Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study

BACKGROUND

The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time.

METHODS

Forty healthy, 4-week-old, formula-fed infants (n = 20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex.

RESULTS

Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median ≥ 80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P < 0.01). Mean ± standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59 ± 0.60) and Food Responsiveness (3.53 ± 0.81), and low for Satiety Responsiveness (2.50 ± 0.73) and Slowness in Eating (1.71 ± 0.60). Better HRQoL scores were significantly (P < 0.05) associated with high General Appetite scores (3 ITQOL concepts, r = 0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r = 0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r = - 0.32 to - 0.47).

CONCLUSION

Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02431377; Registered May 1, 2015.

Profiles of Temperament among Youth with Specific Phobias: Implications for CBT Outcomes

Specific phobias (SPs) are characterized by excessive fear or anxiety regarding an object or situation. SPs often result in a host of negative outcomes in childhood and beyond. Children with SPs are broadly assumed to show dispositional over-regulation and fearfulness relative to children without SPs, but there are few attempts to distinguish dispositional patterns among children with SPs. In the present study, we examined trajectories of differing temperamental profiles for youth receiving a CBT-based treatment for their SP. Participants were 117 treatment seeking youth (M Age = 8.77 years, Age Range = 6-15 years; 54.7% girls) who met criteria for a SP and their mothers. Three temperament profiles emerged and were conceptually similar to previously supported profiles: well-adjusted; inhibited; and under-controlled. While all groups showed similarly robust reductions in SP severity following treatment, differences among the three groups emerged in terms of broader internalizing symptoms, externalizing symptoms, and global outlook. The well-adjusted group was higher in functioning initially than the other two groups. The inhibited group had initial disadvantages in initial internalizing symptoms. The under-controlled group showed greatest comorbidity risks and had initial disadvantages in both internalizing and externalizing symptoms. These distinct clusters represent considerable heterogeneity within a clinical sample of youth with SP who are often assumed to have homogenous behavior tendencies of inhibition and fearfulness. Findings suggest that considering patterns of temperament among children with phobias could assist treatment planning and inform ongoing refinements to improve treatment response.

Affective temperaments in anorexia nervosa: The relevance of depressive and anxious traits

BACKGROUND

Affective temperaments have been so far understudied in anorexia nervosa (AN) despite the relevance of personality and both affective and anxious comorbidity with regard to vulnerability, course, and outcome of this deadly disorder.

METHODS

Ninety-eight female inpatients diagnosed with AN and 131 healthy controls (HCs) were enrolled in this study and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in addition to assessments of eating psychopathology, depression, and anxiety.

RESULTS

AN patients and HCs differed in all affective temperaments. The diagnostic subtypes of AN differed as well with binge-purging individuals being more cyclothymic and anxious than those with restricting-type AN. TEMPS-A scores correlated with body mass index and eating psychopathology but not with duration of illness. Concerning comorbidity, grater scores on the depressive and lower scores on the hyperthymic temperaments were found in depressed patients. Those who had either an anxious or irritable temperament were significantly more diagnosed with an anxious disorder than those who did not show this temperament. When logistic regression was performed, high depressive/low hyperthymic and high irritable/anxious traits resulted to be associated with depressive and anxious comorbidity, respectively, independently of confounding factors.

LIMITATIONS

Cross-sectional design, some patients on medications, few baseline clinical differences between diagnostic subtypes, no other personality assessments.

CONCLUSIONS

An affective continuum strongly associated with mood and anxious comorbidity emerged in AN. Such an evaluation could have several research and clinical implications given the need of improving treatment individualization and early interventions for such a complex disorder.

A Twin Factor Mixture Modeling Approach to Childhood Temperament: Differential Heritability

Twin factor mixture modeling was used to identify temperament profiles while simultaneously estimating a latent factor model for each profile with a sample of 787 twin pairs (Mage  = 7.4 years, SD = .84; 49% female; 88.3% Caucasian), using mother- and father-reported temperament. A four-profile, one-factor model fit the data well. Profiles included "regulated, typical reactive," "well-regulated, positive reactive," "regulated, surgent," and "dysregulated, negative reactive." All profiles were heritable, with lower heritability and shared environment also contributing to membership in the "regulated, typical reactive" and "dysregulated, negative reactive" profiles.

How many infants are temperamentally difficult? Comparing norms from the Revised Infant Temperament Questionnaire to a population sample of UK infants

The original norms for the Revised Infant Temperament Questionnaire (RITQ) were published in 1978 and were based on a small sample from the US. The aim of this study is to compare temperament scores from the original RITQ against scores from a large population-based cohort of infants from the UK. This study consists of 10,937 infants from the Avon Longitudinal Study of Parents and Children (ALSPAC) born between April 1991 and December 1992 in the southwest of England. Infant temperament at 6 months of age was reported by parents using the adapted RITQ. Responses were scored according to the RITQ manual and then categorized into temperament groups (easy, intermediate low, intermediate high, and difficult) using either the RITQ norms or norms derived from the data. The scores for each temperament subscale and the proportion of children in each temperament group were compared across the two methods. Subscale scores for the ALSPAC sample were higher (more "difficult") than the RITQ norms for rhythmicity, approach, adaptability, intensity, and distractibility. When RITQ norms were applied, 24% infants were categorized as difficult and 25% as easy, compared with 15% difficult and 38% easy when ALSPAC norms were used. There are discrepancies between RITQ norms and the ALSPAC norms which resulted in differences in the distribution of temperament groups. There is a need to re-examine RITQ norms and categorization for use in primary care practice and contemporary population-based studies.

[Temperament and character traits measured by temperament and character inventory (TCI) by Cloninger in patients with ischemic heart disease]

Ischemic heart disease (IHD) is one of the main causes of death and disability worldwide. This situation stimulates research of its ethiopathogenesis. The role of psychosocial factors like depression, stress is underlined. Also personality traits play an important role in this process. The aim of study was to assess temperament and character traits in a group of patients with IHD.

MATERIAL AND METHODS

Temperament and Character Inventory (TCI) was used to determine temperament and character dimensions. Temperament traits: harm avoidance (HA), reward dependence (RD), novelty seeking (NS), persistence (P), character traits: cooperativeness (C), self-directedness (SD), self-transcendence (ST). Each of these traits has a varying number of subscales. The dimensions are determined from a 240-item questionnaire.

RESULTS

Patients with IHD obtained higher scores in HA dimension of the TCI questionnaire. The study group achieved lower score in a subscale of NS called extravagance (NS3), and higher score of C dimension called compassion (C4).

CONCLUSION

The intensity of temperament and character traits are different in a group of patients with IHD in comparison with the control group especially in dimensions of HA, NS3 and C4. Variables that differentiated the study group were also sex, age and years of education.

[The Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A)--an important tool to study affective temperaments]

The aim of the paper is to describe the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) constructed by prominent researchers of affective disorders, under the direction of Hagop Akiskal, and functioning in full version since 2005. The article refers to the definitions of temperament, including the concept of affective temperament, related to the area of emotionality and conceptualized as the endophenotype of affective disorders. Based on clinical observations, initially four types of temperament had been delineated: hiperthymic, depressed, irritable and cyclothymic, and, subsequently, the anxious temperament was added. Full version of the scale contains 110 items for the five types of temperament, which were discussed in detail. The TEMPS-A has been translated into 32 languages and its verification was performed in many countries, including Poland. The scale has been widely used in epidemiological and clinical studies in general population, in patients with affective disorders, and in other diseases. In affective disorders, different types of temperament show, among others, a relationship to the type and symptomatology of bipolar disorder as well as to a predisposition to suicidal behavior. In Poznań centre, an association between several dimensions of temperament of the TEMPS-A, and prophylacic efficacy of lithium has been shown. Different types of temperament also play a role in other mental disorders and somatic diseases. In the final section of the article, the studies performed so far on the molecular-genetic determinants of temperament dimensions, measured by the TEMPS-A are presented.

