Associação entre Temperamento e o Uso de Práticas da Medicina Alternativa e Complementar

Resumo Trata-se de um estudo brasileiro, transversal, mediado pela Internet com o objetivo de descrever como diferenças temperamentais associam-se ao uso de oito práticas de medicina alternativa e complementar (MAC): ioga, meditação, reiki, acupuntura, massagem, tai chi chuan, homeopatia e floral. A amostra foi composta por 22.415 indivíduos, sendo 69,5% mulheres, com idade média de 28,8 anos (DP = 9,1). As práticas mais utilizadas foram massagem e ioga e as variáveis sexo, idade, renda e diagnóstico psicopatológico ao longo da vida associaram-se a todas as práticas, exceto com tai chi chuan. Análise inferencial se baseou em modelo de regressão logística e os resultados foram calculados com base na razão de chances com intervalo de confiança de 95%. Observou-se que manifestações adaptativas de traços e de tipos psicológicos, associaram-se a maiores chances de praticar MAC. Resultados sugerem que perfis com maior regulação emocional tendem a utilizar mais frequentemente MAC e, possivelmente, obter benefícios.

Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts

BACKGROUND

To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample.

METHODS

It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation.

RESULTS

The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior.

LIMITATIONS

It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young.

CONCLUSIONS

Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.

Sex-dependent role of CD300f immune receptor in generalized anxiety disorder

Generalized Anxiety Disorder (GAD) presents a high prevalence in the population, leading to distress and disability. Immune system alterations have been associated with anxiety-related behaviors in rodents and GAD patients. CD300f immune receptors are highly expressed in microglia and participate not only in the modulation of immune responses but also in pruning and reshaping synapses. It was recently demonstrated that CD300f might be influential in the pathogenesis of depression in a sex-dependent manner. Here, we evaluated the role of CD300f immune receptor in anxiety, using CD300f knockout mice (CD300f-/-) and patients with GAD. We observed that male CD300f-/- mice had numerous behavioral changes associated with a low-anxiety phenotype, including increased open field central locomotion and rearing behaviors, more exploration in the open arms of the elevated plus-maze test, and decreased latency to eat in the novelty suppressed feeding test. In a cross-sectional population-based study, including 1111 subjects, we evaluated a common single-nucleotide polymorphism rs2034310 (C/T) in the cytoplasmatic tail of CD300f gene in individuals with GAD. Notably, we observed that the T allele of the rs2034310 polymorphism conferred protection against GAD in men, even after adjusting for confounding variables. Overall, our data demonstrate that CD300f immune receptors are involved in the modulation of pathological anxiety behaviors in a sex-dependent manner. The biological basis of these sex differences is still poorly understood, but it may provide significant clues regarding the neuropathophysiological mechanisms of GAD and can pave the way for future specific pharmacological interventions.

Allopurinol for fibromyalgia pain in adults: A randomized controlled trial

BACKGROUND

Allopurinol is a potent inhibitor of the enzyme xanthine oxidase used in the treatment of hyperuricemia and gout. Because it is well known that purines exert multiple affects on pain transmission, we hypothesized that the inhibition of xanthine oxidase by allopurinol could be a valid strategy to treat pain in humans. This study aimed to compare the analgesic efficacy of oral allopurinol versus placebo as an adjuvant therapy in patients displaying fibromyalgia.

METHODS

This randomized, double-blinded, placebo-controlled study included 60 women with the diagnosis of fibromyalgia. Patients were randomly assigned to receive either oral allopurinol 300 mg (n = 31) or placebo (n = 29) twice daily during 30 days. The patients were submitted to evaluation for pain sensitivity, anxiety, depression, and functional status before treatment, and 15 and 30 days thereafter.

RESULTS

Oral administration of allopurinol 300 mg twice daily was ineffective in improving pain scores measured by several tools up to 30 days of treatment (P > 0.05). Additionally, no significant effects of allopurinol over anxiety, depressive symptoms, and functional status of fibromyalgia patients were observed in the present study.

CONCLUSIONS

Although previous findings indicated that allopurinol could present intrinsic analgesic effects in both animals and humans, this study showed no benefit of the use of oral allopurinol as an adjuvant strategy during 30 days in women displaying fibromyalgia. However, considering previous promising results, new prospective studies are still valid to further investigate allopurinol and more selective purine derivatives in the management of pain syndromes.

The Association Between Eating-Compensatory Behaviors and Affective Temperament in a Brazilian Population

Eating-compensatory behaviors are associated with biological and psychological complications, with high rates of morbidity and mortality. Different elements may contribute to the development of eating-compensatory behaviors, such as genetic, physiological, environmental, and temperamental factors. Therefore, the aim of this study was to examine the association between affective temperaments and eating-compensatory behaviors. A sample of 27,501 volunteers, between 18 and 55 years old, mean age 28.9 ± 8.7 years (69.6% women), were assessed by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). The results showed that eating-compensatory behaviors were associated with distinctive affective temperaments. Cyclothymic types were more associated with eating-compensatory behaviors. The avoidant and irritable types presented lower percentages of eating-compensatory behaviors in women and men, respectively. In conclusion, this study highlighted that participants who adopted frequent eating-compensatory behaviors are more likely to have dysfunctional affective traits. Consequently, the affective temperaments should be considered as a strategy to build capacity for prevention, treatment, and care of eating-compensatory behaviors.

Low affective temperament consistency during development: Results from a large retrospective study

BACKGROUND

Temperament is still regarded as a stable part of personality, an "endophenotype" developed early in life. However, how frequently temperament traits can change throughout life is not clear. The aim of this study was to investigate affective temperament changes from late childhood to adolescence and from late adolescence to adulthood.

METHODS

We used data from a cross-sectional web-based survey collected from the Brazilian Internet Study on Temperament and Psychopathology. We used the Affective and Emotional Composite Temperament Scale questionnaire to assess temperament at time of participation, and at age of 10-12 and 18 years, retrospectively, dividing affective temperaments into four major groups: internalized, externalized, stable and unstable. The final sample consisted of 36,255 participants from 24 to 40 years of age (71.9% women).

