Identifying Cloninger's temperament profiles as related to the early development of the metabolic cardiovascular syndrome in young men

Food and nutrient intakes by temperament traits: findings in the Helsinki Birth Cohort Study

BACKGROUND/OBJECTIVES

Previous studies have shown that the temperament traits are related to risk factors for chronic diseases, which could be partly explained by lifestyle habits. However, little is known whether temperament traits associate with diet. The aim of this study was to examine the cross-sectional associations between temperament traits and the whole diet.

SUBJECTS/METHODS

We studied 1668 men and women, aged 56-70, from the Helsinki Birth Cohort Study. Temperament was measured using the Tridimensional Personality Questionnaire. Information on diet was collected by a validated 128-item food frequency questionnaire. The associations of temperament traits; novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P), with diet were tested by linear regression analysis.

RESULTS

After adjustment for potential confounders, greater HA was related to poorer diet quality, including lower consumption of vegetables, fruits, fish and several vitamins. RD was associated with healthier diet quality, including higher consumption of vegetables and intake of vitamin E and lower intake of alcohol. NS was significantly related to higher intake of fish, fat and alcohol and lower consumption of cereals, milk products and carbohydrates. No significant associations between P and intake of foods and nutrients were observed.

CONCLUSIONS

Our results suggest that there is an association between temperament traits and diet. Especially greater HA seems to associate with poorer diet quality and greater RD with healthier diet quality.

Epigenetics of Metabolic Syndrome as a Mood Disorder

Mood disorders comprise major depressive disorder (MDD), bipolar disorder (BD) and the milder forms of these two disorders. Reccurring MDD is also known as unipolar disorder. The distinction between unipolar and bipolar disorders was first suggested in 1957 by Leonard and was made official after support by several studies in 1980. Indeed, in 150 AD, Aretaeus of Cappadocia wrote “It seems to me that melancholia is the beginning and a part of mania”. Additionally, Kraepelin, who proposed the first medical disease model in psychiatry a century ago, considered recurrent unipolar depression cases under the category of bipolar disorder and conceptualized spectrum disorders. Because today’s classification systems conduct cross-sectional diagnosis, they do not consider family history, long-term characteristics and multidimensional approaches on symptoms. This method prioritizes reliability over validity and it rules out psychiatric disorders in etiology. Actually, a spectrum model which covers physical diseases is conceivable. The concept of epigenetics considers mood disorders, Alzheimer’s disease, attention deficit and hyperactivity disorder, Carney syndrome, multiple endocrine neoplasia type I and II, breast and prostate cancers, carsinoid tumors, cerebrovascular and cardiovascular diseases and metabolic syndrome together. This review addressed the relationship between metabolic syndrome and mood disorders in this context along with genetic, clinical and environmental factors such as climate, geographic factors, migration and changeable lifestyles. Genetic and clinical variables are affective temperament, childhood trauma and use of antidepressants and antipsychotics.

Predictors of metabolic syndrome in first manic episode

OBJECTIVE

In the present study we aimed to investigate, whether an association between metabolic syndrome (MetS) and clinical features and affective temperaments exists or not in first manic episode of bipolar disorder (BD) and to clarify the prevalence and predictors of MetS.

METHOD

A total of 150 patients who were received a diagnosis of bipolar disorder type I according to DSM-IV criteria and who were experiencing their first manic episode (FME) were screened consecutively for inclusion. NCEP ATP III formulated an operational definition of MetS based on the presence of three or more of the following characteristics: abdominal obesity (waist circumference), hypertriglyceridemia, low HDL or being on an antilipidemic agent, high blood pressure or being on an antihypertensive agent, and fasting hyperglycemia or being on antiglycemic agent. The patients who had been in remission period for at least 8 weeks were evaluated with SKIP-TURK and TEMPS-A. Remission was defined as YMRS score <5.

RESULTS

37 (32.5%) patients had a MetS. Previous depressive episode, seasonality, negative family history and childhood trauma are determined as the predictors of MetS. Anxious and irritable temperament scores were higher in MetS (+) patients.

