Search

One of the most common vascular brain malformations is developmental venous anomaly (DVA). This anomaly is usually considered to be asymptomatic but there are some reports in the literature about DVA causing neurological symptoms due to neurovascular compression, obstructive hydrocephalus, venous infarction, or intracerebral hemorrhage. There are no publications on DVA causing psychiatric symptoms. This paper presents a clinical case of DVA in which the patient develops a mood disorder along with neurological symptoms that are typical for a parietal brain lesion. Along with this clinical case, a review of literature is presented which includes classification of vascular brain malformations, prevalence of DVA, clinical manifestations, and characteristics in imaging studies. The article also reviews the functions of the parietal lobe, discusses mood disorders possibly related to parietal lesions, and briefly introduces cyclothymic disorder.

One of the most common vascular brain malformations is developmental venous anomaly (DVA). This anomaly is usually considered to be asymptomatic but there are some reports in the literature about DVA causing neurological symptoms due to neurovascular compression, obstructive hydrocephalus, venous infarction, or intracerebral hemorrhage. There are no publications on DVA causing psychiatric symptoms. This paper presents a clinical case of DVA in which the patient develops a mood disorder along with neurological symptoms that are typical for a parietal brain lesion. Along with this clinical case, a review of literature is presented which includes classification of vascular brain malformations, prevalence of DVA, clinical manifestations, and characteristics in imaging studies. The article also reviews the functions of the parietal lobe, discusses mood disorders possibly related to parietal lesions, and briefly introduces cyclothymic disorder [ABSTRACT FROM AUTHOR]

Objective: To determine if acute treatment with aripiprazole (APZ) would be superior to treatment with placebo in reducing dysfunctional symptoms of elevated mood and/or irritability in symptomatic children and adolescents at familial high risk for bipolar disorder (BPD) whose mood episodes occur spontaneously. These are patients we have previously referred to as suffering from "cyclotaxia."Methods: This was single-site, randomized, double-blind, placebo-controlled outpatient clinical trial in which youths aged 5-17 years who met diagnostic criteria for either cyclothymic disorder (CYC) or BPD not otherwise specified (BP-NOS) were randomly assigned to receive either APZ or placebo. Eligible participants had at least one parent with BPD, another first- or second-degree relative afflicted with a mood disorder, and also had not responded to psychotherapy. Treatment with APZ was initiated at a dose of approximately 0.1 mg/kg/day and could be increased by approximately 0.05 mg/kg/day at each study visit. Patients were seen weekly for 4 weeks and then every other week thereafter for 12 weeks. The primary outcome measure was mean change from baseline on Young Mania Rating Scale (YMRS) total score.Results: A total of 59 patients (30 APZ, 29 placebo) aged 11.8 (SD = 2.7) years were randomized and returned for at least one postbaseline assessment. The mean total daily doses of active APZ and placebo were 7.1 mg (SD = 3.7) and 7.4 mg (SD = 4.2), respectively. At the 12-week time point, APZ was superior to placebo on the primary outcome measure (p < 0.005). Most adverse events were mild and transient in nature. There was a significant difference in weight gain from baseline between patients who received APZ (2.3 kg [SD = 3.3]) and those who received placebo (0.7 kg [SD = 1.8]).Conclusion: This double-blind trial found that APZ was significantly more efficacious than placebo in reducing symptoms of mania in children and adolescents with cyclotaxia. [ABSTRACT FROM AUTHOR]

