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Background: In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients.Methods: A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively.Results: In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1-7.2).Limitations: The sample was relatively small, and their educational level was very low.Conclusion: A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials. [ABSTRACT FROM AUTHOR]

Objective: Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS.Method: Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up.Results: Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period.Limitations: RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident.Conclusion: There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms. [ABSTRACT FROM AUTHOR]

Background Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carry significant burden in the clinical management of bipolar depression, whereas the use of antidepressants raises both efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlates of TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients. Methods Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-II depressed outpatients exposed to antidepressants. Results Second-generation antipsychotics (SGA) (p = .005), lithium (≤ .001), cyclothymic/irritable/hyperthymic temperaments (p = ≤ .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and depressive mixed features (p = .003) differed between TEM + cases vs. TEM − controls. Upon multinomial logistic regression, the accounted psychopathological features correctly classified as much as 88.6% of TEM + cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns]. Specifically, lithium [B = − 2.385; p = .001], SGAs [B = − 2.354; p = .002] predicted lower rates of TEM + in contrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixed features did not [B = 1.267; p = ns]. Limitations Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias and Berkson's biases. Permissive operational criterion for TEM. Relatively small sample size. Conclusions Cyclothymic temperament and mixed depression discriminated TEM + between TEM − cases, although only lithium and the SGAs reliably predicted TEM +/− grouping. Larger-sampled/powered longitudinal replication studies are warranted to allow firm conclusions on the matter, ideally contributing to the identification of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiological studies suggest that cyclothymic disorder is the most prevalent subtype of bipolar disorder (BD). However, it is rarely diagnosed, especially in youth. This may be because it can be difficult to ascertain whether a youth meets diagnostic criteria. Clearer, easy-to-apply criteria could reduce misdiagnosis. The objective oftable this study was to determine whether proposed research diagnostic criteria for cyclothymic disorder (RDCyc), based on DSM-5 criteria, could be quantified and validated in youth.Methods: Participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study were recruited based on symptoms of mania and followed prospectively. RDCyc criteria were: 1) At least one core symptom each of mania and depression; 2) one additional symptom of mania and of depression; 3) persistence over two consecutive six-month periods, and 4) impairment. Exclusionary criteria were having a [hypo]manic or depressive episode. Outcomes at the two-year follow-up were compared between RDCyc youth and other diagnostic groups (BD I/II, BD NOS/non-RDCyc cyclothymic disorder, disruptive behavior disorders [DBD], depression).Results: Thirty-seven youth met RDCyc criteria. There were no consistent differences between the RDCyc youth and youth with other BD subtypes (ps=0.001-0.960, with all-but-one p value >0.02). RDCyc youth had higher depression (p<0.0005) and mania scores (p=0.001), lower functioning (p=0.012), and higher suicide risk than DBD youth (p=0.001). They had higher mania scores than depressed youth (p.018).Limitations: The majority of youth in the sample were recruited due to elevated symptoms of mania, which may limit the generalizability of the results. Youth were followed for two years, which may not be long enough to determine whether or not they will eventually develop a manic or depressive episode.Conclusions: Applying RDCyc criteria identified youth who were similar to others with BD and were more impaired than those with DBD. Using these criteria could reduce misdiagnosis and increase our understanding of this prevalent, but largely ignored, diagnosis. [ABSTRACT FROM AUTHOR]

Background: This study intended to determine whether certain traits of temperament are associated with former and current ADHD symptomatology in a non-clinical sample of 18 year old males.Methods: We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a socio-demographic questionnaire, screening for substance abuse, temperament (TEMPS-M), past (WURS) and current (ADHD symptom checklist) ADHD symptomatology.Results: We found a correlation of cyclothymic (p<.001), irritable (p<.001) and anxious (p<.05) temperament with occurrence and severity of past and present ADHD symptomatology. No significant correlation has been detected for hyperthymic and depressive temperament. Judged retrospectively, ADHD symptoms were strongly consistent over time.Limitations: The sample consists of men only. These had to be fit enough to be enlisted for military service; men with severe mental or physical disorders were thus excluded. Furthermore, the cross-sectional study design does not allow making conclusions about the temporal relationships between ADHD symptoms and substance misuse.Conclusions: These results indicate that a temperament based approach towards those affected by ADHD might be useful. Subtyping ADHD by integrating temperament profiles in diagnosis and treatment of the disorder could help explain some of the heterogeneity of the disease. [ABSTRACT FROM AUTHOR]

Background: We recently demonstrated in the structural equation modeling that four of five affective temperaments, as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire version (TEMPS-A), are strong mediators between childhood abuse and depressive symptoms in the nonclinical general adult population. In this study, we hypothesized that affective temperaments, childhood abuse, and adult life events have moderator effects that interact with one another on depressive symptoms. The hierarchical multiple regression analysis was used to analyze this interaction model.Methods: The 286 participants from the nonclinical general adult population were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), Life Experiences Survey (LES), TEMPS-A, and Child Abuse and Trauma Scale (CATS). The data were analyzed using hierarchical multiple regressions with interactions.Results: Depressive temperament enhanced and hyperthymic temperament inhibited the depressogenic effects of childhood abuse, while irritable temperament enhanced and hyperthymic temperament inhibited the depressogenic effects of adult negative (stressful) life events. Adult positive life events had an inhibitory moderator effect on depressive symptoms that was increased by cyclothymic and anxious temperaments. Neglect, punishment, and total childhood abuse enhanced the effects of negative life events on depressive symptoms.Limitations: As the subjects of this study were nonclinical, the findings should not be generalized to patients with mood disorders. In this cross-sectional study, there may be interdependence between the measured variables.Conclusions: This study, using the hierarchical multiple regression analysis with interaction, demonstrated the positive and negative interactions between any two of affective temperaments, childhood abuse, and adult life events, and the influence on depressive symptoms in the nonclinical general adult population. Important moderator roles for affective temperaments, childhood abuse, and adult life events on depressive symptoms were suggested. [ABSTRACT FROM AUTHOR]

Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities. [ABSTRACT FROM AUTHOR]

Objective Learning more about how biological traits, like temperament and sensitivity in the behavioral inhibition (BIS) and behavioral activation (BAS) systems, relate to mood pathology is consistent with the Research Domain Criteria initiative׳s goal of investigating mechanisms of risk. Method Korean young adults ( n =128) and American young adults ( n =630, of whom 23 has recent treatment for bipolar disorder, and 21for depression) completed self-report questionnaires, including the TEMPS-A, the BIS/BAS scales, Beck Depression Inventory (BDI), and Hypomanic Checklist (HCL-32). Linear regression quantified relations between mood symptoms, sample characteristics, temperament, and BIS/BAS. Results Temperament styles explained 49% of the variance in BDI scores. BIS explained an additional 1% of the variance in BDI scores. BAS Fun and Reward ( p <.01), in addition to cyclothymic and hyperthymic temperaments ( p <.001) explained 21% of the variance in HCL-32 scores. Sample characteristics were not significant predictors in the full model. Limitations Differences in sample size, the cross-sectional study design, and lack of collateral report or behavioral measures of constructs are limitations. Conclusions Affective temperament and BIS/BAS are complementary but distinct constructs. Affective temperament, particularly cyclothymic, may represent a stronger diathesis for mood pathology, and seems potent irrespective of culture or diagnosis. Assessing temperament may help overcome some challenges in diagnosing mood disorders. [ABSTRACT FROM AUTHOR]