RESULTS

Most of the sample (66.2%) changed to a different affective temperament group at adulthood. We found a significant decrease in internalized temperaments from 10-12 to 18 years of age (34.5% to 25.0% in women and 31.8% to 26.7% in men), parallel with an increase of externalized temperaments (14.1% to 20.3% in women and 17.3% to 19.6% in men). From 18 years of age to adult life, stable temperaments decreased slightly in frequency (37.9% to 32.5% in women and 38.6% to 36.8% in men), while unstable types increased (16.9% to 24.0% in women and 15.3% to 18.4% in men).

LIMITATIONS

The retrospective design and self-reported evaluation may bias self-perception.

CONCLUSIONS

Affective temperaments often change over time, contrary to the classic view of temperament as a consistent phenotype.

The latent structure of the Young Schema Questionnaire-Short Form

Objective:

The current study aimed to examine the latent structure of a web-based, Brazilian Portuguese version of the Young Schema Questionnaire-Short Form (YSQ-SF).

Method:

The sample consisted of 15,557 adult participants – 4,702 men and 10,855 women – with age ranging from 18 to 60 years. Confirmatory factor analysis was used to test the a priori conceptual 15-factor model presumed to underlie the YSQ-SF item set.

Results:

Most items displayed high levels of reliability (factor loadings greater than 0.7) and low liability to random measurement error (residual variances below 0.02), indicating that the a priori YSQ-SF factor structure is adequate.

Discussion:

These findings offer empirical evidence supporting YSQ-SF construct validity and, consequently, its application in adults.

Gender differences of cannabis smoking on serum leptin levels: population-based study

OBJECTIVE

To evaluate the serum leptin levels in cannabis smokers.

METHODS

This was a cross-sectional population-based study of participants between the ages of 18 and 35 years. The data were collected through a self-administered questionnaire covering sociodemographic data and the use of psychoactive substances. Leptin levels were measured using a commercial ELISA kit.

RESULTS

Of the 911 participants, 6.7% were identified as cannabis smokers and had significantly lower leptin levels (p = 0.008). When stratified by gender, there was a significant decrease in leptin levels among male smokers (p = 0.039).

CONCLUSION

Cannabis smoking was linked to leptin levels in men, suggesting that the response to biological signals may be different between men and women.

Serum levels of interleukins IL-6 and IL-10 in individuals with posttraumatic stress disorder in a population-based sample

To evaluate the serum levels of IL-6 and IL-10 anti-inflammatory interleukins in individuals with post-traumatic stress disorder (PTSD) in a population-based study. This is a paired study nested in a cross-sectional population-based study. All individuals who presented PTSD and did not present major depressive disorder, diagnostic by interview--Mini International Neuropsychiatric Interview were selected. From these, 41 healthy controls were matched by sex and age. Serum levels of IL-6 and IL-10 were measured by the ELISA, using commercial kits. The group of individuals with PTSD showed a significant increase in the serum levels of IL-6 and IL-10. Our results suggest that individuals with PTSD may present an activation of the immune system, which may lead to neuroinflammation.

Distinct sensitivity to caffeine-induced insomnia related to age

Caffeine acts by antagonizing the effect of the endogenous homeostatic sleep factor adenosine. In the current study we aimed to evaluate the pattern of caffeine-induced insomnia and its relation to age and sex in a general population sample derived from a web survey. The sample included 75,534 participants (28.1% men) from 18 to 75 years who answered self-report questionnaires by accessing a website in Brazilian Portuguese (BRAINSTEP project). In our sample, 3620 (17.0%) men and 9920 (18.3%) women reported insomnia due to caffeine intake. Caffeine-induced insomnia increased with aging in both men and women. This difference remained after adjusting for sociodemographic, psychiatric and sleep related variables as well as caffeine intake. Women showed higher proportion of caffeine-induced insomnia than men, but this difference did not remain after controlling for covariates. Also, individuals with caffeine-induced insomnia reported poorer sleep quality, higher latency to fall asleep and a higher proportion of psychiatric diagnoses and daily use of hypnotic drugs. In conclusion, our results show an age-associated increase in caffeine-induced insomnia and poorer mental health indicators among people with caffeine-induced insomnia complaints.

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Objective:

To evaluate the prevalence of alcohol abuse and/or dependence in a population-based sample of young adults and assess the prevalence of comorbid mood disorders, anxiety, and suicide risk in this population.

Methods:

This cross-sectional, population-based study enrolled 1,953 young adults aged 18-35 years. The CAGE questionnaire was used to screen for alcohol abuse and/or dependence, with CAGE scores ≥ 2 considered positive. Psychiatric disorders were investigated through the structured Mini International Neuropsychiatric Interview (MINI).

Results:

Alcohol abuse and/or dependence was identified in 187 (9.60%) individuals (5.10% among women and 15.20% among men). Alcohol abuse and/or dependence were more prevalent among men than women, as well as among those who used tobacco, illicit drugs or presented with anxiety disorder, mood disorder, and suicide risk.

Conclusion:

These findings suggest that alcohol abuse and/or dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention programs.

Association of weight control behaviors with body mass index and weight-based self-evaluation

Objective:

To determine the frequency of weight control behaviors (WCBs) and their correlation with body mass index (BMI) and weight-based self-evaluation.

Methods:

Data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from 27,501 volunteers (30.4% men, mean age 28.9±8.7 years).

Results:

The most prevalent WCBs for men and women were exhaustive physical exercise and prolonged fasting, respectively. Frequent exhaustive physical exercise was the only behavior more often adopted by men. BMI was positively associated with WCBs, which were very frequent in obese subjects. About 15% of normal-weight women reported using diuretics and laxatives, and 12.2% reported vomiting as a WCB at least occasionally. Among subjects who regarded body weight highly in their self-evaluation, there was a strong positive association with all WCBs, at similar degrees, in both genders. Compared to those who never base their intrinsic personal value on body weight, those who frequently base intrinsic value on body weight were at 25-30 times higher risk of inducing vomiting.

Conclusion:

The prevalence of participants adopting WCBs was high, especially in women and obese subjects. Weight-based self-evaluation was more strongly associated with WCBs than BMI.

