relationship to the creativity parameters. RESULTS Five personality/temperament factors emerged. Two of these factors had prominent relationships with creativity measures. A Neuroticism/Cyclothymia/Dysthymia Factor, comprised mostly of NEO-PI-R-Neuroticism and TEMPS-A-Cyclothymia and TEMPS-A-Dysthymia, was related to BWAS-Total scores (r=0.36, p<0.0001) and BWAS-Dislike subscale scores (r=0.39, p<0.0001). An Openness Factor, comprised mostly of NEO-PI-R-Openness, was related to BWAS-Like subscale scores (r=0.28, p=0.0006), and to ACL-CPS scores (r=0.46, p<0.0001). No significant relationship was found between temperament/personality and TTCT-F and TTCT-V scores. CONCLUSIONS Neuroticism/Cyclothymia/Dysthymia and Openness appear to have differential relationships with creativity. The former could provide affective (Neuroticism, i.e. access to negative affect, and Cyclothymia, i.e. changeability of affect) and the latter cognitive (flexibility) advantages to enhance creativity. Further studies are indicated to clarify mechanisms of creativity and its relationships to affective processes and bipolar disorders.
Collapse
Affiliation(s)
- Connie M Strong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2124, Stanford, CA 94305-5723, USA
| | | | | | | | | | | |
Collapse
|
28
|
BARBATO GIUSEPPE. SEASONAL CHANGES IN MOOD AND CREATIVE ACTIVITY AMONG EMINENT ITALIAN WRITERS. Psychol Rep 2007. [DOI: 10.2466/pr0.101.7.771-777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
29
|
Akiskal HS, Akiskal KK, Lancrenon S, Hantouche EG, Fraud JP, Gury C, Allilaire JF. Validating the bipolar spectrum in the French National EPIDEP Study: overview of the phenomenology and relative prevalence of its clinical prototypes. J Affect Disord 2006; 96:197-205. [PMID: 16824616 DOI: 10.1016/j.jad.2006.05.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 05/15/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have been undertaken to ascertain the feasibility of using the bipolar (BP) spectrum in clinical practice. The only systematic national study is the French EPIDEP Study of consecutive inpatients and outpatients presenting with major depressive episodes (MDE). The protocol was developed in 1994 and implemented in 1995; publication of its first data began in 1998. This report provides the complete data set of the EPIDEP. METHODS Forty-eight psychiatrists, practicing in 15 sites in four regions of France (Paris, Besançon, Bordeaux and Marseille), were all trained on a common protocol based on DSM-IV criteria for MDE (n=537) subdivided into BP-I (history of mania), BP-II (history of hypomania), as well as extended definitions of the "softer spectrum" beyond BP-I and BP-II. Measures tapping into this spectrum included the Hypomania Checklist (HCA), the cyclothymic (CT), depressive (DT) and hyperthymic (HT) temperament scales. These measures and course permitted post-hoc assignment of MDE in the bipolar spectrum, based in part on the Akiskal, H.S., Pinto, O., 1999. [The evolving bipolar spectrum: Prototypes I, II, III, IV. Psychiatr. Clin. North Am. 22, 517-534] proposal: depression with history of spontaneous hypomanic episodes (DSM-IV, BP-II), cyclothymic depressions (BP-II(1/2)), antidepressant-associated hypomania (BP-III) and hyperthymic depressions (BP-IV). <<Strict UP>> was thereby limited to an exclusion diagnosis for the remainder of MDE. LIMITATION In the clinical setting, psychiatrists cannot be entirely blind to the observations in the various clinical evaluations and instruments. However, the systematic multisite collection of such data tended to minimize any such biases. RESULTS After excluding patients lost to follow-up, among 493 presenting with MDE with complete data files, the BP-II rate was estimated at index at 20%; 1 month later, systematic probing for hypomania doubled the rate of BP-II to 39%. The comparison between BP-II and UP showed differential phenomenology, such as hypersomnia, increased psychomotor activation, guilt feelings and suicidal thoughts in BP-II. Related data demonstrated the importance of CT in further qualifying of MDE to define a distinct, more severe ("darker") BP-II(1/2) variant of BP-II. Moreover, BP-III, arising from DT and associated with antidepressants, emerged as a valid soft bipolar variant on the basis of the phenomenology of hypomania and bipolar family history. Finally, we found preliminary evidence for the inclusion of BP-IV into the bipolar spectrum, its total hypomania score falling intermediate between BP-II and strict UP. Using this broader diagnostic framework, the bipolar spectrum (the combined "hard" BP-I phenotype, BP-II and the soft spectrum) accounted for 65% of MDE. CONCLUSION The EPIDEP study achieved its objectives by demonstrating the feasibility of identifying the bipolar spectrum at a national level, and refining its phenomenology through rigorous clinical characterization and validation of bipolar spectrum subtypes, including MDE with brief hypomanias, cyclothymia and hyperthymia. The spectrum accounted for two out of three MDE, making "strict UP" less prevalent than BP as redefined herein. Our findings were anticipated by Falret, who in 1854 had predicted that many melancholic patients in the community would 1 day be classified in his circular group. We also confirmed Baillarger's observation in the same year that episodes (in this study, hypomanic episodes) could last as short as 2 days. Our findings deriving from a systematic French national database a century and a half later invite major shifts in clinical and public health services, as well as in the future conduct of psychopharmacologic trials. In this respect, the systematic training of clinicians in four regions of France represents a national resource for affective disorders and can serve as a model to effect change in diagnostic practice in other countries.