Background Recently, we reported a significantly negative association of cyclothymic temperament scores with activations of the left lingual gyrus during esthetic judgments of paintings, suggesting that cyclothymic temperament may be associated with the left lingual gyrus. In view of potential associations of cyclothymic temperament, bipolar disorder and dementia, this study examined the relationship of temperament to lingual gyrus activity using a working memory task as a new context. Methods N -back tasks (0-, 1-, 2- and 3-back tasks) were performed on 34 healthy subjects using functional MRI. Multiple regression analyses were applied to measure the association between cyclothymic temperament scores and each of 4 beta images corresponding to 0-, 1-, 2- and 3-back tasks with gender, age and the other temperament scores (depressive, hyperthymic, irritable and anxious) as covariates. Results The whole brain analysis corrected for multiple comparisons revealed a significant activation of the left lingual gyrus associated with cyclothymic temperament scores in a new context—working memory for both 2- and 3-back tasks. Limitations The number of subjects was relatively small. The subjects were almost medical staff or students and the results should be interpreted with caution. Conclusions The present findings reconfirm that cyclothymic temperament may be associated with the left lingual gyrus. [ABSTRACT FROM AUTHOR]

Background Patients with bipolar disorder (BD) suffer from greater physical morbidity and mortality than the general population. The aim of the present study is to explore the prevalence and clinical correlates of General Medical Conditions (GMC) in a large consecutive sample of patients with BD. Method The study sample comprised of 347 patients who met DSM-IV -TR criteria for BD I ( n =207, 59.7%), BD II or Cyclothymic Disorder ( n =140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders – Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (MD) and without (No-MD) Metabolic Diseases (MD) and patients with (AAD) and without (No-AAD) Autoimmune-Allergic Diseases (AAD). Results The most commonly reported GMCs were: Headache, Hypercholesterolemia (>200 mg/dl), Chronic Constipation, Obesity, Arterial Hypertension (BP >140/90 mmHg), Hypothyroidism, Allergic Rhino-Conjunctivitis, Irritable Bowel Syndrome, Hypertriglyceridemia (>150 mg/dl), Metabolic Syndrome, Hiatus Hernia, Dysmenorrhea, Urticaria, Atopic Dermatitis, Psoriasis, Seborrheic Dermatitis, Diabetes Mellitus, Bronchial Asthma, Cardiac Arrhythmias, Biliary Lithiasis, and COPD. In our sample, MD ( n =148, 42.7%) and AAD ( n =167, 48.1%) were the most common categories of GMCs. Interestingly, the lifetime prevalence of cancer and neoplastic diseases was very low: 1 patient (.3%) reported Lung Adenocarcinoma and 2 (.6%) patients Bowel Cancer. In the group comparisons, length of pharmacological treatment (OR=1.054; 95% CI=1.030–1.078), age at onset of first major episode (OR=1.043; 95% CI=1.019–1.067), length of the current episode (OR=1.025; 95% CI=1.020–1.533) and absence of lifetime comorbid substance abuse (OR=.373; 95% CI=.141–.989) were statistically associated with the presence of comorbid MD; while only AD-induced hypomania (OR=1.62; 95% CI=1.011–2.597), and cyclothymic temperament (OR=1.051; 95% CI=1.016–1.087) were statistically associated with the presence of comorbid AAD. Limitations Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation. Conclusion MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the “systemic” nature of mood disorders and a promising target for future treatment options. [ABSTRACT FROM AUTHOR]

Background There is evidence that patients with bipolar disorder (BD) score higher on affective temperament ratings compared to healthy controls (HCs). Moreover, unaffected relatives demonstrate similar patterns as BD patients suggesting that such temperaments are related to the genetic risk for BD and may serve as endophenotypes for the disorder. It is unknown whether affective temperaments are associated with other core features of BD, such as impairments in neurocognition. This study examined the relationship between affective temperaments and neurocognition in patients with BD and in HCs. Methods Temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire version (TEMPS-A) in 64 patients with BD and 109 HCs. Neurocognitive functioning was evaluated using the MATRICS Consensus Cognitive Battery (MCCB). Correlational analyses between temperaments and cognition were conducted in BD and HC subjects. Results Data suggest that affective temperaments and neurocognition are correlated. In BD higher ratings of cyclothymia and irritability were associated with better processing speed, working memory, reasoning and problem-solving. In the HC group, increased irritability was related to worse performance on measures of attention and social cognition. Limitations Lack of functional outcome measures to evaluate the impact of temperaments and cognition on psychosocial functioning. It would be useful to test these findings on unaffected relatives of BD patients. Conclusions Cyclothymic and irritable temperaments are correlated with specific aspects of neurocognition in BD. This study is among the few exploring the dimensional relationship between temperaments and cognition in BD, and provides preliminary evidence for future studies investigating the neural and genetic mechanisms underlying the association between these variables. [ABSTRACT FROM AUTHOR]

Background There is a well-known association between artistic creativity and cyclothymic temperament but the neural correlates of cyclothymic temperament have not yet been fully identified. Recently, we showed that the left lingual gyrus and bilateral cuneus may be associated with esthetic judgment of representational paintings, we therefore sought to investigate brain activity during esthetic judgment of paintings in relation to measures of cyclothymic temperament. Methods Regions of interest (ROI) were set at the left lingual gyrus and bilateral cuneus using automated anatomical labeling, and percent signal changes of the ROIs were measured by marsbar toolbox. The associations between percent signal changes of the ROIs during esthetic judgments of paintings and cyclothymic temperament scores were investigated by Pearson׳s coefficient. Moreover, the associations were further analyzed using multiple regression analysis whereby cyclothymic temperament scores were a dependent factor and percent signal changes of the 3 ROIs and the other 4 temperament scores were independent factors. Results There was a significantly negative association of cyclothymic temperament scores with the percent signal changes of the left lingual gyrus during esthetic judgments of paintings, but not with those of bilateral cuneus. Even after adjustment using multiple regression analysis, this finding remained unchanged. Limitations The number of subjects was relatively small and the task was limited to appreciation of paintings. Conclusions The present findings suggest that cyclothymic temperament may be associated with the left lingual gyrus. [ABSTRACT FROM AUTHOR]

Background Recent studies indicate that choice of profession is related to differences in affective temperament, which is probably due to various predispositions needed to efficiently perform particular professions. The aim of the present study was to assess affective temperament and executive functions in a sample of emergency medicine professionals. Methods 75 emergency medicine professionals were enrolled in the study. Affective temperament was assessed by means of TEMPS-A. Executive functions were assessed by means of Trail Making Test and Stroop Color Word Interference Test. Results Subjects showed significantly higher rates of hyperthymic, compared to depressive, cyclothymic, irritable and anxious temperaments. The principal component analysis revealed that hyperthymic temperament contributes to a different factor, than the remaining ones. Higher rates of depressive, cyclothymic, irritable and anxious temperaments were related to poorer performance in Trail Making Test, whereas hyperthymic temperament had the opposite effect. Limitations Due to the size of the sample, results of the present study may have lacked power to show all the relationships between tested variables. Conclusions Hyperthymic temperament promotes efficient performance of complex tasks under time pressure. Depressive, cyclothymic, irritable and anxious temperaments have the opposite effect. This makes hyperthymic temperament a desirable trait in emergency medicine professionals, performing complex medical tasks under extreme conditions. [ABSTRACT FROM AUTHOR]

