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The dual-system theory of bipolar spectrum disorders: A meta-analysis. Clin Psychol Rev 2020; 83:101945. [PMID: 33217713 DOI: 10.1016/j.cpr.2020.101945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 01/05/2023]
Abstract
Bipolar spectrum disorders are characterized by alternating intervals of extreme positive and negative affect. We performed a meta-analysis to test the hypothesis that such disorders would be related to dysregulated reinforcement sensitivity. First, we reviewed 23 studies that reported the correlation between self-report measures of (hypo)manic personality and measures of reinforcement sensitivity. A large relationship was found between (hypo)manic personality and BAS sensitivity (g = .74), but not with BIS sensitivity (g = -.08). This stands in contrast to self-reported depression which has a small, negative relationship with BAS sensitivity and a large positive one with BIS sensitivity (Katz et al., 2020). Next, we reviewed 33 studies that compared reinforcement sensitivity between euthymic, bipolar participants and healthy controls. There, bipolar disorder had a small, positive relationship with BAS sensitivity (g = .20) and a medium, positive relationship with BIS sensitivity (g = .64). These findings support a dualsystem theory of bipolar disorders, wherein BAS sensitivity is more closely related to mania and BIS sensitivity more closely to bipolar depression. Bipolar disorders show diatheses for both states with euthymic participants being BAS- and BIS- hypersensitive. Implications for further theory and research practice are expounded upon in the discussion.
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Dupuis M, Meier E, Rudaz D, Strippoli MPF, Castelao E, Preisig M, Capel R, Vandeleur CL. Psychiatric symptoms and response quality to self-rated personality tests: Evidence from the PsyCoLaus study. Psychiatry Res 2017; 252:118-125. [PMID: 28260642 DOI: 10.1016/j.psychres.2017.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/27/2017] [Accepted: 02/18/2017] [Indexed: 11/26/2022]
Abstract
Despite the fact that research has demonstrated consistent associations between self-rated measures of personality dimensions and mental disorders, little has been undertaken to investigate the relation between psychiatric symptoms and response patterns to self-rated tests. The aim of this study was to investigate the association between psychiatric symptoms and response quality using indices from our functional method. A sample of 1,784 participants from a Swiss population-based cohort completed a personality inventory (NEO-FFI) and a symptom checklist of 90 items (SCL-90-R). Different indices of response quality were calculated based on the responses given to the NEO-FFI. Associations among the responses to indices of response quality, sociodemographic characteristics and the SCL-90-R dimensions were then established. Psychiatric symptoms were associated with several important differences in response quality, questioning subjects' ability to provide valid information using self-rated instruments. As suggested by authors, psychiatric symptoms seem associated with differences in personality scores. Nonetheless, our study shows that symptoms are also related to differences in terms of response patterns as sources of differences in personality scores. This could constitute a bias for clinical assessment. Future studies could still determine whether certain subpopulations of subjects are more unable to provide valid information to self-rated questionnaires than others.
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Affiliation(s)
- Marc Dupuis
- Institute of Psychology, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland.
| | - Emanuele Meier
- Institute of Psychology, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland
| | - Dominique Rudaz
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Switzerland
| | - Marie-Pierre F Strippoli
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Switzerland
| | - Enrique Castelao
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Switzerland
| | - Martin Preisig
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Switzerland
| | - Roland Capel
- Institute of Psychology, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland
| | - Caroline L Vandeleur
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Switzerland
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Murray G, Leitan ND, Thomas N, Michalak EE, Johnson SL, Jones S, Perich T, Berk L, Berk M. Towards recovery-oriented psychosocial interventions for bipolar disorder: Quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms. Clin Psychol Rev 2017; 52:148-163. [DOI: 10.1016/j.cpr.2017.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 02/08/2023]
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Dupuis M, Capel R, Meier E, Rudaz D, Strippoli MPF, Castelao E, Preisig M, Vandeleur CL. Do bipolar subjects' responses to personality questionnaires lack reliability? Evidence from the PsyCoLaus study. Psychiatry Res 2016; 238:299-303. [PMID: 27086248 DOI: 10.1016/j.psychres.2016.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/26/2015] [Accepted: 02/21/2016] [Indexed: 12/12/2022]
Abstract
Differences in personality scores between subjects with and without mood disorders might result from response biases rather than specific personality traits per se. The aim of this study was to compare subjects with bipolar disorders (BPD) to non-bipolar subjects in terms of response quality to the NEO-FFI. Using data from the population-based cohort study PsyCoLaus, subjects were compared in terms of responses to the NEO-FFI, and indices of response quality were calculated. Hierarchical regression analyses were performed and controlled for sociodemographic factors, depressive episodes, dysthymia, anxiety disorders and substance use disorders. Consistent with the literature, subjects with BPD had higher scores in neuroticism and openness, and lower scores in conscientiousness. However, significant differences were measured for response reliability and validity. In particular, the indices of response quality including response reliability were lower in subjects with BPD suggesting that bipolar subjects might have more difficulty in providing consistent answers throughout questionnaires. However, regression models resulted in small associations between mania/hypomania and response quality, and showed that differences in response quality were mainly attributable to correlates of BPD instead of the presence of mania/hypomania itself. The current findings suggest that bipolar subjects' responses to questionnaires are biased, making them less reliable.