CONCLUSION

According to our results, links between MetS and BD may also have been predicted by genetic and environmental factors.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

Cloninger’s Temperament Dimensions, Socio-economic and Lifestyle Factors and Metabolic Syndrome Markers at Age 31 Years in the Northern Finland Birth Cohort 1966

The aim of this study was to assess the association between temperament and metabolic syndrome markers. Cloninger’s Temperament and Character Inventory and clinical examination were carried out in 1997 in the Northern Finland Birth Cohort 1966 ( N = 4364 respondents). Novelty seeking was positively associated with waist circumference in both genders. Systolic blood pressure was highest in men with high harm avoidance and low persistence scores and lowest in women with high reward dependence and high persistence scores. Childhood socio-economic status did not confound these associations. Smoking and alcohol consumption were associated with higher novelty seeking. Our results suggest that temperament is associated with metabolic syndrome markers and this association may be partly mediated by lifestyle factors and socio-economic status in adulthood.

Linking an Anxiety-Related Personality Trait to Cardiac Autonomic Regulation in Well-Defined Healthy Adults: Harm Avoidance and Resting Heart Rate Variability

OBJECTIVE

Anxiety trait, anxiety and depression states have all been reported to increase risks for cardiovascular disease (CVD), possibly through altering cardiac autonomic regulation. Our aim was to investigate whether the relationship between harm avoidance (HA, an anxiety-related personality trait) and cardiac autonomic regulation is independent of anxiety and depression states in healthy adults.

METHODS

We recruited 535 physically and mentally healthy volunteers. Participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Tri-dimensional Personality Questionnaire. Participants were divided into high or low HA groups as discriminated by the quartile value. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV). We obtained the time and frequency-domain indices of HRV including variance (total HRV), the low-frequency power (LF; 0.05-0.15 Hz), which may reflect baroreflex function, the high-frequency power (HF; 0.15-0.40 Hz), which reflects cardiac parasympathetic activity, as well as the LF/HF ratio.

RESULTS

The BDI and HA scores showed associations with HRV parameters. After adjustment for the BDI scores and other control variables, HA is still associated with reduced variance, LF and HF power. Compared with the participants with low HA, those with high HA displayed significant reductions in variance, LF and HF power and a significant increase in their LF/HF ratio.

CONCLUSION

This study highlights the independent role of HA in contributing to decreased autonomic cardiac regulation in healthy adults and provides a potential underlying mechanism for anxiety trait to confer increased risk for CVD.

Metabolic syndrome prevalence in different affective temperament profiles in bipolar-I disorder

OBJECTIVE

Temperament originates in the brain structure, and individual differences are attributable to neural and physiological function differences. It has been suggested that temperament is associated with metabolic syndrome (MetS) markers, which may be partly mediated by lifestyle and socioeconomic status. Therefore, we aim to compare MetS prevalence between different affective temperamental profiles for each season in bipolar patients.

METHODS

Twenty-six bipolar type-I patients of a specialized outpatient mood disorder unit were evaluated for MetS according to new definition proposed by the International Diabetes Federation in the four seasons of a year. Temperament was assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego - autoquestionnaire version (TEMPS-A).

RESULTS

The proportions of MetS were 19.2, 23.1, 34.6, and 38.5% in the summer, fall, spring, and winter, respectively. Only depressive temperament scores were higher (p = 0.002) during the winter in patients with MetS.

CONCLUSION

These data suggest that depressive temperament profiles may predispose an individual to the development of MetS in the winter.

Harm avoidance and cerebral infarction

OBJECTIVE

Harm avoidance, a trait indicative of behavioral inhibition, is associated with disability and dementia in old age, but the basis of these associations is uncertain. We test the hypothesis that higher level of harm avoidance is associated with increased likelihood of cerebral infarction.

METHOD

Older persons without dementia completed a standard measure of harm avoidance. During a mean of 3.5 years of follow-up, 257 (of 1,082) individuals died of whom 206 (80%) underwent brain autopsy. The number of chronic cerebral infarcts (microscopic plus gross; expressed as 0, 1, or >1) was assessed on neuropathologic examination, completed in 192 individuals at the time of analyses.