Background Comorbidity between ADHD and Bipolar Disorder (BD) is associated with greater severity of BD. The current study aims at investigating, in a specialized mood disorders clinic, the percentage of comorbid ADHD-BD subjects and assessing the impact of ADHD on the severity of BD. Methods Out of 539 mood disorders subjects, the medical records of 138 BD subjects were scrutinized in terms of their clinical and demographic characteristics, and their scores at the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist were logged. Those positively scoring at the ASRS-v1.1 underwent clinical assessment by a senior psychiatrist specialized in ADHD. Comorbid ADHD-BD subjects were then compared with BD sufferers without ADHD. Results Sixty-three (45.65%) of the participants were screened positive at the ASRS-v1.1. 49 were clinically assessed for the presence of ADHD. Only 27 (55%) received a diagnosis of ADHD. Comorbid ADHD-BD subjects were found to be younger at the onset of BD, showed higher numbers of depressive episodes, more anxiety and substance use disorders, more borderline personality traits and greater cyclothymic temperament. Comorbid BD-ADHD subjects reported more childhood emotional abuse. Limitations Some subjects were unreachable and thus not clinically assessed for ADHD. Conclusions More than 20% of BD subjects were suffering from ADHD. The comorbidity of the two disorders was associated with worse outcomes, possibly resulting from stressful early-life events. More than 40% of the subjects who scored positively at the ASRS-v1.1 did not suffer from ADHD, which suggests that this scale should be used with caution in BD subjects. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The first aim of this study is to investigate the impact of different temperaments in opiate dependency patients. The second aim of this study is to define therapy relevant subgroups in opiate addiction for further basic clinical research and therapy. Methods: In the time period from September to November 2010, 101 patients (72 males and 29 females) which fulfilled the diagnosis of opiate dependency according to DSM-IV-TR were recruited consecutively. All patients were in treatment at the Oum El Nour rehabilitation center/Lebanon (Inpatient and Outpatient groups). Lesch Alcoholism Typology modified for assessment of opiate addicts, and the briefTEMPS-M, Arabic version were used. Results: The organic Type IV group was the most prevalent (48.5%) among the sample followed by the Affective Type III group (41.6%) and the minority represented the two other types (I & II). The organic Type IV group represented the major type in the cyclothymic and anxious temperament. In the contrary the other two groups (I & II) were the minority among the cyclothymics. [Copyright &y& Elsevier]

Abstract: Background: Affective temperaments are presumed to underlie bipolar psychopathology. The TEMPS-A has been widely used to assess affective temperaments in clinical and non-clinical samples. Cross-sectional research supports the association of affective temperaments and mood psychopathology; however, longitudinal research examining risk for the development of bipolar disorders is lacking. The present study examined the predictive validity of affective temperaments, using the TEMPS-A, at a three-year follow-up assessment. Methods: The study interviewed 112 participants (77% of the original sample) at a three-year follow-up of 145 non-clinically ascertained young adults psychometrically at-risk for bipolar disorders, who previously took part in a cross-sectional examination of affective temperaments and mood psychopathology. Results: At the reassessment, 29 participants (26%) met criteria for bipolar spectrum disorders, including 13 participants who transitioned into disorders during the follow-up period (14% of the originally undiagnosed sample). Cyclothymic/irritable and hyperthymic temperaments predicted both total cases and new cases of bipolar spectrum disorders at the follow-up. Cyclothymic/irritable temperament was associated with more severe outcomes, including DSM-IV-TR bipolar disorders, bipolar spectrum psychopathology, major depressive episodes, and substance use disorders. Hyperthymic temperament was associated with bipolar spectrum psychopathology and hypomania, whereas dysthymic temperament was generally unassociated with psychopathology and impairment. Limitations: The present sample of young adults is still young relative to the age of onset of mood psychopathology. Conclusions: These results provide the first evidence of the predictive validity of affective temperaments regarding risk for the development of bipolar psychopathology. Affective temperaments provide a useful construct for understanding bipolar psychopathology. [Copyright &y& Elsevier]

Abstract: Background and aims: This study represents the standardisation of the Serbian version of the TEMPS-A scale on non-clinical adult population, as well as external validation with TCI-R scale of temperaments which has already been evaluated on Serbian population. Methods: The TEMPS-A has been administered to 570 healthy adults without histories of mental disorders, 47% male, 53% female, aged between 20 and 76 (M=35.55; SD=14.14). In line with the state census data, the sampling was partially stratified according to gender, age categories, education and regional area of the participants. Results: In contrast to many other studies, six factors were extracted herein, including 41 items with loadings above .50, explaining 44.40% of the total variance. The internal consistency of the scale was α=.83, and the average test–retest coefficient (rho=.82) indicates a stable reliability. The highest positive correlations were obtained between the depressive and cyclothymic scales, depressive and anxious scales, and cyclothymic with anxious scales. The highest values were detected on hyperthymic and the lowest on depressive temperament. The highest positive correlations were reported between harm avoidance (measured by the TCI-R) and depressive, anxious, cyclothymic temperament, and between novelty seeking and hyperthymic temperament. The highest negative correlation was detected between harm avoidance and hyperthymic. Finally, females scored higher on depressive, cyclothymic and anxious, while males scored higher on hyperthymic temperament. Limitations: The participants׳ educational background was slightly higher than that of the general population of Serbia. Since the scale is aimed at its administration in clinical population as well, it is necessary that its structure and validity be also tested on specific clinical subpopulations in the future. Conclusions: The current study is significant in having confirmed that the TEMPS-A can be reliably and validly used in identifying affective temperaments in the adult nonclinical population in Serbia, which provides the basis and norms for future comparisons with clinical subpopulations. [Copyright &y& Elsevier]

Abstract: Background: Affective temperaments such as cyclothymic and hyperthymic temperaments have been regarded as potential antecedents of bipolar disorder but the neural substrates underlying these temperaments have not been identified. The aim of this study is to determine whether these temperaments are associated with specific neural substrates in regional brain morphology in healthy subjects. Methods: We conducted a cross-sectional neuroimaging study of 60 healthy subjects (30 males and 30 females) with affective temperaments. All participants underwent the Mini-International Neuropsychiatric Interview (MINI) to screen for the past and present psychiatric disorder. The scores of cyclothymic and hyperthymic temperaments were measured by the Temperament Scale of Memphis, Pisa, Paris and San Diego-Autoquestionnaire. We analyzed the association between voxel-based morphometry of the brain and these affective temperaments. Results: Subjects classified as having high cyclothymic scores had a significantly larger gray matter volume of the left medial frontal gyrus (MFG) than low cyclothymic subjects. High hyperthymic males also had significantly larger gray matter volume of the left MFG than low hyperthymic males, but there was no difference in females. Subjects with both high cyclothymic and high hyperthymic temperaments demonstrated significantly larger gray matter volume of the left MFG than their counterparts. Region of interest analysis revealed that peaks of these clusters showed a significant positive correlation of the regional volume with temperament scores. Limitations: The subjects were relatively young and the number was relatively small. Due to the nature of a cross-sectional research design, we could not determine the causal relationship between temperament and the volume changes. Conclusions: These findings suggest that cyclothymic and hyperthymic temperaments in healthy subjects may have their morphological basis in the left MFG. [Copyright &y& Elsevier]

Abstract: Background: The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. Methods: A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. Results: Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. Limitations: Correlational study Conclusions: CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype. [Copyright &y& Elsevier]

Abstract: Background: The Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Autoquestionnaire (TEMPS-A) is a widely used self-reported tool aimed at measuring the affective temperaments that define the bipolar spectrum, with cyclothymic, depressive, irritable, hyperthymic, and anxious subscales. Confirmatory factor analysis (CFA) was rarely used to confirm the expected five-factor model. Measurement invariance was never tested. Methods: Cross-sectional, survey design involving 649 Italian college students (males: 47%). The short 39-item TEMPS-A and the 12-item General Health Questionnaire (GHQ-12) were used as measures of the affective temperaments and of psychological distress, respectively. CFA was applied to the TEMPS-A. Measurement invariance by gender, age and levels of psychological distress on the GHQ-12 was calculated with the establishment of subsequent equivalence constraints in the model parameters across groups. Results: The expected five-factor model had the best fit for all CFA indexes. Configural, metric and scalar invariance of the five-factor model of the TEMPS-A was proved across gender, age and levels of psychological distress of the participants. The hyperthymic temperament subscale has low or no links with the other affective temperament subscales, which were interrelated with medium to large effect sizes. Limitations: College students might be not representative of the general population. No information on the clinical status of the students was available beyond self-report data. Conclusion: The study proved the measurement invariance of the (short) TEMPS-A, which is a pre-requisite to compare groups or individuals in cross-sectional and longitudinal surveys. Generalizability cannot be assumed without replication of the findings in clinical samples. [Copyright &y& Elsevier]