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Affiliation(s)
- Marc Dupuis
- Institute of Psychology, University of Lausanne, Switzerland.
| | - Roland Capel
- Institute of Psychology, University of Lausanne, Switzerland
| | - Emanuele Meier
- Institute of Psychology, University of Lausanne, Switzerland
| | - Dominique Rudaz
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Prilly, Switzerland
| | - Marie-Pierre F Strippoli
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Prilly, Switzerland
| | - Enrique Castelao
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Prilly, Switzerland
| | - Martin Preisig
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Prilly, Switzerland
| | - Caroline L Vandeleur
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Department of Psychiatry, Prilly, Switzerland
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A meta-analysis of temperament and character dimensions in patients with mood disorders: Comparison to healthy controls and unaffected siblings. J Affect Disord 2016; 194:84-97. [PMID: 26803780 DOI: 10.1016/j.jad.2015.12.077] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/30/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cloninger's psychobiological model of personality has been extensively applied to subjects affected by mood disorders (MOOD). However, most studies are widely heterogeneous in terms of sample size, methods of assessment, and selection of participants. METHODS We conducted a systematic review of literature and a random effects meta-analysis of studies comparing at least two of the following groups: (a) adults with a primary MOOD diagnosis (Bipolar Disorder (BP) or major depressive disorder (MDD)), (b) their unaffected siblings (SIB) or (c) healthy subjects (HS), and reporting quantitative results from the Tridimensional Personality Questionnaire (TPQ) or the Temperament and Character Inventory (TCI). Subgroup, sensitivity and meta-regression analyses were also conducted. RESULTS High Harm Avoidance and low Self-Directedness were consistently associated with MOOD and SIB samples. BP was characterized by higher scores in Novelty Seeking and Self-Transcendence than HS, SIB and MDD. Age seemed to have a negative effect on Novelty Seeking and a positive effect on Harm Avoidance, Cooperativeness and Self-Transcendence. An euthymic mood state was associated with reduced Harm Avoidance, but increased Reward Dependence, Self-Directedness and Cooperativeness. LIMITATIONS The quality of the included studies varied and was relatively low. Moreover, publication bias and heterogeneity in the distribution of effect sizes may also have limited our results. CONCLUSION High Harm Avoidance and Low Self-Directedness may be trait markers for MOOD in general, while high Novelty Seeking and high Self-Transcendence may be specific to BP. Future studies are needed to disentangle the state-trait effect of each personality dimension.