Borderline Personality (BPD) and Bipolar (BP) disorders stimulate an academic debate between their distinction and the inclusion of Borderline in the Bipolar spectrum. Opponents to this inclusion attribute the important differences and possible diagnostic incomprehension to overlapping symptoms. We tested 248 Borderline and 113 Bipolar patients, consecutively admitted to the Psychiatric Unit, through DSM-IV Axis I and II Disorders (SCID-I/II), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS) and Borderline Personality Disorder Severity Index-IV (BPDSI-IV). All the tests statistically discriminated the disorders (p < 0.0001). Overlapping symptoms resulted significantly different (impulsivity = 5.32 in BPD vs 1.55 in BP, p < 0.0001; emotional instability = 7.11 in BPD vs 0.55 in BP, p < 0.0001) and the range of their scores gives the opportunity for an even more precise discrimination. Distinctive traits (e.g. irritability or sexual arousal) are also discussed in order to try to qualify the core of these disorders to a higher degree. Comorbidity proves to be extremely small (3.6%). However, Borderline patients with manic features offer a privileged point of view for a deeper analysis. This allows for the possibility of a more precise examination of the nature and load of each symptom. Borderline Personality and Bipolar Disorders can be distinguished with high precision using common and time-sparing tests. The importance of discriminating these clinical features may benefit from this evidence. [ABSTRACT FROM AUTHOR]

Background: The current categorical split of mood disorders in bipolar (BP) disorders and depressive disorders has recently been questioned. The presence of a significant number of manic/hypomanic symptoms in patients with recurrent unipolar depression seems to challenge the traditional dichotomy of unipolar-BP disorder. Two highly unstable personality features, i.e., the cyclothymic temperament (CT) and borderline personality disorder, have been found to be more common in BP disorder than in major depressive disorder. Aim: The aim was to assess the distributions of the number of mood spectrum, CT, and borderline personality items between two groups. Finding no bimodal distribution (a "zone of rarity") of these items would support a continuity between the two disorders. Methods: Forty euthymic BP disorder patients and forty unipolar depression patients were administered the Structured Clinical Interview for the Mood Spectrum, which assesses lifetime symptoms, traits, and lifestyles that characterize threshold and subthreshold mood episodes. CT was assessed using Temperament Evaluation of Memphis, Pisa, Paris and San Diego-A relative to CT and borderline personality trait (BPT) was assessed using Structured Clinical Interview for DSM Disorders II personality questionnaire relative to BPT. The distribution of the number of CT and BPT items was studied by Kernel density estimate. Result: Patient with recurrent depression endorsed manic/hypomanic items though less than BP group. However, the Kernel density estimates distributions of the number of hypomanic/manic items, CT and BPT items in the entire sample had a normal-like shape (i.e. no bimodality). Conclusion: Normal-like curves in the distributions of mood symptoms, number of CT and BPT items in the entire sample, suggest significant amount of overlap of these characteristic in both the groups. Using the bimodality approach, continuity between BP and major depressive disorder (MDD) seems to be supported, questioning the current categorical splitting of BP and MDD based on classic diagnostic validators. [ABSTRACT FROM AUTHOR]

Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record [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 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 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]

Background: The Mood Disorder Questionnaire (MDQ) has been translated to many languages and has been used in many countries as a screening instrument for bipolar disorder. The main objective of this study was to evaluate validity of the Thai version of the MDQ as a screening instrument for bipolar disorder in a psychiatric outpatient sample, and to determine its optimum question #1 item threshold value for bipolar disorder. Methods: The English language Mood Disorder Questionnaire (MDQ) was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the prefinal version, as well as final adjustments. Two hundred and fifty major depressive disorder outpatients were further assessed by the Thai version of the MDQ and the Thai version of the Mini International Neuropsychiatric Interview (MINI). During the assessment, reliability and validity analyses, and receiver operating characteristic curve (ROC) analysis were performed. Results: The Thai version of the MDQ screening had adequate internal consistency (Cronbach's alpha =0.791, omega total =0.68, and omega hierarchical =0.69). The optimal question #1 item threshold value was at least five positive items, which yielded adequate sensitivity (76.5%), specificity (72.7%), positive predictive value (74.3%), and negative predictive value (75.0%). The ROC area under the curve (AUC) for this study was 0.82 (95% confidence interval: 0.70 to 0.90). Conclusion: The Thai version of the MDQ had some useful psychometric properties for screening for bipolar disorder in a mood disorder clinic setting, with a recommended question #1 item threshold value of at least five positive items. [ABSTRACT FROM AUTHOR]