Abstract: Background: Current models theorize that affective temperaments underlie the development and expression of mood psychopathology. Recent studies support the construct validity of affective temperaments in clinical and non-clinical samples. However, one concern is that affective temperaments may be describing characteristics that are better captured by models of normal personality. We conducted two studies examining: (a) the association of affective temperaments with domains and facets of normal personality, and (b) whether affective temperaments accounted for variance in mood symptoms and disorders, impairment, and daily-life experiences over-and-above variance accounted for by normal personality. Methods: Study 1 included 522 young adults who completed the TEMPS-A and the NEO-PI-3. Study 2 included 145 participants who were administered the TEMPS-A, NEO-FFI, interviews assessing psychopathology and impairment, and an assessment of daily life experiences. Results: Study 1 revealed that personality domains and facets accounted for one-third to one-half of the variance in affective temperaments. However, study 2 demonstrated that affective temperaments accounted for unique variance in measures of psychopathology, impairment, and daily-life experiences after partialling variance associated with personality domains. Specifically, cyclothymic/irritable temperament predicted bipolar disorders, impairment, borderline personality traits, urgency, and anger in daily life. Hyperthymic temperament predicted hypomanic episodes, grandiosity, sensation seeking, and increased activity in daily life. Limitations: The study was limited by the fact that only domain, not facet-level, measures of FFM were available in study 2. Conclusions: The findings support the validity of hyperthymic and cyclothymic/irritable temperaments as indicators of clinical psychopathology and indicate that they provide information beyond normal personality. [Copyright &y& Elsevier]

Abstract: Background: Treatment adherence (TA) is crucial during almost any phase of bipolar disorder (BD), including type-II (BD-II) acute depression. While a number of issues have been traditionally accounted on the matter, additional factors should be likewise involved, including affective temperaments and some clinically suggestive psychopathological traits whose systematic assessment represents the aim of this study. Methods: Two hundred and twenty BD-II acute depressed outpatients were consecutively evaluated using the Structured Clinical Interviews for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition Axis-I and II Disorders, Hamilton scales for Depression and Anxiety, Temperament Evaluation of the Memphis Pisa Paris San Diego-Auto-questionnaire-110-item, Visual Analogue Scale (VAS), Zuckerman's Sensation-Seeking Scale-Form-V (SSS-V), Barratt's Impulsivity Scale-11-item, State-Trait Anxiety Inventory modules, Severity module of the Clinical Global Impression Scale for BD, Morisky 8-Item Medication Adherence Scale (MMAS-8) and the Clinician Rating Scale (CRS). Patients were divided into non-adherent vs. treatment-adherent cases depending on MMAS-8+CRS scores. Results: In the TA− group, higher VAS and cyclothymic temperament scores were highly correlated (r=.699; p≤.001). Those latter scores, along with SSS-V scores and the occurrence of lifetime addiction to painkiller and/or homeopathic medications available over the counter defined a “therapeutic sensation seeking” pattern allowing to correctly classify as much as 93.9% [Exp(B)=3.490; p≤.001] of TA− cases (49/220). Limits: Lack of objective TA measures and systematic pharmacological record; recall bias on some diagnoses; and relatively small sample size. Conclusions: Stating the burden of TA in BD, additional studies on this regard are aimed, ideally contributing to enhance the management of BD itself. [Copyright &y& Elsevier]

Abstract: Background: It is generally accepted that a range of factors affect adherence to psychotropic medications. In the present study, we focused on the influence of affective temperaments (i.e., depressive, hyperthymic, cyclothymic, irritable, and anxious temperaments) on treatment adherence. Methods: Thirty-eight psychiatric consecutive inpatients were instructed to perform Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire version (TEMPS-A) for affective temperaments, Drug attitude inventory-10 (DAI-10) for concordance and persistence, and Visual Analogue Scale (VAS) for compliance. Results: VAS scores for dose compliance were significantly and negatively associated with irritable temperament scores whereas DAI-10 scores were significantly and positively associated with male gender, depressive temperament scores and hyperthymic temperament scores. Limitations: The main limitations of the study were the relatively small number of subjects and the lack of objective method of adherence. Conclusions: These findings suggest that patients with irritable temperament may be poor in their compliance with treatment, and that more education may be required for patients with irritable temperament in order to maintain good compliance. In contrast, men and patients with depressive or hyperthymic temperament have a relatively positive attitude towards medication. [Copyright &y& Elsevier]

Abstract: Background: Consistently with the involvement of affective temperaments in professional choices, our research team is aiming to outline the temperamental profile of subjects who are applying to enter a military career in the Italian Armed Forces. In this study we aim to verify the importance of temperamental traits not only in choosing the military career as a profession, but also in passing or failing the entrance examinations. Methods: We compared the affective temperaments (evaluated by TEMPS-A[P]) of those applying to become a cadet officer in the Italian Navy, divided into various subgroups depending on whether they passed or failed the entrance examination at various levels (high school final test, medical (physical and psychiatric), mathematical examination and aptitude test). We also tested for correlations between grades received and temperamental scores. Results: Higher scores for those with a hyperthymic and lower scores for those with a depressive, cyclothymic or irritable temperament characterized applicants taking medical exams and aptitude tests. Higher scores on the high school final test correlated with lower hyperthymic, cyclothymic and irritable temperament scores. No correlations were found between temperamental traits and mathematical examinations. Multivariate analysis stressed the negative impact of a cyclothymic temperament and the poor discriminant power of temperaments regarding medical and mathematical examinations, and aptitude tests. Conversely, temperaments showed good discriminant power as far as psychiatric examinations are concerned. Conclusions: Hyperthymic temperamental traits appear to be important not only in choosing a profession, but also in passing entrance examinations. Even so, affective temperaments (strong hyperthymic and weak cyclothymic, depressive and irritable traits) are the only successfully predictors of the outcome of psychiatric examinations and, to a lesser extent, medical examinations and aptitude tests. Achieving high school graduation and passing mathematical exams are independent of temperamental traits. [Copyright &y& Elsevier]

Abstract: Background: Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients. Methods: Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide. Results: We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales. Limitations: In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study. Discussion: We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour. [Copyright &y& Elsevier]

