The relationship between impulsivity and lipid levels in bipolar patients: does temperament explain it?

BACKGROUND: The aim of this study was to investigate whether there was a relationship between impulsivity and lipid levels in patients with bipolar disorder (BD) and to examine the correlation of impulsivity and lipid levels with temperament subtypes. METHODS: For this purpose, one hundred patients who were admitted to our out-patient unit for routine controls, had been in remission for at least 8weeks, and diagnosed as BD according to the DSM-IV were evaluated consecutively. Impulsivity and temperament were evaluated with the BIS-11 and the TEMPS-A. Blood samples were obtained to measure levels of lipids (cholesterol, triglyceride, high density lipoprotein-HDL, low density lipoprotein-LDL). RESULTS: A weak correlation was found between impulsivity scores and triglyceride levels (r=0.190, p=0.050). Correlation was found between impulsivity scores and depressive, anxious, cyclothymic, and irritable temperaments (r=0.371, p<0.001; r=0.458, p<0.001; r=0.541, p<0.001; r=0.530, p<0.001), while triglyceride levels were only related with depressive and anxious temperaments (r=0.485, p=0.001 and r=0.391, p=0.006). CONCLUSIONS: Temperament is an important mediator of the relationship between lipid levels and trait impulsivity in patients with BD.

Is the relationship between affective temperament and resilience different in depression cases with and without childhood trauma?

OBJECTIVE: The aim of this study was to investigate if the relationship between affective temperament and resilience in major depression is different in cases with and without childhood trauma. METHODS: For this purpose 100 cases with major depressive disorder (MDD) diagnosis according to DSM-IV were evaluated consecutively in their regular outpatient clinic follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and SanDiego-Autoquestionnaire) Temperament Questionnaire, resilience was evaluated with The Resilience Scale for Adults (RSA)-Turkish version. The presence of childhood trauma (CT) was determined by Early Trauma Inventory. RESULTS: In MDD cases without CT a correlation was present between psychological resilience and hyperthymic temperament, while there was a correlation between psychological resilience and depressive temperament in cases with CT. The relationship between depressive temperament and psychological resilience in cases with CT was observed in the perception of self, family cohesion, and social resources dimensions of psychological resilience. CONCLUSION: In depression cases with and without childhood trauma, the relationship between temperament and resilience appears to be different. According to our results psychological resilience was associated with hyperthymic temperament in depressive cases without childhood trauma, while it was associated with depressive temperament in depressive cases with childhood trauma.

Alexithymia in patients with conversion disorder.

BACKGROUND AND AIMS: In the recent years, it has been observed that alexithymia is not specified for the psychosomatic disorders. It is known that alexithymia is observed frequently in various psychiatric disorders especially in the somatoform disorders. The aim of this study is to evaluate alexithymia in the patients with the conversion disorder. METHODS: The study was performed in the Psychiatry Outpatients Clinics of the Izmir Atatürk Training and Research Hospital and Erenköy Psychiatry Education and Research Hospital. A total of 93 cases-47 outpatients who were diagnosed with conversion disorder according to the DSM-IV criteria and 46 age, gender and educational level matched healthy controls-were included in the study. All the cases were assessed by a Structured Clinical Interview for DSM-IV and were evaluated with a questionnaire (which included demographics and clinical data), the Toronto Alexithymia Scale and the Somatosensory Amplification Scale. RESULTS: When the two groups were compared, the Toronto Alexithymia Scale scores (except "externally oriented thinking" subscale) and the Somatosensory Amplification Scale score of the conversion disorder group were statistically significantly higher than the control group. The number of the alexithymic cases of the patient group was significantly higher than the control group's. CONCLUSIONS: The level of alexithymia in conversion disorder patients, without any other psychiatric disorder, is higher than that of the healthy controls. During the evaluation of the psychological state of patients with conversion disorder, it could be useful to keep in mind the probability of them having alexithymia to determine the type of suitable therapy.

Is there a relationship between age at menarche and clinical and temperamental characteristics in bipolar disorder?

