Personality in unipolar and bipolar manic-malancholic patients

Change and stability of needs from middle adolescence to young adulthood in Swedish females

The Cesarec–Marke Personality Schedule, a Swedish inventory for the measurement of needs, was administered to a sample of females, aged 15, and readministered 10 years later. Longitudinal analyses showed that most dispositions changed significantly, although the changes were rather small. All traits were moderately stable over the 10‐year period.

Impulsivity, personality and bipolar disorder

Background

Increased impulsivity is a diagnostic feature of mania in bipolar disorder (BD). However it is unclear whether increased impulsivity is also a trait feature of BD and therefore present in remission. Trait impulsivity can also be construed as a personality dimension but the relationship between personality and impulsivity in BD has not been explored. The aim of this study was to examine the relationship of impulsivity to clinical status and personality characteristics in patients with BD.

Methods

We measured impulsivity using the Barratt Impulsiveness Scale (BIS-11) and personality dimensions using Eysenck Personality Questionnaire in 106 BD patients and demographically matched healthy volunteers. Clinical symptoms were assessed in all participants using the Clinical Global Impressions Scale, the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale. Based on their clinical status patients were divided in remitted (n = 36), subsyndromal (n = 25) and syndromal (n = 45).

Results

There was no difference in BIS-11 and EPQ scores between remitted patients and healthy subjects. Impulsivity, Neuroticism and Psychoticism scores were increased in subsyndromal and syndromal patients. Within the BD group, total BIS-11 score was predicted mainly by symptoms severity followed by Psychoticism and Neuroticism scores.

Conclusions

Increased impulsivity may not be a trait feature of BD. Symptom severity is the most significant determinant of impulsivity measures even in subsyndromal patients.

Characteristics of Patients with High Lie Scores in a Personality Test

BACKGROUND

It is reported that persons with high Lie score (L score) of a personality test are aggressively self-confident and are also related to depression or schizophrenia In this study, we examined the characteristics of patients with high L scores on the Maudsley Personality Inventory (MPI) and examined the significance of the L score.

MATERIALS AND METHODS

We collected the data of 10789 subjects and examined the relationship between L score or the number of characteristic biased persons and the parameters of age, sex, education level, occupation, and degree of pain. Furthermore, we examined the changes in extraversion-introversion (E score), neuroticism (N score), and L scores at approximately 1 year after surgery in 1711 patients who underwent surgery at our university hospital or affiliated hospitals.

RESULTS

L score was significantly higher among persons with a high degree of pain, and ratio of the characteristic biased persons in L score was significantly high among persons in their 40s to 60s, healthcare professionals and those with a high degree of pain. Moreover, L score scarcely changed between before and after surgery when compared with E score and N score.

CONCLUSION

L score is not greatly influenced by an individual's state of mind or situation at different times, and may indicate the personality traits proper to the person. It is shown that L score may indicate the personality trait characteristics of persons who want to make themselves look good in the eyes of other.

Is suppressed thyroid-stimulating hormone (TSH) associated with subclinical depression in the Danish General Suburban Population Study?

BACKGROUND

The first phase of the Danish General Suburban Population Study (GESUS) including 8214 individuals was an attempt to evaluate the association between subclinical hypothyroidism without or with elevated peroxidase antibodies and depression. No such association was found. In the second phase, including 14,787 individuals, we have focused on suppressed TSH (thyroid-stimulating hormone) and depression.

AIMS

To evaluate to what extent suppressed TSH is associated with subclinical depression.

METHODS

The total scores of the Major Depression Inventory (MDI) were used to evaluate subclinical depression, both by its total score and by an algorithm of the subthreshold depressed by presence of at least three of the 10 ICD-10 depression symptoms. Serum levels of TSH were used to classify the individuals into suppressed (TSH < 0.4 mIU/l), elevated (TSH ≥ 3.8 mIU/l) and normal reference (TSH between 0.4 and 3.7 mIU/l).