Collapse
Affiliation(s)
- Hagop S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA 92161, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Nettle D. Schizotypy and mental health amongst poets, visual artists, and mathematicians. JOURNAL OF RESEARCH IN PERSONALITY 2006. [DOI: 10.1016/j.jrp.2005.09.004] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Hantouche EG, Akiskal HS. Toward a definition of a cyclothymic behavioral endophenotype: which traits tap the familial diathesis for bipolar II disorder? J Affect Disord 2006; 96:233-7. [PMID: 16427137 DOI: 10.1016/j.jad.2004.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2004] [Accepted: 08/17/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although the cyclothymic temperament appears to be related to the familial diathesis of bipolar disorder, exhibiting high sensitivity for bipolar II (BP-II) disorder, it is presently uncertain which of its constituent traits are specific for this disorder. METHODS In a sample of 446 major depressive patients (BP-II and unipolar), in the French National EPIDEP study, the cyclothymic temperament was assessed by using clinician- and self-rated scales. We computed the frequency of individual traits and relative risk for family history of bipolarity. RESULTS From both clinician- and self-rated scales, four items related to mood reactivity, energy, psychomotor and mental activity were significantly highly represented in the subgroup with positive family history of bipolarity. The item "rapid shifts in mood and energy" obtained the highest relative risk (OR=3.42) for positive family history of bipolarity. CONCLUSION These findings delineate those cyclothymic traits which are most likely to tap a familial-genetic diathesis for BP-II, thereby identifying traits which can best serve as a behavioral endophenotype for this bipolar subtype. Such an endophenotype might underlie the cyclic course of bipolar disorder first described in France 150 years ago by Falret and Baillarger.
Collapse
Affiliation(s)
- E G Hantouche
- Université Paris VI Mood Center, Hôpital Pitiè-Salpêtrière, Paris, France
| | | |
Collapse
|
32
|
Akiskal HS, Benazzi F. The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. J Affect Disord 2006; 92:45-54. [PMID: 16488021 DOI: 10.1016/j.jad.2005.12.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Presently it is a hotly debated issue whether unipolar and bipolar disorders are categorically distinct or lie on a spectrum. We used the ongoing Ravenna-San Diego Collaboration database to examine this question with respect to major depressive disorder (MDD) and bipolar II (BP-II). METHODS The study population in FB's Italian private practice setting comprised consecutive 650 outpatients presenting with major depressive episode (MDE) and ascertained by a modified version of the Structured Clinical Interview for DSM-IV. Differential assignment of patients into MDD versus BP-II was made on the basis of discrete hypomanic episodes outside the timeframe of an MDE. In addition, hypomanic signs and symptoms during MDE (intra-MDE hypomania) were systematically assessed and graded by the Hypomania Interview Guide (HIG). The frequency distributions of the HIG total scores in each of the MDD, BP-II and the combined entire sample were plotted using the kernel density estimate. Finally, bipolar family history (BFH) was investigated by structured interview (the Family History Screen). RESULTS There were 261 MDD and 389 BP-II. As in the previous smaller samples, categorically defined BP-II compared with MDD had significantly earlier age at onset, higher rates of familial bipolarity (mostly BP-II), history of MDE recurrences (>or=5), and atypical features. However, examining hypomania scores dimensionally, whether we examined the MDD, BP-II, or the combined sample, kernel density estimate distribution of these scores had a normal-like shape (i.e., no bimodality). Also, in the combined sample of MDE, we found a dose-response relationship between BFH loading and intra-MDE hypomania measured by HIG scores. LIMITATIONS Although the interviewer (FB) could not be blind to the diagnostic status of his private patients, the systematic rigorous interview process in a very large clinical population minimized any unintended biases. CONCLUSIONS Unlike previous studies that have examined the number of DSM-IV hypomanic signs and symptoms both outside and during MDE, the present analyses relied on the more precise hypomania scores as measured by the HIG. The finding of a dose-response relationship between BFH and HIG scores in the sample at large strongly suggests a continuity between BP-II and MDD. Our data indicate that even in those clinically depressed patients without past hypomanic episodes (so-called "unipolar" MDD), such scores are normally rather than bimodally distributed during MDE. Moreover, the absence of a 'zone of rarity' in the distribution of hypomanic scores in the combined total, MDD and BP-II MDE samples, indicates that MDD and BP-II exist on a dimensional spectrum. From a nosologic perspective, our data are contrary to what one would expect from a categorical unipolar-bipolar distinction. In practical terms, intra-MDE hypomania and BFH, especially in recurrent MDD, represent strong indicators of bipolarity.
