Difference in Temperament and Character Inventory scores between depressed patients with bipolar II and unipolar major depressive disorders

Background

Although some core personality variables are known to be characteristic of unipolar or bipolar depression, few studies have compared the personality profile between these two disorders.

Methods

Temperament and Character Inventory (TCI) was employed to assess the personality of 36 depressed patients with bipolar II disorder (BPII), 90 patients with unipolar major depressive disorder (UP), and 306 healthy controls. The TCI was administered during the depressive episode in BPII and UP patients so that the results can be applied in a clinical setting.

Results

Significantly higher scores in harm avoidance (p < 0.0001) and lower scores in self-directedness (p < 0.0001) and cooperativeness (p < 0.05) were observed in both BPII and UP patients compared to controls. Lower novelty seeking in UP patients compared to BPII patients and controls was observed in females (p < 0.0001, p < 0.01, respectively). A significant difference in self-transcendence score was observed between BPII and UP patients in females (p < 0.0005), with higher scores in BPII (p = 0.009) and lower scores in UP (p = 0.046) patients compared to controls. A logistic regression model predicted BPII in depressed females based on novelty seeking and self-transcendence scores with a sensitivity of 89% and a specificity of 73%, but did not accurately predict BPII in males.

Limitations

Patients in our study were limited to those receiving outpatient treatments, and bipolar patients were limited to those with BPII.

Conclusions

Novelty seeking and self-transcendence scores of TCI might be useful in the differentiation of UP and BPII in female patients.     

Temperament and character inventory dimensions as a predictor of response to antidepressant treatment in major depression

BACKGROUND: Cloninger's theory of personality, including 4 temperament dimensions and 3 character dimensions, is one of the most noteworthy theories in recent years. Several studies have explored temperament dimensions as a predictor of response to antidepressant treatments in major depression, but these have provided inconsistent results. The present study explored temperament as well as character dimensions, as measured by the Temperament and Character Inventory (TCI), as possible predictors of response to maprotiline, the most-widely prescribed antidepressant in Japan. METHODS: 86 consecutive patients with major depression underwent a 16-week open trial of maprotiline. They filled out the TCI at baseline, and were followed up at weeks 8 and 16 by using the Hamilton Rating Scale for Depression. RESULTS: Hierarchial logistic regression analyses demonstrated that response to maprotiline was significantly predicted by the cooperativeness score at the 8-week outcome assessment, and by the self-directedness score at the 16-week outcome assessment, after controlling the possible effects of clinical variables on the response. There was no evidence that either temperament dimensions or their 2-way interactions significantly predicted the response. LIMITATIONS: Large replication studies with other antidepressants are needed for generalizing the results in this study. CONCLUSIONS: The results in this study regarding temperament dimensions seem consistent with findings in previous studies, which are, as a whole, inconsistent with each other. It is suggested that character dimensions (particularly cooperativeness and self-directedness), rather than temperament dimensions, may be important predictors of response to antidepressants. Antidepressants may differ in the personality configurations that predict optimal responses.     

Temperament and Character Inventory (TCI) as predictors of depression among Japanese college students

To examine the predictive power of Cloninger's psychobiology model of depression, 167 Japanese college students were studied on two occasions, with an interval of approximately three months. At Time 1 (T1), the Temperament and Character Inventory (TCI) and Self-rating Depression Scale (SDS) were distributed. At Time 2 (T2), the SDS was distributed again. The T2 SDS score was positively correlated with Harm Avoidance and negatively correlated with Reward Dependence and Self-directedness at T1. However, after controlling for the T1 SDS score, the T2 SDS score was predicted only by T1 Self-directedness. These data suggest that lower Self-directedness can be predictive of depression, whereas higher Harm Avoidance and lower Reward Dependence are state-dependent.     