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]

Objective Early-onset bipolar ( BP) disorder and other poor prognosis characteristics are more prevalent in patients from the United States than from the Netherlands and Germany (abbreviated as Europe). We explored the impact of parental loading for affective illness on onset and other characteristics of BP disorder. Method Parental history for unipolar ( UP) and bipolar ( BP) depression and course of illness characteristics were obtained from self-report in adults (average age 42) with BP disorder. Illness characteristics were examined by χ2 and multinomial logistic regression in relationship to the degree of parental loading: i) both parents negative; ii) one UP disorder; iii) one with BP disorder; and iv) both affected. Results After controlling for many poor prognosis factors, compared with those from Europe, patients from the United States had more iii) one parent with BP disorder and iv) both parents affected. An early age of onset of BP disorder was independently associated with this increased parental loading for affective disorder. Conclusion Parental history of BP disorder and both parents with a mood disorder were more common in the United States than Europe and were associated with an early onset of bipolar disorder and other poor prognosis characteristics. These findings deserve replication and exploration of the potential mechanisms involved and their therapeutic implications. [ABSTRACT FROM AUTHOR]

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: 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: 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: 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: Cyclothymic disorder is a subtype of bipolar disorder included in the Diagnostic and Statistical Manual of Mental Disorders since 1980, but largely neglected in research. Additionally, it is rarely diagnosed clinically, in spite of evidence that it may be the most prevalent form of bipolar disorder. Neglect has contributed to confusion about the diagnosis and clinical presentation of cyclothymic disorder. Its status as a mood disorder is also ambiguous due to overlap in terminology and symptoms with temperament and personality disorders. Subthreshold bipolar disorder appears more prevalent among young people than previously thought, and follows a range of trajectories from remission to escalation—raising questions about risk factors and traits associated with the varied course. Cyclothymic disorder may be an important diathesis for major mood disorders. Constructs such as cyclothymic disorder link major mood disorder and peri-clinical fluctuations of mood, thus warranting a prominent role in dimensional models of mood and psychopathology. Current evidence indicates that cyclothymic disorder is a prevalent and highly impairing disorder on the bipolar spectrum, with the potential to make unique contributions to our understanding of the risk factors and outcomes associated with bipolar disorder. The inclusion of cyclothymic disorder in future research studies is essential to accurate diagnosis and effective treatment for the full spectrum of bipolar disorder, as well as understanding the developmental trajectory of bipolar spectrum disorders. [Copyright &y& Elsevier]

Over the last three decades, cyclothymia has been positioned in one of two principal ways: formally classified as a mood disorder, and less formally categorized at a 'cyclothymic temperament' ( CT) level. This review considers its historic evolution and provides five models for conceptualizing independence or interdependence between cyclothymia as a temperament style and as a formal mood disorder. Findings argue for CT to be conceded and appropriately defined. Secondly, it is recommended that cyclothymia's expression as a mood disorder should be positioned within the bipolar II disorder class-albeit perhaps having briefer mood swings and fewer episodes, more rapid cycling, and greater reactivity to environmental factors than is conceptualized currently for bipolar II disorders. By allowing cyclothymia both axis I and axis II status (although necessitating differing terminology), research evaluating any shared biological underpinnings and any predisposition provided by the CT temperament style to a later formalized bipolar II condition would be advanced. [ABSTRACT FROM AUTHOR]

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]