Collapse
Affiliation(s)
- Hagop S Akiskal
- International Mood Center, University of California at San Diego, VA Psychiatry Service, 116A, 3350 La Jolla Village Drive, 92161, USA.
| | | |
Collapse
|
33
|
Akiskal HS, Akiskal K, Allilaire JF, Azorin JM, Bourgeois ML, Sechter D, Fraud JP, Chatenêt-Duchêne L, Lancrenon S, Perugi G, Hantouche EG. Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study. J Affect Disord 2005; 85:29-36. [PMID: 15780673 DOI: 10.1016/j.jad.2003.12.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Accepted: 12/05/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions. METHODS Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity. RESULTS PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity. CONCLUSION These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.
Collapse
Affiliation(s)
- Hagop S Akiskal
- International Mood Center, VA Psychiatry Service, VA Hospital, University of California at San Diego, 3350 La Jolla Village Dr. (116-A), San Diego, CA 92161, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Akiskal HS, Akiskal KK, Haykal RF, Manning JS, Connor PD. TEMPS-A: progress towards validation of a self-rated clinical version of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire. J Affect Disord 2005; 85:3-16. [PMID: 15780671 DOI: 10.1016/j.jad.2004.12.001] [Citation(s) in RCA: 429] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2004] [Accepted: 12/09/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Our aim was to validate the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) in a clinical population. METHODS The study was conducted in two Memphis mood clinics involving 398 affectively ill patients with young to middle index age (42 years+/-13 S.D.), who were 95% white, 62% female, and 51% bipolar spectrum. A subset of 157 of the entire sample were retested in 6-12 months, and the entire sample was then subjected to factor analysis (PCA extraction method with varimax rotation). RESULTS We obtained high test-retest reliability ranging from 0.58 for the irritable, to 0.68, 0.69 and 0.70, respectively, for the cyclothymic, dysthymic and hyperthymic. The hypothesized four-factor structure of the TEMPS-A was upheld, with the cyclothymic explaining 14% of the variance, followed by the irritable, hyperthymic, and dysthymic together accounting for another 14%. Internal consistency was excellent, with Chronbach alphas ranging from 0.76 for the dysthymic to 0.88 for the cyclothymic. Exploratory factor analysis revealed 2 super factors, Factor I loading on cyclothymic, irritable, and dysthymic temperaments, and Factor II loading heavily on the hyperthymic. The 50-item TEMPS-A-Clinical Version was constructed by using a cutoff of alpha > or =0.4 for traits loading exclusively on their original temperaments. We also proposed a longer 69-item version for future study, in which we permitted a greater number of traits based on clinical considerations (alpha cutoff 0.30). LIMITATION The sample was preponderantly white, and may not generalize to other U.S. ethnic groups. This earlier version of TEMPS-A did not include the anxious temperament. CONCLUSIONS We psychometrically validated the TEMPS-A in affectively ill outpatients, leading to an instrument suitable for use in psychiatric, especially affectively ill, populations. It is noteworthy that in this clinically ill population we succeeded in measuring traits which could make subjects vulnerable to affective episodes, as well as those of adaptive nature. For instance, the dysthymic emerged as bound to routine, self-blaming, shy-nonassertive, sensitive to criticism, yet self-denying, dependable, and preferring to work for someone else rather than be the boss. The hyperthymic had the highest number of "positive" traits: upbeat, fun-loving, outgoing, jocular, optimistic, confident, full of ideas, eloquent, on the go, short-sleeper, tireless, who likes to be the boss, but single-minded, risk-taker, and unlikely to admit to his/her meddlesome nature. The cyclothymic emerged as labile with rapid shifts in mood; unstable in energy, self-esteem and socialization; unevenly gifted and dilettante; yet keen in perception, intense in emotions, and romantic. The irritable emerged as skeptical and critical (which might be considered intellectual virtues), but otherwise having the "darkest" nature of all temperaments: grouchy, complaining, dissatisfied; anger- and violence-prone, and sexually jealous. The foregoing temperament attributes, observed in a moderately severe group of patients with affective disorders, nonetheless testify to the evolutionary context of these disorders-"submissive" behavior, territoriality, romantic charm, and last, but not least, sexually jealous with its associated specter of violence. We hypothesize that the putative social and limbic mechanisms underlying mood disorders appear to have archaic origins on an evolutionary scale. We finally submit that the traits underlying affective disorders are very much part of human nature.