Polymorphism in CRHR1 gene affects the IL-1β levels in suicidal attempters

Approximately one million people commit suicide every year, being suicide attempts and ideation even more common. Changes in stress response and activation of the immune system have been associated with suicide risk. Here we investigated the interaction between immune system and HPA axis alterations in the suicide risk, looking for the influence of rs110402 CRHR1 SNP in the IL-1β levels according to suicide ideation and attempt. This study evaluated 171 subjects of which 15 had suicidal ideation, 20 had suicide attempt and 136 were controls. Genotyping was performed by real-time PCR and IL-1β levels were measured by ELISA. Our data showed that for each point increase in IL-1β levels the risk of suicide attempt increased 5% [relative risk = 1.05 (95% CI: 1.0-1.10)]. After sample stratification by rs110402 SNP genotypes, we observed that in subjects carrying the A allele the risk raised to 15% [relative risk = 1.15 (95% CI: 1.03-1.28)], suggesting an apparent effect modification. Thus, this study showed that alterations in CRHR1 gene were associated with higher levels of IL-1β, and increased risk for suicide, reinforcing the importance of multifactorial interactions of biological markers for psychiatric disorders.

Increased serum neurotrophin levels related to alcohol use disorder in a young population sample

BACKGROUND

The diagnosis of alcohol use disorder is based on clinical signs and on the measurement of biological markers. However, these markers are neither sufficiently sensitive, nor specific enough, for determining the effects of alcohol abuse on the central nervous system. Serum neurotrophins are important regulators of neural survival, development, function, and plasticity and have been found to be reduced in alcohol use disorder. The aim of this study was to investigate the alterations in serum neurotrophin levels (brain-derived neurotrophic factor [BDNF], glial-derived neurotrophic factor [GDNF], and nerve growth factor [NGF]) in alcohol use disorder in a young population, and thus possibly representing the early stages of the illness.

METHODS

This is a cross-sectional study, nested in a population-based study of people aged 18 to 35, involving 795 participants. The participants responded to the CAGE questionnaire, and a CAGE score of ≥2 was considered to be a positive screen for the abuse/dependence or moderate to severe alcohol use disorder. Serum BDNF, GDNF, and NGF levels were measured by ELISA.

RESULTS

In the CAGE ≥ 2 group, GDNF (p ≤ 0.001) and NGF (p ≤ 0.001) serum levels were significantly increased, and the BDNF elevation was near a statistical significance (p = 0.068) when compared to the CAGE < 2 group. A significantly positive correlation was observed only in the CAGE ≥ 2 group for BDNF/GDNF (r = 0.37, p < 0.001) and GDNF/NGF (r = 0.84, p < 0.001) levels. The correlation between the NGF and BDNF levels was significantly positive in both groups (r = 0.28, p < 0.001 for the CAGE < 2 group, and r = 0.30, p = 0.008 for the CAGE ≥ 2 group).

CONCLUSIONS

These results suggest that elevated neurotrophins are candidate markers for the early stages of alcohol misuse.

Cocaine abuse and effects in the serum levels of cytokines IL-6 and IL-10

BACKGROUND

Cocaine abuse is capable of activating the innate immune system in the CNS resulting in deregulation of homeostasis between pro and antiinflammatory cytokines. The aim of this study was to investigate serum levels of pro and antiinflammatory cytokines, IL-6 and IL-10 respectively, in cocaine users from a young population-based sample.

METHODS

This is a case-control study nested in a cross-sectional population-based survey, with individuals of 18 and 35 years old. Two groups were selected: 24 healthy controls and 12 subjects who reported cocaine use. Serum IL-6 and IL-10 were measured by ELISA using a commercial kit.

RESULTS

There was a statistically significant increase in IL-6 (p=0.037) and decrease in IL-10 (p=0.007) serum levels, between cocaine users and the control group. There was also an increase in the ratio IL-6/IL-10 (p=0.013) among cocaine users individuals, when compared to the control group.

CONCLUSIONS

Our results suggest that cocaine users showed an activation of the immune system when compared a control group, demonstrating a disruption in the balance of pro and antiinflammatory cytokines. Thus, peripheral cytokines may represent a putative biomarkers for cocaine users, contributing to the development of diagnosis and effective treatments.

Validation of the "rule of three", the "red sign" and temperament as behavioral markers of bipolar spectrum disorders in a large sample

BACKGROUND

Akiskal proposed the "rule of three" for behavioral indicators with high specificity for bipolarity in patients with major depression episodes. We evaluated these distinctive behaviors in controls and subjects with major depression or bipolar disorder.

METHODS

data was collected in the BRAINSTEP project with questions on general behaviors, style and talents. Univariate analysis was first conducted in 36,742 subjects and confirmatory multivariate analysis in further 34,505 subjects (22% with a mood disorder). Odds ratios were calculated adjusting for age.

RESULTS

Univariate analysis showed that 29 behavioral markers differentiated bipolar subjects from those with unipolar depression. The most robust differences in those with bipolarity (ORs >4) were ≥3 religion changes, ≥3 marriages, cheating the partner regularly, having ≥60 lifetime sexual partners, pathological love, heavy cursing, speaking ≥3 foreign languages, having ≥2 apparent tattoos, circadian dysregulation and high debts. Most behaviors were expressed in a minority of patients (usually around 5-30%) and usually the "rule of three" was the best numerical marker to distinguish those with bipolarity. However, multivariate analysis confirmed 11 of these markers for differentiating bipolar disorder from unipolar depression (reversed circadian rhythm and high debts for both genders, ≥3 provoked car accidents and talent for poetry in men, and frequent book reading, ≥3 religion changes, ≥60 sexual partners, pathological love ≥2 times, heavy cursing and extravagant dressing style in women).

LIMITATIONS

Self-report data collection only.

CONCLUSIONS

These behavioral markers should alert the clinician to perform a thorough investigation of bipolarity in patients presenting with a depressive episode.