RESULTS

On postmortem examination, chronic cerebral infarcts were found in 89 (42 with 1, 47 with >1). Higher harm avoidance was associated with higher likelihood of infarcts (odds ratio = 1.083, 95% confidence interval = 1.040-1.128). A moderately high level of the trait (score = 17, 75th percentile) was associated with a 2.4-fold increase in the likelihood of infarction compared with a moderately low level of the trait (score = 6, 25th percentile). These associations persisted in models that controlled for other cardiovascular risk factors.

CONCLUSION

Higher level of the harm avoidance trait may be a risk factor for cerebral infarction.

Temperament, character and serotonin activity in the human brain: a positron emission tomography study based on a general population cohort

BACKGROUND

The psychobiological model of personality by Cloninger and colleagues originally hypothesized that interindividual variability in the temperament dimension 'harm avoidance' (HA) is explained by differences in the activity of the brain serotonin system. We assessed brain serotonin transporter (5-HTT) density in vivo with positron emission tomography (PET) in healthy individuals with high or low HA scores using an 'oversampling' study design. Method Subjects consistently in either upper or lower quartiles for the HA trait were selected from a population-based cohort in Finland (n = 2075) with pre-existing Temperament and Character Inventory (TCI) scores. A total of 22 subjects free of psychiatric and somatic disorders were included in the matched high- and low-HA groups. The main outcome measure was regional 5-HTT binding potential (BPND) in high- and low-HA groups estimated with PET and [11C]N,N-dimethyl-2-(2-amino-4-methylphenylthio)benzylamine ([11C]MADAM). In secondary analyses, 5-HTT BPND was correlated with other TCI dimensions.

RESULTS

5-HTT BPND did not differ between high- and low-HA groups in the midbrain or any other brain region. This result remained the same even after adjusting for other relevant TCI dimensions. Higher 5-HTT BPND in the raphe nucleus predicted higher scores in 'self-directedness'.

CONCLUSIONS

This study does not support an association between the temperament dimension HA and serotonin transporter density in healthy subjects. However, we found a link between high serotonin transporter density and high 'self-directedness' (ability to adapt and control one's behaviour to fit situations in accord with chosen goals and values). We suggest that biological factors are more important in explaining variability in character than previously thought.

Personality change after Internet-delivered cognitive behavior therapy for depression

Background. The Temperament and Character Inventory (TCI) by Cloninger is a widely used instrument to measure personality dimensions. Two dimensions of the TCI, Harm avoidance (HA) and Self-Directedness (SD), are known to be influenced by depressed mood. This study investigated changes in HA and SD after 10 weeks of Internet-delivered cognitive behavior therapy (ICBT) in a sample of clinically depressed subjects (N = 108). Differences in personality changes among treatment responders and non-responders were also investigated. Exploratory investigations on changes for other TCI dimensions, were also conducted.

Methods. Depressed subjects were randomized either to ICBT or to a moderated online discussion group, which served as an active control group. The interventions lasted for 10 weeks. TCI was measured at baseline and after treatment. Depressive symptoms were assessed using the Beck Depression Inventory-II.

Results. There were significant changes on HA and SD after ICBT. However, when comparing post-treatment HA and SD to the control, no differences were found. Among responders, larger changes compared to non-responders were found in HA and in SD, as well as in Cooperativeness.

Conclusions. The study showed that HA and SD changed after ICBT. The changes in personality seem related to improvement in depression rather than a direct effect of ICBT.

Personality as a risk factor for the metabolic syndrome: a systematic review

OBJECTIVE

The metabolic syndrome is a cluster of risk factors for the development of cardiovascular disease and/or type 2 diabetes. Personality can be defined as a stable set of behavioral characteristics of a person. In this review we systematically reviewed whether different personality characteristics are associated with the risk of having or developing the metabolic syndrome.

METHODS

Systematic review.

RESULTS

In total 18 studies were included. Thirteen cross-sectional analyses, and ten longitudinal analyses were grouped according to personality constructs: hostility, anger, and Type A behavior, temperament, neuroticism, and Type D personality. Conflicting evidence was reported on persons with high hostility, neuroticism, or Type D personality scores to be associated with an increased metabolic syndrome prevalence and development. All significant findings do point in the same direction: a more negative, or hostile personality type is associated with an increased prevalence of metabolic syndrome and its development over time.