Describing temperament in an ungulate: a multidimensional approach

Studies on animal temperament have often described temperament using a one-dimensional scale, whereas theoretical framework has recently suggested two or more dimensions using terms like “valence” or “arousal” to describe these dimensions. Yet, the valence or assessment of a situation is highly individual. The aim of this study was to provide support for the multidimensional framework with experimental data originating from an economically important species (Bos taurus). We tested 361 calves at 90 days post natum (dpn) in a novel-object test. Using a principal component analysis (PCA), we condensed numerous behaviours into fewer variables to describe temperament and correlated these variables with simultaneously measured heart rate variability (HRV) data. The PCA resulted in two behavioural dimensions (principal components, PC): novel-object-related (PC 1) and exploration-activity-related (PC 2). These PCs explained 58% of the variability in our data. The animals were distributed evenly within the two behavioural dimensions independent of their sex. Calves with different scores in these PCs differed significantly in HRV, and thus in the autonomous nervous system’s activity. Based on these combined behavioural and physiological data we described four distinct temperament types resulting from two behavioural dimensions: “neophobic/fearful – alert”, “interested – stressed”, “subdued/uninterested – calm”, and “neoophilic/outgoing – alert”. Additionally, 38 calves were tested at 90 and 197 dpn. Using the same PCA-model, they correlated significantly in PC 1 and tended to correlate in PC 2 between the two test ages. Of these calves, 42% expressed a similar behaviour pattern in both dimensions and 47% in one. No differences in temperament scores were found between sexes or breeds. In conclusion, we described distinct temperament types in calves based on behavioural and physiological measures emphasising the benefits of a multidimensional approach.

Amygdala and hippocampus fail to habituate to faces in individuals with an inhibited temperament

Habituation is a basic form of learning that reflects the adaptive reduction in responses to a stimulus that is neither threatening nor rewarding. Extremely shy, or inhibited individuals, are typically slow to acclimate to new people, a behavioral pattern that may reflect slower habituation to novelty. To test this hypothesis, we used functional magnetic resonance imaging to examine habituation to neutral faces in 39 young adults with either an extreme inhibited or extreme uninhibited temperament. Our investigation focused on two key brain regions involved in response to novelty--the amygdala and the hippocampus. Habituation to neutral faces in the amygdala and hippocampus differed significantly by temperament group. Individuals with an uninhibited temperament demonstrated habituation in both the amygdala and hippocampus, as expected. In contrast, in individuals with an inhibited temperament, the amygdala and hippocampus failed to habituate across repeated presentations of faces. The failure of the amygdala and hippocampus to habituate to faces represents a novel neural substrate mediating the behavioral differences seen in individuals with an inhibited temperament. We propose that this failure to habituate reflects a social learning deficit in individuals with an inhibited temperament and provides a possible mechanism for increased risk for social anxiety.

[Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment]

Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents

BACKGROUND

Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents).

METHOD

A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits.

RESULTS

We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes. Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (approximately 33%) comprised low symptom probands and mothers with scores in the healthy range. Class 2 ( approximately 43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (approximately 24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother-daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype.

CONCLUSIONS

A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother-daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.

[Temperament traits, depression and cognitive functioning of patients with coronary heart disease]

Current studies on Coronary Heart Disease (CHD) show significant relationship with depression, which play important role in the course and clinical pictures of the illness. The stress factors may cause disturbances of Limbic System--Hypothalamic-Pituitary-Adrenal axis--LHPA, and initiation both of depression and coronary hearth disease. Current studies show the important role of personality and temperament related to brain functions in pathogenesis both depression and CHD. In patients with CHD the relationship between depressed symptoms and cognitive dysfunctions connected with structural and functional brain abnormalities, especially on prefrontal cortex and hippocampus were detected. The mechanism of depressed symptoms and cognitive disturbances in CHD is still unclear and future studies on these topics are needed. This study is expected to lead to better understanding of etiopathogenesis of CHD and its connections with depression and cognitive dysfunctions and to creation of efficient treatment programs in these disturbances.

A prospective test of anxiety sensitivity as a moderator of the relation between gender and posttraumatic symptom maintenance among high anxiety sensitive young adults

The primary aim of this study was to evaluate the individual and combined influence of anxiety sensitivity (AS) and gender on the longitudinal prediction of posttraumatic symptoms. A large nonclinical sample of young adults (n=404) was prospectively followed over approximately 18 months. The primary findings indicated that gender and AS were uniquely associated with posttraumatic symptom levels during the follow-up period. Moreover, AS appeared more strongly (positively) related to posttraumatic stress symptoms during the follow-up period among females than males. These data provide novel prospective evidence regarding the interplay of relatively well-established risk factors implicated in the maintenance of posttraumatic stress symptoms.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

This paper reports the results of two studies in a nonclinical (n=105) and primary care outpatient sample (n=110), in which Depressive Personality Disorder (DPD), Dysthymia, and depression were assessed for their distinctive relationship with perfectionism. Results from both studies found that self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with three dimensions of perfectionism-Concern over Mistakes, Doubts about Actions, and Parental Criticism. In the nonclinical sample, variance in measures of DPD was predicted by measures of perfectionism after controlling for depression and Dysthymia symptoms. A similar pattern of findings was observed in the primary care sample. This relationship with perfectionism did not occur when Dysthymia or depressive symptoms were predicted. Nevertheless, much of the variance in measures of DPD, Dysthymia, and depressive symptoms is associated with each other and not perfectionism. It is concluded that a common factor or set of factors underlies these disorders, but that DPD may be more strongly related to perfectionism than Dysthymia and depression. As a common factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby increasing the discriminant validity of their measures.

The emotion reactivity scale: development, evaluation, and relation to self-injurious thoughts and behaviors

Prior research has examined the relations between various facets of emotion and psychopathology, with a great deal of recent work highlighting the importance of emotion regulation strategies. Much less attention has been given to the examination of emotion reactivity. This study reports on the development and evaluation of the Emotion Reactivity Scale (ERS), a 21-item self-report measure of emotion sensitivity, intensity, and persistence, among a sample of 87 adolescents and young adults. Factor analysis revealed a single factor of emotion reactivity best characterized the data. The ERS showed strong internal consistency (alpha=.94), convergent and divergent validity via relations with behavioral inhibition/activation and temperament, and criterion-related validity as measured by associations with specific types of psychopathology and self-injurious thoughts and behaviors (SITB). Moreover, emotion reactivity statistically mediated the relation between psychopathology and SITB. These findings provide preliminary support for the ERS and suggest that increased emotion reactivity may help explain the association between psychopathology and SITB.

A case series on the hypothesized connection between dementia and bipolar spectrum disorders: bipolar type VI?

BACKGROUND

The concept of bipolar spectrum disorders has opened therapeutic opportunities for patients with atypical and complex affective conditions. The literature has recently described several commonalities in pathophysiological processes of bipolar disorders and dementia. However, this connection has been insufficiently appreciated at the clinical level, in part because affective dysregulation in the elderly and, particularly in the dementia setting, is typically attributed either to secondary depressive states or otherwise relegated to a neurologically understandable behavioral complication resulting from cerebral disease.

METHODS

We selected a case series of 10 elderly patients with late-onset mood and related behavioral symptomatology and cognitive decline without past history of clear-cut bipolar disorder. Clinical features, temperament, cognition, family history and pharmacological response were assessed to identify prototypical patients to illustrate the complexities of the dementia-bipolar interface.

RESULTS

Mixed and depressive mood symptoms were most commonly observed and all patients had been premorbidly of hyperthymic, cyclothymic and/or irritable temperaments. Most patients had a family history of bipolar disorder or disorders related to the bipolar diathesis. Symptoms were often refractory to or aggravated by antidepressants and acetylcholinesterase inhibitors, whereas mood stabilizers and/or atypical antipsychotics were beneficial, promoting behavioral improvement in all treated patients and marked cognitive recovery in five.

LIMITATIONS

Case series with retrospective methodology.

CONCLUSION AND CLINICAL IMPLICATIONS

Patients with cognitive decline and frequent mood lability might be manifesting a late-onset bipolar spectrum disorder, which we posit as type VI. We further posit that dementia and/or other biopsychosocial challenges associated with aging might release latent bipolarity in such individuals. Antidepressants, even drugs targeting dementia, might aggravate the behavioral dysregulation in these patients. Evaluation of premorbid temperament and/or family history of bipolarity and related disorders might help in broadening the clinical and biological understanding of such patients, providing a rationale for better customized treatment along the lines of mood stabilization and avoidance of antidepressants.

