Age distribution of the melancholic type of personality (typus melancholicus) in outpatients with major depression: a comparison with a population without a history of depression

Early perinatal diagnosis of mothers at risk of developing post-partum depression--a concise guide for obstetricians, midwives, neonatologists and paediatricians

OBJECTIVE

In this article, we tried to provide all those involved in perinatal medicine with a concise guide to detect mothers at risk of developing post-partum depression. Motherhood is a critical situation characterized by role conflicts because conflicts among the role of mother, worker and wife are the norm in the post-partum period and may jeopardize the mother's existence.

METHODS

We have described a kind of personality that is at great risk of developing post-partum depression because of the incapacity to creatively manage situations of role conflict. This personality structure is called typus melancholicus, and we operationally defined its main features: orderliness, conscientiousness, hypernomia/heteronomia and intolerance of ambiguity.

RESULTS

We have shown how these mothers may typically behave during pregnancy and early motherhood: they cannot avoid behaving with feverish perfectionism, developing an exaggerated preoccupation towards the unborn child and hostility towards persons and events that are experienced as an obstacle to their search for perfection. They ultra-carefully follow all the steps concerning paediatric check-ups and feel all the responsibility relating to the care of the child, without being able to delegate to someone else or share their feelings.

CONCLUSION

We hope to provide those clinicians who are engaged in the care of pregnant women and their children with a valuable and user-friendly instrument for understanding and making a timely diagnoses of at-risk psychopathological phenomena.

Altruism versus self-centredness in the personality of depressives in the 1950s and 1990s

BACKGROUND

Research in personality features of patients with major depression has emphasised their tendency to set high standards for themselves. Two directions of acting on high standards have been differentiated which can be summarised as altruistic and self-centred attitudes. Typus melancholicus and narcissistic personality features are representative for them. Since both types of features are age correlated, the question had to be settled whether this reflects an individual process of social adaptation or an epochal change of values.

METHODS

The study is based on a representative sample of case records of first episode depressives. Two cohorts of the 1950s and two of the 1990s were sampled. In both decades, one cohorts' age of onset was below 40 whereas the other cohorts' age of onset was over 40. Each cohort comprised 20 patients, yielding a total sample of 81 patients. The information from the records was prepared and evaluated in a two step procedure according to v. Zerssen.

RESULTS

Increase of altruism and decrease of self-centredness with advancing age could be confirmed. There is a weak to moderate epochal decline of altruistic attitudes only in the older cohorts and a marked increase of self-centred attitudes in both, the young and the old cohorts.

LIMITATIONS

The assessment of depression diagnosis and personality types by means of case records in a retrospective design could limit the reliability and validity of the measured concepts. In addition, items regarding narcissistic features were not validated in other samples.

CONCLUSION

Both, the age effect and the epochal effect show that such aspects should be born in mind for the psychotherapeutic treatment of depressive patients. This is especially important since basic personality attitudes contribute to the etiology of depression, partly conveyed by societal values, partly by requirements of life-spans in the individual life history.

Typus melancholicus: personality structure and the characteristics of major unipolar depressive episode

BACKGROUND

The melancholic type of personality (TM) has long been considered in continental and Japanese psychopathology as a relevant vulnerability trait constellation for the development of depression.

METHOD

The symptom presentation in an outpatient population of 116 subjects suffering from a DSM-IV major depressive episode was rated according to the standardized documentation system of the Association for Methodology and Documentation in Psychiatry (AMDP). Personality features were explored by means of the Criteria for Typus Melancholicus (CTM).

RESULTS

Statistically significant differences in depression-related psychopathological scores (i.e. higher level of guilt feelings, feeling of the loss of feelings, loss of vital drive and lower degrees of irritability and dysphoria) were found between TM and non-TM subjects, supporting the phenomenic specificity of TM depression at both symptom and subsyndromal level. LIMITATION AND CONCLUSIONS: Although our results were obtained in a selected sample of outpatients at an University Mental Health Center, they are indicative of psychopathological differences between TM and NTM in the core symptoms of depression. These differences highlight the importance of including TM criteria for phenotypic characterization of depressive disorder, suggesting that it may improve diagnostic and therapeutic practice and might be a reasonable psychopathologic endophenotype in investigating affective-spectrum vulnerability in at-risk populations.

Prevalence of typus melancholicus in healthy germans

BACKGROUND

There have been few studies concerning the prevalence of Typus melancholicus (TM) in healthy volunteers based on age or sex. To our knowledge, no such studies have been performed in healthy Germans, but several in healthy Japanese people. Therefore, it is necessary to also determine the prevalence of TM in healthy Germans, in order to know whether the prevalence of TM is cross-culturally constant.

SUBJECTS AND METHODS

We examined the prevalence of TM in 121 healthy German volunteers (62 men and 59 women with a mean age +/- SD of 43.9 +/- 16.8 years and 47.4 +/- 15.9 years, respectively). Kasahara's Inventory for the Melancholic Type Personality (KIMTP) and von Zerssen's F-List (F-List) were used to identify TM. The subjects were divided by age into three groups: those aged 40 years or less (group A), those aged 41-60 years (group B), and those aged 61 years or more (group C). Mean total KIMTP and F-List scores were calculated. In addition, we also calculated mean scores of the two KIMTP TM factors ['harmony in personal relationships' (factor 1) and 'social norms' (factor 2)]. Differences in scores between men and women were analyzed by Student's t test. Differences in scores between the three age groups were evaluated by one-way analysis of variance and Scheffé's test.