RESULTS

We identified 285 individuals with suppressed TSH and 1266 individuals with elevated TSH. The MDI total score was 7.55 in suppressed TSH individuals, 6.22 in elevated TSH individuals and 6.52 in normal reference individuals (P = 0.01). When the MDI was used diagnostically to identify subclinical depression, the prevalence was 8.07% in suppressed TSH individuals, 5.8% in normal reference individuals and 5.29% in elevated TSH individuals.

CONCLUSION

This population-based study supports that persons with suppressed TSH (subclinical hyperthyroidism) seem to have a risk, although small, of subclinical depression.

Differences in neuroticism and extraversion between patients with bipolar I or II and general population subjects or major depressive disorder patients

BACKGROUND

Whether levels of neuroticism or extraversion differ between patients with bipolar disorder (BD), major depressive disorder (MDD) and subjects from the general population, or between BD I and BD II patients, remains unclear.

METHODS

BD patients (n=191) from the Jorvi Bipolar Study, and MDD patients (n=358) from both the Vantaa Depression Study and the Vantaa Primary Care Depression Study cohorts, were interviewed at baseline and at 18 months. A general population comparison group (n=347) was surveyed by mail. BD patients' neuroticism and extraversion scores, measured by Eysenck Personality Inventory, were compared at an index interview, when the levels of depression and mania were lowest, with scores of MDD patients and general population controls. Comparisons were also made between BD I (n=99) and BD II (n=92) patients.

RESULTS

In multinomial logistic regression, BD patients had higher neuroticism (OR=1.17, p<0.001) and lower extraversion (OR=0.92, p=0.003) than the general population. When entered simultaneously into the model, the effect of extraversion disappeared. In logistic regression, the levels of neuroticism and extraversion did not differ between BD and MDD patients, or between BD I and II patients.

LIMITATIONS

Patients' personality scores were not pre-morbid.

CONCLUSIONS

Levels of neuroticism and extraversion are unlikely to differ between BD and MDD patients, or between BD I and II patients. The overall level of neuroticism is moderately higher and extraversion somewhat lower in BD patients than in the general population. High neuroticism may be an indicator of vulnerability to both bipolar and unipolar mood disorders.

The distinct temperament profiles of bipolar I, bipolar II and unipolar patients

BACKGROUND

Despite a plethora of studies, controversies abound on whether the long-term traits of unipolar and bipolar patients could be differentiated by temperament and whether these traits, in turn, could be distinguished from subthreshold affective symptomatology.

METHODS

98 bipolar I (BP-I), 64 bipolar II (BP-II), and 251 unipolar major depressive disorder (UP-MDD) patients all when recovered from discrete affective episodes) and 617 relatives, spouses or acquaintances without lifetime RDC diagnoses (the comparison group, CG) were administered a battery of 17 self-rated personality scales chosen for theoretical relevance to mood disorders. Subsamples of each of the four groups also received the General Behavior Inventory (GBI).

RESULTS

Of the 436 personality items, 103 that significantly distinguished the three patient groups were subjected to principal components analysis, yielding four factors which reflect the temperamental dimensions of "Mood Lability", "Energy-Assertiveness," "Sensitivity-Brooding," and "Social Anxiety." Most BP-I described themselves as near normal in emotional stability and extroversion; BP-II emerged as labile in mood, energetic and assertive, yet sensitive and brooding; MDD were socially timid, sensitive and brooding. Gender and age did not have marked influence on these overall profiles. Within the MDD group, those with baseline dysthymia were the most pathological (i.e., high in neuroticism, insecurity and introversion). Selected GBI items measuring hypomania and biphasic mood changes were endorsed significantly more often by BP-II. Finally, it is relevant to highlight a methodologic finding about the precision these derived temperament factors brought to the UP-BP differentiation. Unlike BP-I who were low on neuroticism, both BP-II and UP scored high on this measure: yet, in the case of BP-II high neuroticism was largely due to mood lability, in UP it reflected subdepressive traits.