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Giakoumaki SG, Karagiannopoulou L, Rózsa S, Zouraraki C, Karamaouna P, Cloninger CR. Psychometric properties of the Greek TCI-R and its clinical correlates: schizotypy and the self-regulation of affective and cognitive functioning. PeerJ 2016; 4:e1830. [PMID: 27019787 PMCID: PMC4806636 DOI: 10.7717/peerj.1830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 11/20/2022] Open
Abstract
Background. The revised Temperament and Character Inventory (TCI-R) measures Cloninger’s psychobiological model of personality. The average effects of individual temperament and character traits have been associated with schizotypy and with impaired regulation of affect and cognition. We extended prior research by testing predictions about the association of specific multidimensional configurations of temperament and character traits on schizotypy, affect balance, and self-perceived cognitive functioning. Method. A well-educated sample of native Greeks (N = 483), completed a new Greek translation of the TCI-R, as well as the Schizotypal Personality Questionnaire (SPQ), the Positive/Negative Affect Schedule (PANAS) and the Cognitive Failures Questionnaire (CFQ). The factor structure of the TCI-R was examined with exploratory and confirmatory tests. Associations between reported measures were examined with correlational and regression analyses. Results. The TCI-R had good psychometric properties as expected from studies in other countries. As predicted, specific configurations of temperament and character were associated with schizotypy, negative affect balance, and cognitive lapses. The “Borderline/Explosive temperament” (high Novelty Seeking, high Harm Avoidance, low Reward Dependence), “Schizotypal/Disorganized character” (low Self-directedness, low Cooperativeness, high Self-transcendence), and “Low Ego Strength/Fragile” profile (high Harm Avoidance, low Persistence, low Self-Directedness) were each strongly associated with higher stereotypy, negative affect balance (low positive affect and high negative affect), and subjective cognitive lapses compared to their contrast groups. Discussion. Multidimensional TCI profiles are strongly related to individual differences in schizotypy and self-reported regulation of affect and cognition. The Greek translation of the TCI-R is psychometrically sound and useful for clinical assessment and research.
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Affiliation(s)
| | | | - Sándor Rózsa
- Department of Psychiatry, Washington University School of Medicine , St. Louis, Missouri , USA
| | | | - Penny Karamaouna
- Department of Psychology, University of Crete , Rethymno , Greece
| | - C Robert Cloninger
- Department of Psychiatry, Washington University School of Medicine , St. Louis, Missouri , USA
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Johnson SL, Tharp JA, Peckham AD, McMaster KJ. Emotion in bipolar I disorder: Implications for functional and symptom outcomes. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 125:40-52. [PMID: 26480234 DOI: 10.1037/abn0000116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.
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Affiliation(s)
- Sheri L Johnson
- Department of Psychology, University of California at Berkeley
| | - Jordan A Tharp
- Department of Psychology, University of California at Berkeley
| | | | - Kaja J McMaster
- Department of Psychology, University of California at Berkeley
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Dopamine transporter gene may be associated with bipolar disorder and its personality traits. Eur Arch Psychiatry Clin Neurosci 2015; 265:281-90. [PMID: 25547317 DOI: 10.1007/s00406-014-0570-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/18/2014] [Indexed: 12/25/2022]
Abstract
Dopamine transporter and its genetic factors have been suggested to play a critical role in the development of bipolar disorder (BPD). However, the importance of the dopamine transporter gene (DAT1) in the pathogenesis of BPD remains unclear. The aims of this study were to assess 18 polymorphisms of the DAT1 gene to determine whether this gene is associated with BPD and whether it influences personality traits of patients with BPD. DAT1 polymorphisms were analyzed in 492 BPD (374 BPDI and 118 BPDII) patients and 436 controls. All participants were screened using the same assessment tool, and all met the criteria for BPD. The Tridimensional Personality Questionnaire was used to assess personality traits in both patients and controls. Several polymorphisms had a weak association with BPD, including rs2550948, rs2652511, and rs2975226 in allele distribution analysis (P < 0.05). Furthermore, the promoter G-A-C-G haplotype (rs6350-rs2975226-rs2652511-rs6413429) was over-represented in the BPD patients compared to the controls (P = 0.007). In personality assessment, the BPDII patients had the highest harm avoidance score, followed by the BPDI patients and controls (P = 3.7 × 10(-32)). In addition, a significant association between rs40184 and harm avoidance was found in the patients with BPD. The DAT1 promoter may be associated with vulnerabilities in BPD. The BPD patients had a higher rate of harm avoidance personality traits than the controls, and DAT1 variants may influence personality traits in patients with BPD.