RESULTS

The KIMTP and F-List scores increased with age in both men and women. In the women, the KIMTP and F-List scores were significantly higher in groups B and C than in group A. In the women, the group C KIMTP factor 1 score was significantly higher than the group A KIMTP factor 1 score. The KIMTP and F-List scores tended to be higher for the women than for the men. Within groups B and C, the KIMTP and F-List scores and the KIMTP factor 1 score were significantly higher for the women than for the men.

CONCLUSION

Overall, the sex and age distributions of scores for both questionnaires were similar to those obtained in previous studies in Japanese people. It is of note that our German subjects and previous Japanese subjects were not demographically controlled and, clearly, cultural backgrounds differed. Thus, KIMTP and the F-List may discriminate the TM personality with some degree of universality despite cultural differences and might be useful in cross-cultural comparisons of TM.

Assessing the social behavior of unipolar depressives: the criteria for Typus melancholicus

AIM

(a) To define the nuclear characteristics of the melancholic type of personality (TM), that in European and Japanese psychopathological tradition is considered the model which most accurately describes the social behavior of unipolar depressives, through clear, valid, and synthetic criteria (criteria for TM = CTM); (b) to evaluate the diagnostic power, reliability, internal consistency, and other psychometric properties of these criteria.

METHODS

Personality features of 115 unipolar depressives consecutively admitted to 2 psychiatric facilities were assessed with the CTM and with the Kasahara Scale (KS). Four further unipolar depressives were assessed with the CTM by 13 different raters (11 CTM-naive and 2 experienced).

RESULTS

The CTM have shown high reliability and internal consistency. They were also highly concordant with the KS scores.

CONCLUSIONS

The CTM can discriminate between TMs and non-TMs and suggests that the TM kind of personality is not a dimensional concept but a coherent structure in which one feature entails the presence of all the others.

Dimensions of the Typus melancholicus personality type

The Typus melancholicus personality type (TMP) is characterised by orderliness, conscientiousness and interpersonal dependence. Several standardised instruments have been developed for the assessment of the Typus melancholicus personality. To date there has been no systematic comparison of these instruments and in particular it has been unclear whether TMP represents a single trait or a personality trait constellation. The aim of this study was the comparison of four TMP questionnaires and the investigation of the dimensionality of the personality as revealed by these questionnaires. The factorial validity of four TMP questionnaires was examined based on a sample of n = 264 psychiatric inpatients and normal controls. In a factor analysis of the items of the TMP questionnaires, four dimensions could be differentiated: Dependence, Intolerance of Ambiguity, Norm-Orientation, and Perfectionism. Psychometric evaluation showed good values for the individual items and the new TMP scales. The four subscales had a differential correlation profile in relation to the dimensions of the five-factor model of personality. The TMP scales could distinguish a group of depressed patients from a group of normal controls. The results show that TMP personality is not a single trait but consists of four related but separate traits. These can be clearly distinguished from those of the five-factor model of personality. The analysis of the TM concept therefore also represents a theoretical perspective for the integration of the personality characteristics which are relevant for depression. Based on this analysis, we constructed a multidimensional TMP inventory which forms the basis for the investigation of the effect of TM personality on clinical outcome and on psychotherapeutic treatment.

Reliability and validity of Kasahara's scale of melancholic type of personality (Typus melancholicus) in a German sample population

We explored the reliability and validity of Kasahara's scale of melancholic type of personality (KMT) in a German sample population. Subjects comprised 66 patients diagnosed with an affective disorder (F3, ICD-10) and 94 controls. Concerning reliability, KMT scores showed internal consistency with Cronbach's alpha coefficients of 0.65 for patients and 0.67 for controls. The KMT items, except for number 13 in controls, showed significant item-total correlations. In a test-retest procedure, the KMT total score and individual item scores were statistically similar and correlated. These results indicate reliability of the KMT. Concerning validity, KMT scores were significantly higher in patients than in controls. By controlling the effects of age and sex, partial correlation coefficients in a comparison of KMT and Zerssen's F-List (F-List) scores were 0.40 in patients and 0.53 in controls. These results show both the constructive and concurrent validity of the KMT. Sufficient reliability and validity of the KMT were shown in this German sample population to encourage cross-cultural investigation of Typus melancholicus.

Typus melancholicus and the Temperament and Character Inventory personality dimensions in patients with major depression

Although many clinical studies have been conducted to determine the etiological role and clinical implications of typus melancholicus for unipolar depression, maladaptive personality features in depressive patients have not been well described. This study explores typus melancholicus, as measured by the rigidity subscale of the Munich Personality Test, and maladaptive personality features, as measured by the Temperament and Character Inventory (TCI), in 131 remitted patients with DSM-IV major depression and 154 normal controls. The patients reported significantly higher scores on rigidity and harm avoidance and significantly lower scores on self-directedness and cooperativeness. Only 23.6% of the variance of the rigidity scale was explained by the variance of the seven TCI scales, in which only persistence was significantly correlated positively to rigidity. Cluster analysis identified four subgroups, two of which were characterized by a high rigidity score. One of these two subgroups showed no maladaptive personality features, as measured by the TCI, while the other showed high harm avoidance and low self-directedness. These results indicate that the personality of depressive patients is characterized not only by typus melancholicus but also by maladaptive personality features, that typus melancholicus is not well represented by any TCI scale, and that typus melancholicus and maladaptive personality features can coexist in some depressive patients.

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.

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.