Harm avoidance in subjects with obsessive-compulsive disorder and their families

INTRODUCTION

This study investigates the role of harm avoidance (HA) as a possible risk factor in the familiality of obsessive-compulsive disorder (OCD). HA is considered to be a genetically influenced personality trait with an increasingly understood neuroanatomical basis.

METHOD

75 subjects with OCD from hospital sites and a community sample and their 152 first degree relatives and 75 age and sex matched controls with their 143 first degree relatives were evaluated with structured clinical interviews (DSM-IV). HA was assessed with Cloninger's Tridimensional Personality Questionnaire (TPQ).

RESULTS

Subjects with OCD had higher scores of HA than controls (p<or=0.001). First degree relatives of OCD cases also showed higher HA than relatives of control subjects (p=0.001).These results remained stable when comparing only OCD subjects versus controls (p<or=0.001) and relatives of OCD cases versus relatives of controls (p=0.005) without current comorbid disorders.

LIMITATIONS

The investigation of HA alone does not allow to disentangle the transmission of biological versus psychological factors related to an elevated level of anxiety in families of OCD cases.

CONCLUSION

This is the first study to extent previous findings of elevated HA in OCD cases to their first degree relatives. Thus, HA may partially mediate the familial risk for OCD.

TEMPS-A (Rome): psychometric validation of affective temperaments in clinically well subjects in mid- and south Italy

BACKGROUND

Our aim was to study the psychometrics and factor structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Italian (Rome) Version. The questionnaire is a self-report 110-item measure that postulates five affective temperaments-the depressive, cyclothymic, irritable, hyperthymic, and anxious-which embody both strengths and liabilities along affective reactivity. In Italian, the TEMPS has previously been validated in its original 32-item version, the TEMPS-I (Pisa), one which did not yet include an anxious subscale.

METHODS

The present sample consisted of 948 nonclinical subjects (27.39 years+/-8.22 S.D.). There were 476 men (50.2%: 28.56 years+/-8.63 S.D.) and 472 women (49.8%: 26.21 years+/-7.61 S.D.). Reliability and validity were assessed by standard psychometric tests.

RESULTS

Principal Components Analysis with Varimax rotation resulted in a 3-factor solution: the first with highest explained variance (8.84%) represents Dysthymic, Cyclothymic and Anxious (Dys-Cyc-Anx) temperaments combined; the second identifies Irritable temperament (5.65% of variance); and the third Hyperthymic temperament (5.16% of variance). Cronbach Alpha coefficients for the three subscales were respectively .89, .77 and .74. The rates for the Dys-Cyc-Anx were 2.7%, and for the Irritable 3.1%. Despite the low rate of the Hyperthymic temperament (.2%), nonetheless 16% were between 1st and 2nd SD. Exploratory factor analysis revealed a positive loading combining Dys-Cyc-Anx with the Irritable; the Hyperthymic loaded negatively on this factor. In terms of dominant temperaments, based on z-scores, 2.7% were dysthymic, 1.7% cyclothymic, .7% hyperthymic, 3.5% irritable and 3% anxious.

LIMITATION

Although developed for self-rated use, the Italian authors nonetheless administered the TEMPS-A in an interview format. It is uncertain in what ways this procedure could have influenced our results, if any. Another limitation is that we did not assess test-retest reliability.

CONCLUSIONS

These data identify at least 3-factors, Dys-Cyc-Anx and Irritable (which are correlated), and Hyperthymic, which is uncorrelated with the others. Though our data are reminiscent of the neuroticism-extraversion distinction, importantly traits are operationalized in affective terms. Beyond the well-known relationship between the Dysthymic and Cyclothymic subscales and that between the Dysthymic and Anxious, the present data reveal a strong relationship between the Cyclothymic and Anxious as well, which is of great relevance for bipolar II. It is also provocative that much of hyperthymia (16%) in the +SD is between the 1st and 2nd SD, thereby "normalizing" this temperament in Italy, as previously reported by TEMPS-I (Pisa) from Northern Italy (and TEMPS-A from Lebanon and Argentina).

On the validity and utility of discriminating among impulsivity-like traits

The ability to make precise distinctions among related personality constructs helps clarify theory and increases the utility of clinical assessment. In three studies, the authors evaluated the validity of distinctions among four impulsivity-like traits: sensation seeking, lack of planning, lack of persistence, and urgency (acting rashly when distressed). Factor analyses indicated that lack of planning and lack of persistence are two distinct facets of one broader trait, whereas urgency and sensation seeking are both very modestly related to each other and to the planning/persistence measures. The authors developed interview assessments of each, and multitrait, multimethod matrix results indicated clear convergent and discriminant validity among the constructs. The distinctions among them were useful: The traits accounted for different aspects of risky behaviors. Sensation seeking appeared to relate to the frequency of engaging in risky behaviors, and urgency appeared to relate to problem levels of involvement in those behaviors.

Temperament and character factors in Korean children with seizure disorders

Although the organic and psychosocial consequences of seizure disorders are thought to affect temperament and character patterns, these patterns in children with seizure disorders have not yet been investigated. We therefore investigated temperament and character patterns in Korean children with seizure disorders and their associations with seizure-related variables. The Korean version of the Junior Temperament and Character Inventory was used to assess temperament and character factors of 65 children with seizure disorders (32 boys, 33 girls; mean age, 10.6 +/- 1.8 years) and 65 healthy controls matched for age and sex. Children with seizure disorders showed higher harm avoidance, and lower persistence, self-directedness, and cooperativeness than controls. In children with seizure disorders, character factors such as self-directedness, cooperativeness, and self-transcendence were significantly associated with seizure type, and cooperativeness was correlated with seizure severity. Novelty seeking and self-directedness were correlated with paternal educational level and parental economic status, respectively. These findings suggest that children with seizure disorders have distinctive temperament and character patterns, with seizure type being the most influential factor modulating character patterns.

Temperament and character personality dimensions in patients with nonspecific musculoskeletal disorders

OBJECTIVE

The aim of this study was to investigate temperament and character dimensions in a group of patients with nonspecific musculoskeletal disorders and to show how personality is related to pain and psychologic distress in pain patients.

METHOD

A total of 78 patients with musculoskeletal disorders were compared with a matched control group of 118 nonpatients. The Temperament and Character Inventory, the Symptom Check List, and the Multidimensional Pain Inventory were used.

RESULTS

The pain patients differed significantly from the controls and exhibited a personality profile with high harm avoidance and low self-directness, which indicate that patients with nonspecific musculoskeletal pain disorders can be characterized as being cautious, insecure, and pessimistic. In addition, they can be described as having difficulties in accepting responsibility, lack of long-term goals, chronically low self-esteem, and struggle with identity. This is probably a salient characteristic of patients with chronic pain. The results also showed that personality dimensions had a stronger correlation to psychologic distress than to pain. The result indicated that harm avoidance probably is an important personality trait in anxiety states.

CONCLUSIONS

The results underline the importance of using instruments assessing personality and psychologic symptoms in patients with nonspecific musculoskeletal disorders both as diagnostic tools and in treatment planning.

Childhood hyperactivity as a predictor of carotid artery intima media thickness over a period of 21 years: the cardiovascular risk in young Finns study

OBJECTIVE

We investigated whether childhood temperament was able to predict carotid artery intima media thickness (IMT) and/or its risk factors in adulthood 21 years later.

METHODS

The subjects were the three youngest age cohorts of the population-based sample of the Cardiovascular Risk in Young Finns study, i.e., those who were aged 3 to 9 years (n = 708) at the baseline. IMT was assessed by ultrasound, and temperament in terms of negative emotionality, hyperactivity, and sociability (following Buss and Plomin). In addition, the levels of traditional risk factors for atherosclerosis were measured in both childhood and adulthood.

RESULTS

Childhood temperament was found to predict adulthood risk factors such as smoking in both genders and body mass index (BMI), systolic blood pressure (SBP), and educational level in women. In women, childhood hyperactivity predicted adulthood IMT after adjustment for childhood and adulthood risk factors for atherosclerosis.

CONCLUSION

These findings suggest that temperament may contribute to the development of IMT in two ways: indirectly through risk factors in both genders and in women directly through a mechanism that is not considered in the present study. There were no significant gender-related differences in temperament, but it seemed to play different roles in different genders. Hyperactivity was a greater risk for girls than for boys.

