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Background and Objectives : Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods : One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results : Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions : ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with "sunny" cyclothymic features might escape the attention of clinicians unless ADHD is present.

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., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria., Methods: This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania., Results: A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder., Conclusions: These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Cyclothymic disorder includes hypomanic and depressive symptoms that do not meet standards for hypomanic episodes and major depressive symptoms. Objectives: To assess the prevalence of cyclothymic disorders in medical, physiotherapy, and dental 1st-year students aged 18–22 years old in Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha. Methods: The study is designed as a cross-sectional study where a web-based survey will be used to evaluate the prevalence of the cyclothymic disorder in 154 first-year Health Professional Education (HPE) students at a university in Central India. Conclusions: This study will assess the prevalence of cyclothymic disorders in HPE students and investigate relationships between different fields of study, age, gender, socio-economic status, place of temporary residence (home/hostel/paying guest), history of addiction (smoking/alcohol/substance abuse/other), past medical history (physical and/or mental), and family history (divorced parents/history of childhood abuse).

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The research features social anxiety in people with such affective disorders as internal tension triggered by social and interpersonal communication. The test group involved 28 individuals with various affective disorders. The control group consisted of 28 respondents without affective personality disorder or depressive symptoms. Psychological diagnostics presupposed specific methods for each selected criterion of social anxiety: 1) negative beliefs about social interaction; 2) increased physiological excitability; 3) desire to avoid social situations; fear in distress; 4) deficit of social skills. The study made it possible to describe the features of the emotional, cognitive, and behavioral background of persons with affective disorders: hyperbolization of life difficulties; avoiding stressful situations; deficiency of adaptive defense mechanisms and energy resources to overcome frustration. The study also revealed a defect in the natural self-regulation of the psychoemotional state of social situations in persons with affective disorders. The results obtained are valuable for understanding the possibilities of psychological correction, aimed at reducing the intensity of negative experiences associated with social anxiety.

This study aims to explore the relationships between delayed sleep phase disorder (DSPD) and emotional dysregulation in 240 patients (134 with cyclothymia, 81 with attention deficit hyperactivity disorder [ADHD] and 25 with both conditions). DSPD was assessed using the Morningness-Eveningness Questionnaire, followed by a clinical evaluation. Affective temperaments and emotional dysregulation were also investigated through the brief version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego and the Reactivity, Intensity, Polarity, Stability questionnaires, respectively. Clinical variables were compared in patients with and without DSPD, and a logistic regression model was used to identify the predictive value of the clinical characteristics on the presence of DSPD. DSPD patients (19% of the total sample) were significantly younger than patients without DSPD, showed an about 4 times higher lifetime history of comorbid ADHD and cyclothymia, and reported higher scores in the irritable and cyclothymic temperamental subscales and in the affective instability and impulsivity dimensions. In the multiple logistic regression, we found a negative predictive value of increasing age on the presence of DSPD, whereas comorbid cyclothymia and ADHD and cyclothymic temperament seem to represent risk factors for DSPD. [ABSTRACT FROM AUTHOR]

Bipolar disorder is a neurological disorder that consists of two main factors, i.e. mania and depression. There are two main drawbacks in clinical diagnosis of the bipolar disorder. First, bipolar disorder is mostly wrongly diagnosed as unipolar depression in clinical diagnosis. This is, because in clinical diagnosis, the first factor is often neglected due to its approach toward positivity. Consequently, the element of bipolarity vanishes and the disease becomes worse. Second, the types of bipolar disorder are mostly misdiagnosed due to similar symptoms. To overcome these problems, the bipolar fuzzy soft set (BFS-set) and bipolar fuzzy soft mappings (BFS-mappings) are useful to tackle bipolarity and to construct a strong mathematical modeling process to diagnose this disease correctly. This technique is extensive but simple as compared to existing medical diagnosis methods. A chart (relation between different types and symptoms of bipolar disorder) is provided which contains different ranges over the interval [ − 1 , 1 ]. A process of BFS-mappings is also provided to obtain correct diagnosis and to suggest the best treatment. Lastly, a generalized BFS-mapping is introduced which is helpful to keep patient's improvement record. The case study indicates the reliability, efficiency and capability of the achieved theoretical results. Further, it reveals that the connection of soft set with bipolar fuzzy set is fruitful to construct a connection between symptoms which minimize the complexity of the case study. [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]

Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17–26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness. [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]

Bipolar disorder is associated with a host of negative physical and interpersonal outcomes including suicide. Emerging adulthood is an age of risk for the onset of bipolar spectrum disorders (BSDs) and there has been increased effort to focus on early identification and subsequent intervention for BSDs during this developmental period. Recent research on the Behavioral Approach System (BAS) hypersensitivity model of bipolar disorder may have implications for the assessment and treatment of BSDs in emerging adulthood. We summarize relevant findings on the BAS hypersensitivity model that support the use of reward sensitivity in the early identification of BSDs and suggest evidence-based strategies for clinical work with emerging adults with BSDs. [ABSTRACT FROM AUTHOR]

In this paper, we review in brief the development of ideas that over time have tried to explain why some individuals are more creative than others and what may be the neurobiological links underlying artistic creativity. We note associations with another unique human idea, that of genius. In particular, we discuss frontotemporal dementia and bipolar, cyclothymic mood disorder as clinical conditions that are helping to unravel the underlying neuroanatomy and neurochemistry of human creativity. This article is part of a Special Issue entitled “Epilepsy, Art, and Creativity”. [ABSTRACT FROM AUTHOR]

Objective: Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning.Methods: Participants (n = 459), 11-18 years of age, were recruited from an urban community mental health center and an academic outpatient clinic; 25 had a diagnosis of CycD. Youth and caregivers completed measures of IA and irritability. Youth and caregivers also completed an assessment of youth friendship quality. Clinical interviewers assessed youth social, family, and school functioning.Results: Youth with CycD had higher scores on measures of irritability and IA than youth with nonbipolar disorders, but scores were not different from other youth with bipolar spectrum disorders. Measures of irritability and IA were correlated, but represented distinct constructs. Regression analyses indicated that irritability was related to friendship quality (p < 0.005). Both IA and irritability were related to social impairment (ps < 0.05-0.0005) and Child Global Assessment Scale (C-GAS) scores (ps = 0.05-0.005). CycD diagnosis was associated with poorer caregiver-rated friendship quality and social functioning (ps < 0.05).Conclusions: We found that irritability and aggression were more severe among youth with CycD than among youth with nonbipolar diagnoses, but did not differ across bipolar disorder subtypes. Among youth seeking treatment for mental illness, irritability and IA are prevalent and nonspecific. Irritability and IA were uniquely related to our outcomes of social and general functioning, suggesting that it is worthwhile to assess each separately, in order to broaden our understanding of the characteristics and correlates of each. [ABSTRACT FROM AUTHOR]

Objective: This pilot study evaluates efficacy of omega-3 fatty acid supplementation (Ω3), individual family psychoeducational psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder [CYC]).Methods: This study was a 12 week, randomized trial of Ω3 versus placebo and IF-PEP versus active monitoring (AM) using a 2 × 2 design (Ω3 + PEP: n = 5; Ω3 + AM: n = 5; placebo + PEP: n = 7; placebo + AM: n = 6). Twenty-three youth ages 7-14 with BP-NOS or CYC were recruited via community advertisements and clinician referrals. Participants could be taking stable medication for attention-deficit/hyperactivity disorder and sleep aids, but no other psychotropics. Independent evaluators assessed participants at screen, baseline, and 2, 4, 6, 9, and 12 weeks. Primary outcome measures were the Kiddie Schedule for Affective Disorders (K-SADS) Depression (KDRS) and Mania (KMRS) Rating Scales, Children's Depression Rating Scale-Revised (CDRS-R), and Young Mania Rating Scale (YMRS). Ω3/placebo conditions were double-blind; independent evaluators were blind to psychotherapy condition.Results: Most participants (83%) completed the 12 week trial. Side effects were uncommon and mild. Intent-to-treat analyses indicated significant improvement in depressive symptoms (KDRS) for combined treatment relative to placebo and AM (p = 0.01, d = 1.70). Across groups, manic symptoms improved over time without significant treatment effects. Effect of IF-PEP on child depression compared with AM was medium (d = 0.63, CDRS-R) to large (d = 1.24, KDRS). Effect of Ω3 on depression was medium (d = 0.48, KDRS).Conclusion: IF-PEP and Ω3 are well tolerated and associated with improved mood symptoms among youth with BP-NOS and CYC. Clinicaltrials.gov Identifier: NCT01507753. [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 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: 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]