Collapse
|
35
|
Akiskal KK, Akiskal HS. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. J Affect Disord 2005; 85:231-9. [PMID: 15780693 DOI: 10.1016/j.jad.2004.08.002] [Citation(s) in RCA: 218] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 08/16/2004] [Indexed: 11/26/2022]
Abstract
We sketch out putative evolutionary roles for affective temperaments within the theoretical framework of mood disorders conceptualized as extremes in an oligogenic model of inheritance, whereby the constituent traits in their dilute phenotypes confer adaptive advantages to individuals and/or their social group. Depressive traits, among other functions, would subserve sensitivity to the suffering of other members of the species, overlapping with those of the generalized anxious temperament, thereby enhancing the survival of not only kin but also other conspecifics. The pursuit of romantic opportunities in cyclothymia suggests that it may have evolved as a mechanism in reproductive success; cyclothymics' creative bent in poetry, music, painting, cooking or fashion design (among men, in particular) also appears useful for sexual seduction. Hyperthymic traits would lend distinct advantages in leadership, exploration, territoriality and mating. These are just some of the possibilities of the rich and complex temperamental traits subserving bipolarity within an evolutionary framework. We test selected aspects of these hypotheses with the use of correlations between the constituent traits of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS) and correlations between the TEMPS and the Temperament and Character Inventory (TCI). Such data support the counterbalancing protective influence of harm avoidance on the risk-taking behavior of cyclothymic individuals, in both men and women. Finally, we outline a hypothesis on the evolutionary function of anxious-depressive traits for women.
Collapse
|
36
|
Erfurth A, Gerlach AL, Hellweg I, Boenigk I, Michael N, Akiskal HS. Studies on a German (Münster) version of the temperament auto-questionnaire TEMPS-A: construction and validation of the briefTEMPS-M. J Affect Disord 2005; 85:53-69. [PMID: 15780676 DOI: 10.1016/s0165-0327(03)00102-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Accepted: 04/09/2003] [Indexed: 10/27/2022]
Abstract
BACKGROUND Based on classic German concepts of a continuum between depressive, hyperthymic, cyclothymic, and irritable temperaments and affective disorder (and adding an anxious type to the four), Akiskal and co-workers developed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego both in interview (TEMPS-I) and auto-questionnaire (TEMPS-A) versions. It is the aim of the present analyses to validate a brief German version of TEMPS-A. METHODS A total of 1056 students of the Westfalische-Wilhelms-Universitat in Munster, Germany, filled out the long 110-item version of the TEMPS-A (Munster translation by Erfurth: TEMPS-M) modified into a five gradation Likert format and with the items randomized. Based on this data we constructed a brief version of the TEMPS-M. In a second study, a sample of 151 students were recruited who filled out the briefTEMPS-M twice, approximately 1 month apart. RESULTS Our psychometric procedures resulted in the retention of 35 items from the original 110. The proposed five-factor structure of the original TEMPS-A was upheld, with relatively few item reclassification (mainly due to some overlap between depressive and anxious traits). Internal consistency (Cronbach alpha values ranging from 0.69 to 0.84) and test-retest reliability were shown. Most importantly, all temperaments in the briefTEMPS-M correlated quite well (Pearson r values ranging from 0.49 to 0.72) with their respective original versions in the longer TEMPS-M. As for construct validity, significant correlation was shown with the Beck Depression Inventory for all but the hyperthymic temperament; the hyperthymic, cyclothymic and irritable correlated highest with the self-report Manic Inventory. LIMITATIONS The study sample of university students was selective. CONCLUSIONS We were able to construct a brief German version of the TEMPS-A auto-questionnaire. We submit this shorter version will be suitable for both clinical (psychiatric and general medical) and neurobiological research, as well as in studies on temperament features in selected populations, e.g., allowing comparisons between regions or different (German-speaking) countries.