Childhood trauma is associated with maladaptive personality traits

The association between childhood trauma and personality traits has been poorly characterized and reported. Our aim was to evaluate whether distinct types of childhood abuse and neglect are associated with various personality dimensions using data from a large web-based survey. A total of 12,225 volunteers responded anonymously to the Internet versions of the Temperament and Character Inventory-Revised (TCI-R) and the Childhood Trauma Questionnaire (CTQ) via our research website, but only 8,114 subjects (75.7% women, mean age 34.8±11.3yrs) who met the criteria for validity were included in the analysis. Childhood trauma was positively associated with harm avoidance and was negatively associated with self-directedness and, to a lesser extent, with cooperativeness. The associations were robust with emotional abuse and neglect but were non-significant or mild with physical trauma. Emotional neglect was associated with reduced reward dependence and persistence. All types of abuse, but not neglect, were associated with increased novelty seeking scores. Reporting of childhood trauma, especially of an emotional nature, was associated with maladaptive personality traits. Further investigation of the effects of different types of childhood trauma on psychological and neurobiological parameters is warranted.

Thinking about dying and trying and intending to die: results on suicidal behavior from a large Web-based sample

OBJECTIVE

Suicide is an important worldwide public health problem. The aim of this study was to characterize risk factors of suicidal behavior using a large Web-based sample.

METHOD

The data were collected by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP) from November 2010 to July 2011. Suicidal behavior was assessed by an instrument based on the Suicidal Behaviors Questionnaire. The final sample consisted of 48,569 volunteers (25.9% men) with a mean ± SD age of 30.7 ± 10.1 years.

RESULTS

More than 60% of the sample reported having had at least a passing thought of killing themselves, and 6.8% of subjects had previously attempted suicide (64% unplanned). The demographic features with the highest risk of attempting suicide were female gender (OR = 1.82, 95% CI = 1.65 to 2.00); elementary school as highest education level completed (OR = 2.84, 95% CI = 2.48 to 3.25); being unable to work (OR = 5.32, 95% CI = 4.15 to 6.81); having no religion (OR = 2.08, 95% CI = 1.90 to 2.29); and, only for female participants, being married (OR = 1.19, 95% CI = 1.08 to 1.32) or divorced (OR = 1.66, 95% CI = 1.41 to 1.96). A family history of a suicide attempt and of a completed suicide showed the same increment in the risk of suicidal behavior. The higher the number of suicide attempts, the higher was the real intention to die (P < .05). Those who really wanted to die reported more emptiness/loneliness (OR = 1.58, 95% CI = 1.35 to 1.85), disconnection (OR = 1.54, 95% CI = 1.30 to 1.81), and hopelessness (OR = 1.74, 95% CI = 1.49 to 2.03), but their methods were not different from the methods of those who did not mean to die.

CONCLUSIONS

This large Web survey confirmed results from previous studies on suicidal behavior and pointed out the relevance of the number of previous suicide attempts and of a positive family history, even for a noncompleted suicide, as important risk factors.

The Affective and Emotional Composite Temperament Scale (AFECTS): Psychometric properties of the Spanish version in a community sample from Mexico City and comparison between remitted psychiatric patients

INTRODUCTION

AFECTS is a novel psychometric instrument that provides an integrated framework based on affective temperamental traits and their trait dimensions. It has the potential to be used in clinical and research fields to study psychopathology and mental health. It is now necessary to field-test this instrument with diverse populations and psychopathological entities.

OBJECTIVE

The primary aim was to test the construct validity and the internal consistency of the Spanish Version of the AFECTS instrument on Mexican subjects. AFECTS characteristics were then compared between general population and stable psychiatric patients.

METHODS

A cross-sectional design involving 350 subjects from the general population in México City and 91 stable patients with a bipolar disorder (BPD, n=20), major depressive disorder (MDD, n=35), or with a schizophrenia (n=36) diagnosis.

RESULTS

A six-factor structure in trait dimensions, explaining 61.4% of the variance, with a Cronbach׳s alpha of 0.93 was found. Euthymic (23%) and hyperthymic (12%) affective temperaments were the most frequent, while dysphoric (3%) and apathetic (3%) were the least. Trait dimension differences were found in Volition, Sensitivity, and the Instability Index between the groups, particularly those with a bipolar disorder.

LIMITATIONS

Use of a self report instrument, and a small sample not representative of the Mexican population or patients with psychiatric conditions.

CONCLUSIONS

The Spanish Version of the AFECTS instrument has adequate psychometric properties. This version of AFECTS will allow the use of this instrument among Spanish speaking populations and contribute to the continued research efforts on integrative models such as AFECT.

Temperament and character traits associated with the use of alcohol, cannabis, cocaine, benzodiazepines, and hallucinogens: evidence from a large Brazilian web survey

OBJECTIVES

To evaluate how personality traits are associated with occasional use, abuse, and dependence of alcohol, cannabis, cocaine, benzodiazepines, and hallucinogens in a large availability sample of adults via online questionnaires.

METHODS

The sample consisted of 8,646 individuals (24.7% men and 75.3% women) who completed an anonymous web survey. Involvement with drugs and temperament/character traits were assessed through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Temperament and Character Inventory - Revised (TCI-R), respectively. Interactions among variables were analyzed using MANOVA with Bonferroni adjustment.

RESULTS

Novelty seeking was the trait most associated with increased involvement with alcohol, cannabis, and cocaine. There was a significant association between harm avoidance and benzodiazepine use. Persistence was lower in cannabis-, benzodiazepine-, and cocaine-dependent subjects, as well as in hallucinogen abusers. Self-directedness was reduced in dependents of all drug classes. No strong relationships were found between other temperament or character dimensions and the severity of drug use.

CONCLUSIONS

Novelty seeking was associated with increased involvement with all drugs studied in this sample, although to a lesser extent with benzodiazepines and hallucinogens. The temperament and character profile for benzodiazepine use was different from that of other drugs due to the relationship with higher harm avoidance and self-transcendence and lower self-directedness.

Leptin in depressive episodes: is there a difference between unipolar and bipolar depression?

OBJECTIVE

The present study investigated whether peripheral leptin levels are associated with current depressive episodes in a cross-sectional study nested within a population-based study.

METHODS

The Mini-International Neuropsychiatric Interview (MINI) 5.0 was used to assess the presence of current depressive episodes. The sample was composed of 206 subjects (103 controls and 103 subjects with a current depressive episode) paired by gender, BMI and age. Medication use and lifestyle characteristics were self-reported.