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]

Sonia was part of a clinical, naturalistic, and longitudinal research project I developed that began in 1998, with patients who consulted at the well-known AIGLE center in Buenos Aires, Argentina. In the project I selected patients with severe and complex psychological symptoms for whom previous treatments were reported by the patients to have been ineffective. The goal of the project was to employ Dr. Héctor Fernández-Álvarez's Integrative Psychotherapy Model to design a new treatment approach involving combined strategies that could successfully work with such individuals. At the time of intake, Sonia was a 44-year-old, divorced, morbidly obese woman living with her 18-year- old mildly retarded son in an apartment purchased for her by her affluent parents. When Sonia came for treatment, she could not manage her son or her own basic needs and finances and had frequent angry outbursts with her family members. She was diagnosed as having bipolar disorder or cyclothymia, trichotillomania, borderline personality disorder, borderline intellectual functioning, and was on medication for these conditions. This case study describes 10 years of treatment, including over 900 sessions, working on the development of Sonia's coping and interpersonal skills and on restructuring her most basic cognitions about herself and her relationships to others, particularly her family members. During the 10 years, the therapy was gradually reduced in intensity as Sonia made gradual but dramatic changes in her self-concept, her obesity, her relationship to her family, and her ability to work and independently manage her life. While because of her long history of previous treatments, Sonia did not consent to take any standardized assessment measures, she did agree to a collaboratively developed, individualized, 27-item List of Problems and Behaviors Questionnaire (LOPBQ). With a scoring range of 0 ("problem not solved at all") to 5 (problem "totally solved") on each item, Sonia went from an average item score of .33 to one of 4.19 over the course of the first 8 years; that is, from a score of 6.7% of a maximum score to 83.8% of a maximum score. The process by which this impressive change took place is detailed. [ABSTRACT FROM AUTHOR]

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: 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: 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: 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]

Background: The present study aimed: to assess prescribing patterns in the treatment of major depression, bipolar disorder type I, cyclothymia, and dysthymia from 1996 to 2007 in a day hospital setting; to evaluate the prevalence of the above-mentioned mood disorders and gender distribution; and to relate familiality, comorbidity, and marital status to each diagnosis. Methods: Medical records for 777 day hospital patients with a diagnosis of major depression, bipolar disorder type I, cyclothymia, or dysthymia were grouped into two 6-year periods so as to compare the prescribing patterns of tricyclic antidepressants, selective serotonin reuptake inhibitors, noradrenergic reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, first-generation antipsychotics, second-generation antipsychotics, and mood stabilizers. Gender, prevalence, familiality, comorbidity, and marital status were related to each diagnosis. Results: The most common mood disorder, with a female preponderance, was major depression, regardless of marital status. High percentages of familiality and comorbidity were found for major depression, while a reduction was found in the utilization of tricyclic antidepressants. There was no statistically significant difference in rates of prescription of selective serotonin reuptake inhibitors and noradrenergic reuptake inhibitors, but some irregularities were found upon evaluating each diagnosis (eg, increased utilization of these agents in dysthymia and major depression, respectively). There was an increase in prescriptions for serotonin and norepinephrine reuptake inhibitors, but no marked differences in utilization of noradrenergic and specific serotonergic antidepressants, which remained basically low. There was no significant difference in prescribing of first-generation antipsychotic agents, although a reduction was found. There was a significant increase in utilization of second-generation antipsychotics and mood stabilizers. Conclusion: Our epidemiological findings are consistent with data reported in the literature regarding the high prevalence of major depression among the mood disorders, as well as the impact of familiality and comorbidity. Analysis of prescribing patterns for antidepressants, antipsychotics, and mood stabilizers in the treatment of mood disorders shows a shift from older to newer drugs, and wider use of mood stabilizers. [ABSTRACT FROM AUTHOR]

The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory–revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment. [ABSTRACT FROM PUBLISHER]

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]