Abstract: Background: High levels of sensation seeking (SS) have been traditionally reported for lifetime bipolar disorder (BD) and/or substance use disorder (SUD) rather than major depressive disorder (MDD). Nonetheless, a renewed clinical attention toward the burden of sub-threshold bipolarity in MDD, solicits for a better assessment of “unipolar” major depressive episodes (MDEs) via characterization of putative differential psychopathological patterns, including SS and predominant affective temperament. Methods: Two hundred and eighty currently depressed cases of MDD and 87 healthy controls were screened using the Zuckerman's sensation seeking scale-Form-V, the Hypomania Check List-32-item (HCL-32), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire-110-item, the Barratt Impulsivity Scale-11-item, the State–Trait Anxiety Inventory modules and the Structured Clinical Interview for DSM-IV axis-I disorders. Cases were divided into HCL-32+(sub-threshold bipolar)/HCL-32−(“true” unipolar depressed) depending on the HCL-32 total score. Results: Upon correlation and multivariate regression analyses, the HCL-32+ patients showed the highest levels of SS, higher prevalence of cyclothymic temperament, and higher rates of multiple lifetime axis-I co-morbidities, including SUD. Limits: Recall bias on some diagnoses, including BD, grossly matched healthy control group, lack of ad-hoc validated measures for ADHD, SUD, or axis-II disorders. Conclusions: In our sample, the occurrence of higher levels of SS in “sub-threshold” bipolar cases outlined a differential psychopathological profile compared to DSM-defined “true unipolar” cases of MDE. If confirmed by replication studies, these findings may aid clinicians in delivering a more accurate diagnosis and a safer use of antidepressants in some MDD cases. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: Background: The affective temperament profiles among patients with mood disorders may be an important parameter in the clinical evaluation of these patients. It has been proposed that temperament traits have familiality and may represent vulnerability markers to identify the risk to developing specific clinical type of mood disorders. To test these theories, measures of temperament were examined in bipolar patients (BP), unipolar major depressive patients (UP), healthy relatives of these patients (HRP) and normal controls (NC). Methods: We compared affective temperament scores, using the brief Brazilian version of TEMPS-A—TEMPS-Rio de Janeiro, between 90 BP, 88 UP, 132 HRP and 136 NC. A MANCOVA model was constructed. Dependent variables were the six subscales of the TEMPS-RJ (depressive, cyclothymic, irritable, hyperthymic, anxious and worrying temperaments). The effects of age and gender were adjusted as covariates. Furthermore, we performed a comparison between a subgroup of 68 HRP, relatives of bipolar patients (HRBP), and the remainders 64 HRP, relatives of unipolar patients (HRUP) and controls. Results: The clinical group (BP, UP) showed higher temperament scores than NC, except for hyperthymic scores. BP showed higher cyclothymic (p<0.001), hyperthymic (p<0.001) and lower anxious (p<0.01) temperament scores than UP. HRP showed lower scores than clinical groups. HRBP scored higher cyclothymic subscale than HRUP and NC groups. Limitations: Bipolar I and II subjects were placed in the same group. Conclusions: The cyclothymic and hyperthymic traits were associated with bipolarity in patients and cyclothymic temperament could be a characteristic trait of the healthy relatives of bipolar patients. Our data support that affective temperament might become a useful tool for clinical evaluation and research purposes in mood disorders. [Copyright &y& Elsevier]

Abstract: Background: The primary purpose of this study was to explore whether age differences in the phenomenology of bipolar disorders from 4 to 17 years of age exist. Methods: Outcome measures included questionnaires pertaining to mood symptoms, psychosocial functioning, and family history of psychiatric illness. Phenomenology was examined in two diagnostic groups: syndromal bipolar disorder (bipolar I or II) and subsyndromal bipolar disorder (bipolar disorder not otherwise specified or cyclothymia) and across six age cohorts: 4–6, 7–8, 9–10, 11–13, and 14–17 years. Analyses examined linear and non-linear age effects on clinician-rated measures of mood and psychosocial functioning. Results: Participants were 535 outpatients (339 males) ages 4–17 years. The proportion diagnosed with comorbid ADHD was significantly lower in the oldest age group. Age groups showed significant moderate decreases in motor activity, aggression, and irritability with age. Many symptoms of depression showed significant increases with age. BP I cases showed much higher manic symptoms, and BP I and BP II cases indicated slightly to moderately higher depressive symptoms, compared to subsyndromal cases. These patterns held after adjusting for comorbid ADHD, and age did not interact with syndrome status. There were also age differences in total scores for measures of mood symptoms and psychosocial functioning. Limitations: Mood ratings were completed based on the same interview that informed the research diagnoses. Also, mood episode at time of interview was not captured. Conclusions: These findings affirm the existence of bipolar disorder from pre-school children through adolescence, with a similar clinical presentation across a wide developmental age span. [Copyright &y& Elsevier]

Abstract: Background: The study aimed to identify specific predictors of soft bipolarity (bipolar II disorder or bipolar disorder not otherwise specified) in depressed patients and to evaluate the global predictive performance of combinations of these predictors. Methods: Subjects included 199 patients with a major depressive episode (MDE) due to soft bipolarity or major depressive disorder. Independent predictors of soft bipolar diagnosis were extracted from 12 previously proposed bipolar features using multiple logistic regression analyses, and the global performance of the combination of these predictors was evaluated using a receiver operating characteristic (ROC) curve. Results: Recurrent MDEs, family history of bipolar disorders in first-degree relatives, cyclothymic temperament, early age at onset of first MDE, and depressive mixed state were independent predictors of soft bipolarity diagnosis [odds ratio (95% confidence interval): 11.22 (2.19–57.63), 8.82 (1.31–59.15), 7.32 (2.22–24.19), 6.22 (1.58–24.57), and 5.57 (1.91–16.30), respectively]. The area under the ROC curve for the relationship between soft bipolarity diagnosis and the number of these five predictors in each patient was 0.911 (highly accurate). The presence of one or more predictors in each patient resulted in highest sensitivity (92.5%) and good specificity (73.1%), whereas that of two or more predictors resulted in good sensitivity (70.0%) and highest specificity (97.5%) for soft bipolarity diagnosis. Limitations: Structured/semistructured interviews were not used. Tools for temperament assessments were different between institutions. Conclusions: A combination of these predictors was quite helpful for a precise diagnosis of soft bipolarity in patients with depression. [Copyright &y& Elsevier]

Abstract: Background: The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego) is a 110-item auto-questionnaire (self-rated) which consists of five temperament scales: depressive, cyclothymic, hyperthymic, irritable and anxious temperaments. It has been translated into over 25 languages and validated in at least 12, with broad cross-cultural cogency. This is a first attempt to validate the TEMPS-A in a very large Chinese population speaking Mandarin. Methods: The Chinese TEMPS-A was adapted from the original English version following a rigorous process of forward translation and backward translation (after the approval of the English back translation by H.S.A. and K.K.A.), it was administered to 985 non-clinical Chinese subjects aged between 18–60 years (53.8% female) in four communities in Guangzhou City, China. A subset of 105 subjects was retested approximately six weeks later. Standard psychometric tests of reliability and validation were performed. Results: The test–retest reliability for depressive (0.74), cyclothymic (0.71), hyperthymic (0.67), irritable (0.66) and anxious (0.83) were respectively as shown in the parentheses. For internal consistency, Chronbach alphas coefficients were 0.68, 0.85, 0.82, 0.83 and 0.87, respectively. Exploratory factor analysis revealed 2 super factors, Factor I loading on anxious, cyclothymic, irritable, and depressive temperaments; and Factor II loading on hyperthymic. Depressive, cyclothymic, irritable and anxious temperaments were correlated with each other. Males had significantly higher scores than females for the hyperthymic and irritable temperaments. The prevalence of the dominant depressive (2.9%), cyclothymic (5.6%), hyperthymic (1.3%), irritable (7.0%) and anxious (5.3%) temperaments were respectively as shown in the parentheses. Limitations: Although it is likely that generalizability of our scale is good for the entire Mandarin-speaking ethnic composition of China today, future research is needed to establish this conclusively. Conclusion: The Chinese TEMPS-A standardized on one of the largest non-clinical samples in any of the other national studies to date, has good internal consistency, coheres well with validated versions in other languages. The findings suggest that it is a psychometrically sound instrument to assess affective temperaments in clinical and biological studies in China. [Copyright &y& Elsevier]