CONCLUSION

There was no clear association between personality measures and the occurrence and development of the metabolic syndrome. There is, however, a cluster of risk factors that include the presence of the metabolic syndrome, as well as a more negative prone personality style, that both predispose to the development of coronary heart disease and diabetes. Future studies should investigate the role of personality measures in the development of these conditions, while taking into account metabolic syndrome, lifestyle and socio-demographic factors.

Temperament affects sympathetic nervous function in a normal population

OBJECTIVE

Although specific temperaments have been known to be related to autonomic nervous function in some psychiatric disorders, there are few studies that have examined the relationship between temperaments and autonomic nervous function in a normal population. In this study, we examined the effect of temperament on the sympathetic nervous function in a normal population.

METHODS

Sixty eight healthy subjects participated in the present study. Temperament was assessed using the Korean version of the Cloninger Temperament and Character Inventory (TCI). Autonomic nervous function was determined by measuring skin temperature in a resting state, which was recorded for 5 minutes from the palmar surface of the left 5th digit using a thermistor secured with a Velcro® band. Pearson's correlation analysis and multiple linear regression were used to examine the relationship between temperament and skin temperature.

RESULTS

A higher harm avoidance score was correlated with a lower skin temperature (i.e. an increased sympathetic tone; r=-0.343, p=0.004) whereas a higher persistence score was correlated with a higher skin temperature (r=0.433, p=0.001). Hierarchical linear regression analysis revealed that harm avoidance was able to predict the variance of skin temperature independently, with a variance of 7.1% after controlling for sex, blood pressure and state anxiety and persistence was the factor predicting the variance of skin temperature with a variance of 5.0%.

CONCLUSION

These results suggest that high harm avoidance is related to an increased sympathetic nervous function whereas high persistence is related to decreased sympathetic nervous function in a normal population.

Temperament clusters in a normal population: implications for health and disease

Background

The object of this study was to identify temperament patterns in the Finnish population, and to determine the relationship between these profiles and life habits, socioeconomic status, and health.

Methods/Principal Findings

A cluster analysis of the Temperament and Character Inventory subscales was performed on 3,761 individuals from the Northern Finland Birth Cohort 1966 and replicated on 2,097 individuals from the Cardiovascular Risk in Young Finns study. Clusters were formed using the k-means method and their relationship with 115 variables from the areas of life habits, socioeconomic status and health was examined.

Results

Four clusters were identified for both genders. Individuals from Cluster I are characterized by high persistence, low extravagance and disorderliness. They have healthy life habits, and lowest scores in most of the measures for psychiatric disorders. Cluster II individuals are characterized by low harm avoidance and high novelty seeking. They report the best physical capacity and highest level of income, but also high rate of divorce, smoking, and alcohol consumption. Individuals from Cluster III are not characterized by any extreme characteristic. Individuals from Cluster IV are characterized by high levels of harm avoidance, low levels of exploratory excitability and attachment, and score the lowest in most measures of health and well-being.

Conclusions

This study shows that the temperament subscales do not distribute randomly but have an endogenous structure, and that these patterns have strong associations to health, life events, and well-being.

The interaction between serotonin receptor 2A and catechol-O-methyltransferase gene polymorphisms is associated with the novelty-seeking subscale impulsiveness

OBJECTIVE

Novelty seeking is a trait that has been consistently associated with problem behaviours. There is evidence for heritability of novelty seeking, but the molecular genetic basis of the trait is still widely unclear.

METHODS

The interaction between polymorphisms of catechol-O-methyltransferase (COMT) and serotonin receptor 2A genes was examined in relation to novelty seeking and its different subscales in healthy Finnish adults. A subsample of 1214 participants derived from a population-based sample was genotyped for the COMT Val158Met (rs4680) and HTR2A T102C (rs6313) genes. Novelty seeking was measured twice, with a 4-year interval, using Cloninger's Temperament and Character Inventory.

RESULTS

The interaction between COMT Val158Met and HTR2A T102C polymorphisms was found to be associated with subscale impulsiveness. T/T carriers of HTR2A T102C polymorphism, that also had Met/Met genotype of COMT Val158Met single nucleotide polymorphism, scored significantly higher on impulsiveness than Val allele carriers (P=0.005).