BACKGROUND: This study investigated whether age at menarche in women with bipolar disorder (BD) is different from that in healthy women and if there is a relationship between age at menarche and clinical and temperamental characteristics of BD. METHODS: We consecutively evaluated 126 euthymic women diagnosed with BD according to DSM-IV. The healthy control group comprised 100 individuals of similar mean age and socioeconomic level. After the diagnostic interview, BD patients completed the Mood Disorders Diagnosis and Follow-Up Form and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire. RESULTS: Age at menarche in BD patients was similar to that in controls. A strong inverse correlation was found between age at menarche and total duration of depressive episodes (r = -0.532). In BD patients, an inverse correlation has been found between age at menarche and depressive and cyclothymic temperament scores (r = -0.384 and r = -0.421). However, a strong correlation has been found between age at menarche and irritable temperament scores (r = 0.488). CONCLUSIONS: Age at menarche is associated with the clinical course of BD. Moreover, age at menarche seems to be associated with traits related to mood.

A dimensional approach to affective disorder: The relations between Scl-90 subdimensions and QEEG parameters.

Objectives: QEEG reflects neuronal activity directly rather than using indirect parameters, such as blood deoxygenation and glucose utilization, as in fMRI and PET. The correlation between QEEG spectral power density and Symptom Check List-90-R may help identify biomarkers pertaining to brain function, associated with affective disorder symptoms. This study aims at determining whether there is a relation between QEEG spectral power density and Symptom Check List-90-R symptom scores in affective disorders. Methods: This study evaluates 363 patients who were referred for the initial application and diagnosed with affective disorders according to DSM-V, with QEEG and Scl-90-R. Spectral power density was calculated for the 18 electrodes representing brain regions. Results: Somatization scores were found to be correlated with Pz and O1 theta, O1 and O2 high beta. Whereas FP1 delta activities were correlated with anxiety, F3, F4, and Pz theta were correlated with obsession scores. Interpersonal sensitivity scores were found to be correlated with F4 delta, P3, T5, P4, T6 alpha and T5, and T6 theta activities. While depression scores were correlated with P3 and T4 delta, as well as T4 theta, there was a correlation between anger and F4, as well as T4 alpha and F8 high beta activities. Paranoia scores are correlated with FP1, F7, T6 and F8 theta, T5 and F8 delta, and O2 high beta activities. Conclusions: According to our results, anxiety, obsession, interpersonal sensitivity, depression, anger, and paranoia are related to some spectral powers of QEEG. Delta-beta coupling seems to be a neural biomarker for affective dysregulation.

Neuropsychological and Neurophysiological Assessment in Different Phases of Bipolar Disorder.

Background: Recent studies have shown that cognitive deficits are significant and pervasive even among remitted bipolar disorder patients. The aim of the current controlled study was to investigate the relationships between cognitive performances, symptom severity, and event-related potentials with regard to different episodes in bipolar patients. Methods: This study was conducted on a total of 60 patients diagnosed with bipolar disorder (20 depressive, 20 manic, and 20 in remission). The Frontal Assessment Battery and Stroop test were used for neuropsychological assessment. Event-related potentials were measured using frontal, central, and parietal EEG recordings, while Nihon-Kohden EMG-EP system was used. Results: Delayed P300 latencies were observed in all phases of bipolar disorder when compared to the controls. There was a positive relationship between frontal, central P300 latencies, and Young Mania Rating Scale scores. A strong positive relationship was also observed between Young Mania Rating Scale scores and Stroop interference scores. A negative relationship was observed between Frontal Assessment Battery scores and frontal, central, and parietal N100 latencies and amplitudes in depressed patients. Consistent with these findings, there was a relationship between Hamilton Depression Rating Scale scores and N100 latencies. There was also a positive relationship between Stroop interference scores and central N200 latency, as well as frontal N200 and parietal N200 amplitudes, while a negative relationship was observed between Stroop total time scores and central N200 latency as well as parietal N200 amplitude in depressed patients. Conclusions: Study findings imply that depression episodes could be associated with decision-making autonomy and memory issues, while there is also a relationship between episodes of mania, impaired inhibitory control, and issues with selective attention. Moreover, these cognitive impairments might be included in the initial phases of processing observed in N100 responses in depression, while processing impairment could be pervasive in mania that results in P300 delays.

The entropy of chaotic transitions of EEG phase growth in bipolar disorder with lithium carbonate.