LIMITATION

We used self-rated personality measures, a possible limitation generic to the paper-and-pencil personality literature. It is therefore likely that BP-I may have over-rated their "sanguinity"; or should one consider such self-report as a reliable reflection of one's temperament? One can raise similar unanswerable questions about "depressiveness" and "mood lability."

CONCLUSION

As contrasted to CG and published norms, the postmorbid self-described "usual" personality is 1) sanguine among many, but not all, BP-I; 2) labile or cyclothymic among BP-II; and 3) subanxious and subdepressive among UP. It is further noteworthy that with the exception of BP-II, the temperament scores of BP-I and MDD were within one SD from published norms. Rather than being pathological, these attributes are best conceived as subclinical temperamental variants of the normal, thereby supporting the notion of continuity between interepisodic and episodic phases of affective disorders. These findings overall are in line with Kraepelin's views and contrary to the DSM-IV formulation of axis-II constructs as being pathological and sharply demarcated from affective episodes.

Do personality traits predict first onset in depressive and bipolar disorder?

The aim was to investigate whether personality traits predict onset of the first depressive or manic episode (the vulnerability hypothesis) and whether personality might be altered by the mood disorder (the scar hypothesis). A systematic review of population-based and high-risk studies concerning personality traits and affective disorder in adults was conducted. Nine cross-sectional high-risk studies, seven longitudinal high-risk studies and nine longitudinal population-based studies were found. Most studies support the vulnerability hypothesis and there is evidence that neuroticism is a premorbid risk factor for developing depressive disorder. The evidence for the scar hypothesis is sparse, but the studies with the strongest design showed evidence for both hypotheses. Only few studies of bipolar disorder were found and the association between personality traits and bipolar disorder is unclear. Neuroticism seem to be a risk factor by which vulnerable individuals can be identified, thus preventing the development of depressive disorder. A connection between personality traits and development of bipolar disorder, and evidence of a personality-changing effect of affective episodes need to be further investigated.

A preliminary open study of the tolerability and effectiveness of nefazodone in major depressive disorder: comparing patients who recently discontinued an SSRI with those on no recent antidepressant treatment

Anecdotal evidence suggests that the recent discontinuation of an SSRI may confound the tolerability of the initiation of nefazodone treatment. We sought to determine whether recent discontinuation of an SSRI interferes with effectiveness and/or tolerability of nefazodone. Twenty-six depressed subjects, 21-63 years old, were recruited at the Massachusetts General Hospital. Thirteen subjects (50%) had discontinued an SSRI within 1-4 weeks due to ineffectiveness and/or side effects. Thirteen subjects (50%) had not taken antidepressants for the previous 6 months. Subjects were administered open nefazodone 50 mg p.o. b.i.d., and doses were increased as tolerated to a maximum of 600 mg/day. Subjects were followed for 12 weeks and were assessed for response and side effects using HAM-D-6 and clinical interviews. Both groups improved significantly on nefazodone; however, there was no statistically significant difference in response (>or=50% decrease in HAM-D-6) rates between completers with prior SSRI treatment (80%) and completers without recent exposure to antidepressants (67%). Response rates based on intent-to-treat (ITT) analysis were 31% for both groups. Association between prior SSRI treatment and discontinuation of nefazodone due to side effects or non-response was not statistically significant. Our study suggests that the rate of negative outcomes with nefazodone is no different whether patients have recently failed an SSRI.

Myers Briggs Type indicator personality profiles in unipolar depressed patients

OBJECTIVE

The current study was designed to compare the distribution of Myers Briggs Type Indicator (MBTI) personality types in patients with Unipolar Depression compared to normative data.

METHOD

The MBTI divides individuals into four dichotomous types: Extroverted and Introverted, Sensing and Intuitive, Thinking and Feeling, and Judging and Perceiving. This yields eight single-factor and sixteen four-factor types. One-hundred-thirty Unipolar Depressed patients were administered the MBTI-Form F.