CONCLUSION

Our results suggest that the interaction between dopaminergic and serotonergic genes might underlie impulsiveness. Together with earlier research our results also stress the importance of considering novelty seeking as a heterogeneous trait with its subscales having different genetic backgrounds.

Vital exhaustion, depressive symptoms and serum triglyceride levels in high-risk middle-aged men

The role of elevated serum triglyceride level as a risk factor of coronary artery disease is well established. Previous results have also indicated that depression or depressive symptoms and vital exhaustion correlate with triglyceride levels. The aim of this study was to investigate the associations of depressive symptoms, vital exhaustion, and health behavior with serum triglyceride levels. The study sample comprised 444 high-risk middle-aged men. Participants completed self-report questionnaires before laboratory tests. Triglyceride concentrations were measured by the enzymatic method. Vital exhaustion and depression were associated with unhealthy lifestyles and triglycerides. Vital exhaustion and depression were closely correlated constructs with comparable relations with known coronary artery disease risk factors. When comparing vital exhaustion (VE) to Beck Depression Inventory (BDI), however, the first one had a stronger correlation with triglycerides (TG), and also, path analyses showed a direct link from vital exhaustion to body mass index but not from depression. Both vital exhaustion and depression are related to triglyceride levels. The relations are partly mediated by unfavorable lifestyles. Although vital exhaustion is not so commonly assessed as depression, results of this study support the importance of vital exhaustion as a health-related psychological risk factor.

Cloninger's temperament traits and preclinical atherosclerosis: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Cloninger's psychobiological model of temperament has recently raised interest as a risk factor for CHD. However, there are no studies that have examined the associations of Cloninger's temperament traits with atherosclerosis.

METHODS

The subjects were 398 men and 657 women (mean age 31.7 years) participating in the Cardiovascular Risk in Young Finns Study. Linear regression analyses were used to examine the cross-sectional associations between temperament traits and preclinical atherosclerosis. Preclinical atherosclerosis was measured with carotid intima-media thickness ultrasound.

RESULTS

Higher novelty seeking (NS) and reward dependence (RD) and lower harm avoidance (HA) were associated with preclinical atherosclerosis. In NS and RD, associations remained significant after adjustments for various risk factors. The effect sizes of these associations were comparable to those of traditional risk factors of coronary heart disease, which is a major finding. No association for persistence (P) was found.

CONCLUSIONS

The present findings imply that examining a wider range of temperament and personality factors may offer new information that can help in explaining the between-individual variation in atherosclerosis and CHD morbidity.

DRD2 C32806T modifies the effect of child-rearing environment on adulthood novelty seeking

Preliminary evidence suggests that there may be longitudinal interactions between environmental and genetic factors in predicting Novelty seeking. We have previously found in small and selected subsample from the Cardiovascular Risk in Young Finns study, that an association between the polymorphism of dopamine receptor D4 was moderated by the childhood environment, as indexed by hostile maternal child-rearing. We wanted to replicate this finding in a population based sample of 1,114 men and women using another candidate gene of dopaminergic system, that is, the dopamine receptor D2 (DRD2). The child-rearing environment of the participants was assessed by their mothers when the participants were children or adolescents, and adulthood Novelty seeking was self-rated by the participants 17 and 21 years later at the ages of 24-39. Genotyping of DRD2 C32806T (rs 1800497) was performed using TaqMan 5'nuclease assay. DRD2 was not directly associated with Novelty seeking, but there was a significant DRD2 x strict maternal disciplinary style interaction in predicting Novelty seeking (F = 7.08, P = 0.008). The interaction showed that when the child-rearing environment was punitive, participants carrying any A1 allele of the DRD2 gene had higher scores on Novelty seeking than carriers of the A2/A2 genotype. The genotype had no effect on Novelty seeking when the childhood environment was more favorable. The findings suggest that the DRD2 may have an environmentally moderated impact on Novelty seeking and that the origins of such an association may lie already in childhood.