Child temperament and risk factors for early childhood caries

PURPOSE

The purpose of this study was to determine if a relationship existed between a mother's perception of her child's temperament and the child's risk factors for early childhood caries (ECC).

METHODS

Data was collected from 629 records of children ages 0 to 4 who were patients of the University of Iowa's Infant Oral Health Program. Data included: (1) maternal report of child's temperament; (2) knowledge of ECC; (3) dietary and oral hygiene habits; and (4) clinical evidence of cavitated and noncavitated lesions and visible plaque on maxillary incisors. Chi-square tests and logistic regression models were used to analyze the data.

RESULTS

Bivariate analyses showed that children reported as "easy" were more likely to: (1) be younger (P=.001); (2) be breast-fed to sleep (P=.046); (3) be breast-fed throughout the night (P=.012); and (4) have their teeth brushed twice daily (P=.006). Children reported as "difficult" were more likely to: (1) be bottle-fed to sleep (P=.002); and (2) have noncavitated lesions (P=.044). Final logistic regression analysis indicated that children perceived as "easy" were more likely to breast-fed throughout the night (odds ratio [OR]= 1.77; P=.016), while those perceived as "difficult" were more likely to be bottle-fed to sleep (OR=1.74; P=.016).

CONCLUSIONS

Maternal reported child temperament may be related to important early childhood caries risk factors.

Depressive symptoms and psychosocial stress across the transition to parenthood: associations with parental psychopathology and child difficulty

The transition to parenthood is often accompanied by depression and stress. Several studies have established risk factors for postpartum depression, e.g., antenatal depression. However, only a few studies have involved fathers. Moreover, most studies focus on the prevalence of depression instead of intraindividual changes over time. Our study investigated differential effects of parental psychopathology and child difficulty on the course of depressive symptoms and feelings of stress for first-time mothers and fathers. Seventy-four mothers and 58 fathers completed questionnaires on depressive symptoms (EPDS) and feelings of stress during pregnancy, and at 1, 3, 12, and 18 months postpartum. Parents rated children's difficulty-fussiness at 3, 12, and 18 months postpartum (ICQ). Parental psychopathology was established during pregnancy using self-reports (SCL-90-R) and anamnestic data. In mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 months postpartum, whereas parents with psychopathology in pregnancy showed a tendency to prolonged depressive phases. In parents with psychopathology, feelings of stress peaked at 12 months postpartum. Child difficulty was associated with elevated levels of psychosocial stress, but only for some participants. Parental psychopathological symptoms during pregnancy should thus be considered as a risk factor for elevated and prolonged depression and elevated psychosocial stress in mothers and fathers across the transition to parenthood.

Temperament and character profiles and the dopamine D4 receptor gene in ADHD

OBJECTIVE

This study was designed to investigate the link among attention deficit hyperactivity disorder (ADHD) in adults, novelty-seeking temperament, and the 48-base pair (bp) dopamine D4 receptor (DRD4) gene variant.

METHOD

This study drew from a larger molecular genetic study of ADHD in which the ascertainment criterion was having an affected sibling pair with ADHD. Parents (N=171) from 96 families provided data. Of the 171 parents, 56 (33%) had a lifetime history of ADHD, with 28 (50%) continuing to meet DSM-IV criteria (i.e., "persistent" ADHD). Latent variable modeling was used to test whether the DRD4 gene variant or Temperament and Character Inventory factors could predict ADHD.

RESULTS

Using latent variable modeling, the authors were able to confirm the first-order factor structure of the Temperament and Character Inventory. Furthermore, novelty seeking predicted ADHD lifetime diagnosis (R(2)=26%), while the DRD4 gene variant independently predicted ADHD (R(2)=5%) but not novelty seeking.

CONCLUSIONS

In this unique sample of parents from multiply affected ADHD families, novelty seeking and the 48-bp DRD4 variant were associated with a lifetime history of ADHD. However, the association between novelty seeking and ADHD does not appear to be due to variation in the 48-bp DRD4 variant.

Affective temperament traits measured by TEMPS-I and emotional-behavioral problems in clinically-well children, adolescents, and young adults

OBJECTIVE

The identification of specific temperament dimensions as correlates or risk factors for psychopathology in infancy, childhood and adolescence might provide key information to elucidate causal mechanisms that underlie these relationships.

METHODS

A non-clinical sample of 1010 students (518 males and 492 females) without major psychiatric disorders was given psychometric assessment using TEMPS-I (the Italian Semi-structured Interview version of the Temperament Evaluation of Memphis, Pisa, and San Diego) and EBC (Emotional and Behavioral Checklist in Infancy, Childhood and Adolescence). Grouping the subjects on the basis of the highest z-score obtained on each of the four temperament scales of TEMPS-I, it was possible to identify the dominant affective temperamental (AT) inclination of each individual: 283 (28.0%) subjects were classified as dominant depressive temperament, 446 (44.2%) as dominant hyperthymic, 221 (21.9%) as dominant cyclothymic, and 60 (5.9%) as dominant irritable. The effects of AT dominant groups on EBC scores were tested by one-way analysis of variance. To control for age and sex effects, we tested the differences within dominant AT groups by a multiple classification analysis (MCA).

RESULTS

As expected, subjects with depressive temperament traits were characterized by social inhibition and lack of antisocial and hyperactive behavior. Cyclothymic subjects reported the highest number of emotional and behavioral problems, compared with the other dominant ATs (depressive, hyperthymic and irritable). In particular, a cyclothymic disposition was most frequently associated with anxiety-sleep disturbances, sensitivity to separation, eating disturbances in females and antisocial-aggressive behavior in males. The relationship between cyclothymic temperament and anxiety-sleep disturbances and antisocial-aggressive behavior increased with age.

LIMITATIONS

Cross-sectional study based on retrospective evaluation.

CONCLUSIONS

Within a juvenile population, depressive temperament is a construct partially overlapping with behavioral inhibition, while extremes of emotionality and behaviors occur preponderantly in those with cyclothymic traits. The cyclothymic disposition turned out to be the most 'morbid', and associated with both internalizing and externalizing disturbances.

Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study

BACKGROUND

One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions.

METHODS

Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity.

RESULTS

PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity.

CONCLUSION

These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.

The proposed factor structure of temperament and personality in Japan: combining traits from TEMPS-A and MPT

BACKGROUND

In Japan, Kraepelin's descriptions on four "fundamental states" of manic depressive illness, the concepts of schizoid temperament by Kretschmer and obsessional and melancholic type temperament by Shimoda and Tellenbach have been widely accepted. This research investigates the construct validity of these temperaments through factor analysis.

METHOD

TEMPS-A measured depressive, cyclothymic, hyperthymic and irritable temperaments and MPT rigidity, esoteric and isolation subscales measured, respectively, melancholic type and schizoid temperaments. Factor analysis was implemented with TEMPS-A alone and TEMPS-A and MPT combined data.

RESULTS

With TEMPS-A alone analysis, Factor 1 included 1 depressive, 11 cyclothymic and 12 irritable temperament items with a factor loading higher than 0.4; Factor 2 included 1 depressive and 10 hyperthymic temperament items; and Factor 3 included 2 depressive temperament items only. With TEMPS-A and MPT combined data, Factor 1 included 3 depressive, 11 cyclothymic and 5 irritable temperament items with a factor loading higher than 0.4 (interpreted as the central cyclothymic tendency for all affective temperaments along Kretschmerian lines and accounting for 11.7% of the variance); Factor 2 included 6 hyperthymic temperament items (6.22% of variance); Factor 3 included 1 cyclothymic, 7 irritable and 1 schizoid temperament items (interpreted as the irritable temperament and accounting for 3.24% of the variance); Factor 4 included 1 depressive temperament and 5 melancholic type items (interpreted as the latter, accounting for 2.66% of the variance); Factor 5 included 5 depressive temperament items, along interpersonal sensitivity and passivity lines, and accounting for 2.31% of the variance; and Factor 6 included 4 schizoid temperament items accounting for 2.07% of the variance.

LIMITATION

We did not use the Kasahara scale, which some believe to better capture the Japanese melancholic type. Sample was 70% male.