RESULTS

Unipolar Depressed patients were significantly more often Introverted, Sensing, Feeling, and Perceiving single-factor types respectively, and Introverted-Sensing-Feeling-Perceiving, and Introverted-Intuitive-Feeling-Perceiving four-factor types. The male Introverted-Sensing-Feeling-Perceiving four-factor type was the most dramatically over-represented.

CONCLUSION

The MBTI effectively discriminates a patient group with Unipolar Depression from a normative population.

Personality dimensions in chronic fatigue syndrome and depression

Chronic fatigue syndrome (CFS) is a poorly understood condition. Possible etiological factors include infectious agents, psychiatric disorders, and personality characteristics. We examined personality dimensions in 30 nondepressed patients with CFS, 20 patients with major depressive disorder (MDD), and 15 healthy controls. On the NEO-FFI, patients with CFS scored significantly lower than healthy controls on the extroversion subscale. On the neuroticism dimension of the Eysenck Personality Questionnaire (EPQ), patients with MDD scored higher than those with CFS, who in turn scored significantly higher than the healthy controls. CFS patients rated themselves as higher on neuroticism and less extroverted when ill than when they were well. Our results suggest that high scores on neuroticism and low scores on extroversion in CFS could be a reaction to chronic illness.

Personality in patients with affective disorders and their relatives

BACKGROUND

In studies of both patients and high-risk subjects, particular patterns of personality have been found to be associated with affective disorders. Neuroticism and features of the melancholic type of personality seem to be risk factors for depression while premorbid features of the manic type of personality predominate in patients with more manic than depressive episodes. While neuroticism prevails in the majority of mental disorders, the 'affective' personality variants appear to be more specifically associated with affective disorders.

METHODS

Personality features were investigated in 122 recovered patients with affective disorders, 58 first-degree relatives (high-risk subjects (HR)) and in the respective control groups (n=48; n=29). Patients were subdivided into: unipolar depression (melancholic subtype); bipolar II; bipolar I with more depressive episodes and bipolar I with more manic episodes. Personality measures were based on the Biographical Personality Interview (BPI) and the Munich Personality Test (MPT).

RESULTS

The melancholic personality type (BPI) decreased from the unipolar depressives to the mainly manic group, while features of the manic type increased. MPT scores failed to discriminate between subgroups of patients. HR were significantly more introverted and had a stronger orientation towards social norms than controls according to the MPT, and showed a tendency towards the melancholic type according to the BPI.

LIMITATIONS

The sizes of some groups or subgroups are relatively small. Therefore, they have to be enlarged in the continuation of the study so as to increase the power of the statistical tests and thus to ascertain the robustness of the results.

CONCLUSION

Features of the typus melancholicus seem to be a risk factor for depression. The identification of highly predictive risk factors provides an opportunity for the development of prevention programs.

Stability and predictive value of self-report personality traits pre- and post-electroconvulsive therapy: a preliminary study

The accuracy and value of personality assessment for depressed patients receiving electroconvulsive therapy (ECT) is an underexplored and controversial area. However, there are data suggesting that personality traits and personality disorders affect the ultimate outcome of depressed patients receiving a variety of somatic treatments including ECT. Despite these data, controversy continues regarding the advisability of evaluating personality functioning in patients with severe depression. This study sought to explore the stability and predictive value of self-reported personality traits in depressed patients undergoing ECT. Sixteen subjects completed a self-report test of personality functioning and the Beck Depression Inventory (BDI) before and after ECT treatment. The results showed that the majority of self-report personality traits were stable pre- and post-ECT treatment. However, major depressive disorder did significantly affect the report of avoidant, histrionic, aggressive-sadistic, and schizotypal personality traits. Treatment did not change the overall personality profile of these subjects. Furthermore, regression analysis controlling for pretreatment depression showed pretreatment borderline personality traits to be significantly related to the posttreatment depression scores (response to treatment). These findings suggest that routine administration of a standard self-report measure of personality may aid in the evaluation of and treatment planning for patients receiving ECT.