RESULTS

Serum leptin levels were lower in currently depressive subjects (10.9 ± 12.0 ng/ml) than in the control group (20.3 ± 24.0 ng/ml; p = 0.023). According to the clinical diagnosis, individuals with bipolar depression present lower leptin levels (8.4 ± 8.1 ng/ml) than those with unipolar depression (12.0 ± 13.4 ng/ml) and the control group (20.3 ± 24.0 ng/ml; p = 0.031). In addition, ANCOVA showed that leptin is an independent factor associated with current depressive episodes (p = 0.018).

CONCLUSION

A decreased leptin level might be a useful peripheral marker associated with depressive episodes in the context of bipolar disorder.

Dysfunctional traits in obese women and underweight men

BACKGROUND

The prevalence of obesity is rapidly increasing worldwide, together with its comorbidities. Our aim was to assess the emotional traits and affective temperaments, according to various Body Mass Index (BMI) groups, in a large sample.

METHODS

Data was collected by a web-survey on psychological and psychiatric measures (BRAINSTEP). The BMI was evaluated by self-reporting and temperament was evaluated by the Affective and Emotional Composite Temperament Scale (AFECTS). The final sample consisted of 10,786 individuals (mean age 27.9 ± 7.8 years, 70% females).

RESULTS

About 40% of the sample had a BMI score higher than normal. The overall BMI score was particularly associated with a higher Desire and a lower Control and Volition (p<0.001 for all), especially in women. Obese females also had significantly lower Coping, Stability, and Caution. In males only, underweight individuals were more fearful and sensitive, and they had a lower Coping and Volition character than normal weight subjects, suggesting a more fragile and immature profile. Linear regression with several adjustments confirmed these associations. Regarding affective temperaments, a Depressive type was more prevalent among underweight subjects, an Obsessive type was associated with a normal BMI, and a Hyperthymic type was apparent in overweight individuals of both genders. Underweight males and females were more prone to having an internalized temperament.

LIMITATIONS

Only self-reporting measures were used in a cross-sectional design.

CONCLUSIONS

Obese women and underweight men have a more dysfunctional trait profile. Addressing these traits may be important for prevention strategies and, possibly, for weight reduction in women.

Immune dysfunction in bipolar disorder and suicide risk: is there an association between peripheral corticotropin-releasing hormone and interleukin-1β?

OBJECTIVE

The aim of the present study was to investigate the relationship between peripheral levels of corticotropin-releasing hormone (CRH) and interleukin-1β (IL-1β) in individuals with bipolar disorder (BD) with and without suicide risk (SR), and controls.

METHODS

A total of 120 young adults (40 controls, 40 subjects with BD without SR, and 40 subjects with BD with SR) were enrolled from a population-based study carried out in the city of Pelotas, Brazil. BD and SR were assessed through the Mini International Neuropsychiatric Interview (MINI 5.0), and peripheral markers were evaluated by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Levels of CRH were significantly lower both in subjects with BD without SR (p = 0.04) and subjects with BD with SR (p = 0.02) when compared to controls. However, levels of IL-1β were increased in subjects with BD with SR (p = 0.05) when compared to controls. Sociodemographic and clinical variables, current mood episode, and use of psychiatric medications were not associated with changes in these markers. No correlation was found between peripheral levels of CRH and IL-1β (p = 0.60) in the population or in the BD with SR group (p = 0.88).

CONCLUSIONS

These results suggest that peripheral mechanisms linking stress hormones and the immune system might be critical patterns involved in suicidal behavior associated with BD.

Emotional traits and affective temperaments in alcohol users, abusers and dependents in a national sample

BACKGROUND

It is unclear how temperament is related to alcohol-related behavior in large population studies. We have used the Affective and Emotional Composite Temperament Scale (AFECTS) model to evaluate how emotional traits and affective temperaments are associated with alcohol use, abuse, and dependence in the general population.

METHODS

Data from 10,603 subjects (mean age=28.0±7.8 years, 70.3% females) was collected anonymously by the Internet in Brazil using the AFECTS model and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Alcohol use was stratified into control, low use, abuse, and dependence groups.

RESULTS

The analysis of dimensional traits showed that Volition and Coping were lower, and Sensitivity was higher, in the abuse and dependence groups, with no differences between the Control and the Low Use groups. Alcohol consumption was also associated with lower Control, Stability, and Caution, and higher with Anger, Anxiety, and Desire, with significant differences between all groups. Regarding affective temperament types, alcohol abuse and dependence were associated with euphoric and cyclothymic temperaments in both genders, which was mirrored by a lower frequency of both euthymic and hyperthymic types. Only hyperthymics were overrepresented in the Control group for both genders.

LIMITATIONS

Data was collected by Internet only.

CONCLUSIONS

A global dysfunction of emotional traits and a predominance of cyclothymic and euphoric temperaments were associated with alcohol-related behavior. Prevention and treatment strategies may be developed more effectively if these traits are taken into account.

The joint structure of major depression, anxiety disorders, and trait negative affect

BACKGROUND

Dimensional models of psychopathology demonstrate that two correlated factors of fear and distress account for the covariation among depressive and anxiety disorders. Nevertheless, these models tend to exclude variables relevant to psychopathology, such as temperament traits. This study examined the joint structure of DSM-IV-based major depression and anxiety disorders along with trait negative affect in a representative sample of adult individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil.

METHODS

The sample consisted of 3,728 individuals who were administered sections D (phobic, anxiety and panic disorders) and E (depressive disorders) of the Composite International Diagnostic Interview (CIDI) 2.1 and a validated version of the Positive and Negative Affect Schedule. Data were analyzed using correlational and structural equation modeling.

RESULTS

Lifetime prevalence ranged from 2.4% for panic disorder to 23.2% for major depression. Most target variables were moderately correlated. A two-factor model specifying correlated fear and distress factors was retained and confirmed for models including only diagnostic variables and diagnostic variables along with trait negative affect.

CONCLUSIONS

This study provides support for characterization of internalizing psychopathology and trait negative affect in terms of correlated dimensions of distress and fear. These results have potential implications for psychiatric taxonomy and for understanding the relationship between temperament and psychopathology.