Collapse
Affiliation(s)
- Andreas Erfurth
- Department of Psychiatry, Münster University Hospital, Albert-Schweitzer-Str. 11, 48129 Münster, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Vahip S, Kesebir S, Alkan M, Yazici O, Akiskal KK, Akiskal HS. Affective temperaments in clinically-well subjects in Turkey: initial psychometric data on the TEMPS-A. J Affect Disord 2005; 85:113-25. [PMID: 15780682 DOI: 10.1016/j.jad.2003.10.011] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2003] [Accepted: 10/31/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND This is a first attempt to evaluate the reliability and factor structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Turkish Version. The questionnaire is a self-report 110-item measure that postulates five affective temperaments-the depressive, cyclothymic, irritable, hyperthymic, and anxious-which embody both strengths and liabilities along affective lines. METHODS The questionnaire was administered to 658 clinically-well subjects in a Turkish university circle. We undertook item analysis and test-retest reliability. We then examined internal consistency through factor analysis with PCA rotation. RESULTS We found good to excellent test-retest reliability (0.73-0.91), and internal consistency (0.77-0.85). We deleted 10 items with factor loading <0.20 for their own subscales, resulting in a questionnaire with 99 items. Despite considerable overlap between depressive and cognitive anxiety traits, a distinct "nervous"-anxious factor emerged as well, and the hypothesized (original English) 5-factor structure of the TEMPS-A was supported. Cut-offs for each temperament were based on z-scores higher than +2S.D. Dominant irritable (3.7%), nervous-anxious (3.7%) and depressive (3.1%) temperaments were the most common in this population, whereas dominant cyclothymic (1.7%) and hyperthymic (1.2%) temperaments were relatively uncommon. These temperaments tended to lose their intensity with age. As expected, women scored significantly higher on the nervous-anxious, and men on the hyperthymic temperaments. LIMITATIONS The sample was composed of younger subjects with higher education than the general population of Turkey. Although the distribution of the scores for each of the temperaments deviated somewhat from normal curves, for heuristic reasons we did attempt to provide prevalence rates based on z-scores. CONCLUSION In this preliminary version of the TEMPS-A, we have retained 100 (of the original 110) traits loading >0.20. Some deleted items referred to sleep, others appeared socially desirability traits in the Turkish culture endorsed by many subjects. Nonetheless, item analyses within each factor revealed traits indicative of personal assets (specific to each temperament) along with those which might represent vulnerability to affective illness. This is in line with the hypothesized original theoretical framework of the senior authors. Even in this "first pass," in its Turkish version the TEMPS-A is a reliable and valid instrument. Further refinement of the instrument will require the study of a nationally representative sample in Turkey.
Collapse
Affiliation(s)
- Simavi Vahip
- Affective Disorder Unit, Department of Psychiatry, Psikiyatri Anabilim Dali, Tip Fakultesi, Ege University, Bornova 35100, Izmir, Turkey.
| | | | | | | | | | | |
Collapse
|
38
|
Nowakowska C, Strong CM, Santosa CM, Wang PW, Ketter TA. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. J Affect Disord 2005; 85:207-15. [PMID: 15780691 DOI: 10.1016/j.jad.2003.11.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Accepted: 11/04/2003] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Understanding of mood disorders can be enhanced through assessment of temperamental traits. We explored temperamental commonalities and differences among euthymic bipolar (BP) and unipolar (MDD) mood disorder patients, creative discipline graduate student controls (CC), and healthy controls (HC). METHODS Forty-nine BP, 25 MDD, 32 CC, and 47 HC completed self-report temperament/personality measures including: The Affective Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A); the Revised NEO Personality Inventory (NEO-PI-R); and the Temperament and Character Inventory (TCI). RESULTS Euthymic BP, MDD, and CC, compared to HC, had significantly increased cyclothymia, dysthymia and irritability scores on TEMPS-A; increased neuroticism and decreased conscientiousness on NEO-PI-R; and increased harm avoidance and novelty seeking as well as decreased self-directedness on TCI. TEMPS-A cyclothymia scores were significantly higher in BP than in MDD. NEO-PI-R openness was increased in BP and CC, compared to HC, and in CC compared to MDD. TCI self-transcendence scores in BP were significantly higher than in MDD, CC, and HC. LIMITATIONS Most of the subjects were not professional artists, and represented many fields; temperament might be different in different art fields. CONCLUSIONS Euthymic BP, MDD, and CC compared to HC, had prominent temperamental commonalities. However, BP and CC had the additional commonality of increased openness compared to HC. BP had particularly high Cyclothymia scores that were significantly higher then those of MDD. The prominent BP-CC overlap suggests underlying neurobiological commonalities between people with mood disorders and individuals involved in creative disciplines, consistent with the notion of a temperamental contribution to enhanced creativity in individuals with bipolar disorders.
