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We describe a consecutive clinical sample of children and adolescents with bipolar disorder (BD), in order to define the pattern of comorbid externalizing disorders and to explore the possible influence of such a comorbidity on their cross-sectional and longitudinal clinical characteristics. The sample consisted of 59 bipolar patients: 35 males and 24 females, with a mean age 14.6 +/- 3 years (range, 7 to 18 years), diagnosed as either type I or II according to DSM-IV. All patients were screened for psychiatric disorders using historical information and a clinical interview, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Severity and subsequent outcome of the symptomatology were recorded with the Clinical Global Impression (CGI), Severity and Improvement Scales, at the baseline and thereafter monthly for a period up to 48 months. BD disorder type I was present in 37 (62.7%) of the patients; 14 (23.7%) were affected by attention deficit-hyperactivity disorder (ADHD) and 10 (16.9%) by conduct disorder (CD). Comorbid ADHD was associated with an earlier onset of BD, while CD was highly associated with BD type I. Anxiety disorders appeared more represented in patients without CD. At the end of the observation, a lower clinical improvement was recorded in patients with CD. In our children and adolescents with BD, comorbidity with externalizing disorders such as ADHD and CD is common. The clinical implications of comorbid ADHD and CD are rather different. ADHD can be viewed as a precursor of a child-onset subtype of BD, while CD might represent a prodromal or a concomitant behavioral complication that identifies a more malignant and refractory form of BD. Copyright © 2003 by Elsevier Science (USA). [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest that temperament features of adolescents may be good predictors of the development of future psychopathology in this population. The aim of the study was to adapt the content and validate the psychometric properties of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto-questionnaire in a sample of Serbian adolescents., Subjects and Methods: The sample included 2113 adolescents, 56% girls and 44% boys, average age 16.73±0.47, attending 48 Serbian secondary schools. The base for the development of this scale included Serbian standardised versions as well as the TEMPS-I, Interview version., Results: The final scale is comprised of 36 items, with six factors (depressive, cyclothymic, hyperthymic, irritable, and anxious-cognitive/somatic) explaining 39.9% of the total variance, the internal consistency coefficient α=0.77, and the average test-retest coefficient (rho=0.84). The correlations among the temperaments ranged from weak to moderate, with the highest positive correlations between the depressive, cyclothymic and anxious scales. The highest values were detected on hyperthymic and the lowest on depressive temperament. Significantly higher scores of depressive, cyclothymic and anxious temperaments were detected in girls, whereas boys had higher scores on the hyperthymic scale., Conclusions: The scale has shown good psychometric properties, which encourages its further use in adolescent population. The results show certain specific features of this population, such as higher scores on all temperament types than the ones in student and adult population and a tendency of socially desirable answers.

The molecular pathogenesis of bipolar disorder (BPD) is poorly understood. Using human-induced pluripotent stem cells (hiPSCs) to unravel such mechanisms in polygenic diseases is generally challenging. However, hiPSCs from BPD patients responsive to lithium offered unique opportunities to discern lithium's target and hence gain molecular insight into BPD. By profiling the proteomics of BDP-hiPSC-derived neurons, we found that lithium alters the phosphorylation state of collapsin response mediator protein-2 (CRMP2). Active nonphosphorylated CRMP2, which binds cytoskeleton, is present throughout the neuron; inactive phosphorylated CRMP2, which dissociates from cytoskeleton, exits dendritic spines. CRMP2 elimination yields aberrant dendritogenesis with diminished spine density and lost lithium responsiveness (LiR). The "set-point" for the ratio of pCRMP2:CRMP2 is elevated uniquely in hiPSC-derived neurons from LiR BPD patients, but not with other psychiatric (including lithium-nonresponsive BPD) and neurological disorders. Lithium (and other pathway modulators) lowers pCRMP2, increasing spine area and density. Human BPD brains show similarly elevated ratios and diminished spine densities; lithium therapy normalizes the ratios and spines. Consistent with such "spine-opathies," human LiR BPD neurons with abnormal ratios evince abnormally steep slopes for calcium flux; lithium normalizes both. Behaviorally, transgenic mice that reproduce lithium's postulated site-of-action in dephosphorylating CRMP2 emulate LiR in BPD. These data suggest that the "lithium response pathway" in BPD governs CRMP2's phosphorylation, which regulates cytoskeletal organization, particularly in spines, modulating neural networks. Aberrations in the posttranslational regulation of this developmentally critical molecule may underlie LiR BPD pathogenesis. Instructively, examining the proteomic profile in hiPSCs of a functional agent-even one whose mechanism-of-action is unknown-might reveal otherwise inscrutable intracellular pathogenic pathways., Competing Interests: Conflict of interest statement: R.C.B.B., L.M.B., G.C., J.S.N., H.M., and J.H.P. are employees of private companies. Their role in the study was solely as researchers with no financial or proprietary involvement.