Background: Bipolar disorder is a familial psychiatric disorder associated with reduced white matter integrity, but it is not clear whether such abnormalities are present in young unaffected relatives and, if so, whether they have behavioral correlates. We investigated with whole brain diffusion tensor imaging whether increased genetic risk for bipolar disorder is associated with reductions in white matter integrity and whether these reductions are associated with cyclothymic temperament. Methods: Diffusion tensor imaging data of 117 healthy unaffected relatives of patients with bipolar disorder and 79 control subjects were acquired. Cyclothymic temperament was measured with the cyclothymia scale of the Temperament Evaluation of Memphis, Pisa and San Diego auto-questionnaire. Voxel-wise between-group comparisons of fractional anisotropy (FA) and regression of cyclothymic temperament were performed with tract-based spatial statistics. Results: Compared to the control group, unaffected relatives had reduced FA in one large widespread cluster. Cyclothymic temperament was inversely related to FA in the internal capsules bilaterally and in left temporal white matter, regions also found to be reduced in high-risk subjects. Conclusions: These results show that widespread white matter integrity reductions are present in unaffected relatives of bipolar patients and that more localized reductions might underpin cyclothymic temperament. These findings suggest that white matter integrity is an endophenotype for bipolar disorder with important behavioral associations previously linked to the etiology of the condition. [Copyright &y& Elsevier]

Background: Previous studies have detected different variables influencing the attitude towards mentally ill individuals but they have never addressed mania. Furthermore, it is not known whether the same factors affect attitudes towards individuals experiencing major depressive or manic episodes. Aims: Besides factors such as familiarity with mental illness, we were interested whether vulnerability to psychosis and mood disorders as well as social desirability can affect attitudes towards major depressive episodes and manic episodes. Methods: Subjects were presented with a case vignette describing an individual experiencing either a major depressive episode or a manic episode (n = 188, age 16-34 years). Their attitudes towards that person were assessed. Furthermore, factors potentially influencing these attitudes have been assessed such as personal vulnerability factors (i.e. cyclothymia and magical ideation) and social desirability bias. Results: Familiarity with the phenomenon of mental illness turned out to influence the attitude towards affective episodes, whereas the influence of the other potential predictors such as their own experience of affective or schizotypal symptoms failed to appear to be of significance. Conclusions: Whereas 'familiarity' turned out to be a factor positively influencing the attitude towards depression, it turned out to have a rather negative influence on the attitude towards mania. This result could have important implications for anti-stigma campaigns. [ABSTRACT FROM AUTHOR]

Abstract: In addition to the classical syndromes of major depression and bipolar I disorder other syndromes with different epidemiology and natural history are included in the group of mood disorders. The life-time prevalence of major depression comes up to 4 to 19% of the population. In bipolar I disorder, the classical manic-depressive illness, the life-time prevalence is 1% according to narrow definitions, and approximately 5% according to broader definitions. The life-time prevalence of dysthymia was found to be approximately 3–7% of the population, that of cyclothymia appr. 0.5%. There is no reliable statistical information for the prevalence of other types of mood disorders, but it is changing according to definition and methods. Mood disorders are severe and chronic diseases, most of which can be considered as lifelong disorders. There seems to be a constant risk of recurrence of bipolar disorders and major depression over the life-span from 30 to 40 years after onset up to the age of 70 or more. Men have a significantly earlier onset of first-episode mania and bipolar disorder. Mood disorders have a frequent comorbidity, especially with substance abuse disorders, which can have an unfavourable influence on the course of the illness. Patients with mood disorders have a higher risk of death by suicide than healthy people. The mortality of patients with mood disorders, especially depression, is higher than that of the general population. [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]

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]