Collapse
Affiliation(s)
- Cecylia Nowakowska
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2350, Stanford, CA 94305-5723, USA
| | | | | | | | | |
Collapse
|
39
|
Akiskal KK, Savino M, Akiskal HS. Temperament profiles in physicians, lawyers, managers, industrialists, architects, journalists, and artists: a study in psychiatric outpatients. J Affect Disord 2005; 85:201-6. [PMID: 15780690 DOI: 10.1016/j.jad.2004.08.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 08/31/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND With the possible exception of cyclothymia in artists, there is a paucity of data in the literature on the temperament in different professions. METHODS For this exploratory study, we sought to generate preliminary data on temperaments among psychiatric outpatients, including physicians (n=41), lawyers (n=30), managers and executives (n=35), industrialists (n=48), architects (n=27), journalists (n=34), and a mixed group of artists (n=48). They were compared with age, sex, social class, and affective disorder matched outpatients outside of these professions, drawn from the same clinical settings to serve as our Comparison Group (CG, n=120). We used an interview version of the Akiskal-Mallya criteria for temperaments. We finally used the DSM-III-R obsessive compulsive personality (OC traits). RESULTS Compared with the CG, lawyers and physicians had high rates of dysthymic temperament and OC traits. Managers, like lawyers and doctors, had high rates on OC traits but were different in being very low on cyclothymic and twice as hyperthymic than the CG was. Industrialists, who, by definition, were self-made, had even higher rates of hyperthymic traits. Both architects and artists seemed to have benefited from being cyclothymic (3-4 times higher than CG's); interestingly, architects had higher levels of OC traits, and artists were less obsessional than the CG was. Overall, among managers/executives and lawyers, 41% met criteria for affective temperaments, whereas the equivalent rate among the remainder was 77%. LIMITATION Given that this is a chart review of existing clinical records, it was not possible to be blind to the profession of the patients. A mixed group of artists may have obscured differences among artists from different domains of art (e.g., poets vs. performing artists), and the same can be said of physicians (e.g., internists vs. surgeons). A disclaimer would be appropriate: Ours is not a study on eminence in the different professions but on the temperament and personality profiles that distinguish among them. CONCLUSIONS Despite the foregoing limitations and overlapping attributes in the different professions, they nonetheless emerged as having distinct temperamental and personality profiles. Dysthymic and obsessional attributes are notable in lawyers and physicians. We confirm the role of cyclothymia in artists and architects. The role of the hyperthymic temperament in managers, self-made industrialists, and journalists, to the best of our knowledge, is being reported for the first time. The role of cyclothymic and hyperthymic temperaments appears to be moderated by obsessional traits across the entire professional realm examined. In particular, artists' creative imagination appears "liberated" by low levels of OC traits, whereas among architects, relatively high levels of OC traits seem to contribute to the execution of their work. More tentatively, judging from the overall levels of affective temperaments in the remaining professions, on average, more of the managers/executives than self-made industrialists could be described as "colder" in temperament, and more of the physicians "warmer" than lawyers are. Journalists, as a group, appeared to possess the broadest representation of affective temperaments. The foregoing conclusions must be regarded as tentative, even hypothetical, in need of verification among professionals without major psychiatric disorders. Nonetheless, temperament profiles among psychiatrically ill professionals in the seven professional realms studies can help predict how they relate to their doctors, family members, colleagues, coworkers, and clients/patients. Such knowledge, in turn, can help the therapeutic process.
Collapse
Affiliation(s)
- Kareen K Akiskal
- International Mood Center, San Diego (USA) and French Depressive and Manic-Depressive Association, Rennes, France
| | | | | |
Collapse
|
40
|
Mendlowicz MV, Akiskal HS, Kelsoe JR, Rapaport MH, Jean-Louis G, Gillin JC. Temperament in the clinical differentiation of depressed bipolar and unipolar major depressive patients. J Affect Disord 2005; 84:219-23. [PMID: 15708419 DOI: 10.1016/j.jad.2004.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Accepted: 01/21/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine differences in temperament profiles between patients with recurrent unipolar and bipolar depression. METHOD Depressed individuals with recurrent major depressive disorder (MDD) (n = 94) and those with bipolar (n = 59) disorders (about equally divided between types I and II) were recruited by newspaper advertisement, radio and television announcements, flyers and newsletters, and word of mouth. All patients were interviewed using the Structured Clinical Interview for DSM III-R (SCID) and had the severity of their depressive episode assessed by means of the 17-item Hamilton Rating Scale for Depression. All patients filled out the TEMPS-A, a validated instrument. RESULTS Temperament differences between bipolar and MDD patients were examined using MANCOVA. Overall significant effect of the fixed factor (bipolar vs. unipolar) was noted for the temperament scores [Hotelling's F((5,142)) = 2.47, p < 0.05]. Overall effects were found for age [F((5,142)) = 2.40, p < 0.05], but not for gender and severity of depression [F((5,142)) = 1.65, p = 0.15 and F((5,142)) = 0.66, p = 0.66, respectively]. Dependent variables included the five subscales of the TEMPS-A, but only the cyclothymic temperament scores showed significant between-group differences. LIMITATION Small bipolar subsample cell sizes did not permit to test the specificity of the findings for bipolar II vs. bipolar I patients. CONCLUSION The finding that the clyclothymic subscale is significantly elevated in the bipolar vs. the unipolar depressive group supports the theoretical assumptions upon which the scale is based, and suggests that it might become a useful tool for clinical and research purposes.