Interleukin-1β is associated with depressive episode in major depression but not in bipolar disorder

Our work was sought to investigate possible changes in peripheral levels of interleukin-1β (IL-1β) according to the diagnosis of major depression (MD) and bipolar disorder (BD) and in different mood episodes. This is a cross-sectional nested in a population-based study comparing 240 young adults (80 controls, 80 MD and 80 BD), balanced for age and gender. Serum levels of IL-1β were significantly higher in MD when compared to control or BD subjects. In addition, when divided by current mood episode, MD subjects in current depression presented higher IL-1β levels than controls. No differences in IL-1β levels were found between different episodes of BD (euthymic, depressed, mania or mixed). Moreover, the use of psychiatric medication was very low in our sample and not associated with changes in IL-1β levels. In conclusion, increased peripheral IL-1β might be a useful marker associated with a depressive episode in the context of MD.

The spinning task: a new protocol to easily assess motor coordination and resistance in zebrafish

The increasing use of adult zebrafish in behavioral studies has created the need for new and improved protocols. Our investigation sought to evaluate the swimming behavior of zebrafish against a water current using the newly developed Spinning Task. Zebrafish were individually placed in a beaker containing a spinning magnetic stirrer and their latency to be swept into the whirlpool was recorded. We characterized that larger fish (>4 cm) and lower rpm decreased the swimming time in the Spinning Task. There was also a dose-related reduction in swimming after acute treatment with haloperidol, valproic acid, clonazepam, and ethanol, which alter coordination. Importantly, at doses that reduced swimming time in the Spinning Task, these drugs influenced absolute turn angle (ethanol increased and the other drugs decreased), but had no effect of distance travelled in a regular water tank. These results suggest that the Spinning Task is a useful protocol to add information to the assessment of zebrafish motor behavior.

Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample

BACKGROUND

Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown.

METHODS

We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable.

RESULTS

Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense.

LIMITATIONS

The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness.

CONCLUSIONS

Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.

Polymorphisms in schizophrenia candidate gene UFD1L may contribute to cognitive deficits

We aimed to investigate UFD1L polymorphisms in schizophrenia and in relation to cognition. A total of 299 cases and 363 controls were genotyped, and 130 patients completed nine neuropsychological tests. We found that rs5992403 AA-genotype carriers showed lower scores on the set-shifting task. Therefore, UFD1L may participate in the core cognitive deficits observed in schizophrenia.

Bullying victimization is associated with dysfunctional emotional traits and affective temperaments

BACKGROUND

Being bullied has been increasingly recognized as a risk factor for the development of psychiatric disorders, but there is very limited evidence on the association of bullying with temperament.

METHODS

The data was collected in a large web-survey on psychological and psychiatric measures (BRAINSTEP). Bullying was assessed with a question on time exposed to bullying (none, <1 year, 1-3 years and >3 years) during childhood and adolescence. Emotional traits and affective temperaments were evaluated with the Affective and Emotional Composite Temperament Scale (AFECTS). The final sample consisted of 50,882 subjects (mean age 30.8 ± 10.4 years, 73.4% females) with valid answers.

RESULTS

About half of the sample reported exposure to bullying and ∼10% reported being victimized by peers for longer than 3 years. Longer exposure to bullying was associated with lower Volition, Coping and Control scores, and more Emotional Sensitivity, Anger and Fear, with statistical significance between all groups. To a lower degree, exposure to bullying was associated with lower Caution and higher Desire scores. Bullying victimization was also associated with a much lower proportion of euthymic and hyperthymic types in both genders, which was compensated by an increase mainly in the proportion of depressive, cyclothymic and volatile types.

LIMITATIONS

Retrospective assessment of bullying with a single question on time exposed to bullying and use of self-report instruments only.

CONCLUSIONS

Being bullied was associated with a broad and profound impact on emotional and cognitive domains in all dimensions of emotional traits, and with internalized and unstable affective temperaments.

ZDHHC8 gene may play a role in cortical volumes of patients with schizophrenia

ZDHHC8 rs175174 polymorphism is located in 22q11.2 region and its role in brain volume has not been fully addressed. A total of 282 schizophrenia patients and 379 controls were genotyped. A sample of 138 patients underwent brain MRI scan. No association was found between schizophrenia and genotypes. Nevertheless, GG-genotype carriers presented gray matter volume (GMV) reduction in frontal lobe compared to A-allele carriers, and cerebellar hemispheres GMV reductions were found in G-allele carriers compared to AA-genotype. Moreover, A-allele carriers presented posterior brain GMV reductions when compared to GG-genotype. These data suggest that ZDHHC8 may play a role in cortical volumes.

The relationship between affective temperaments, defensive styles and depressive symptoms in a large sample

BACKGROUND

Affective temperaments may represent heritable subclinical manifestations of mood disorders. The concept of ego defense mechanisms also has provided a model for the comprehension of mood psychopathology. The relationships between affective temperaments, defense styles and depressive symptoms remain unknown.

METHODS

We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Socio-demographic information was collected and participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the defense style questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R).

RESULTS

Among 9937 participants (4472 male; 45%), individuals with hyperthymic or euthymic temperaments were more likely to present a mature defense style, whereas an immature defensive style was predominantly observed in individuals with cyclothymic, volatile, depressive, dysphoric, euphoric and disinhibited temperaments. Higher immature and lower mature defense style scores were independently associated with depressive symptoms. Participants with either euthymic or hyperthymic temperaments were less likely to endorse depressive symptoms. Euthymic and hyperthymic temperaments moderated the correlations of mature/immature defenses with depressive symptoms.

LIMITATIONS

The data was collected from a convenience web-based sample. The study was cross-sectional.

CONCLUSIONS

Affective temperaments are associated with distinct defense styles. These two personality theories provide distinct but interacting views for comprehension of depressive psychopathology.

Development and validity data of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP)

BACKGROUND

The internet provides a research opportunity for psychiatry and psychology. This article presents the development and preliminary data of a large web-survey created to study how temperament relates to other psychological measures, behavior and psychiatric disorders.

METHODS

We used the Affective and Emotional Composite Temperament Scale (AFECTS) to evaluate temperament and we selected several self-report instruments to evaluate behavior, psychological constructs and mental disorders. The system provides anonymous psychological (phase 1) and psychiatric (phase 2) feedback and includes questions to assess the validity of the answers. Each phase has around 450 questions. This system was broadcast utilizing Brazilian media.