Background: Temperament and personality traits have been suggested as endophenotypes for bipolar disorder based on several lines of evidence, including heritability. Previous work suggested an anxious-reactive factor identified across temperament and personality inventories that produced significant group discrimination and could potentially be useful in genetic analyses. We have attempted to further characterize this factor structure in a sample of bipolar patients., Methods: A sample of 1195 subjects with bipolar I disorder was evaluated, all with complete data available. Dimension reduction across two inventories identified 18 factors explaining 39% of the variance., Results: The two largest factors reflected affective instability and general anxiety/worry, respectively. Subsequent analyses of the clinical features associated with bipolar disorder revealed specificity for the factors in a predictable pattern. Cluster analysis of the factors identified a subgroup defined by a strong lack of general anxiety and low affective instability represented by the first two factors. The remaining subjects could be distinguished into two clusters by the presence of either more positive characteristics, including persistence/drive, spirituality, expressivity, and humor, or more negative characteristics of depression and anxiety., Limitations: These analyses involved bipolar I subjects only and must be extended to other bipolar spectrum diagnoses, unaffected relatives, and individuals at risk., Conclusions: These results suggest that temperament and personality measures access latent traits associated with important clinical features of bipolar disorder. By translating clinical variables into quantitative traits, we may identify subgroups of bipolar patients with distinct clinical profiles, thereby facilitating both individual treatment strategies and genetic analyses., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Assess strengths and limitations of mixed bipolar depression definitions made more inclusive than that of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by requiring fewer than three 'non-overlapping' mood elevation symptoms (NOMES)., Method: Among bipolar disorder (BD) out-patients assessed with Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, we assessed prevalence, demographics, and clinical correlates of mixed vs. pure depression, using less inclusive (≥3 NOMES, DSM-5), more inclusive (≥2 NOMES), and most inclusive (≥1 NOMES) definitions., Results: Among 153 depressed BD, compared to less inclusive DSM-5 threshold, our more and most inclusive thresholds, yielded approximately two- and five-fold higher mixed depression rates (7.2%, 15.0%, and 34.6% respectively), and important statistically significant clinical correlates for mixed compared to pure depression (e.g. more lifetime anxiety disorder comorbidity, more current irritability), which were not significant using the DSM-5 threshold., Conclusion: Further studies assessing strengths and limitations of more inclusive mixed depression definitions are warranted, including assessing the extent to which enhanced statistical power vs. other factors contributes to more vs. less inclusive mixed bipolar depression thresholds having more statistically significant clinical correlates, and whether 'overlapping' mood elevation symptoms should be counted., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The objective of this study was to assess the strengths and limitations of a mixed bipolar depression definition made more inclusive than that of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by counting not only 'non-overlapping' mood elevation symptoms (NOMES) as in DSM-5, but also 'overlapping' mood elevation symptoms (OMES, psychomotor agitation, distractibility, and irritability)., Methods: Among bipolar disorder (BD) out-patients assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, we assessed prevalence, demographics, and clinical correlates of mixed vs. pure depression, using more inclusive (≥3 NOMES/OMES) and less inclusive DSM-5 (≥3 NOMES) definitions., Results: Among 153 depressed BD, counting not only NOMES but also OMES yielded a three-fold higher mixed depression rate (22.9% vs. 7.2%) and important statistically significant clinical correlates for mixed compared to pure depression (more lifetime anxiety disorder comorbidity, more current irritability, and less current antidepressant use), which were not significant using the DSM-5 threshold., Conclusion: To conclude, further studies with larger numbers of patients with DSM-5 bipolar mixed depression assessing strengths and limitations of more inclusive mixed depression definitions are warranted, including efforts to ascertain whether or not OMES should count toward mixed depression., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Unlabelled: Panic disorder patients are hypervigilant to danger cues and highly sensitive to unpredictable aversive events, what leads to anticipatory anxiety, that is one key component of the disorder maintenance. Prefrontal cortex seems to be involved in these processes and beta band activity may be related to the involvement of top-down processing, whose function is supposed to be disrupted in pathological anxiety. The objective of this study was to measure frontal absolute beta-power (ABP) with qEEG in panic disorder and agoraphobia (PDA) patients compared to healthy controls., Methods: qEEG data were acquired while participants (24 PDA patients and 21 controls) watched a