Collapse
Affiliation(s)
- Mauro V Mendlowicz
- Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | | | |
Collapse
|
41
|
Akiskal HS. Searching for behavioral indicators of bipolar II in patients presenting with major depressive episodes: the "red sign," the "rule of three" and other biographic signs of temperamental extravagance, activation and hypomania. J Affect Disord 2005; 84:279-90. [PMID: 15708427 DOI: 10.1016/j.jad.2004.06.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 06/03/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Since 1977, the work of the author has shown the primacy of behavioral activation, flamboyance, and extravagance in detecting hypomania, the historical hallmark of cyclothymic and the broader spectrum of bipolar II (BP-II) disorders. In other words, the soft spectrum is more likely to declare itself in behavioral rather than mood disturbances. The obligatory search for elation and related mood changes a la DSM-IV (and its interview form, the SCID) during the clinical interview is often doomed to failure, thereby "condemning" the patient to a unipolar diagnosis, and hence to sequential and often tragic failures with antidepressants or combinations thereof. METHODS To characterize behavioral signs of good specificity, though individually of low sensitivity for BP-II in patents presenting with major depression, the author undertook a chart review of over 1000 depressive patients he had examined extending over a period of nearly three decades. The Mood Clinic Data Questionnaire (MCDQ) used in the author's Memphis mood clinic permitted systematization of unstructured observations. BP-II had been independently confirmed by hypomania of > or =2 days and/or cyclothymia over the course of the index illness (both of which were validated by family history for bipolarity in earlier research in our clinic). RESULTS Triads of behavior or traits in the patients' biographical history-as well as in the biologic kin-involving polyglottism, eminence, creative achievement, professional instability, multiple substance/alcohol use, multiple comorbidity (axis I and axis II), multiple marriages, a broad repertoire of sexual behavior (including brief interludes of homosexuality), impulse control disorders, as well as ornamentation and flamboyance (with red and other bright colors dominating) were specific for BP-II. Temperamentally, many of these individuals thrive on activity-they are indeed "activity junkies." LIMITATION The reported findings pertain primarily to the differential diagnosis between BP-II and unipolar depression. Replication of the approach espoused herein will require quantification of the operational definitions of the observed phenomenology. CONCLUSION The findings, which make sense in an evolutionary model of the advantage that "dilute" bipolar traits confer to human biography and erotic life, suggest that such behavioral traits can be useful provisionally in assigning a depressive episode to the realm of the bipolar II spectrum. Overall, the perspective espoused in this paper indicates that temperamental excesses and, more generally, a biographical approach, represent a more coherent approach than hypomanic episodes in the diagnosis of BP-II patients. Finally, such a diagnostic approach underscores the importance of incorporating evolutionary considerations and principles in understanding the origin of affective disorders.
Collapse
Affiliation(s)
- Hagop S Akiskal
- International Mood Center, University of California at San Diego, V.A. Hospital 3350, La Jolla Village Dr. (116-A), San Diego CA 92161, USA.
| |
Collapse
|
42
|
Wills G. Creativity, mental disorder and jazz. Br J Psychiatry 2004; 184:185. [PMID: 14754839 DOI: 10.1192/bjp.184.2.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
43
|
|
44
|
Abstract
The unitary Kraepelian concept of manic-depressive illness which incorporated attenuated forms, personal dispositions to mood instability, as well as much of the terrain of remitting depressions, may be considered by many to be too broad. On the other hand, the presently preferred unipolar-bipolar dichotomy in official nosology fails to account for the very common occurrence of clinical and subclinical conditions in the interface of major depressive disorders and bipolarity. The emerging concept of the bipolar spectrum represents a provocative working hypothesis to account for these conditions.