Temperament profiles in personality disorders among a young adult population

The objective of this study was to describe the temperament dimension profiles assessed by the Temperament and Character Inventory (TCI) among young adults with the DSM-III-R personality disorder (PD). Our hypothesis was that PD clusters and separate PDs can be distinguished from one another by their specific temperament profiles. As a part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the cohort members living in the city of Oulu at the age of 31 years (n=1609) were invited to participate in a two-phase field study. The Structured Clinical Interview for DSM-III-R for PDs (SCID-II) was used as diagnostic instrument. The final study sample consisted of the 1311 subjects who had completed the Hopkins Symptom Check List-25 questionnaire for screening and had given a written informed consent. Of the 321 SCID interviewed subjects, 74 met the criteria for at least one PD and had completed the TCI. The mean TCI scores of subjects with PD and control subjects without PD (n=910) were compared. Low Novelty Seeking, high Harm Avoidance and low Reward Dependence characterized cluster A and C PDs. Subjects with a cluster B PD did not differ from controls, except for Novelty Seeking, which was high. The temperament dimensions could not distinguish different PDs very well, with the only exception of persons with obsessive-compulsive PD. PD clusters were associated with different profiles of temperament, lending some support for Cloninger's typology.

The Serotonin Receptor 2A Gene Moderates the Influence of Parental Socioeconomic Status on Adulthood Harm Avoidance

We examined whether the T102C polymorphism of the serotonin receptor 2A gene (HTR2A) moderated the influence of childhood or adolescence parental socioeconomic status (SES) on adulthood temperament trait harm avoidance (HA) in a population-based sample of 1246 healthy Finnish men and women, who were 24-39 years of age in the last follow-up phase. High parental SES predicted low adulthood HA. In addition, the C allele of the T102C polymorphism was associated with high HA in one of the two test settings, and with the mean of the two measurements. Most importantly, we found that the T102C polymorphism moderated the influence of parental SES, such that high parental SES predicted low adulthood HA in subjects with the T/T or T/C genotypes, while this was not true for those carrying the C/C genotype. The role of the T102C polymorphism was most pronounced among those with high parental SES. We conclude that the T102C polymorphism of the HTR2A gene may be involved in the development of temperament by moderating the influence of environmental conditions.

Linking stress to inflammation

There is ample evidence for the influence of central nervous system modulation through inflammatory cellular reactions under psychosocial stress. These inflammatory reflexes might be of major influence not only for metabolic and vascular disease but also for many autoimmune diseases for which stress has been reported as a risk factor. In prospective trials on the influence of risk factors for the occurrence of cardiovascular events, both psychosocial stress and autonomic nervous control of the cardiovascular system were shown to have a major impact on event rates. The underlying cause of these findings seems to be explained in part by the direct influences of autonomic reflexes, potentially induced by psychosocial tasks, on the progression of atherosclerosis. Hence, future prospective studies that aim at deciphering the influence of chronic psychosocial stress and autonomic function on the pathogenesis of inflammatory and metabolic disease will need to include neurophysiologic, molecular, and clinical parameters. Because the neuroimmunologic axis can be seen as a system connecting mental states with inflammatory reactions, pro-inflammatory mediators and anti-inflammatory strategies should be studied as such in experimental settings.

Tryptophan hydroxylase 1 gene haplotypes modify the effect of a hostile childhood environment on adulthood harm avoidance

We conducted a series of tests to determine whether there is any association between tryptophan hydroxylase 1 (TPH1) and temperament in adulthood. In addition to testing for main effects, we investigated whether TPH1 gene variation modifies the influence of childhood environment on temperament in adulthood. The subjects were 341 healthy adults whose childhood environment was assessed by their mothers in 1980 and who self-rated their temperaments twice, in 1997 and 2001. We found no association between the TPH1 gene and temperament; however, among women, the TPH1 gene modified a relationship between adverse childhood environment and harm avoidance in adulthood. This finding was confirmed in the same sample in another test setting 4 years later. The presence of the A/A haplotype of the TPH1 intron 7 A218A and A779C polymorphism predicted a high level of adulthood harm avoidance in the presence of a hostile childhood environment as defined in terms of emotional rejection, maternal neglect and harsh and inconsistent discipline. In addition, the findings suggest a gene-environment correlation for novelty seeking in men.