computer simulation (CS), consisting of moments classified as "high anxiety" (HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. The statistical analysis was performed by means of a repeated measure analysis of variance (two-way ANOVA) and ABP was the dependent variable of interest. The main hypothesis was that a higher ABP in PDA patients would be found related to controls. Moreover, in HAM the ABP would be different than in LAM., Results: the main finding was an interaction between the moment and group for the electrodes F7, F8, Fp1 and Fp2. We observed a higher ABP in PDA patients when compared to controls while watching the CS. The higher beta-power in the frontal cortex for the PDA group may reflect a state of high excitability, together with anticipatory anxiety and maintenance of hypervigilant cognitive state., Conclusions: our results suggest a possible deficiency in top-down processing reflected by a higher ABP in the PDA group while watching the CS and they highlight the recruitment of prefrontal regions during the exposure to anxiogenic stimuli., Limitations: the small sample, the wide age range of participants and the use of psychotropic medications by most of the PDA patients., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Akiskal proposed the "rule of three" for behavioral indicators with high specificity for bipolarity in patients with major depression episodes. We evaluated these distinctive behaviors in controls and subjects with major depression or bipolar disorder., Methods: data was collected in the BRAINSTEP project with questions on general behaviors, style and talents. Univariate analysis was first conducted in 36,742 subjects and confirmatory multivariate analysis in further 34,505 subjects (22% with a mood disorder). Odds ratios were calculated adjusting for age., Results: Univariate analysis showed that 29 behavioral markers differentiated bipolar subjects from those with unipolar depression. The most robust differences in those with bipolarity (ORs >4) were ≥3 religion changes, ≥3 marriages, cheating the partner regularly, having ≥60 lifetime sexual partners, pathological love, heavy cursing, speaking ≥3 foreign languages, having ≥2 apparent tattoos, circadian dysregulation and high debts. Most behaviors were expressed in a minority of patients (usually around 5-30%) and usually the "rule of three" was the best numerical marker to distinguish those with bipolarity. However, multivariate analysis confirmed 11 of these markers for differentiating bipolar disorder from unipolar depression (reversed circadian rhythm and high debts for both genders, ≥3 provoked car accidents and talent for poetry in men, and frequent book reading, ≥3 religion changes, ≥60 sexual partners, pathological love ≥2 times, heavy cursing and extravagant dressing style in women)., Limitations: Self-report data collection only., Conclusions: These behavioral markers should alert the clinician to perform a thorough investigation of bipolarity in patients presenting with a depressive episode., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Recent celebrity deaths have been widely reported in the media and turned the public attention to the coexistence of mood, psychiatric and substance-abuse disorders. These tragic and untimely deaths motivated us to examine the scientific and clinical data, including our own work in this area. The self-medication hypothesis states that individuals with psychiatric illness tend to use heroin to alleviate their symptoms. This study examined the correlations between heroin use, mood and psychiatric disorders, and their chronology in the context of dual diagnosis., Methods: Out of 506 dual diagnosed heroin addicts, 362 patients were implicated in heroin abuse with an onset of at least one year prior to the associated mental disorder (HER-PR), and 144 patients were diagnosed of mental illness at least one year prior to the associated onset of heroin use disorder (MI-PR). The retrospective cross-sectional analysis of the two groups compared their demographic, clinical and diagnostic characteristics at univariate and multivariate levels., Results: Dual diagnosis heroin addicts whose heroin dependences existed one year prior to their diagnoses (HER-PR) reported more frequent somatic comorbidity (p≤0.001), less major problems at work (p=0.003), more legal problems (p=0.004) and more failed treatment for their heroin dependence (p<0.001) in the past. More than 2/3 reached the third stage of heroin addiction (p=<0.001). Their length of dependence was longer (p=0.004). HER-PR patients were diagnosed more frequently as affected by mood disorders and less frequently as affected by psychosis (p=0.004). At the multivariate level, HER-PR patients were characterized by having reached stage 3 of heroin dependence (OR=2.45), diagnosis of mood disorder (OR=2.25), unsuccessful treatment (OR=2.07) and low education (OR=1.79)., Limitations: The main limitation is its retrospective nature. Nonetheless, it does shed light on what needs to be done from a clinical and public health perspective and especially prevention., Conclusions: The data emerging from this study, does not allow us to determine a causal relation between heroin use and mental illness onset. However, this data, even if requiring longitudinal studies, suggest that self-medication theory, in these patients, can be applied only for chronic psychoses, but should not be applied to patients with mood disorders using heroin., (Copyright © 2015. Published by Elsevier B.V.)