CONCLUSION

These analyses confirm the factor validity of depressive, hyperthymic, cyclothymic and irritable temperaments (TEMPS-A), as well as the melancholic type and the schizoid temperament (MPT). Traits of the depressive and melancholic types emerge as rather distinct. Indeed, our results permit the delineation of an interpersonally sensitive type that "gives in to others" as the core features of the depressive temperament; this is to be contrasted with the higher functioning, perfectionistic, work-oriented melancholic type. Mood dysregulation is represented by the largest number of traits in this population. Contrary to a widely held belief that the melancholic type with its devotion to work and to others is the signature temperament in Japan, cyclothymic traits account for the largest variance in this nonclinical population. Hyperthymic temperament, melancholic type and schizoid temperaments appear largely independent of mood dysregulation. In this Japanese population, TEMPS-A may identify temperament constructs more comprehensively when implemented with melancholic type and schizoid temperament question items added to it. The proposed new Japanese Temperament and Personality (JTP) Scale has self-rated items divided into six subscales.

Temperament and risky behaviors: a pathway to HIV?

BACKGROUND

Certain sexual behaviors and abuse of substances contribute to the risk of becoming HIV-infected. Because dispositional characteristics are likely to influence this process, we examined the association between temperament and HIV serostatus in subjects with heavy use of drugs and various sexual risk behaviors.

METHODS

Two hundred and thirty individuals (81% of whom were HIV-infected) were assessed for underlying temperamental characteristics, substance use, and risky sexual behaviors. Toward this goal, a factor analysis was conducted on a new self-rated Temperament Autoquestionnaire (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A)). MANOVA was used to examine overall associations between risky behaviors and temperament. Additionally, directed MANOVAs were conducted for each of six drugs of abuse (alcohol, marijuana, cocaine, opioids, other stimulants, and sedative hypnotics).

RESULTS

Factor analysis confirmed the hypothesized temperament structure of five distinct factors: Cyclothymic, hyperthymic, anxious, irritable-explosive, and depressive. Heavy users of cocaine, other stimulants, and alcohol were more likely to have an irritable-explosive temperament. Interestingly, heavy users of opioids were more likely to show depressive and hyperthymic traits. The inclusion of HIV status as a predictor of temperament did not alter the results. Unlike a previous study, no direct significant relationships were found between risky sexual behaviors and specific temperaments.

LIMITATIONS

Relatively small sample size for a factor analytic study, and cross-sectional design, which cannot determine a cause and effect relationship.

CONCLUSIONS

We succeeded in studying and validating five distinct affective temperaments in a substance abuse population. Irritable-explosive, and to a lesser extent, depressive and hyperthymic traits, were associated with substance use, and may place individuals at risk for HIV infection via that mechanism. That current risky sexual practices were not directly linked to temperament may reflect modification in sexual behavior following the acquisition of HIV disease.

Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder

INTRODUCTION

Although several recent studies suggest that bipolar disorder most commonly begins during childhood or adolescence, the illness still remains under-recognized and under-diagnosed in this age group. As part of the French Bipolar network and in line with the hypothesis that juvenile depression is pre-bipolar , we evaluated the rate of onset of bipolar disorders in a naturalistic 2-year prospective study of consecutive, clinically depressed children and adolescents, and to test whether the cyclothymic temperament underlies such onset.

METHODS

Complete information was obtained from both parents and patients in 80 of 109 depressed children and adolescents assessed with Kiddie-SADS semi-structured interview, according to DSM IV criteria. They were also assessed with a new questionnaire on cyclothymic-hypersensitive temperament (CHT) from the TEMPS-A cyclothymic scale adapted for children (provided in ), and other assessment tools including the Child Depression Inventory (CDI), Young Mania Rating Scale, Clinical Global Assessment Scale (CGAS), and Overt Aggressive Scale (OAS).

RESULTS

Of the 80 subjects, 35 (43%) could be diagnosed as bipolar at the end of the prospective follow-up. This outcome was significantly more common in those with cyclothymic temperament measured at baseline. Most of these patients were suffering from a special form of bipolar disorder, characterized by rapid mood shifts with associated conduct disorders (CD), aggressiveness, psychotic symptoms and suicidality.

LIMITATION

The primary investigator, who took care of the patients clinically, was not blind to the clinical and psychometric data collected. Since all information was collected in a systematic fashion, the likelihood of biasing the results was minimal.

CONCLUSION

We submit that the CHT in depressed children and adolescents heralds bipolar transformation. Unlike hypomanic or manic symptoms, which are often difficult to establish in young patients examined in cross-section or by history, cyclothymic traits are detectable in childhood. Our data underscore the need for greater effort to standardize the diagnosis and treatment of pre-bipolar depressions in juvenile patients.

The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies?

BACKGROUND

The modern concept of affective disorders focuses increasingly on the study of subthreshold conditions on the border of manic or depressive episodes. Indeed, a spectrum of affective conditions spanning from temperament to clinical episodes has been proposed by the senior author. As bipolar disorder is a familial illness, an examination of cyclothymic temperament (CT) in controls and relatives of bipolar patients is of major relevance.

METHODS

We recruited a total sample of 177 healthy symptom-free volunteers. These controls were divided into three groups. The first one is comprised of 100 normal subjects with a negative familial affective history (NFH); the second of 37 individuals, with positive affective family history (PFH); and a third of 40 subjects, with at least one sib or first-degree kin with bipolar disorder type I according to the DSM-IV (BPR). The last two groups defined at risk individuals. We interviewed all subjects with CT, as described by the senior author.

RESULTS

We found a statistically significant difference in the rates of CT between the subjects in BPR versus others. CT was also more prevalent in the PFH compared with NFH. Additionally, the simple numeration of the CT traits exhibited gradation in the distribution of individuals inside the NFH, PFH and BPR. Finally, categorically defined CT and CT traits predominated in females. LIMITATION and

CONCLUSION

Although not all relatives of bipolar probands were studied, our results exhibit an aggregation of CT in families with affective disorder-and more specifically those with bipolar background. These results allow us to propose the importance of including CT for phenotypic characterization of bipolar disorder. Furthermore, our results support a spectrum concept of bipolar disorder, whereby CT is distributed in ascending order in the well-relatives of those with depressive and bipolar disorders. We submit that this temperament represents a behavioral endophenotype, serving as a link between molecular and behavioral genetics.

Proposal for a bipolar-stimulant spectrum: temperament, diagnostic validation and therapeutic outcomes with mood stabilizers

BACKGROUND

Stimulant abuse and dependence in confusing admixtures with features of bipolar disorder has been variously conceptualized. DSM-IV-TR rules tend to be liberal in permitting the diagnosis of substance-induced disorder, and rather strict for a bipolar diagnosis in such cases. Accordingly, if bipolarity is ever considered in this interface, it usually pertains to syndromal bipolar I disorder.

METHOD

We therefore focused on the more prevalent but relatively neglected admixture of stimulant abuse with bipolar II and lesser degrees of bipolarity. We examined in our dual diagnosis program the longitudinal progression of the dual pathology in 10 patients who had proven refractory to past efforts to treat the stimulant component. In doing so, we wished to better delineate the nature of the clinical interface of the stimulant bipolar spectrum and its response to anticonvulsant mood stabilizers.

RESULTS

In nearly all cases cyclothymic and hyperthymic traits preceded the use of stimulants by years, which seemed to serve the purpose of controlling or maintaining the subthreshold rewarding mood condition. Eventually clinically more ominous and socially destructive pathology evolved, with contributions from both the bipolar diathesis and the addictive process. Seven of 10 cases had bipolar familial indicators. Nearly all evidenced hypomanic and/or irritable depressive states with mixed features during protracted sobriety from the stimulant. Except for two of the 10 patients, substantial (30-45 point) gains were made on DSM-IV-TR axis V general assessment of functioning (GAF) scores with the use of largely "mood-stabilizing" anticonvulsants. This was paralleled with the reduction of craving. These data highlight the human dimensions of the bipolar-stimulant abuse interface, and document functional outcomes (rather than mere changes in rating scales which may not necessarily reflect clinically relevant improvement).

LIMITATION

Open case series of 10 patients.