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Berutti M, Nery FG, Sato R, Scippa A, Kapczinski F, Lafer B. Association between family history of mood disorders and clinical characteristics of bipolar disorder: results from the Brazilian bipolar research network. J Affect Disord 2014; 161:104-8. [PMID: 24751316 DOI: 10.1016/j.jad.2014.02.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare clinical characteristics of bipolar disorder (BD) in patients with and without a family history of mood disorders (FHMD) in a large sample from the Brazilian Research Network of Bipolar Disorders. METHODS Four-hundred eighty-eight DSM-IV BD patients participating in the Brazilian Research Network of Bipolar Disorders were included. Participants were divided between those with FHMD (n=230) and without FHMD (n=258). We compared these two groups on demographic and clinical variables and performed a logistic regression to identify which variables were most strongly associated with positive family history of mood disorders. RESULTS BD patients with FHMD presented with significantly higher lifetime prevalence of any anxiety disorder, obsessive-compulsive disorder, social phobia, substance abuse, and were more likely to present history of suicide attempts, family history of suicide attempts and suicide, and more psychiatric hospitalizations than BD patients without FHMD. Logistic regression showed that the variables most strongly associated with a positive FHMD were any comorbid anxiety disorder, comorbid substance abuse, and family history of suicide. LIMITATIONS Cross-sectional study and verification of FHMD by indirect information. CONCLUSION BD patients with FHMD differ from BD patients without FHMD in rates of comorbid anxiety disorder and substance abuse, number of hospitalizations and suicide attempts. As FHMD is routinely assessed in clinical practice, these findings may help to identify patients at risk for particular manifestations of BD and may point to a common, genetically determined neurobiological substrate that increases the risk of conditions such as comorbidities and suicidality in BD patients.
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Affiliation(s)
- Mariangeles Berutti
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Fabiano G Nery
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Rodrigo Sato
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Angela Scippa
- Center for Treatment of Affective Disorders (CETHA), Department of Psychiatry, Federal University of Bahia, Salvador, Brazil
| | - Flavio Kapczinski
- Bipolar Disorder Program (PROTAHBI), Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Noto MN, de Souza Noto C, de Jesus DR, Zugman A, Mansur RB, Berberian AA, Leclerc E, McIntyre RS, Correll CU, Brietzke E. Recognition of bipolar disorder type I before the first manic episode: challenges and developments. Expert Rev Neurother 2014; 13:795-806; quiz 807. [DOI: 10.1586/14737175.2013.811132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Perroud N, Baud P, Ardu S, Krejci I, Mouthon D, Vessaz M, Guillaume S, Jaussent I, Olié E, Malafosse A, Courtet P. Temperament personality profiles in suicidal behaviour: an investigation of associated demographic, clinical and genetic factors. J Affect Disord 2013; 146:246-53. [PMID: 23044284 DOI: 10.1016/j.jad.2012.09.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/13/2012] [Accepted: 09/15/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Personality traits have been suggested as possible risk factors for suicidal behaviours. Cloninger's model of personality (TCI), given its neurobiological background, might provide an ideal tool for the identification of dimensions associated with suicide attempt. METHODS A number of 1333 suicide attempters and 589 non-suicide attempters suffering from different DSM-IV Axis I disorders were assessed using either the temperament and character inventory (TCI) or the tridimensional personality questionnaire (TPQ), as well as other self-report questionnaires evaluating dimensions associated with suicidal behaviour, such as impulsivity and anger traits. The severity of suicide attempts and the methods used were also assessed. Subjects were genotyped for polymorphisms within the key genes involved in monoaminergic pathways and the HPA axis. RESULTS Compared with non-suicide attempters, suicide attempters scored higher for harm avoidance (HA) and novelty seeking (NS), and lower for self-directedness (SD). The difference was independent of Axis I disorders. Higher HA and NS scores were associated with a greater severity of suicidal behaviour. A multivariate model showed that HA was the single temperamental dimension independently related to suicide attempt history, beside impulsivity and anger-related traits. The genetic factors investigated did not play a significant role in modulating these temperamental dimensions. LIMITATIONS The TCI was available for only half of the sample. CONCLUSIONS Early detection of subjects displaying high HA and low SD, associated with high impulsivity and poor anger control, may help to prevent suicidal behaviours. Physicians should therefore be aware of these risk factors so that they can offer the best primary care intervention.
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Affiliation(s)
- Nader Perroud
- Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland.
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