Background: Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested., Methods: Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques., Results: No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003)., Limitations: Data collected are self-reported and no urinalyses were performed., Conclusions: The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression., Methods: 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A)., Results: The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile., Limitations: We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers., Conclusion: Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Links between affective temperaments and folk culture have been infrequently explored systematically. Creativity and personality and temperament studies, conversely, have reported several associations. Tango is one of the most typical Argentinean folk dance-musical repertoires. The main purpose of this study is to compare affective temperaments between Argentinean professional tango dancers and the general population., Methods: TEMPS-A was administered to a sample of 63 professional tango dancers and 63 comparison subjects from the general population who did not practice tango. Subscale median scores and total median scores with non-parametric statistics were analyzed., Results: Median scores on hyperthymic subscale (p ≤ 0.001), irritable subscale (p=0.05) and total median score were significantly higher among tango dancers compared to controls (p ≤ 0.001)., Limitations: Self-report measures were used. A larger sample size would have provided greater statistical power for data analysis. Besides, the naturalistic study design did not allow controlling for other clinical variables and limited the generalization of results to broader populations., Conclusions: Our data adds new evidence for the hypothesis that artistic performance is related to one's temperament. Tango passionata, which has both melancholic and vigorous (including "upbeat") features, seems to impart tango dancers' hyperthymic and irritable temperament features. Our study supports the increasing literature on the validity of utilizing temperament as a sub-affective traits in relation to artistic creativity and performing arts., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences., Methods: 459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance., Results: Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females., Limitations: The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships., Conclusions: Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Migraine is a common comorbidity among individuals with bipolar disorder, but the underlying mechanisms for this co-occurrence are poorly understood. The aim of this study was to investigate the genetic background of bipolar patients with and without migraine., Methods: We performed a genome-wide association analysis contrasting 460 bipolar migraneurs with 914 bipolar patients without migraine from the Bipolar Genome Study (BiGS)., Results: We identified one genome-wide significant association between migraine in bipolar disorder patients and rs1160720, an intronic single nucleotide polymorphism (SNP) in the NBEA gene (P=2.97 × 10(-8), OR: 1.82, 95% CI: 1.47-2.25), although this was not replicated in a smaller sample of 289 migraine cases., Limitations: Our study is based on self-reported migraine., Conclusions: NBEA encodes neurobeachin, a scaffolding protein primarily expressed in the brain and involved in trafficking of vesicles containing neurotransmitter receptors. This locus has not previously been implicated in migraine per se. We found no evidence of association in data from the GWAS migraine meta-analysis consortium (n=118,710 participants) suggesting that the association might be specific to migraine co-morbid with bipolar disorder., (Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in neurogenesis and neuroplasticity. Decreased blood levels of BDNF have been found during acute manic and depressive states. BDNF has been proposed as a biomarker in illness phases of mood disorders. No information is available regarding BDNF levels during the mixed states of bipolar disorder (BD). The aim of this study was to evaluate BDNF levels during mixed episodes of BD patients and compare them with those of healthy subjects and depressed patients., Methods: Plasma BDNF levels were measured by an ELISA assay in 18 patients with major depressive episode (MDE), 19 patients with mixed episode (ME) and 15 healthy subjects (HS)., Results: BDNF levels were significantly higher in HS, as compared with patients׳ samples (HS vs. MDE patients: p<001; HS vs. ME patients: p=.022). No significant differences were found between BDNF levels of ME and MDE patients. The severity of illness as assessed by CGI-S was significantly higher in ME than in MDE patients (p=.01)., Limitations: The small sample size may have weakened the power of statistical analyses. All patients received mood-stabilizing and antidepressant treatments which have been reported to influence peripheral BDNF levels., Conclusions: Our results are consistent with previous studies showing reduced BDNF during both manic and depressive episodes. This finding supports the role of BDNF as a state-marker of mood episodes, and may represent a contribution to a unitary approach model between unipolar and BDs, as well as to the manic-depressive spectrum model., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: The short version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) is a useful instrument to measure affective temperaments. Aims of the present