RESULTS

After the exclusion of 21.5% of the volunteers (those who failed the validation questions), 41,427 participants concluded the first part of the system (mean age=31.2±10.5 yrs, 26.9% males), and 21,836 (mean age=32.5±10.9 yrs, 25.1% males) completed phase 2. Around 25% have received a psychiatric diagnosis from a mental health professional. Demographic and temperament profiles of those who completed either only 80 questions, only phase 1, or the whole system were similar. The rate of non-serious answers (e.g. on bizarre behaviors) was very low and congruency of answers was very high. The internal consistency of classical trait scales (TCI-R and PANAS) was high (Cronbach's alpha>0.80) for all dimensions.

LIMITATIONS

Relatively high dropout rate due to the length of the process and an overrepresentation of female, young and well-educated subjects.

CONCLUSIONS

The BRAINSTEP provides valid and abundant data on psychological and psychiatric measures.

The Affective and Emotional Composite Temperament (AFECT) model and scale: a system-based integrative approach

Based on many temperament frameworks, here we propose an integration of emotional and affective temperaments (the AFECT model), forming a common substrate for mood, behavior, personality and part of cognition. Temperament is conceived as a self-regulated system with six emotional dimensions: volition, anger, inhibition, sensitivity, coping and control. The different combinations of these emotional dimensions result in 12 affective temperament types, namely depressive, anxious, apathetic, obsessive, cyclothymic, dysphoric, irritable, volatile, disinhibited, hyperthymic and euphoric. We also developed and validated a self-report scale to evaluate this construct, the Affective and Emotional Composite Temperament Scale (AFECTS).

METHODS

Exploratory and confirmatory psychometric analyses were performed with the internet version of the AFECTS in 2947 subjects (72% females, 35±11years old).

RESULTS

The factors interpreted as volition, anger, inhibition, sensitivity, coping and control showed very good Cronbach's alphas for 5 dimensions (0.87-0.90) and acceptable alpha for inhibition (0.75). Confirmatory factor analysis corroborated this 6-factor structure when considering inhibition as a second-order factor with fear and caution as first-order factors (SRMR=0.061; RMSEA=0.053). In the Affective section, all 12 categorical affective temperaments were selected in the categorical choice, with 99% of volunteers identifying at least one adequate description of their affective temperament.

LIMITATIONS

Only the internet version was used in a general population sample.

CONCLUSION

The AFECT model provides an integrated framework of temperament as a self-regulated system, with implications for mental health, psychiatric disorders and their treatment. The AFECTS showed good psychometric properties to further study this model.

The Circadian Energy Scale (CIRENS): two simple questions for a reliable chronotype measurement based on energy

This study presents the Circadian Energy Scale (CIRENS), a very short and simple chronotype measurement tool based on energy. The CIRENS consists of two introspective questions about the usual energy level (very low, low, moderate, high, or very high, scored 1 to 5) in the morning and in the evening. The difference between energy level scores (-4 to 4) felt by respondents in the evening and morning defines the chronotype score and classification. A concurrent validity analysis of the CIRENS with the widely used Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) was conducted using a sample of 225 college students, and with MSFsc, a sleep-based chronotype assessment tool based on the Munich Chronotype Questionnaire (MCTQ), using a sample of 34,530 subjects (18-83 yrs, 27% males). This large sample was collected in a Web survey for behavioral correlates of the CIRENS with variables previously associated with chronotype differences. The correlation of the CIRENS chronotype score was r = -.70 with the MEQ and r = .32 with the MSFsc. CIRENS chronotype scores declined with age and were not affected by sex. Both CIRENS and MSFsc chronotype scores were related to differences in tobacco, caffeine, and cola soft-drink consumption (all higher in evening types). The CIRENS provides a simple chronotype index and a measure of absolute energy throughout the day and seems to be a reliable chronotype assessment tool that may be useful both clinically and for large-scale studies.

Unpredictable chronic stress model in zebrafish (Danio rerio): behavioral and physiological responses

Zebrafish (Danio rerio) have emerged as a promising model organism to study development, toxicology, pharmacology, and neuroscience, among other areas. Despite the increasing number of studies using zebrafish, behavioral studies with this species are still elementary when compared to rodents. The aim of this study was to develop a model of unpredictable chronic stress (UCS) in zebrafish. We evaluated the effects of UCS protocol during 7 or 14 days on behavioral and physiological parameters. The effects of stress were evaluated in relation to anxiety and exploratory behavior, memory, expression of corticotrophin-releasing factor (CRF) and glucocorticoid receptor (GR), and cortisol levels. As expected, UCS protocol increased the anxiety levels, impaired cognitive function, and increased CRF while decreased GR expression. Moreover, zebrafish submitted to 7 or 14 days of UCS protocol presented increased cortisol levels. The protocol developed here is a complementary model for studying the neurobiology and the effects of chronic stress in behavioral and physiological parameters. In addition, this protocol is less time consuming than standard rodent models commonly used to study chronic stress. These results confirm UCS in zebrafish as an adequate model to preclinical studies of stress, although further studies are warranted to determine its predictive validity.

Association of temperament with subjective sleep patterns

BACKGROUND

Emotional and cognitive functioning have been involved in insomnia etiology, and sleep disturbances are closely related to psychiatric disorders and personality traits. This study investigates the association of temperament with subjective sleep parameters.

METHODS

In this web-survey, 5129 subjects (25.3% males) completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, anger, drive and control) and affective (e.g. cyclothymic, hyperthymic) temperaments. Subjects also answered questions regarding subjective sleep parameters, psychiatric diagnosis, psychotropic medication intake and cigarette smoking.

RESULTS

As control scores decreased, the later were the bed and the wake up time. Total sleep time was weakly associated with emotional temperaments. The higher the score of anger and the lower the score of control, the higher was the sleep-onset latency. As the anger score increased and the drive, fear and control scores decreased, the higher the number of nightly awakenings. The higher the drive and the control and the lower the anger scores, the better the sleep quality. For affective temperaments, depressives, labiles (related to ADHD) and cyclothymics (related to bipolar II disorders) go to bed and wake up later and have a worse profile regarding other sleep parameters. Hyperthymics and euthymics showed favorable sleep profiles.