CONCLUSION

We propose a bipolar-stimulant spectrum-what the senior author has elsewhere labeled bipolar III-1/2-where subthreshold bipolar traits are complicated by stimulant abuse, eventually leading to pathology characteristic of both disorders. The contribution of bipolarity to this spectrum is supported by: (1) premorbid cyclothymic and hyperthymic traits; (2) familial bipolarity; (3) presence of subthreshold bipolar signs and symptoms during protracted sobriety. We further submit that anticonvulsants in this spectrum not only treat the acute escalation of activated and mixed depressive states, withdrawal phenomena, and craving for the stimulant, but also the craving for activation and mood enhancement of the underlying temperament. We submit that the latter might be crucial for the successful attenuation of the underlying diathesis for stimulant seeking behavior, abuse and dependence.

The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature

We sketch out putative evolutionary roles for affective temperaments within the theoretical framework of mood disorders conceptualized as extremes in an oligogenic model of inheritance, whereby the constituent traits in their dilute phenotypes confer adaptive advantages to individuals and/or their social group. Depressive traits, among other functions, would subserve sensitivity to the suffering of other members of the species, overlapping with those of the generalized anxious temperament, thereby enhancing the survival of not only kin but also other conspecifics. The pursuit of romantic opportunities in cyclothymia suggests that it may have evolved as a mechanism in reproductive success; cyclothymics' creative bent in poetry, music, painting, cooking or fashion design (among men, in particular) also appears useful for sexual seduction. Hyperthymic traits would lend distinct advantages in leadership, exploration, territoriality and mating. These are just some of the possibilities of the rich and complex temperamental traits subserving bipolarity within an evolutionary framework. We test selected aspects of these hypotheses with the use of correlations between the constituent traits of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS) and correlations between the TEMPS and the Temperament and Character Inventory (TCI). Such data support the counterbalancing protective influence of harm avoidance on the risk-taking behavior of cyclothymic individuals, in both men and women. Finally, we outline a hypothesis on the evolutionary function of anxious-depressive traits for women.

Factorial structure and internal consistency of the German TEMPS-A scale: validation against the NEO-FFI questionnaire

BACKGROUND

The purpose of the study was to evaluate the psychometric properties of the German version of the TEMPS-A questionnaire. Besides the reliability of the temperament scales, validity was the focus of interest. Therefore, the relationship between the TEMPS-A and the well-established personality questionnaire NEO-FFI, whose factors show theoretical overlap with temperaments, was investigated.

METHOD

A total of 227 students aged between 20 and 42 years were asked to fill in both instruments. Reliability coefficients for the five temperament scales and correlations among the scales of both questionnaires were calculated, as well as multiple linear regression analysis with the five personality factors and gender as independent, and the five temperaments as dependent variables.

RESULTS

Reliability indices for the five temperament scales were satisfactory, with values ranging between 0.63 (depressive) and 0.76 (anxious). Women scored higher on depressive and anxious scales, whereas men had higher scores on hyperthymic temperament. Correlations within the temperament scales showed close relationships between depressive, anxious and cyclothymic temperaments; cyclothymic and irritable temperament were also related. The personality factors of the NEO-FFI predicted temperaments fairly well and explained between 41% and 58% of the variance; the main effects were exerted by neuroticism and extraversion, while the irritable temperament was primarily explained by low agreeableness.

LIMITATION

The study sample was relatively small and selected.

CONCLUSION

The TEMPS-A scale has sufficient reliability and good validity in a non-clinical sample. It opens new possibilities for clinical research at the interface of mental disorders, temperament and personality. Such research is in progress.

Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study

BACKGROUND

The aims of this study were to identify the dominant affective temperamental characteristics of patients with bipolar disorder (BP) and their clinically well first-degree relatives and to compare the prevalence rates of these temperaments with those in healthy control subjects.

METHODS

One hundred bipolar I probands and their 219 unaffected first-degree relatives were enrolled in the study. The control group consisted of healthy subjects without any personal or family history of bipolar disorder, matched with the age and gender of the probands and first-degree relatives. To identify the dominant affective temperaments, the Turkish version of TEMPS-A scale was used.

RESULTS

At least one dominant temperament was found in 26% of the proband group, in 21.9% of the relative group, and 6.0% and 10.0% of the control groups, respectively. The most noteworthy finding was that both the probands and their relatives had significantly higher frequency of hyperthymic temperament than the controls.

LIMITATIONS

Temperament had not been assessed premorbidly in the probands with bipolar disorder.

CONCLUSIONS

The study supports the familial, possibly genetic, basis for the hyperthymic temperament in the genesis of bipolar I dosorder. That the cyclothymic temperament was not similarly represented, may be due to the higher specificity of the cyclothymic temperament to the bipolar II sybtype (which we did not study). More research is needed on the relevance of cyclothymic and other temperaments to the genetics of bipolar disorders selected by rigorous subtyping along the clinical spectrum of bipolarity.

Familiality of temperament in bipolar disorder: support for a genetic spectrum

BACKGROUND

The array of different diagnoses and clinical presentations seen in the family members of bipolar probands suggests a quantitative or spectrum phenotype. Consistent with this idea, it has been proposed that an underlying quantitative variation in temperament may be the primary phenotype that is genetically transmitted and that it in turn predisposes to bipolar disorder (BP). Choosing the appropriate phenotypic model for BP is crucial for success in genetic mapping studies. To test this theory, various measures of temperament were examined in the family members of bipolar probands. We predicted that a gradient of scores would be observed from those with BP to those with major depression to unaffected relatives to controls.

METHODS

Members of 85 bipolar families and 63 control subjects were administered clinical interviews for diagnosis (SCID) and two temperament assessments, the TEMPS-A and TCI-125. Subjects with BP, major depressive disorder, unaffected relatives, and controls were compared on each temperament scale and on eight factors extracted from a joint factor analysis of the TEMPS-A and TCI-125.

RESULTS

The four groups were found to be significantly different and with the expected order of average group scores for four of the TEMPS-A scales, three of the TCI-125 scales, and one of the extracted factors. On the fifth TEMPS-A scale, hyperthymic, controls scored higher than the other three subject groups contrary to expectations. Significant differences were seen between unaffected relatives and controls on the hyperthymic scale and on the first extracted factor, anxious/reactive.

LIMITATIONS

Controls were mainly recruited through advertisements, which may have introduced an ascertainment bias. It is also possible that mood state at the time of completing the questionnaire influenced subject's rating of their temperament. Additionally, bipolar I and bipolar II subjects were placed in the same group even though they had some differing clinical features.

CONCLUSIONS

Our data support the theory that some dimensions of temperament are transmitted in families as quantitative traits that are part of a broader bipolar spectrum. In particular, the hyperthymic scale of the TEMPS-A and the anxious/reactive extracted factor distinguished unaffected relatives from controls. The hyperthymic scale yielded results opposite to expectation with controls higher than any family group. This may be an artifact of the self-rated form of the questionnaire, a consequence of our grouping bipolar I and II subjects together, or the result of a "protective" factor and bears further study. Nevertheless, both of these scales may be useful quantitative traits for genetic mapping studies.

Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls

OBJECTIVE

Understanding of mood disorders can be enhanced through assessment of temperamental traits. We explored temperamental commonalities and differences among euthymic bipolar (BP) and unipolar (MDD) mood disorder patients, creative discipline graduate student controls (CC), and healthy controls (HC).

METHODS

Forty-nine BP, 25 MDD, 32 CC, and 47 HC completed self-report temperament/personality measures including: The Affective Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A); the Revised NEO Personality Inventory (NEO-PI-R); and the Temperament and Character Inventory (TCI).

RESULTS

Euthymic BP, MDD, and CC, compared to HC, had significantly increased cyclothymia, dysthymia and irritability scores on TEMPS-A; increased neuroticism and decreased conscientiousness on NEO-PI-R; and increased harm avoidance and novelty seeking as well as decreased self-directedness on TCI. TEMPS-A cyclothymia scores were significantly higher in BP than in MDD. NEO-PI-R openness was increased in BP and CC, compared to HC, and in CC compared to MDD. TCI self-transcendence scores in BP were significantly higher than in MDD, CC, and HC.

LIMITATIONS

Most of the subjects were not professional artists, and represented many fields; temperament might be different in different art fields.