study are to validate the Chinese Version of the Short TEMPS-A, and to explore whether it could be useful to distinguish patients with mood disorders from healthy controls or differentiate patients with bipolar disorder (BPD) from those with major depressive disorder (MDD) in Chinese population., Methods: A sample of 715 participants, including 387 patients with MDD, 143 with BPD and 185 healthy controls, was recruited. All participants completed The Chinese Version of the Short TEMPS-A. Standard psychometric tests of reliability and validation were performed. ANOVA, non-parameter test and Multiple Logistic Regression were used to test the association between TEMPS-A scores and mood disorders., Results: The originally proposed five factors of the Chinese Version of the Short TEMPS-A were upheld. The Chronbach-Alpha coefficients of it varied from 0.70 to 0.89 and test-retest Spearman׳s Correlation Coefficients varied from 0.52 to 0.85. Significant differences were found across the three groups on all five TEMPS-A subscales (P<0.001). Multiple Logistic Regression showed that hyperthymic temperament distinguished patients with BPD from those with MDD (OR 1.28, 95% CI 1.14-1.45, P<0.001) after controlling for age, gender and the severity of depression., Limitations: The cross-sectional self-report design, unbalanced demographic characteristics and undifferentiated subtypes of bipolar disorders might limit the generalizability of the results., Conclusion: The Chinese Version of the Short TEMPS-A shows good reliability and validity. It might be used as a screening tool in the general population to identify the vulnerability for developing a mood disorder and the potential risk for bipolar disorder among those who only have depressive symptoms., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: The self-rated auto-questionnaire, the Temperament Scale of Memphis, Pisa, Paris and San Diego (TEMPS-A) is the latest development in the study of temperamental attributes. It has been used and validated in different cultures and countries. The current study aims at validating the Chinese (Cantonese) version of the TEMPS-A and comparing the psychometric properties of the long and short forms of the translated scale., Methods: The Chinese (Cantonese) version of TEMPS-A was prepared with the standard translation and back-translation method, and approved by the original authors (HSA & KKA). It was administered to medical students of the two local universities, and results were analyzed., Results: 613 valid questionnaires were returned. The Cronbach-Alpha coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperament subscales were 0.63, 0.82, 0.78, 0.80, and 0.84, respectively. The strongest correlation was observed between the cyclothymic and irritable temperaments (R=0.600). Factor analysis yielded one large composite (depressive and anxious) and four homogenous factors, cyclothymic, anxious, hyperthymic and irritable. A newly reconstituted 43-item short form, based on methods suggested by the original authors yielded similar factor structure., Limitations: The narrow age range of subjects somewhat limits generalization of the results. However, external and concurrent validations against other validated scales have been demonstrated for the original English versions as well as against the most commonly used languages of the world; furthermore, such validation has also been demonstrated for Chinese (Mandarin)., Conclusions: The Chinese (Cantonese) version of TEMPS-A and the reconstituted 43-item short form were found to have good internal consistency and factor structures comparable to those of other languages from diverse cultures across the planet. We propose that the Cantonese TEMPS-A is a useful tool for local use., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: We investigated temperamental dimensions of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) as well as bipolarity features in male and female subjects engaging in extreme or/and high risk sports., Methods: The web-based case-control study was performed in 480 subjects engaging in extreme or/and high risk sports (255 male, 225 female) aged 26 ± 6 years and in 235 age- and sex-matched healthy controls subjects (107 male, 128 female), aged 28 + 9 years. The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. The Mood Disorder Questionnaire (MDQ) was employed for the assessment of bipolarity., Results: Both male and female athletes had significantly higher scores of hyperthymic temperaments compared with control male and female subjects who had declared themselves as not involved into the activities of extreme or/and high risk sports. In addition, compared with controls, male sportsmen had lower scores of depressive and anxious temperaments, and female athletes had higher scores of cyclothymic and irritable temperaments. Both male and female athletes obtained significantly higher scores of bipolarity as measured by the MDQ, than control men and women., Limitations: Web-based study involving a risk of selection and recall bias, problematic homogeneity of the experimental group., Conclusions: Subjects engaged into extreme or/and high risk sports have significantly higher scores of hyperthymic temperament, measured by the TEMPS-A and present sex-specific features of other temperaments. Such subjects obtain also greater bipolarity scores as measured by the MDQ., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Considerable evidence has demonstrated that melancholic and atypical major depression have distinct biological correlates relative to undifferentiated major depression, but few studies have specifically