Abstract: Background: The Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Questionnaire (TEMPS) has, in its self and rater-wise evaluation form, been designed to evaluate temperamental characteristics in clinical and non-clinical populations. Methods: In this study we aim to extend the field of correlations of TEMPS to include the Occupational Personality Questionnaire, ipsative version (OPQ32i). These correlations, if present, could provide a partial contribute to the validation process of TEMPS, currently in progress in various countries. OPQ32 is a self-report personality questionnaire designed to give information on an individual''s preferred behavior, as assessed in terms of a number of work-related characteristics. In 921 applicants, who were competing to become cadets in the Italian Navy, we assessed, during the entrance examination, the correlations between TEMPS-A[P] and OPQ32i. Results: Depressive temperament implies a low level of ability to relate to others; hyperthymic temperament implies high levels of feelings and emotions, and the capability to relate to people; cyclothymic temperament appears to be distinguished by creativity and a low level of relationships with others; irritable temperament partly overlaps with cyclothymic temperament, the main difference being the higher level of energy and the lower level of empathy of irritable subjects. Conclusions: The four affective temperaments, in our sample, proved to significantly differ in the work capacity features measured by OPQ32 factors. These observed correlations between the two tests partially contributes to the ongoing validation process of TEMPS-A[P]. From a personality standpoint this study further supports the hypothesis that temperaments belong to the realm of normality rather than that of pathology, in line with their putative adaptive role. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: Background: Numerous validation studies have examined the TEMPS-A in both clinical and nonclinical samples. However, the majority of these studies utilized cross-sectional assessments in laboratory or clinical settings. The present study is the first to examine the expression of affective temperaments in daily life using experience sampling methodology (ESM). Methods: 138 participants completed the TEMPS-A and received a personalized digital assistant that signaled them eight times daily for one week to complete questionnaires that assessed affect, cognition, behavior, sense of self, and social interaction. Results: As expected, cyclothymic/irritable temperament was positively associated with negative affect, risky behavior, and restlessness, and was negatively associated with positive affect and preference to be with others in daily life. In contrast, hyperthymic temperament was associated with positive affect, fullness of thought, doing many and exciting things, grandiosity, and preference to be with others in daily life. Dysthymic temperament was modestly associated with worry, and was positively associated with trouble concentrating, fullness of thought, and a preference for social contact. Cross-level interactions indicated that cyclothymic/irritable temperament was associated with elevated stress reactivity in daily life. Limitations: ESM data collection was limited to one week. Longer assessment periods might better capture the cyclical nature of affective temperaments. Conclusions: This was the first study to examine affective temperaments in daily life. The findings offer further validation of the TEMPS-A, as well as the maladaptive nature of the cyclothymic/irritable temperament. [Copyright &y& Elsevier]

Abstract: Background: Temperament appears to be a factor involved in professional attitudes. The most impressive findings are those on the importance of cyclothymia in art and of hyperthymia in leadership. Aim: In this study we raise the issue of whether the relationship between hyperthymic temperament and the choice of a military career, previously reported among Italian Air Force applicants, can be extended to another military service such as the Italian Navy. Methods: We compared temperaments between those who had applied to become a cadet officer in the Italian Air Force or in the Italian Navy, with special reference to gender differences and the ability of the two types of applicants to pass the psychiatric examination for admission that we had recently assessed in the Italian Air Force. Results: Hyperthymic traits were well represented in both these armed services. Navy applicants differed from air-force applicants in obtaining higher depressive, cyclothymic and irritable scores. Navy applicants who passed the psychiatric entrance examination (PEE) showed the same incidence of hyperthymic temperament as their Air Force counterparts, but higher depressive, cyclothymic and irritable scores. Considering gender, among Air Force applicants depressive traits were better represented in males; conversely, among Navy applicants they were better represented in females. If we consider gender together with PEE results, the highest hyperthymic scores were more frequently found among males who passed and females who failed to pass the PEE. On the other hand, a greater number of cyclothymic traits were found in females who passed and males who failed to pass the PEE. Conclusions: It was confirmed that hyperthymic temperament represents the temperamental profile of those who aim to become a cadet officer in the Italian armed forces. This study further supports the idea that hyperthymic traits bring distinct advantages in a professional field, such as a military career, which is closely related to leadership. [Copyright &y& Elsevier]

Abstract: Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adults. Many ADHD patients experience affective symptoms that resemble the cyclothymic temperament trait, which is suggested to be a part of the bipolar spectrum. However, the relationship between adult ADHD and cyclothymic temperament has never been systematically studied. Methods: A sample of 586 clinically diagnosed Norwegian adult ADHD patients and 721 population derived controls responded to the 21-item cyclothymic subscale of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A). Self-reported data on psychiatric symptoms, comorbidity, educational and occupational level, and known comorbidity in family members, including bipolar disorder, was also obtained. Results: The mean TEMPS-A scores were 13.0 for patients and 4.6 for controls (p<0.001), and 71% of the patients compared to 13% of the controls were classified as having a cyclothymic temperament (TEMPS score ≥11 points). Among ADHD patients, cyclothymic temperament was strongly associated with more childhood and adult ADHD symptoms, lower educational and occupational achievements and increased psychiatric comorbidity, including bipolar disorder (10%). In addition, 49% screened positive on the Mood Disorder Questionnaire. Limitations: Although the cyclothymic TEMPS-A scale has been used in clinical settings in Norway for many years, it has not yet been officially validated. Conclusions: Cyclothymic temperament is highly prevalent in adults with ADHD, and this characterises a subgroup of more psychiatrically impaired individuals, possibly reflecting an underlying affective instability with a pathophysiology closer to the bipolar spectrum disorders. [Copyright &y& Elsevier]

Abstract: Background: Growing evidence points to an association of daily light exposure and both mood and mood disorders. In recent studies, we demonstrated that higher illuminance of daytime may be positively associated with hyperthymic temperament while lower illuminance of daytime may be positively associated with cyclothymic temperament. However, it is not possible to determine whether hyperthymic or cyclothymic temperament induces higher or lower illuminance via heliotropism or non-heliotropism or whether higher or lower illuminance induces hyperthymic or cyclothymic temperament via light effects. Methods: In order to elucidate these questions, we sought to compare bipolar temperaments between residents who live in regions with varying levels of sunshine. Japan has 4 large islands —Hokkaido, Honshu, Shikoku, and Kyushu. Sapporo in Hokkaido and Oita in Kyushu located at 43° and 33° of latitude differ significantly in mean yearly sunshine. We investigated the data of 189 subjects (94 from Sapporo and 95 from Oita) including their data of Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A). Results: Multiple regression analyses revealed that latitude (Sapporo or Oita) effect predicted significant variance of hyperthymic temperament, but not of the other temperaments. Limitations: The limitation of the present study was that there was a small but significant difference in age between the subjects of Sapporo and those of Oita. Therefore, we included age in the multiple regression analysis. Second, there were several climate factors other than sunshine which were significantly different between Sapporo and Oita. We cannot exclude these effects completely. Finally, we did not consider other factors such as psychosocial factors which might have affected bipolar temperaments. Conclusions: The present findings suggest that relatively lower latitude (potentially via more sunshine) may induce hyperthymic temperament. [Copyright &y& Elsevier]

Abstract: Background: Previous research has examined the association of affective temperaments, as measured by the TEMPS-A, with DSM bipolar disorders. However, the relation of the TEMPS-A with risk for bipolar disorder remains unclear. The present study examined the association of affective temperaments with psychopathology, personality, and functioning in a nonclinically ascertained sample of young adults at risk for bipolar disorder. Methods: One hundred forty-five participants completed the TEMPS-A, as well as interview and questionnaire measures of psychopathology, personality, and functioning. Results: Cyclothymic/irritable temperament was associated with a range of deleterious outcomes, including mood disorders and impaired functioning. It was negatively associated with agreeableness and conscientiousness, and positively associated with current depressive symptoms, neuroticism, borderline symptoms, impulsivity, and grandiosity. Dysthymic temperament was positively associated with current depressive symptoms, neuroticism and agreeableness, but was unrelated to mood psychopathology. Hyperthymic temperament was associated with bipolar spectrum disorders, hypomania or interview-rated hyperthymia, extraversion, openness, impulsivity, and grandiosity. Limitations: The present study was cross-sectional. Longitudinal studies utilizing the TEMPS-A are needed to better understand the predictive validity of the TEMPS-A for the development of bipolar disorder. Conclusions: Early identification of individuals who fall on the bipolar spectrum may hasten appropriate intervention or monitoring, and prevent misdiagnosis. The TEMPS-A appears to be a useful tool for assessing affective temperaments and bipolar spectrum psychopathology. The results support previous research documenting the association of cyclothymic/irritable temperament with bipolar psychopathology and other negative outcomes. [Copyright &y& Elsevier]