CONCLUSIONS

Euthymic BP, MDD, and CC compared to HC, had prominent temperamental commonalities. However, BP and CC had the additional commonality of increased openness compared to HC. BP had particularly high Cyclothymia scores that were significantly higher then those of MDD. The prominent BP-CC overlap suggests underlying neurobiological commonalities between people with mood disorders and individuals involved in creative disciplines, consistent with the notion of a temperamental contribution to enhanced creativity in individuals with bipolar disorders.

Toward a validation of a tripartite concept of a putative anxious temperament: psychometric data from a French national general medical practice study

BACKGROUND

Although generalized anxiety disorder (GAD) is currently described as a time-limited state mental disorder, emerging evidence suggests that it is best considered as an exaggeration of a putative "anxious temperament" (AT). It is presently unknown whether it is a distinct or unitary construct of a melange of anxious traits related to Cluster-C personality disorders.

METHODS

As part of a Franco-American collaborative study, we developed the 15-item Operational Criteria for Anxious Personality (OCAP), expanding criteria sets developed earlier by one of us (H.S.A.). The study, which was conducted in the French primary care medical sector, included 1112 young adults (18-40 years), seeking help for isolated anxious complaints, never treated before-and without any diagnosable disorder on the axis I of DSM-IV. As previous papers have reported the preliminary validity of OCAP, especially concurrent validity with the State-Trait Anxiety Inventory (STAI) (Speilberger), in this report, we focus on its full psychometric properties.

RESULTS

The present data indicate a normal distribution of AT items, a satisfactory Chronbach's coefficient (0.64), and the presence at intake of three different subtypes of AT: "anxious-avoidant," "anxious-phobic," and "anxious-sensitive." After a prospective 6-month follow-up, the major criteria of AT were stable in 80% of cases, and for specific AT items, the stability rate varied between 65% and 80%; much of the unstable items were accounted by improvement during naturalistic treatment. The latter could explain the different factor structure obtained at follow-up, which tended to be less heterogeneous, and represented by one global factor.

LIMITATION

We used a categorical (yes/no) rather than a Likert-type gradation of frequency and intensity of anxiousness items and relatively low number of items, especially for those involving worrying about one's own health or that of one's loved ones.

CONCLUSIONS

Anxiousness as a temperamental dimension appears to involve putative subtypes along "worrying," "phobic," "sensitive" (and "avoidant") dimensions.

Temperament profiles in physicians, lawyers, managers, industrialists, architects, journalists, and artists: a study in psychiatric outpatients

BACKGROUND

With the possible exception of cyclothymia in artists, there is a paucity of data in the literature on the temperament in different professions.

METHODS

For this exploratory study, we sought to generate preliminary data on temperaments among psychiatric outpatients, including physicians (n=41), lawyers (n=30), managers and executives (n=35), industrialists (n=48), architects (n=27), journalists (n=34), and a mixed group of artists (n=48). They were compared with age, sex, social class, and affective disorder matched outpatients outside of these professions, drawn from the same clinical settings to serve as our Comparison Group (CG, n=120). We used an interview version of the Akiskal-Mallya criteria for temperaments. We finally used the DSM-III-R obsessive compulsive personality (OC traits).

RESULTS

Compared with the CG, lawyers and physicians had high rates of dysthymic temperament and OC traits. Managers, like lawyers and doctors, had high rates on OC traits but were different in being very low on cyclothymic and twice as hyperthymic than the CG was. Industrialists, who, by definition, were self-made, had even higher rates of hyperthymic traits. Both architects and artists seemed to have benefited from being cyclothymic (3-4 times higher than CG's); interestingly, architects had higher levels of OC traits, and artists were less obsessional than the CG was. Overall, among managers/executives and lawyers, 41% met criteria for affective temperaments, whereas the equivalent rate among the remainder was 77%.

LIMITATION

Given that this is a chart review of existing clinical records, it was not possible to be blind to the profession of the patients. A mixed group of artists may have obscured differences among artists from different domains of art (e.g., poets vs. performing artists), and the same can be said of physicians (e.g., internists vs. surgeons). A disclaimer would be appropriate: Ours is not a study on eminence in the different professions but on the temperament and personality profiles that distinguish among them.

CONCLUSIONS

Despite the foregoing limitations and overlapping attributes in the different professions, they nonetheless emerged as having distinct temperamental and personality profiles. Dysthymic and obsessional attributes are notable in lawyers and physicians. We confirm the role of cyclothymia in artists and architects. The role of the hyperthymic temperament in managers, self-made industrialists, and journalists, to the best of our knowledge, is being reported for the first time. The role of cyclothymic and hyperthymic temperaments appears to be moderated by obsessional traits across the entire professional realm examined. In particular, artists' creative imagination appears "liberated" by low levels of OC traits, whereas among architects, relatively high levels of OC traits seem to contribute to the execution of their work. More tentatively, judging from the overall levels of affective temperaments in the remaining professions, on average, more of the managers/executives than self-made industrialists could be described as "colder" in temperament, and more of the physicians "warmer" than lawyers are. Journalists, as a group, appeared to possess the broadest representation of affective temperaments. The foregoing conclusions must be regarded as tentative, even hypothetical, in need of verification among professionals without major psychiatric disorders. Nonetheless, temperament profiles among psychiatrically ill professionals in the seven professional realms studies can help predict how they relate to their doctors, family members, colleagues, coworkers, and clients/patients. Such knowledge, in turn, can help the therapeutic process.

TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament

OBJECTIVE

To validate a short English-language version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. Its constituent subscales and items were formulated on the basis of the diagnostic criteria for affective temperaments (cyclothymic, dysthymic, irritable, hyperthymic, and anxious), originally developed by the first author and his former collaborators. Further item wording and selection were achieved at a later stage through an iterative process that incorporated feedback from clinicians, researchers, and research volunteers.

METHOD

A total of 510 volunteers (284 patients with mood disorders, 131 relatives of bipolar probands, and 95 normal controls) were recruited by advertisement in the newspapers, announcements on radio and television, flyers and newsletters, and word of mouth. All participants were interviewed using the Structured Clinical Interview for DSM-III-R, and completed the 110-item TEMPS-A and the Temperament and Character Inventory (TCI-125). The factorial structure, the alpha coefficients, and the item-total correlations coefficients of the TEMPS-A and the correlation coefficients between the dimensions of the TCI and the TEMPS-A subscales were then determined.

RESULTS

A principal components analysis with a Varimax rotation found that 39 out of the 110 original items of the TEMPS-A loaded on five factors that were interpreted as representing the cyclothymic, depressive, irritable, hyperthymic, and anxious factors. Coefficients alpha for internal consistency were 0.91 (cyclothymic), 0.81 (depressive), 0.77 (irritable), 0.76 (hyperthymic), and 0.67 (anxious) subscales. We found statistically significant positive correlations between all-but the hyperthymic-subscales and harm avoidance. Positive correlations with the hyperthymic and cyclothymic, and novelty seeking and negative correlations with the remaining subscales were also recorded. Other major findings included positive correlations between the hyperthymic and reward dependence, persistence and self-directedness; positive correlation between the self-transcendence and the cyclothymic, hyperthymic and the anxious; and negative correlations between the depressive, cyclothymic, irritable, anxious and cooperativeness.

LIMITATION

As the full-scale anxious temperament was added after the four scales of the TEMPS-A were developed, it has only been evaluated in 345 subjects.

CONCLUSIONS

These data indicate that the TEMPS-A in its shortened version is a psychometrically valid scale with good internal consistency. The proposed five subscale structure is upheld. Concurrent validity against the TCI is shown. Most importantly, for each of the temperaments, we were able to show positive attributes which are meaningful in an evolutionary context, along with traits which make a person vulnerable to mood shifts. This hypothesized dual nature of temperament, which is upheld by our data, is a desirable characteristic for a putative behavioral endophenotype in an oligogenic model of inheritance for bipolar disorder.