Genetic and Environmental Influences on the Junior Temperament and Character Inventory in a Preadolescent Twin Sample

This study evaluated the genetic and environmental structure of personality variables from the Junior Temperament and Character Inventory (JTCI), in 605 pairs of 9- and 10-year old twins. There is a paucity of information on the biometric structure of temperament and character traits in preadolescent children. Latent factor models were fit to the subscales/items of each trait as a method of estimating genetic and environmental effects on true score variance, especially since internal consistency and reliability were moderate or low for some scales (particularly Reward Dependence and Persistence). Shared environmental influences on Cooperativeness were substantial. Significant heritability estimates were obtained for Self-directedness and Harm Avoidance, but not Novelty Seeking, Reward Dependence or Persistence. With the exception of Harm Avoidance, each of the scales failed to show measurement invariance with respect to sex, suggesting these scales may differ in meaning for boys and girls at this age. Edited by Danielle Posthuma.     

Temperament and personality features in patients with major depression, panic disorder and mixed conditions.

METHOD: Forty-two patients with Panic Disorder (P), 18 with Major Depression (MD), 35 with both conditions (MIX) and 45 healthy subjects (C) were tested with the Tridimensional Personality Questionnaire and the Structured Interview for DSM-III-R Personality Disorders. RESULTS: A different prevalence of Dependent (P = 16.7%, MD = 5.6%, MIX = 41.4%, C = 2.1%) (P < 0.001), Obsessive-Compulsive (P = 4.8%, MD = 27.8%, MIX = 3.4%, C = 0%) (P < 0.001) and Histrionic (P =23.8%, MD = 0%, MIX = 31%, C = 4.2%) (P = 0.001) personality disorders (PD) was found among groups. Harm Avoidance (HA) (P < 0.001) and Reward Dependence (RD) (P <0.001) were higher in patients than in controls. As expected the patients with comorbid conditions (MIX) showed higher HA levels (P < 0.01) and a greater prevalence of PDs, particularly of Cluster C compared to patients with pure disorders. CONCLUSIONS: This study suggests that high HA and RD scores are associated with P, MD and MIX, and the former dimension is even higher in MIX patients.     

Alexithymia and depression: a prospective study of patients with major depressive disorder

The authors conducted a 12-month follow-up study to determine the association between alexithymia and depression in 116 outpatients with major depressive disorder (MDD) and 540 control subjects from the general population. Alexithymia was screened using the Toronto Alexithymia Scale (TAS-20), and depression was assessed using the Beck Depression Inventory (BDI). The results show that the severity of depression was significantly associated with alexithymia. In addition, the BDI scores increased or decreased proportionately with the change in TAS-20 score in both groups. These results lend further support to the idea that alexithymia may be a state-dependent phenomenon.     

Temperament and character in women with postpartum depression

Summary Objective: To investigate whether women with postpartum depression differ in personality traits from healthy postpartum women, healthy controls from the normal Swedish population and non-postpartum women with major depression. Methods: Forty-five women with postpartum depression were compared with 62 healthy postpartum women, 62 age-matched, healthy, non-postpartum women from a normal sample and 74 non-postpartum women with major depression from a clinical sample. The edinburgh postnatal depression scale was used in order to screen for postpartum depression. A clinical diagnostic interview was done including a rating with the Montgomery-Asberg depression rating scale. Personality i.e. temperament and character was measured by the temperament and character inventory. Results: Harm avoidance (HA) was higher (p < 0.001) and self-directedness (SD) scored lower (p < 0.001) in women with postpartum depression compared to healthy postpartum women. These differences were the most important differences between these two groups. Women with postpartum depression scored lower (p = 0.001) in cooperativeness (CO) and higher (p = 0.019) in self-transcendence (ST) compared to healthy postpartum women. Women with postpartum depression scored overall similar to women with major depression. Conclusion: High HA and low SD can be seen as vulnerability factors for developing a depression and especially in a stressful situation as childbirth.     

The diagnosis of major depression in patients with cancer: a comparative approach

Depressive symptoms not only impair quality of life in cancer patients but constitute an independent risk factor for increased mortality. In order to accurately and efficiently identify depression in cancer patients, the authors developed a biostatistical strategy to identify items of the 21-item, observer-rated Hamilton Rating Scale for Depression (Ham-D) that would optimize the diagnosis of depression among cancer patients. Exhibiting a relatively high sensitivity and specificity, our most optimal diagnostic tool contained six Ham-D items (late insomnia, agitation, psychic anxiety, diurnal mood variation, depressed mood, and genital symptoms). This study may serve as a prototype to generate valid instruments accurate for the diagnosis of major depression in other populations of cancer patients.     