Cloninger's Temperament Dimensions and Threat, Stress, and Performance Appraisals During Different Challenges Among Young Adults

We examined the relationship of Cloninger's temperament factors-Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence-to perceived threat and stress and performance appraisals during different challenges, i.e., mental arithmetic, the reaction time task, and three public speaking tasks, among 97 young adult men and women. Temperament was measured by the Temperament and Character Inventory. The results showed that, although some of the predictions made by Cloninger's model were confirmed, some were unsupported. The results revealed also some associations between temperament and cognitive appraisals that were intelligible, but not predicted by Cloninger's model. There were considerable domain specificity and gender differences in the associations found. Cloninger's temperament dimensions are related to threat, stress, and performance appraisals, thereby influencing individual's stress vulnerability, adjustment, and personal functioning.

Job strain and early atherosclerosis: the Cardiovascular Risk in Young Finns study

OBJECTIVE

The purpose of this study was to determine whether job strain and social support are associated with early atherosclerosis measured by carotid intima-media thickness (IMT) in young adults.

METHODS

The subjects were 478 men and 542 women (mean age 32.3) who were participating in the ongoing prospective Cardiovascular Risk in Young Finns study. Job strain was defined as a joint effect of job demands and job control. Early atherosclerosis was determined with IMT ultrasound. The associations between job strain, social support, and IMT were evaluated using multiple linear regressions.

RESULTS

In men, job strain was associated with increased IMT after adjustment for age. This association was not attenuated by additional adjustment for established risk factors of coronary heart disease. In women, job strain was not associated with IMT. No 3-way interaction of job demand, job control, and social support on IMT was found.

CONCLUSION

These findings suggest that job strain may be related to atherosclerosis already in its early nonsymptomatic stages in men.

Cloninger's temperament dimensions and epidermal growth factor A61G polymorphism in Finnish adults

This study examines a link between human temperament and epidermal growth factor (EGF). There is evidence that dopaminergic neurotransmission in the central nervous system has a role in temperament, especially in novelty seeking. Functional polymorphism in EGF gene has an impact on EGF production, and EGF, in turn, appears to affect the development of midbrain dopaminergic neurons. Epidermal growth factor gene A61G polymorphisms were studied in a randomly selected sample of 292 Finnish adults. Their temperaments were assessed twice (with a 4-year test-retest interval) with Cloninger's Temperament and Character Inventory consisting of four dimensions, i.e. novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (P). The findings on men showed a significant association between a presence of the G/G polymorphism and scoring in the highest tertile on NS in both test and retest. The same was true with men who scored high on RD, especially on sensitivity, in both tests. Among women, G/G polymorphism was associated with a stable high level of P. Importantly, temperament dimensions, as assessed with one test only, did not provide replicable associations with EGF polymorphism across the two measurements. Our results demonstrate the importance of reliable phenotype assessment and lend support to the hypothesis that dopaminergic activity is one factor underlying stable temperament.

The TPH intron 7 A218C polymorphism and TCI dimension scores in alcohol-dependent patients: hints to nonspecific psychopathology

AIMS

A linkage of certain alleles of the tryptophan hydroxylase (TPH) intron 7 A218C polymorphism to suicidality and antisocial behaviour has been described. The aim of our study was to find any association between dimensions of the Temperament and Character Inventory (TCI) indicating impulsivity and the TPH polymorphism alleles in unselected alcohol-dependent patients and age-matched controls.

METHODS

We examined 159 alcohol-dependent patients and 161 controls with the TCI and genotyped them for the TPH intron 7 A218C polymorphism alleles.

RESULTS

Although homozygous TPH genotypes were found more often in alcohol-dependent patients than in controls, an association between TCI dimensions and TPH alleles was not observed in the complete sample. Alcohol-dependent patients, however, scored significantly higher for harm avoidance (HA) and lower for self-directedness (SD) than controls regardless of TPH genotype. Among controls, for those with the A/A genotype, harm avoidance was as high as in the group of alcohol-dependent patients, persistence (P) in that genotype was significantly lower than for all other genotypes in the patient and control group.

CONCLUSION

Even if there is no association between TCI dimensions and TPH genotype in our sample, hints to nonspecific psychopathology in connection with the A/A genotype are found.