delineated neuropsychological performance for them., Method: In a six-week prospective longitudinal study, we simultaneously compared neuropsychological performance among melancholic depression (n=142), atypical depression (n=76), undifferentiated major depression (n=91), and healthy controls (n=200) during a major depressive episode and a clinically remitted state, respectively. We administered neuropsychological tests assessing processing speed, attention, shifting, planning, verbal fluency, visual spatial memory, and verbal working memory to all participants., Results: During the depressive state, the three subtypes displayed extensive cognitive impairment, except for attention, when compared with the healthy controls. Melancholic depression significantly differed from atypical depression in processing speed and verbal fluency. In the remitted state, the three subtypes recovered their visual spatial memory and verbal working memory functions to the healthy control level. The recovery of the other domains (processing speed, set shifting, planning, and verbal fluency), however, was different across the subtypes. No predictive relationship existed between neuropsychological performance and the treatment outcome., Limitations: The drop-out rate in the six-week longitudinal study was relatively high., Conclusion: Our data provide preliminary evidence that during depressed states the three major depressive subtypes display similar cognitive deficits in some domains but differ in such domains as processing speed and verbal fluency. The recovery of the cognitive deficits following clinical remission from depression may be associated with subtypes of major depressive disorder., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness., Methods: Five hundred fifty-nine (253 men and 306 women) consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI)., Results: Higher cyclothymia and irritable temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II patients and higher anxiety than patients with other Axis I diagnoses. Severe "male" depression was more common in BD-II patients compared to BD-I and MDD patients. BD-I patients and those with other axis I diagnoses reported lower BHS ≥9 scores than those with BD-II and MDD., Limitations: The study had the limitations of all naturalistic designs, that is, potentially relevant variables were not addressed. Furthermore, the cross-sectional nature of the study did not allow conclusions about causation, and the use of self-report measures could be potentially biased by social desirability., Conclusion: MDD patients were more likely to have higher anxious temperament, higher hopelessness and lower hyperthymic temperament scores, while BD-I patients more often had cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The present study aimed at investigating the possible changes of some features of loving relationships during long-term treatment of depression with both selective serotonin reuptake inhibitors (SSRIs) and tricyclics (TCAs), by means of a specifically designed test, the so-called "Sex, Attachment, Love" (SALT) questionnaire. The sample was composed by 192 outpatients (123 women and 69 men, mean age±SD: 41.2±10.2 years), suffering from mild or moderate depression, according to DSM-IV-TR criteria, that were selected if they were treated with one antidepressant only for at least six months and were involved in a loving relationship. The results showed that SSRIs had a significant impact on the feelings of love and attachment towards the partner especially in men, while women taking TCAs complained of more sexual side effects than men. These data were supported also by the detection of a significant interaction between drug and sex on the "Love" and "Sex" domains. The present findings, while demonstrating a dimorphic effect of antidepressants on some component of loving relationships, need to be deepened in future studies., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: We investigated the effect of co-morbid bipolar disorder and bulimia on temperamental dimensions measured by TEMPS-A, relative to "pure" bulimia and "pure" bipolar disorder, in female patients., Methods: The study was performed on 47 patients with bipolar disorder (BD) with a mean age of 36±10 years, 96 patients with bulimia or bulimic type of anorexia, mean age 26±9 years and 50 control healthy females (HC), mean age 29±6 years. Among bulimic patients, a group of 68 subjects with co-morbid bulimia with bipolarity (BD+B) was identified, based on positive score of the Mood Disorder Questionnaire (MDQ). The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. Parametric analysis was performed for 4 groups (BD, "pure" bulimia (PB), BD+B and HC), with 28 subjects randomly chosen from each group, using analysis of variance and cluster analysis., Results: All clinical groups significantly differed from control group by having higher scores of depressive, cyclothymic, irritable and anxious temperaments and lower of hyperthymic one. Among patients, significantly higher scores of cyclothymic and irritable temperaments were found in BD+B compared to both PB and BD. These differences were also reflected in cluster analysis, where two clusters were identified., Limitations: Bipolarity in bulimic patients assessed only by the MDQ., Conclusions: These results show that co-morbid bulimia and bipolar disorder is characterized by extreme dimensions of both cyclothymic and irritable temperaments, significantly higher than each single diagnosis. Possible clinical implications of such fact are discussed., (Copyright © 2014 Elsevier B.V. All rights reserved.)