Abstract: Objective: While there is an increasing recognition of the role of subthreshold symptomatology in bipolar disorder, little attention has been dedicated to its only formally acknowledged subtype, cyclothymic disorder. The aim of this investigation was to provide a controlled evaluation of DSM-IV cyclothymic disorder by using a broad assessment strategy geared to subclinical signs. Methods: Sixty-two patients who met the DSM-IV criteria for cyclothymic disorder and did not present comorbidity with other mood disorders, alcohol and drug abuse, and borderline personality disorder and 62 control subjects matched for sociodemographic variables were administered the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), the Clinical Interview for Depression (CID) and the Mania Scale (MAS). Results: In DSM-IV terms, there was an overlap with anxiety disorders in more than half of the cases. About 3 patients out of 4 were found to present with at least one DCPR syndrome (particularly demoralization and irritable mood). Cyclothymic patients displayed significantly higher levels of depressive and anxiety disturbances on the CID, with particular reference to reactivity to social environment. They also had significantly higher scores on the MAS. Limitations: The study was cross-sectional and the sample, because of the exclusion criteria, may not be representative of the clinical populations in psychiatric settings. Conclusion: In our patients with cyclothymia, without comorbidity with major mood disorders, DSM-IV anxiety disorders, psychosomatic clinical syndromes (irritable mood, demoralization) and subclinical symptoms such as reactivity to social environment resulted to be more frequent than in controls. The use of a broad assessment strategy aimed at subclinical symptomatology may help identifying clinical phenomena that cut across the current definition of subthreshold forms of bipolar disorder. [Copyright &y& Elsevier]

Abstract: Background: We sought to examine correlations between clinical validators and temperaments in clinical practice. Methods: We provided the self-report TEMPS-A (50 item long) to 123 consecutive patients seen in the Mood Disorders Program of Tufts Medical Center. Temperament was assessed as cyclothymia, dysthymia, irritable or hyperthymia. Cut-offs were tested using (50%) and (75%) thresholds of affirmative responses, as well as highest percent for dominant temperament. We reported no dominant temperament at 75% cut-off . Multivariate regression modeling was conducted to assess confounding bias. Results: Using clinical and demographic validators, cyclothymia was the most strongly validated temperament, followed by dysthymia and hyperthymia. Irritable temperament did not appear to be valid in this sample. A 75% item endorsement cut-off appeared to identify clinically important temperaments in slightly less than half of this sample. Those without any temperament at 75% cut-off had better prognostic features. 50% cut-off was highly nonspecific, and poorly correlated with diagnostic validators. Conclusions: Affective temperaments correlate with clinical validators, most robustly for cyclothymia. 75% cut-off on the TEMPS may provide a useful categorical definition of abnormal affective temperaments in mood disorders. With that definition, slightly less than one-half of patients with mood disorders have affective temperaments. Those without abnormal affective temperaments have better prognostic features. [Copyright &y& Elsevier]

Abstract: Background: Suicidal behavior is one of the most alarming signs not only in psychiatry, and current major depressive episode is the most frequent medical condition among suicide victims and attempters. The aim of the study was to investigate the relationship between the individual pattern of affective temperaments, non-typical symptoms of depression as measured with the Gotland Scale for Male Depression (GSMD), hopelessness and suicidal behavior in major mood disorder patients. Methods: Participants were 346 adult inpatients (151 men and 195 women) with major mood disorders consecutively admitted to the Department of Psychiatry of the Sant''Andrea University Hospital in Rome, Italy. All the patients were administered the TEMPS-A, the GSMD, and the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI). Results: A Two Step Cluster Analysis procedure, performed to reveal natural groupings within patients'' response set, indicated that there were 2-groups: a cyclothymic–depressive–anxious group and a hyperthymic group. More than 81% of the patients with prevailing cyclothymic–depressive–anxious temperament had mild to severe suicidal risk on the MINI vs. only around 42% of the patients with prevailing hyperthymic temperament. Sixty-four percent of patients with prevailing cyclothymic–depressive–anxious temperament had BHS scores of 9 or higher versus only 13% of patients with prevailing hyperthymic temperament. Also, patients with prevailing cyclothymic–depressive–anxious temperament more likely had higher GSMD than patients with prevailing hyperthymic temperament. Limitations: The correlational nature of the study limits causal conclusions to be drawn. Conclusions: Our results indicate that affective temperament measure along with Gotland Scale for Male Depression could be useful tools in screening and identifying those affective disorder patients who are at higher risk of suicidal behavior. [Copyright &y& Elsevier]

Abstract: Aims: The aim of this study was to assess the impact of temperamental traits in alcohol dependent patients on the course of illness. Methods: The case files of 116 alcohol dependent patients, according to ICD-10 and DSM-IV-TR, were examined retrospectively. All patients were in treatment between 02/08 and 03/09 at the Psychiatric Department of the General Hospital Vienna, either at the alcohol outpatient clinic or the psychiatric ward, which has the treatment focus on alcohol dependence. The brief TEMPS-M auto-questionnaire was used to assess the temperamental distribution. The dimensions of alcohol dependence have been assessed using the Lesch Alcoholism Typology, a computerized structured interview. The potential effect of temperamental scores on various outcomes describing the course of illness is investigated using multi-variable regression models. Results: Cyclothymic score was the only temperament which significantly influenced the age of onset of alcohol abuse and age of onset of alcohol dependence. Backward selection among temperaments exhibits depressive temperament as most important effect regarding the likelihood of suicide-attempts in the patient''s case history and anxious temperament as most important effect regarding having psychiatric treatment focusing on alcohol dependence prior to current in- or outpatient stay. Limitations: The sample size of this study is small compared to the number of investigated outcomes and temperaments. Further, a healthy control group, matched for age and gender, was not available for comparison of the temperament sub-scores. Conclusion: Dominant cyclothymic, but also depressive and anxious temperament, seem to be negative predictors for the course of illness in alcohol dependence. Regarding positive long term outcome specific evidence based medical treatment approaches are needed for these patients. [Copyright &y& Elsevier]

Abstract: Background: The multiple factors likely to influence estimates of the prevalence of bipolar spectrum disorders (BSD) make it difficult to determine its actual prevalence. A systematic review was undertaken to explore the availability and quality of epidemiological data for BSD. This will inform the Global Burden of Disease 2010 study. Methods: Electronic databases searched were Medline, PsycInfo and EMBASE using search terms generated in consultation with a research librarian. Reference lists were searched and experts contacted to obtain articles not identified through the database search. Prevalence data pertaining to point, 6month or 12month prevalence of BSD were sought. Results: The mean pooled prevalence was 0.741% (point) and 0.843% (6/12months). The study region, response rate and diagnostic tool had a significant impact on prevalence estimates but there were no significant differences in prevalence across prevalence types, gender, sample coverage, economic status and bipolar subtype. Little or no prevalence data was apparent for many regions of the world. Also, the entire bipolar spectrum was rarely assessed. Limitations: Although stringent quality assurance methodology was used, controlling for all sources of variability around the pooled prevalence was not possible. Conclusions: This systematic review has made significant contributions to the epidemiological profile of BSD. Prevalence estimates will be used to generate estimates of burden for BSD in the global burden of disease 2010 study. [Copyright &y& Elsevier]