Relationship between hypochondriacal concerns and personality dimensions and traits in a military population

Our aim was to examine the relationship between personality dimensions and hypochondriacal concerns and somatic symptoms in a military population. The Schedule of Nonadaptive and Adaptive Personality along with measures of hypochondriacal concerns and somatic symptoms were administered to 602 military veterans who had been on active duty during the 1991 Gulf War. Factor analyses identified six separable dimensions-two of hypochondriacal concerns, two of somatic symptoms, and two of possible mechanisms of symptom generation-for study. Multiple regression models determined the proportion of variation in these measures of somatic distress explained by personality scales. Personality measures explained between 26% and 38% of the variance in hypochondriacal concerns and somatic symptoms, and Negative Temperament accounted for most of this. Moderately strong positive correlations were observed between trait scales Mistrust, Low Self-Esteem, and Eccentric Perceptions and the various measures of somatic distress. Thus, when Negative Temperament was taken into account, few significant correlations between personality measures and hypochondriacal concerns or somatic symptoms remained. Negative temperament or neuroticism is strongly associated with hypochondriacal concerns. Important features of hypochondriasis and somatic distress appear to lie within the domain of personality. It remains for future research to show whether negative temperament is a vulnerability factor for hypochondriasis or hypochondriasis is itself a personality disorder.

Issues In Temperamental Unsuitability Re-Examining Concepts And Current Practice In The British Army

Currently, in the UK military, and particularly in the Army, a significant number of personnel are regularly discharged on the grounds of being assessed as "Temperamentally Unsuitable (TU) for military duties", under Queen's Regulations (QRs): (Army) 9.414 and 9.434 (1). In the last two years (2001--2003), preliminary figures suggest that approximately 700 serving personnel were recommended for discharge under this category by only four psychiatrists in the south of England. The regulations governing TU have been in existence and essentially unchanged since their development long before the 1960s albeit subject to parliamentary quinquennial review. The Army General and Administrative Instructions (AGAI) (2) standards also remain unchanged over this period. This paper raises questions about the current validity and relevance of existing TU concepts and regulations with suggestions as to what is being proposed in the context of changing roles, technology and advances in the modern armed forces.

The mood spectrum in unipolar and bipolar disorder: arguments for a unitary approach

OBJECTIVE

This study examined the extent to which individuals with a lifetime diagnosis of recurrent unipolar disorder endorse experiencing manic/hypomanic symptoms over their lifetimes and compared their reports with those of patients with bipolar I disorder.

METHOD

The study group included 117 patients with remitted recurrent unipolar depression and 106 with bipolar I. Subjects had their clinical diagnosis confirmed by the Mini International Neuropsychiatric Interview and were administered the Structured Clinical Interview for the Mood Spectrum, which assesses lifetime symptoms, traits, and lifestyles that characterize threshold and subthreshold mood episodes as well as "temperamental" features related to mood dysregulation.

RESULTS

The patients with recurrent unipolar depression endorsed experiencing a substantial number of manic/hypomanic symptoms over their lifetimes. In both patients with recurrent unipolar depression and patients with bipolar I disorder, the number of manic/hypomanic items endorsed was related to the number of depressive items endorsed. In the group with recurrent unipolar depression, the number of manic/hypomanic items was related to an increased likelihood of endorsing paranoid and delusional thoughts and suicidal ideation. In the bipolar I group, the number of lifetime manic/hypomanic items was related to suicidal ideation and just one indicator of psychosis.

CONCLUSIONS

The presence of a significant number of manic/hypomanic items in patients with recurrent unipolar depression seems to challenge the traditional unipolar-bipolar dichotomy and bridge the gap between these two categories of mood disorders. The authors argue that their mood spectrum approach is useful in making a more accurate diagnostic evaluation in patients with mood disorders.

Alexithymia and personality in relation to dimensions of psychopathology

OBJECTIVE

The authors examined the capacity of alexithymia to predict a broad range of psychiatric symptoms relative to that of other personality dimensions, age, and gender.

METHOD

The Toronto Alexithymia Scale, the Temperament and Character Inventory, and the SCL-90-R were administered to 254 psychiatric patients. Multivariate linear regression analyses were performed.

RESULTS

The difficulties identifying feelings factor of the Toronto Alexithymia Scale significantly predicted all SCL-90-R subscale scores and was particularly effective, relative to the personality dimensions of the Temperament and Character Inventory, in predicting somatization. The Temperament and Character Inventory dimensions emerged as distinct and conceptually meaningful predictors for the different SCL-90-R subscales.

CONCLUSIONS

A broad range of current psychopathology is associated with difficulties in cognitively processing emotional perceptions. Further research needs to clarify whether alexithymia represents a risk factor for mental illness and poorer outcome.

Integrating Research on Temperament and Childhood Psychopathology: Its Pitfalls and Promise

This article discusses the promise and problems associated with integrating research on child temperament and research on childhood psychopathology. Unfortunately, these 2 extensive and influential areas of psychological research with children have largely been conducted independently of each other. This article provides a summary of the disciplinary, conceptual, and methodological issues that have hampered an integration of these 2 important bodies of research. It also highlights the great promise that such an integration could have for advancing causal theories of childhood disorders and for eventually improving the treatment provided to children with serious emotional and behavioral disturbances.

A sib-pair study of the Temperament and Character Inventory scales in major depression

BACKGROUND

Certain aspects of the personality may be associated with the vulnerability to develop depression. A sib-pair method has been used to examine the familiality of the 7 scales of the Temperament and Character Inventory (TCI) and whether this could be related to the genetic vulnerability to develop depression.

METHODS

Probands with depression and their nearest-aged siblings from Wales were compared with healthy control probands and their nearest-aged siblings on the TCI and measures of depressed mood.

RESULTS

All 7 scales of the TCI were familial, and scores on 6 of the scales were similar to US population scores. However, the Welsh subjects' scores on the self-transcendence scale were markedly lower than the US mean, suggesting strong cultural or national influences on this measure. Harm avoidance scores were substantially influenced by current and past depression, but this scale also showed stable traitlike characteristics that are likely related to the genetic vulnerability to depression. Novelty seeking and self-directedness were also partly state-dependent and were negatively correlated with low mood; high scorers may be resilient to the development of depression. High reward dependence may also protect against the development of depression and is unrelated to mood state. The cooperativeness, persistence, and self-transcendence scales appear to have a limited relationship with the development of depression.

CONCLUSIONS

Harm avoidance, reward dependence, novelty seeking, and self-directedness have traitlike characteristics that are related to the familiality of depression. Cooperativeness, self-transcendence, and persistence are also familial, but this appears to be unrelated to depression.

Temperamental differences between healthy, asthmatic, and allergic children before onset of illness: a longitudinal prospective study of asthma development

The authors investigated the link between children's temperament and the development of asthma and allergies. Prospective longitudinal data on children at the ages of 3-5 months, 3-5 years, and 7-9 years were collected. At age 7-9 years, analyses were performed on data for 3 groups of children (n = 42): those with asthma (no allergies), those with allergies (no asthma), and those with neither asthma nor allergies (the control group). Data for children who developed asthma or allergies prior to age 7-9 years were not analyzed. Differences were found in the premorbid period between the control group and the children who later developed asthma or allergies as well as between the asthma and allergy groups. After onset of illness, no temperamental differences were observed between the 3 groups. The study shows the importance of longitudinal design for asthma research.

The temperament profiles of school-age children

Maternal reports of child temperament were used to develop temperament profiles of school-age children. The subjects were 883 children who were between 4 and 12 years of age. The children's families varied substantially in their socioeconomic status and race/ethnicity. To develop the profiles, the dimensions derived from the School-Age Temperament Inventory were subjected to a second order principal factor analysis with varimax rotation. Pearson chi-squares were used to determine whether sociodemographic variables were proportionally represented among the profiles. Forty-two percent of the children were classified into four temperament profiles. High maintenance and cautious/slow to warm up were deemed as challenging temperaments. Industrious and social/eager to try were mirror images of those profiles and were labeled easy. Some children were both types of challenging or easy profiles. The generalizability of the profiles in relation to the sociodemographic variables of gender, age, race/ethnicity, and socioeconomic status was also examined. Challenging temperament profiles were disproportionately represented by boys, Hispanic children, and those from lower socioeconomic families. Girls were over represented in the group that included both types of easy temperaments. Social/eager to try children were more often from higher rather than lower socioeconomic status families. Clinical applications and research implications for the profiles are discussed. The profiles can be used as exemplars that parents can use to recognize their child's temperament. Further research is needed to explore whether different developmental outcomes are associated with the profiles.