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 © 2014 Elsevier B.V. All rights reserved.)

Background: Affective temperaments such as cyclothymia, which may be the fundamental substrates for bipolar disorder and bipolar II in particular, have been reported to be associated with abnormalities in the regions that are related to cognitive deficits in bipolar disorder. However, few studies have examined the effects of affective temperaments on neuropsychological performance in individuals with bipolar disorder., Method: In a six-week prospective study, we administered Chinese version of TEMPS-A (Temperament Evaluation of Memphis, Pisa, San Diego-Autoquestionnair) to 93 patients with bipolar I depression, 135 patients with bipolar II depression, and 101 healthy controls. Cognitive function was assessed with a battery of neuropsychological tasks, including attention, processing speed, set shifting, planning, verbal working memory, verbal fluency, and visual spatial memory. Mixed-effects statistical models were used to assess the effects of affective temperaments on cognitive function., Results: Bipolar patients with hyperthymic temperament showed greater cognitive deficits in set shifting (p=0.05) and verbal working memory (p=0.026) than did bipolar patients with non-predominant temperaments (predominant temperament was defined as one standard deviation above the mean). The differences in estimated marginal means were -0.624 (95% CI, -1.25 to 0) and -0.429 (95% CI, -0.81 to -0.05), respectively. Significant temperament X bipolar subtype interaction effects were observed for set shifting (Wald X(2)=18.161, p<0.001), planning (Wald X(2)=7.906, p=0.048), and visual spatial memory (Wald X(2)=16.418, p=0.001)., Limitation: The anxious temperament was not evaluated., Conclusion: Our data suggest that hyperthymic temperament may be associated with cognitive deficits in some specific domains in bipolar disorder; and that the effect of temperaments may be different across subtypes of bipolar disorder., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy., Methods: 512 survivors of the L'Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, were reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR)., Results: Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in 8 of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about one-fourth in females. By using ROC curves, DSM-5 criteria E and D showed the highest AUC values in males (.876) and females (.837), respectively., Limitations: The use of self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment., Conclusions: This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: Individuals with bipolar disorder (BP) are often misdiagnosed with major depressive disorder (MDD). In this study, we developed a Chinese version of 15-point hypomania scale (HCL-15) in order to determine its sensitivity and specificity in the diagnosis of BP and BP-II in particular., Methods: A total of 623 individuals suffering a major depressive episode (MDE) were systematically interviewed with both Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition, and HCL-15. A cutoff score of 8 or more in HCL-15 was suggested for BP., Results: Of the 623 depressed patients, 115 (18.5%) actually required a diagnosis of BP-I, and another 159 (25.5%) could be more appropriately diagnosed with BP-II, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The sensitivity of 15-HCL in detection of BP-II was 0.78 and 0.46 for BP-I; the specificity was 0.9 and 0.69, respectively. The specificity of HCL-15 for BP versus MDD was as high as 0.93. Approximately 60%-80% of all questions in the HCL-15 questionnaire revealed positive responses from patients, while items 11 and 12, measuring the consumption of alcohol, coffee and cigarettes, demonstrated a low positive response rate., Conclusions: The HCL-15 assessment scale was fairly sensitive and highly specific for a BP-II diagnosis but not for a BP-I diagnosis. Some items in the HCL-15 symptom list need to be further modified to better fit Chinese culture and customs. The HCL-15 scale could be a useful tool in clinical practice for screening individuals with BP-II in order to avoid a misdiagnosis of MDD., (Copyright © 2014 Elsevier Inc. All rights reserved.)