Neuropsychological function and diurnal variation in depression

Twenty-six patients suffering from DSM-III-R major depressive episode with diurnal variation of mood were examined at approximately 8 AM and 8 PM, using a neuropsychological test battery. We found that tests of executive function, especially the verbal fluency test, were sensitive measures of diurnal variation, but that personality measures were relatively robust in that they were not significantly affected by diurnal variations of mood. The relevance of detecting and assessing diurnal changes of mood with reliable, objective measures of performance is discussed.

Typus melancholicus is not the premorbid personality trait of unipolar (endogenous) depression

The present paper aims to examine whether Typus melancholicus is a distinguishing premorbid personality of unipolar (endogenous) depressive patients vis-à-vis psychiatric patients with different diagnoses and healthy control subjects. Two observer-rated scales for Typus melancholicus were administered to a consecutive series of psychiatric patients (n = 140) and a group of control subjects (n = 84). To the authors' own surprise, the only statistically significant finding was the low Typus melancholicus score among unipolar (endogenous) depressives in comparison with normal controls but not with other psychiatric patients. In addition, this finding held only for one of the two rating scales and among women only. According to the other rating scale for Typus melancholicus, there was no difference between unipolar (endogenous) depressives and the normal control or other psychiatric patients. These findings are discussed with particular emphasis on the methodological aspects of studies of premorbid personality of psychiatric disorders, a favored subject in the psychiatric science for decades.

Personality traits of Japanese patients in remission from an episode of primary unipolar depression

Personality traits were assessed by means of the Munich Personality Test (MPT) in 75 Japanese subjects, 27 patients in remission from an episode of moderate to severe primary unipolar depression, with melancholic features during one episode or more of the disorder, in 24 patients in remission from other non-organic mental disorders and in 24 healthy controls. Compared with healthy controls, unipolar depressives displayed decreased Frustration Tolerance and elevated Rigidity as well as a stronger Orientation towards Social Norms. No significant difference was found between patients in remission from either unipolar depression or other mental disorders. However, the increase in Rigidity in comparison with healthy subjects was significant in the depressives only whereas the other patients, in contrast to the depressives, had significantly lower scores in Extraversion than the healthy subjects. Our results in Japanese patients are similar to findings of previous German studies, including two high risk studies, in which the same assessment instrument was used. This suggests that, beyond cultural differences, Rigidity, possibly in combination with a strong Orientation towards Social Norms and a reduced Frustration Tolerance, is a stable vulnerability marker for at least the more severe forms of primary unipolar depression.

Premorbid personality in patients with uni- and bipolar affective disorders and controls: assessment by the Biographical Personality Interview (BPI)

The relationship between premorbid personality and subtypes of affective disorder was investigated by means of the Biographical Personality Interview (BPI) and by a self-rating scale. Interviewer and rater (BPI) were blind to diagnosis. A total of 52 patients with unipolar depression or bipolar II disorder (D/Dm), 32 bipolar-I patients (DM) and 39 control subjects (C) were examined. Expert rating of "typus melancholicus" features (BPI) were found to be more pronounced in D/Dm than in DM and C. "Typus manicus" features were also distinguished between both clinical groups, whereas anxious-insecure features were not significantly different between the groups of patients. In contrast to the expert-rated personality variants, self-rating of personality features did not reveal any significant differences between the two clinical groups. Potential sources of the discrepancies between the questionnaire data and the interview data are discussed. It is concluded that premorbid features of "typus manicus" and "typus melancholicus" predicted, respectively, a predominant manic and a predominant depressive course of an affective disorder.