The application of chaos measures the association of EEG signals which allows for differentiating pre and post-medicated epochs for bipolar patients. We propose a new approach on chaos necessary for proof of EEG metastability. Shannon entropies of concealed patterns of Schwarzian derivatives from absolute instantaneous frequency transformations of EEG signals after Hilbert transform are compared and found significantly statistically different between pre and post-medication periods when fitted to von Bertalanffy's functions. Schwarzian dynamics measures was compared at first baseline and then at the end of the first hour of one dose 300 mg lithium carbonate intake for the same subject in depressive patients. With an application of Schwarzian derivative on the prediction of von Bertalanffy's models, integration and segregation of phase growth orbits of neural oscillations can be understood as an influence of chaos on the mixing of frequencies. A phase growth constant parameter was performed to determine the bifurcation parameter of von Bertalanffy's model at each given non-overlapped EEG segment. Schwarzian derivative was sometimes very close positive near the origin but stayed negative for most of the number of segments. Lithium carbonate changed the chaotic invariants of the EEG Schwarzian dynamics and removed sharp boundaries in the bipolar spectrum.

[The relationship between attachment style, and temperament, personality and bipolar symptoms: a controlled study on bipolar patients and their children]. / Iki Uçlu Olgular ve Çocuklarinda Baglanma Biçiminin Mizaç, Kisilik ve Klinik Özellikler ile Iliskisi: Kontrollu Bir Çalisma.

OBJECTIVE: This study aimed to identify the attachment style of bipolar patients and their children, and to investigate the relationship between attachment style, and temperament, personality characteristics, and clinical features of bipolar disorder. METHOD: The study included 44 euthymic bipolar patients, 35 of their healthy children (>16 years old), and 84 healthy controls (matched in terms of age, gender, and sociocultural background with the patients and their children). Diagnostic interviews were conducted using SCID-I, SCID-II, and SCID-NP. Bipolar symptoms were evaluated using SCIP-TURK. Temperament and attachment style were measured using TEMPS-A and AAS. RESULTS: More of the bipolar patients had an avoidant attachment style and more of their children had an anxious/ambivalent attachment style than did the healthy controls (p < 0.001 and p << 0.001). There was a negative correlation between insecure attachment and hyperthymic temperament (p = 0.008 and r = -0.623, and p = 0.049, r = -0.386). Insecure attachment style in the bipolar patients was predicted by borderline personality disorder, the severity of manic/depressive episodes, and depressive temperament. Insecure attachment in their children was predicted by anxious-avoidant and anxious-ambivalent attachment styles, the number of depressive episodes, irritable temperament (children), low-level social functioning, and a depression-mania-remission pattern. CONCLUSION: We observed a reciprocal relationship between insecure attachment style and mood disorders. This study shows that depressive temperament in bipolar patients and irritable temperament in their children predicted insecure attachment in both patients and their children.

QEEG - spectral power density of brain regions in predicting risk, resistance and resilience for bipolar disorder: A comparison of first degree relatives and unrelated healthy subjects.

BACKGROUND: Temperament stems from the brain circuitry. Genetic differences among people are attributable to differences in neurophysiological function. Affective temperament is proposed endophenotype for bipolar affective disorder. QEEG - spectral power density is thought to be an index of general affective and cognitive brain activity. The association of spectral power density with types of affective temperament may enlighten endophenotypes for bipolar affective disorder disposition. METHOD: TEMPS-A scale and rest QEEG were done on 25 euthymic patients, their healthy first degree relatives (n = 25) and 25 unrelated healthy control subjects. All patients were on lithium maintenance therapy. RESULTS: F4 and T4 delta wave activity were similar between patients and first degree relatives, while Pz alpha activity was similar in first degree relatives and unrelated healthy subjects (p = 0.025, p = 0.001, p = 0.010). Cyclothymic and hyperthymic temperament scores were similar between patients and first degree relatives but higher than unrelated healthy subjects (p = 0.015, p = 0.010). F7 beta and F7-O2 high beta power were correlated with hyperthymic and irritable temperaments respectively in bipolar subjects (r = 0.439, 0.387; 0.405, 0.364; 0.226, 0.351). T3-F4-T4 delta powers were correlated with cyclothymic temperament in patients and their first degree relatives (r = 0.443, 0.420, 505). Pz alpha power and hyperthymic temperament were inversely correlated in first degree relatives and unrelated healthy subjects (r = -0.256 and -0.311). CONCLUSION: Medial temporal network may be associated with bipolar affective disorder heritability. On the other hand, left dorsolateral prefrontal beta and high beta activities may be a neural marker for disorder resistance together with right occipital high beta power.