Gastric dysmotility in patients with major depression

BACKGROUND: Depressed patients frequently complain about vegetative symptoms. The aim of the present study was to evaluate gastric electrical activity in patients suffering from major depression in relation to their symptoms. METHODS: Electrogastrography (EGG) was performed before and after a test meal ingestion in 21 patients suffering from major depression and control subjects. A structured interview was used to assess the severity of clinical as well as abdominal symptoms. RESULTS: Patients presented with significantly elevated proportions of tachygastria. Significant differences were found for the parameter arrhythmia, the coefficient of dominant frequency and slow wave after the test meal ingestion. A positive correlation was found between tachygastria and ANS score as well as tachygastria and the item "sweating". LIMITATIONS: Further studies are warranted to include more patients and to investigate interaction with specific antidepressive drugs. DISCUSSION: This is the first study demonstrating an increased amount of tachygastria in patients suffering from major depression which might be caused by increased sympathetic modulation. The correlation of tachygastria with the amount of gastric symptoms underlines the clinical significance of this finding.     

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression.

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.     

Temperament traits in seasonal affective disorder, suicide attempters with non-seasonal major depression and healthy controls.

BACKGROUND: Very few studies have compared the temperament traits in matched suicidal and non-suicidal patients with major depression. METHODS: We compared the temperament traits in two matched groups of patients with major depressive disorder (MDD), MDD with seasonal subtype (SAD) without any suicide attempt (n = 23) and MDD without seasonal variation who attempted suicide (non-SAD SA), and compared the patients to matched healthy controls by using the Karolinska Scales of Personality (KSP) and the Marke-Nyman Temperament (MNT) questionnaires. RESULTS: Both the SAD and non-SAD SA groups showed significantly higher Somatic Anxiety, Muscular Tension, Psychasthenia, Irritability, Suspicion, and lower Socialization and Validity than the controls. The non-SAD SA group also showed significantly higher Psychic Anxiety, Detachment and Guilt as compared to controls. When the SAD and the non-SAD SA were compared, we found significantly higher Somatic Anxiety, Psychic Anxiety and Muscular Tension for the non-SAD SA group. CONCLUSIONS: Both SAD and non-SAD SA patients display different temperament profiles compared to controls and in comparison with each other and the suicide attempters show especially high trait anxiety and hostility. CLINICAL RELEVANCE: The results suggest that trait anxiety and hostility, but not impulsivity, are associated with suicidal behavior in major depression.     

Cardio-respiratory coupling in untreated patients with major depression

BackgroundDepressive disorders are known to be associated with higher risks of cardiovascular diseases. Several studies have reported an imbalance within the autonomic nervous system (ANS) as one putative cause. Previous investigations showed decreased cardio-respiratory coupling in depressive patients that were treated with nortriptyline. We aimed to compare parameters of heart rate variability and cardio-respiratory coupling between unmedicated patients suffering from major depressive disorder (MDD) and healthy controls in order to further understand autonomic dysfunction in the disease.MethodsWe investigated eighteen unmedicated patients with major depressive disorder and eighteen matched healthy controls. Electrocardiogram and respiratory signals were obtained during a twenty minute resting period. Time- and frequency based parameters of HRV, respiratory sinus arrhythmia (RSA), approximate entropy of heart rate (ApEn_RR) and respiratory rate (ApEn_Resp) were calculated. Additionally, cross-ApEn between RR-intervals and respiration time series was determined, reflecting coupling of both signals.ResultsPatients showed an increased heart rate and LF/HF-ratio. Respiratory sinus arrhythmia (RSA) and ApEn_RR were reduced in patients in comparison to controls. Breathing rate, ApEn_Resp and cross-ApEn did not differ between the two groups.DiscussionIncreased heart rate, increased LF/HF-ratio, reduced RSA and reduced ApEn_RR indicate a decrease of cardiac vagal modulation in depressive patients. No difference of cardio-respiratory coupling was observed. Respiratory parameters and cross-ApEn did not differ between both groups, and thus we conclude that diminished vagal modulation is mainly limited to cardiac modulation.     