Bipolar disorder (including manic-depressive disorder) is a psychiatric illness affecting approximately 1% to 2% of the general population, with no difference in prevalence among men and women. Patients with Bipolar disorder can often present with bizarre oral manifestations to the dentist. These patients might be undergoing pharmacological treatment for their psychological condition and these drugs may produce oral side effects and adverse reactions with the drugs that a dentist might prescribe for a dental condition. Before commencing any treatment, the dental practitioner should confirm or update information about the current medication regimen of the patient, degree of compliance, ability to provide consent and overall psychological profile of such patients. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to assess sociodemographic and clinical differences between inpatients with major mood disorders and the cyclothymic phenotype, and pure BDs or MDDs. Methods Participants were 281 adult inpatients consecutively admitted to the Department of Psychiatry of the Sant'Andrea University Hospital in Rome, Italy, between January 2008 and June 2010. The patients completed the Hamilton Scale for Depression, the Young Mania Rating Scale, the TEMPS-A, and the Beck Hopelessness Scale. Results 38.7% of the MDD patients and 48.3% of the BD patients satisfied criteria to be included in the cyclothymic groups. Above 92% of the patients with the cyclothymic phenotype reported suicidal ideation at the item#3 of the HAMD17. Furthermore, patients with the cyclothymic phenotype reported higher hopelessness than other patients. Conclusions Our results support the clinical usefulness of the concept of soft bipolar spectrum. Patients with the cyclothymic phenotype differ from pure MDD patients and BD patients for temperamental profile and clinical variables. [ABSTRACT FROM AUTHOR]

Disorders of the bipolar spectrum (e.g. cyclothymic disorder) and subthreshold manifestations of mood disorders (such as temperamental traits) have been suggested to influence the course of psychiatric diseases. Cyclothymic temperament (as described by Kraepelin and as measured by Akiskal's temperament scale, the TEMPS) has been suggested to be the most morbid and prodromal element in the pathogenic chain of personal disposition to behavioural and emotional problems. We studied the effects of affective temperaments on psychoactive substance use, on alcohol dependence and opioid dependence. In particular, we wanted to test the hypothesis whether cyclothymic temperament mediates a deleterious effect. 1380 inhabitants of residential student homes in Austria, 116 alcohol dependent patients at the Medical University of Vienna and 101 opioid dependent patients at the Oum El Nour rehabilitation center in Lebanon were investigated. Temperament was assessed using the briefTEMPS-M auto-questionnaire. In opioid dependence, subtypes were assessed according to the LAT interview (www.lat-online.at). In the college student group, cyclothymic (and irritable) temperament serves as predictor of self-reported nicotine dependence, alcohol abuse and cannabis use. In alcohol dependent patients, cyclothymic temperament influenced the age of onset of alcohol abuse and the age of onset of alcohol dependence. In the opioid dependence group, patients exhibiting symptoms of severe negative childhood development according to the LAT interview (e.g. prenatal trauma, cerebral trauma before the age of 14) showed the highest percentage of cyclothymic temperament. Our data show that cyclothymic temperament as measured by the briefTEMPS-M is an important negative pathoplastic factor for substance-related addictive disorders. [ABSTRACT FROM AUTHOR]

The present study is examined the expression of affective temperaments in daily life using experience sampling methodology (ESM). 138 participants completed the TEMPS-A and were then signaled eight times daily for one week to complete questionnaires that assessed affect, cognition, behavior, sense of self, and social interaction. 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. Cross-level interactions indicated that cyclothymic/irritable temperament was associated with elevated stress reactivity in daily life. 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. [ABSTRACT FROM AUTHOR]

In this text we are showing a patient with a very complex “life story”, dominated by extreme difficulties in the developmental period, strong family complications and personal problems, which probably significantly influenced the development of later psychological difficulties. The clinical picture is dominated by symptoms of borderline personality disorder (BPD), but also shows symptoms that would fall under bipolar affective disorder (BD) and cyclothymia. During the screening of the patient and during treatment, we tried to resolve the resulting diagnostic dilemma. Some authors even believe that BPD falls into the BD spectrum of disorders, whereas others insist on the viewpoint that it is a comorbidity of two separate entities. For clinical practice, the important fact is that BD and BPD multiplies the risk of suicidal patients, which requires prompt and adequate combined treatment. The primary psychopharmacological methods are used for BD, while primary psychotherapeutic treatment is used for BPD. In this study, we’ll in detail deal with the comorbidity of BD and BPD, which are becoming more frequent psychiatric comorbidities, while emphasizing individual and integrative psychopharmacological therapies as the only approach that can act on several factors and ensure the best possible treatment outcome. [ABSTRACT FROM AUTHOR]