What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome

Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. It is now widely recognised that obesity (especially abdominal fat accumulation), hyperglycaemia, dyslipidaemia and hypertension are common metabolic traits that, concurrently, constitute the distinctive insulin resistance or metabolic syndrome. Cross-sectional and prospective data provide an emerging picture of associations of both physical activity habits and cardiorespiratory fitness with the metabolic syndrome. The metabolic syndrome, is a disorder that requires aggressive multi-factorial intervention. Recent treatment guidelines have emphasised the clinical utility of diagnosis and an important treatment role for 'therapeutic lifestyle change', incorporating moderate physical activity. Several previous narrative reviews have considered exercise training as an effective treatment for insulin resistance and other components of the syndrome. However, the evidence cited has been less consistent for exercise training effects on several metabolic syndrome variables, unless combined with appropriate dietary modifications to achieve weight loss. Recently published randomised controlled trial data concerning the effects of exercise training on separate metabolic syndrome traits are evaluated within this review. Novel systematic review and meta-analysis evidence is presented indicating that supervised, long-term, moderate to moderately vigorous intensity exercise training, in the absence of therapeutic weight loss, improves the dyslipidaemic profile by raising high density lipoprotein-cholesterol and lowering triglycerides in overweight and obese adults with characteristics of the metabolic syndrome. Lifestyle interventions, including exercise and dietary-induced weight loss may improve insulin resistance and glucose tolerance in obesity states and are highly effective in preventing or delaying the onset of type 2 diabetes in individuals with impaired glucose regulation. Randomised controlled trial evidence also indicates that exercise training decreases blood pressure in overweight/obese individuals with high normal blood pressure and hypertension. These evidence-based findings continue to support recommendations that supervised or partially supervised exercise training is an important initial adjunctive step in the treatment of individuals with the metabolic syndrome. Exercise training should be considered an essential part of 'therapeutic lifestyle change' and may concurrently improve insulin resistance and the entire cluster of metabolic risk factors.

Vital exhaustion, temperament, and cardiac reactivity in task-induced stress

The associations between vital exhaustion (long-term stress), temperament, and cardiac reactivity were studied during an experimentally induced stress in a sample of 76 healthy subjects. Vital exhaustion was assessed with the Maastricht Questionnaire(MQ), and temperament with Cloninger's Temperament and Character Inventory (TCI). Cardiac reactivity was measured in terms of heart rate, respiratory sinus arrhythmia, and pre-ejection period. They were continuously measured during three stressors, i.e. mental arithmetic, reaction time, and giving speech. Results showed that vital exhaustion (long-term stress) was first of all associated with parasympathetic withdrawal. In addition, among exhausted persons the initial parasympathetic tone had no effect on task-induced parasympathetic reactivity, whereas in non-exhausted subjects parasympathetic reactivity was greatest when initial parasympathetic tone was high. Vital exhaustion interacted with temperament and gender: exhausted, persistent women expressed the highest level of physiological stress reactivity. Findings suggest that background stress may diminish one's capacity to cope with acute stress.

Affects and autonomic cardiac reactivity during experimentally induced stress as related to precursors of insulin resistance syndrome

This study examined the association of insulin resistance syndrome (IRS) precursors with state affects and autonomic reactivity in randomly selected healthy young adults. It was asked whether IRS precursors are able to predict a person's mental and physiological coping with acute stress over an 11-year follow-up period. IRS parameters were serum insulin, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, body-mass index, and subscapular skinfold thickness. In the psychophysiological experiment, state affects and cardiac responses (heart rate, respiratory sinus arrhythmia, and pre-ejection period) were measured during different challenges. The main result was that IRS precursors predicted high levels of negative emotions during the challenges; IRS accounted for 19% of the variance in tiredness. IRS was unrelated to cardiac reactivity. Mechanisms underlying the associations found are discussed.

Depression and self-reported physical health in patients with coronary disease: mediating and moderating factors

OBJECTIVES

The purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors.

METHODS

We conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models.

RESULTS

Five regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2 = 0.22); depression plus angina and fatigue (R2 = 0.53); depression plus positive affect and novelty seeking and their interaction (R2 = 0.48); depression plus spousal support (R2 = 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2 = 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariate r = 0.39, partial r = 0.37-0.13).

CONCLUSIONS

The effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.