Premorbid personality aspects in mood and schizophrenic disorders

This study examines premorbid personality traits from a self-reported and family-reported perspective on a group of unipolar major depression (n = 27), bipolar (n = 21), and schizophrenic (n = 16) recovered inpatients, and a control group (n = 21). Using the Munich Personality Test (MP-T Scales) of von Zerssen for self-reporting and family-reporting personality traits, and the Kischkel scale for the measurement of "intolerance of ambiguity," we found more "rigidity," less "esoteric tendencies," and more "intolerance of ambiguity" among unipolar depressive patients. Schizophrenic patients showed more esoteric tendencies and less "extraversion." Results confirm the hypothesis supported by many authors regarding a particular personality structure in unipolar major depression characterized by rigidity and ambiguity intolerance. This personality pattern for unipolar depressives seems to be different from the depressive personality disorder proposed by DSM-IV. Schizophrenic individuals differ by means of their self- and family-reported extraversion. Clinical and theoretical implications of these findings are discussed.

Personality traits in subjects with bipolar I disorder in remission

This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia - Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.

Personality traits during depression and after clinical recovery

We investigated whether and how acute depressive symptoms affect the self-report of maladaptive personality traits. Sixty-eight acutely depressed patients underwent the Structured Interview for DSM-III Personality Disorder (SIDP) before and after pharmacological treatment, allowing us to determine whether self-reported maladaptive personality traits are different during depression and after successful clinical recovery. After the initial SIDP administration (during an episode of major depression), patients received desipramine treatment (dose range 150-300 mg/day) over a course of 4-5 weeks before readministration of the SIDP. For those who recovered from their depression (n = 39), cluster III trait scores were significantly lower than those assessed at baseline, and there was a lower frequency of cluster III categorical diagnoses for a personality disorder after treatment than before treatment. Recovered patients also had significantly lower cluster I personality trait scores after treatment as compared with baseline ratings. For those who did not recover from their depression after treatment (n = 29), cluster I trait scores were in fact higher than those measured at baseline, but there were no differences in categorical diagnoses before and after treatment. Cluster II personality traits and categorical diagnoses were not different between those who did and did not recover from their depression. Thus, depression may have a significant effect on the assessment of cluster I and cluster III personality traits. It is possible that cluster I and III 'personality traits' may be interwoven with depressive features and therefore subject to state influences, whereas cluster II personality traits may entail enduring, long-term characteristic modes of thinking, feeling, and behaving.

Premorbid personality traits of men who develop unipolar or bipolar disorders

In 1972, all Swiss males in the Canton of Zurich who reported for a compulsory medical examination for selection for military service were given the Freiburg Personality Inventory. This was repeated in half the sample on three subsequent occasions. From 1983 to 1988, an effort was made to identify all male psychiatric cases. There were 99 unipolars and 26 bipolars. The unipolars who had their age of onset after the personality testing displayed elevated scores on a constellation of symptoms labelled autonomic lability which consisted of items that correlated highly with neuroticism. The trait endured even when it was retested at age 36 years. The bipolars did not differ from the controls in any respect on any occasion.

Personality and psychopathology: an application of the five-factor model

Our review is concerned with the relationship of the five-factor model of personality to psychopathology, focusing in particular on Axis II personality disorders and depression. The five factors provide a particularly compelling model for interpreting the Axis II personality disorders as maladaptive variants of normal personality traits. However, we also discuss methodological and conceptual limitations of this application. There has been little research on the relationship of Openness, Agreeableness, and Conscientiousness to Axis I mental disorders, but considerable attention has been given to Neuroticism and Extraversion. We focus in particular on the difficulty in distinguishing between the various ways in which personality can relate to depression, either as a predisposition to, a complication of, a pathoplastic effect upon, or a spectrum variant of the mental disorder. We conclude with recommendations for future research.