Abstract: Objective: The relationship between anxiety and impulsivity is controversial and not well explored. In a previous study we compared impulsivity, measured by different rating tools, in patients with anxiety disorders vs. healthy controls. In the same sample we now explore the influence of comorbid soft bipolar spectrum disorders on the relationship between anxiety disorders and impulsivity. Method: A sample including 47 subjects with anxiety disorder(s) and 45 control subjects matched for demographic, educational and work characteristics underwent a diagnostic evaluation by the Mini Neuropsychiatric Interview (MINI); a symptomatological evaluation by the Bech–Rafaelsen Depression and Mania Scale (BRDMS), the State–Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); a temperamental and personological evaluation by the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego—Modified (TEMPS-M), the Separation Anxiety Symptoms Inventory (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI); and, finally, a psychometric and a neuro-cognitive evaluation of impulsivity by the Barratt Impulsiveness Scale (BIS) and the Immediate and Delayed Memory Task (IMT/DMT). The initial sample of patients with anxiety disorders was then subdivided into two subgroups depending on the presence of comorbid cyclothymia (Cyclo+, n=26 and Cyclo−, n=21). For the diagnosis of cyclothymic disorder, we used both the DSM-IV-TR criteria and also a modified threshold for hypomania with a duration of 2days. We compared symptomatological, temperamental, personological and impulsivity measures in Cyclo+, Cyclo− and controls. Results: The comparison between Cyclo+, Cyclo− and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by greatest symptomatological impairment, highest scores in temperamental scales, and highest levels of interpersonal sensitivity and separation anxiety. Cyclo− subjects resulted to be more impulsive compared to controls concerning the retrospective trait measures, but not in the neuro-cognitive test. Limitations: Correlational cross-sectional study. Conclusion: In our patients with anxiety disorders, without lifetime comorbidity with major mood episodes, trait and state impulsivity resulted to be greater than in controls. In particular impulsivity was highest in patients with both anxiety disorders and cyclothymia. In anxious–cyclothymic patients also separation anxiety and interpersonal sensitivity were more severe than in anxious patients without cyclothymia and controls. Our findings suggest that impulsivity, rather than being directly related to the presence of the anxiety disorder, could be associated with comorbidity with cyclothymia. [Copyright &y& Elsevier]

Abstract: Background: Several studies indicate a specific relationship between bipolar disorder and stimulant use and abuse. It has generally been assumed that cocaine use represents self-enhancement or attempts to optimize one''s level of hypomania, cyclothymia or hyperthymia. This topic required further examination among heroin abusers because cocaine abuse is commonly comorbid with heroin abuse. Methods: Cocaine abuse by bipolar subjects was investigated in a group of 1090 treatment-seeking heroin addicts enrolled between 1994 and 2005. We collected data with 1) the Drug Addiction History Rating Scale; and 2) the Semi-structured Interview for Depression, which inquires systematically among others, about hypomania, cyclothymia, hyperthymia and depressive temperament. Subjects were aged 29±6 years, and predominantly male (76.2%). Results: Univariate and multivariate analyses provided correlations in favour of a link between current cocaine abuse and double diagnosis, with special relevance to the bipolar spectrum, as well as psychotic disorders (p <0.0001). Limitation: The modality of access to cocaine in different communities and the difficulty to distinguish cocaine use from abuse by the rating scale administered may have limited the interpretation of results. Conclusions: If cocaine abuse precedes that of heroin or is concomitant, heroin may hypothetically serve as a “mood balancer” which transiently dampens subthreshold excitatory states and mood swings. Our data further suggest the need for a more complex model linking cocaine and bipolarity: subthreshold bipolarity, including hyperthymic and cyclothymic temperaments, seems to predispose to heroin addiction, but craving for the suppressed hypomania in turn could lead to cocaine abuse, which eventually unmasks a frank bipolar disorder — in some cases leading to mixed state, severe mania, as well as psychosis beyond mania. Prospective observations would shed further insight on this complex interface of major clinical and public health importance. [Copyright &y& Elsevier]

Abstract: The construct of bipolar disorder, or bipolar spectrum disorders, has been a source of controversy in recent years. Some have argued that subtle variants within the putative bipolar spectrum are merely the creation of overzealous clinicians, perhaps encouraged by various special interest groups. In reality, the concept of a bipolar spectrum may be inferred from numerous classical sources, dating back to the 19th century and even into antiquity. The Greek philosopher Aristotle, usually considered the author of a work called Problemata, appears to have recognized some form of the bipolar spectrum, more than two millennia ago. This recognition continues throughout the 19th century, and into our own time. Such transcultural findings across many centuries have implications for the “objective" nature of psychiatric disease. [Copyright &y& Elsevier]

Abstract: Although first detailed descriptions of what we today term “bipolar disorders” are generally attributed to E. Kraepelin [Kraepelin, E., 1899 (1976 tr). Manic depressive insanity and paranoia. (reprint of English translation). Arno, New York], a review of French psychiatric literature from Esquirol to the middle of 20th century reveals major clinical contributions to the development of the concept of cyclic mood disorders, their phenomenology and classification as embodied in DSM-IV. The main treatise was published by the Paris psychiatric schools of Salpêtrière, Bicêtre, Charenton, Sainte-Anne and Vanves. Already much before Kraepelin, French authors had described most symptoms and the course of future DSM-IV bipolar, manic, major depressive [Falret, J.-P., 1854. De la folie circulaire ou forme de maladie mentale caracterisée par l''alternative régulière de la manie et de la mélancolie, Bull. Acad. Méd. XIX, 382–400.; Baillarger, J., 1854. Note sur un genre de folie dont les accès sont caractérisés par deux périodes régulières, l''une de dépression, l''autre d''excitation, Bull. Acad. Méd. XIX, 340 et Ann. Méd. Psychol. XII, 369], hypomanic and mixed episodes [Falret, J., 1861. Principes à suivre dans la classification des maladies mentales, Ann. Méd. Psychol. XIX, 145.; Falret, J., 1866, 1867. La folie raisonnante ou folie morale, Ann. Méd. Psychol. XXIV, 382, XXV, 68], as well as – under other names – the characteristics of bipolar II disorder, various specifiers describing mood episode and course of recurrent episodes [Ritti, A., 1883. Traité clinique de la folie à double forme (folie, circulaire, délire à formes alternes). Doin, Paris]. The synthesis of these clinical observations led to Magnan''s “intermittent madness” (1893), a precursor of Kraepelin''s “manic-depressive psychosis”. After 1899, French authors generally adhered to their classification of autonomous depressive disorder (melancholia), as distinct from manic-depressive insanity, thereby foreshadowing (much before the work of such Germanophone authors as Leonhard [Leonhard, K., 1957 (1979 tr). Aufteilung der endogenen Psychosen und ihre differenzierte Atiologie. Berlin: Akademie-Verlag; English transl. by R. Berman, Irvington, New York] and Angst [Angst, J., 1966. Zur Atiologie and Nosologie endogener depressiver Psychosen. Springer: Berlin, Heidelberg, New York]) the DSM-IV dichotomy of depressive (unipolar)/bipolar disorders (UP–BP dichotomy). It is further noteworthy that Falret [Falret, J.-P., 1854. De la folie circulaire ou forme de maladie mentale caracterisée par l''alternative régulière de la manie et de la mélancolie, Bull. Acad. Méd. XIX, 382–400] had hinted at the possibility that short hypomanic episodes at the tail end of depressive episodes in ambulatory patients represented formes frustes of circular insanity, thereby anticipating the latest developments in bipolarity — what today is considered the softer end of the bipolar spectrum. The UP–BP dichotomy and the bipolar spectrum today are the two main competing nosologic conceptual frames for mood disorders in both American and European psychiatry — and world psychiatry at large. [Copyright &y& Elsevier]

Abstract: Background: In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD). Methods: Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD [Ghaemi, S.N., Ko, J.Y., Goodwin, F.K., 2002. Cade''s Disease and beyond: misdiagnosis, antidepressant use and a proposed definition for bipolar spectrum disorder. Can. J. Psychiatry 47, 125–134.]. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE). Results: Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p &#60;0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: ‘I''ve never threatened suicide or injured myself on purpose’ (sensitivity=0.93; positive predictive value [PPV]=56.7); ‘I have tantrums or angry outbursts’ (sensitivity 0.66; PPV=65.6%); and ‘Giving in to some of my urges gets me into trouble’ (sensitivity=0.76; PPV=59.6%). Limitations: All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated. Conclusions: Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]