Heart rate variability in patients with major depression

This study compared cardiac autonomic modulation in physically healthy patients with major depressive disorder to that in mentally healthy heart transplant recipients and physically and mentally healthy comparison subjects by using a nonlinear measure and a conventional measure of heart rate variability. No significant differences in cardiac autonomic modulation were noted between the depressive group and the transplant recipients, but both of those groups had significantly lower mean values for heart rate variability measures relative to the healthy comparison subjects. The results support the hypothesis that cardiac autonomic imbalance (reduced vagal modulation) to the extent of cardiac neuropathy is present in depression.     

Temperament in the clinical differentiation of depressed bipolar and unipolar major depressive patients

OBJECTIVE: To examine differences in temperament profiles between patients with recurrent unipolar and bipolar depression. METHOD: Depressed individuals with recurrent major depressive disorder (MDD) (n = 94) and those with bipolar (n = 59) disorders (about equally divided between types I and II) were recruited by newspaper advertisement, radio and television announcements, flyers and newsletters, and word of mouth. All patients were interviewed using the Structured Clinical Interview for DSM III-R (SCID) and had the severity of their depressive episode assessed by means of the 17-item Hamilton Rating Scale for Depression. All patients filled out the TEMPS-A, a validated instrument. RESULTS: Temperament differences between bipolar and MDD patients were examined using MANCOVA. Overall significant effect of the fixed factor (bipolar vs. unipolar) was noted for the temperament scores [Hotelling's F((5,142)) = 2.47, p < 0.05]. Overall effects were found for age [F((5,142)) = 2.40, p < 0.05], but not for gender and severity of depression [F((5,142)) = 1.65, p = 0.15 and F((5,142)) = 0.66, p = 0.66, respectively]. Dependent variables included the five subscales of the TEMPS-A, but only the cyclothymic temperament scores showed significant between-group differences. LIMITATION: Small bipolar subsample cell sizes did not permit to test the specificity of the findings for bipolar II vs. bipolar I patients. CONCLUSION: The finding that the clyclothymic subscale is significantly elevated in the bipolar vs. the unipolar depressive group supports the theoretical assumptions upon which the scale is based, and suggests that it might become a useful tool for clinical and research purposes.     

Effects of self-esteem on state and trait components of interpersonal dependency and depression in the workplace

This longitudinal study was undertaken to clarify the relationships among self-esteem, interpersonal dependency, and depression, focusing on a trait and state component of interpersonal dependency and depression. In a sample of 466 working people, self-esteem, interpersonal dependency, job stressor, and depression were assessed at 2 points of time. A structural equation model (SEM) was created to differentiate the trait component of interpersonal dependency, depression and the state component of interpersonal dependency, depression. The model revealed that self-esteem influenced trait interpersonal dependency and trait depression but not state interpersonal dependency or depression. Setting a latent variable as a trait component to differentiate trait and state in interpersonal dependency and depression in SEM was found to be effective both statistically and clinically.     

The Danish PET/depression project: PET findings in patients with major depression.

BACKGROUND: It is hypothesized from previous positron emission tomography (PET) studies of patients with major depression that dysfunction of regions of the limbic system and the frontal lobes in close connection with the basal ganglia is involved in the pathophysiology of major depression. METHODS: By means of PET and 15O labelled radioactive water we determined an index of the neuronal activity by mapping the cerebral blood flow distribution of 42 unselected in-patients suffering from moderate to severe depression and 47 healthy controls controlling for age and gender. The PET maps were co-registered to magnetic resonance images of the anatomy of the brain. RESULTS: The functions-of-interest analysis revealed significant gender differences in cerebral blood flow and changes in the relative distribution of the blood with increasing age. The patients had increased activity of the hippocampus and the cerebellum compared to the healthy controls when corrected for these confounders and the influence of antidepressant medication. Furthermore, data in the Danish Psychiatric Central Register showed that the patients studied were representative of the population of depressed patients admitted to the hospital during the study period. CONCLUSION: Our main finding is increased blood flow to the hippocampus, even when controlling for a number of confounders. This is in accordance with a rapidly expanding literature suggesting an important role for this structure in major depression.