Psychological test characteristics of depressed and panic patients

This study compared the psychological test performance of patients with major depression (MD) (n = 23), patients with panic disorder (PD) (n = 20), and normal subjects (n = 24). Results indicated that scores of normal subjects were significantly less pathological than those of both patient groups on almost all psychological test scales, but that the test performance of the two patient groups did not differ. The only difference between the two patient groups was on the level of self-reported and observer-rated depression. Both patient groups exhibited significant personality pathology, and the rate of personality disorders diagnosed by the Millon Clinical Multiaxial Inventory (MCMI) (base rate greater than 84) was 73% for PD patients and 86% for MD patients. The problems of assessing personality during episodes of MD and PD and the possible overdiagnosis of personality disorders by the MCMI are discussed.

Personality in depression: concordance between clinical assessment and questionnaires

The concordance between Vanggaard's concept of character neurosis and three personality questionnaires (Marke-Nyman Temperament Scale, Cesarec-Marke Personality Scale, and Eysenck Personality Questionnaire) was evaluated in 73 patients who were treated for a major depression in general practice. After an interview with the patients Vanggaard classified 57 of them to be without character neurosis, and the remaining 16 patients were considered to have a character neurosis. It was found that Eysenck's Neuroticism scale significantly corresponded to Vanggaard's classification. Among the other personality scales Acquiescence and Autonomy were the most important. Studies on the predictive validity of these subscales are in progress.

Personality of recovered patients with bipolar affective disorder

Personality traits of 45 patients with bipolar affective disorder who were fully recovered were compared with those of 78 patients with unipolar affective disorder (also fully recovered) and with those of 1172 never mentally ill first-degree relatives. The most striking finding is the similarity in personality between the recovered bipolar and unipolar patients, who both differed substantially from the never-ill group on measures of emotional strength. Bipolar men had normal levels of extraversion, whereas bipolar women, like unipolar women, were introverted.

Platelet MAO, personality and response to lithium prophylaxis

Patients with bipolar affective disorder and who were maintained on long lithium prophylaxis were evaluated retrospectively regarding response to lithium. Good responders to lithium prophylaxis were compared to non-responders and to normal controls on platelet MAO activity, and on psychological variables (Eysenck's extraversion, neuroticism, psychoticism and lie scale; Foulds' extrapunitiveness, intropunitiveness and dominance). Lithium responders, non-responders and normal controls had similar platelet MAO activity. There was a tendency for higher plasma lithium levels to be associated with higher platelet MAO activity in male patients but not in females. Lithium non-responders exhibited significant correlations between their platelet MAO activity and their test scores on psychoticism, and extraversion. Lithium non-responders, compared to responders and normals, showed abnormal personality profiles on neuroticism, and dominance.

Classification and diagnosis of depression

There is no general consensus how to classify and diagnose depressive disorders. The main reason is disagreement regarding etiology. This is reflected in the several theoretical models of depression which has been proposed. On the other hand, a reliable way of characterizing groups of patients that can be used by both clinicians and researchers, is necessary both for communication and progress of research. Facing this situation, the inclusion of etiological theories in classification of depression obviously would be an obstacle to the use of such a classification system by clinicians of various theoretical orientation at current. Thus, a classification system which describes the clinical features of the mental disorders comprehensively and at the lowest order of inference necessary to identify the disorder in a reliable way is needed. The third edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) represents such a classification system. By providing operational diagnostic criteria for each diagnosis, DSM-III represents a major achievement of classification in clinical psychiatry and research. This paper will present the classification of depression and the problem of differential diagnosis as outlined in DSM-III. Further, the validity of the DSM-III classification of depression will be discussed with reference to some recent research findings on biopsychosocial and treatment aspects of depressive disorders.

Neuropsychological and computerized tomographic evaluations of young alcoholics

The purpose of the study was to evaluate whether the mood of an alcoholic contributed to the impairment on intellectual tests. The Marke-Nyman Temperament Scale and the Beck Depression Inventory were administered to 37 male alcoholics. It was found that there were no significant differences in personality or mood between intellectually impaired and intellectually intact subjects.