Collapse
Affiliation(s)
- Hagop S Akiskal
- University of California at San Diego and VA Psychiatry Service (116A), 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| |
Collapse
|
45
|
Ghadirian AM, Gregoire P, Kosmidis H. Creativity and the Evolution of Psychopathologies. CREATIVITY RESEARCH JOURNAL 2001. [DOI: 10.1207/s15326934crj1302_2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
46
|
Richards R. Creativity and the Schizophrenia Spectrum: More and More Interesting. CREATIVITY RESEARCH JOURNAL 2001. [DOI: 10.1207/s15326934crj1301_13] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
|
48
|
Kinney DK, Richards R, Lowing PA, LeBlanc D, Zimbalist ME, Harlan P. Creativity in Offspring of Schizophrenic and Control Parents: An Adoption Study. CREATIVITY RESEARCH JOURNAL 2001. [DOI: 10.1207/s15326934crj1301_3] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
49
|
Abstract
Kraepelin had a modern vision of affective illness. He hypothesized that affective recurrences arose from enduring dispositions of depressive, cyclothymic, irritable, or 'manic' types. These dispositions appeared as 'temperaments' in English translations of his work. In the extreme, such temperamental gloominess or moodiness is today officially diagnosed as 'dysthymic' or 'cyclothymic'; irritable and hyperthymic (or manic) dispositions have not received official sanction in the contemporary psychiatric nomenclature. This paper reviews recent research which supports Kraepelin's theoretical framework regarding dysthymic and cyclothymic dispositions both as clinically relevant extreme forms of temperament and as precursors of major affective episodes. Compelling lines of evidence along epidemiologic, clinical-descriptive, familial-genetic, therapeutic, and follow-up perspectives are summarized for each disposition. Much of what in contemporary psychiatry is considered to be in the realm of subthreshold affective conditions, overlaps considerably with Kraepelin's concepts of the trait affective dispositions described herein. Most importantly, although Kraepelin's observations were based primarily on hospitalized, severely ill affective patients, his broad vision still guides us today for understanding etiology and instituting public health and preventive measures in major affective episodes.
Collapse
Affiliation(s)
- H S Akiskal
- VA Psychiatry Service (116A), 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
| |
Collapse
|
50
|
Akiskal HS, Bourgeois ML, Angst J, Post R, Möller H, Hirschfeld R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000; 59 Suppl 1:S5-S30. [PMID: 11121824 DOI: 10.1016/s0165-0327(00)00203-2] [Citation(s) in RCA: 549] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Until recently it was believed that no more than 1% of the general population has bipolar disorder. Emerging transatlantic data are beginning to provide converging evidence for a higher prevalence of up to at least 5%. Manic states, even those with mood-incongruent features, as well as mixed (dysphoric) mania, are now formally included in both ICD-10 and DSM-IV. Mixed states occur in an average of 40% of bipolar patients over a lifetime; current evidence supports a broader definition of mixed states consisting of full-blown mania with two or more concomitant depressive symptoms. The largest increase in prevalence rates, however, is accounted for by 'softer' clinical expressions of bipolarity situated between the extremes of full-blown bipolar disorder where the person has at least one manic episode (bipolar I) and strictly defined unipolar major depressive disorder without personal or family history for excited periods. Bipolar II is the prototype for these intermediary conditions with major depressions and history of spontaneous hypomanic episodes; current evidence indicates that most hypomanias pursue a recurrent course and that their usual duration is 1-3 days, falling below the arbitrary 4-day cutoff required in DSM-IV. Depressions with antidepressant-associated hypomania (sometimes referred to as bipolar III) also appear, on the basis of extensive international research neglected by both ICD-10 and DSM-IV, to belong to the clinical spectrum of bipolar disorders. Broadly defined, the bipolar spectrum in studies conducted during the last decade accounts for 30-55% of all major depressions. Rapid-cycling, defined as alternation of depressive and excited (at least four per year), more often arise from a bipolar II than a bipolar I baseline; such cycling does not in the main appear to be a distinct clinical subtype - but rather a transient complication in 20% in the long-term course of bipolar disorder. Major depressions superimposed on cyclothymic oscillations represent a more severe variant of bipolar II, often mistaken for borderline or other personality disorders in the dramatic cluster. Moreover, atypical depressive features with reversed vegetative signs, anxiety states, as well as alcohol and substance abuse comorbidity, is common in these and other bipolar patients. The proper recognition of the entire clinical spectrum of bipolarity behind such 'masks' has important implications for psychiatric research and practice. Conditions which require further investigation include: (1) major depressive episodes where hyperthymic traits - lifelong hypomanic features without discrete hypomanic episodes - dominate the intermorbid or premorbid phases; and (2) depressive mixed states consisting of few hypomanic symptoms (i.e., racing thoughts, sexual arousal) during full-blown major depressive episodes - included in Kraepelin's schema of mixed states, but excluded by DSM-IV. These do not exhaust all potential diagnostic entities for possible inclusion in the clinical spectrum of bipolar disorders: the present review did not consider cyclic, seasonal, irritable-dysphoric or otherwise impulse-ridden, intermittently explosive or agitated psychiatric conditions for which the bipolar connection is less established. The concept of bipolar spectrum as used herein denotes overlapping clinical expressions, without necessarily implying underlying genetic homogeneity. In the course of the illness of the same patient, one often observes the varied manifestations described above - whether they be formal diagnostic categories or those which have remained outside the official nosology. Some form of life charting of illness with colored graphic representation of episodes, stressors, and treatments received can be used to document the uniquely varied course characteristic of each patient, thereby greatly enhancing clinical evaluation.
Collapse
Affiliation(s)
- H S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA.
| | | | | | | | | | | |
Collapse
|