LIMITATIONS

Sample included a significant number of subjects with psychiatric diseases and on psychotropic medication.

CONCLUSION

Dysregulated emotional activation (expressed as higher anger, and lower control and drive), as well as depressive, labile and cyclothymic affective temperaments were related to more dysfunctional sleep patterns.

Emotional and affective temperaments and cigarette smoking in a large sample

BACKGROUND

Tobacco use has been associated with externalized personality traits. Our aim was to evaluate the association of smoking with emotional and affective temperaments in a large sample.

METHODS

In this cross-sectional web-based survey, volunteers completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, drive, anger, and control) and affective temperaments (e.g. cyclothymic, irritable), and questions about smoking.

RESULTS

Among the 5379 subjects (1370 males), there were 60% non-smokers, 17% quitters and 23% current smokers. Non-smokers had higher fear and control and lower anger than quitters and smokers, and higher drive than smokers. Quitters had higher drive and control and lower anger than smokers. Smoking was lower among apathetics, depressives, euthymics and hyperthymics and higher in cyclothymics and labiles. Lower drive and higher anger were associated with heavier smoking. Less adaptive temperament was related to higher prevalence of and heavier smoking.

LIMITATIONS

The data was collected from a convenience sample by the internet, and most volunteers assessed the instrument through a psychoeducational website for bipolar spectrum disorders, leading to a higher proportion of cyclothymics; the assessment of smoking habits was limited to two questions; the study was cross-sectional.

CONCLUSIONS

Smoking was associated with lower fear, control and drive, higher anger and unstable externalized affective temperaments. Lower control and higher anger were associated with being a heavy smoker and current smoking. Assessment of temperament may help decision about treatments for smoking cessation.

Distinctive effects of unpredictable subchronic stress on memory, serum corticosterone and hippocampal BDNF levels in high and low exploratory mice

Stress affects learning and memory processes and sensitivity to stress greatly varies between individuals. We studied behavioral and neurobiological effects of unpredictable subchronic stress (USCS) in two behavioral extremes of mice from the same strain (CF1) selected by their exploratory behavior of the central arena of an open field. The top and bottom 25% explorers were classified as low exploratory (LE) and high exploratory (HE) mice, respectively. The open field task, the novel object recognition task (NOR), sucrose intake and tail suspension task were evaluated in LE and HE groups exposed to USCS for two weeks or control conditions. Also serum corticosterone and hippocampal BDNF and S100B levels were analyzed. Both stressed groups exhibited less exploratory activity when submitted to USCS, but their difference in exploratory behavior remained. This short stress protocol did not induce changes in sucrose intake or immobility in the tail suspension task. Also, LE mice exhibited impaired NOR performance after USCS, whereas HE mice changed their pattern of exploration towards less exploration of the familiar object. HE had lower corticosterone levels than LE mice, but corticosterone levels increased after stress only in HE mice. Hippocampal BDNF in LE was lower than in HE but decreased after USCS only in HE mice, whereas S100B levels were not different between groups and did not change with USCS. In conclusion, our results suggest that individual differences in exploratory behavior in rodents from the same strain influence cognitive and biochemical response to stress.

Emotional and affective temperament in 23 professional areas

BACKGROUND

Preliminary data has shown temperament differences in workers of a few professions, particularly in artists.

METHODS

3805 subjects (75.5% female, mean 32.4+/-9.8 years) of 23 broad professional areas answered a web-survey with the Combined Emotional and Affective Temperament Scale (CEATS).

RESULTS

Educational level was correlated with drive and control, was lower in depressives and apathetics and higher in euthymics and hyperthymics. Fear was lower in administration and communications and higher in computing and office workers. Drive was lower in those unemployed and at home and higher in fitness and administration. Control was lower in arts and higher in teaching and health caring. Anger was lower in subjects in the areas of teaching and health caring and higher in human studies and unemployed. For affective temperament scores: depressive was lower in fitness and higher in human studies; anxious and apathetic scores were lower in fitness and higher in unemployed subjects; cyclothymic was lower in health caring and higher in unemployed; euthymic score was lower in human studies and higher in fitness; irritable was lower in religion and higher in unemployed; labile was lower in health caring and higher in unemployed; disinhibited was lower in engineering and higher in communications and arts; hyperthymic was lower in human studies and high in fitness.

LIMITATION

Convenience sample by the internet and most subjects assessed the instruments through a psychoeducational website for bipolar spectrum disorders, which may have biased the absolute scores of emotional temperaments.

CONCLUSIONS

Professional areas and educational level are associated with distinct emotional and affective profiles.

Caffeine, mental health, and psychiatric disorders

Caffeine intake is so common that its pharmacological effects on the mind are undervalued. Since it is so readily available, individuals can adjust their own dose, time of administration and dose intervals of caffeine, according to the perceived benefits and side effects of each dose. This review focuses on human studies of caffeine in subjects with and without psychiatric disorders. Besides the possibility of mild drug dependence, caffeine may bring benefits that contribute to its widespread use. These benefits seem to be related to adaptation of mental energy to the context by increasing alertness, attention, and cognitive function (more evident in longer or more difficult tasks or situations of low arousal) and by elevating mood. Accordingly, moderate caffeine intake (< 6 cups/day) has been associated with less depressive symptoms, fewer cognitive failures, and lower risk of suicide. However, its putative therapeutic effects on depression and ADHD have been insufficiently studied. Conversely, in rare cases high doses of caffeine can induce psychotic and manic symptoms, and more commonly, anxiety. Patients with panic disorder and performance social anxiety disorder seem to be particularly sensitive to the anxiogenic effects of caffeine, whereas preliminary data suggests that it may be effective for some patients with obsessive compulsive disorder (OCD). The threshold for the anxiogenic effect of caffeine is influenced by a polymorphism of the A2A receptor. In summary, caffeine can be regarded as a pharmacological tool to increase energy and effortful behavior in daily activities. More populational (cross-sectional and prospective) and experimental studies are necessary to establish the role of caffeine intake in psychiatric disorders, especially its putative efficacy on depressive mood and cognitive/attentional disorders.