Bipolar Spectrum Disorder May Be Associated With Family History of Diseases.

BACKGROUND: This study aims at investigating into the presence of family history of diabetes, ischemic heart disease, thyroid disease, cancer, cerebrovascular disease, and epilepsy in bipolar patients. METHODS: Totally 1,148 patients admitted to our outpatient unit between January 2018 and January 2020, who were diagnosed with bipolar disorder according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), from whom informed consent was obtained, were cross-sectionally and consecutively evaluated. Each patient was questioned regarding a family history of diabetes, ischemic heart disease, thyroid disease, cancer (gastrointestinal, breast and prostate cancer, leukemia, and lymphoma), cerebrovascular disease and epilepsy in first- and second-degree relatives. RESULTS: Diabetes, ischemic heart disease, cancer, cerebrovascular disease and epilepsy were more common in the family histories than in bipolar patients. A strong correlation was found between family history positive for epilepsy and bipolar disorder with psychotic symptoms. Also, a correlation was found between family history for diabetes and seasonal course and family history positive for thyroid disease and comorbid anxiety disorder. CONCLUSIONS: This study is the first to investigate into the frequency of physical diseases in the family histories of bipolar patients. Current therapies target the association between common leading pathways and symptoms whereas it is the association between stress and neural circuits that underlie the pathophysiology that should be targeted.

[Psychopathology and temperament in parents of adolescents with substance use disorders: a controlled study]. / Madde Kullanim Bozuklugu Olan Ergenlerin Ebeveynlerinde Psikopatoloji ve Mizaç: Kontrollü Bir Calisma.

OBJECTIVE: The aim of the present study was to investigate the characteristics of psychopathology and temperament in parents of adolescents with substance use disorders (SUD). We compared the psychiatric diagnoses and temperament characteristics of parents of adolescents with SUD with parents of adolescents without SUD. METHODS: Diagnostic interviews of the parents were conducted with 3 instruments: Structured Clinical Interview for DSM non-patients, Axis 1 Disorders, and Axis 2 Disorders (SCID-NP, SCID-I, and SCID-II). Temperament characteristics were evaluated with TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire), Turkish version. RESULTS: Mood disorders (P = 0.010), and avoidant (P = 0.005) and paranoid (P = 0.011) personality were more frequent in mothers of adolescents with SUD than in the controls, whereas mood disorders (P = 0.011), SUD (P = 0.047), and paranoid personality (P = 0.008) were more frequent in the fathers of adolescents with SUD than in the controls. Depressive, cyclothymic, and anxious temperament scores (respectively P = 0.023, P = 0.00, and P = 0.003) were higher in mothers than in the controls, and depressive temperament (P = 0.013) scores were higher in fathers of adolescents with SUD than in the controls. CONCLUSION: DSM Axis I and Axis II disorders were more frequent in the parents of adolescents with SUD than in the parents of adolescents without SUD. The difference in temperament characteristics exists in both groups. Familial effects have significant clinical implications for SUD in adolescents, such as individual features and peer effect.

[Quality of life in major depressive disorder: a cross-sectional study]. / Major Depresif Bozuklukta Yasam Kalitesi: Kesitsel Bir Calisma.

OBJECTIVE: To investigate quality of life and its association with depression in patients with major depressive disorder. METHOD: The study included 74 patients diagnosed with major depressive disorder according to DSM-IV. The Hamilton Depression Rating Scale (HAM-D) was used to assess the severity of depression; and the, Medical Outcomes Study Short Form-36 (MOS SF-36) and EuroQol 5-D (EQ-5D) were used to measure quality of life. RESULTS: In the assessment of quality of life, it was determined that Patients with major depressive disorder scored significantly lower on all domains of MOS SF-36 compared to Turkish normative data. The depressive disorder patients had lower EQ-5D health utility index scores, in comparison to Turkish normative data. There was a significant negative correlation between mean HAM-D score and all domains of MOS SF-36 and EQ-5D health utility index scores. When quality of life in depressive patients was compared according to episode type, patients with recurrent type major depressive disorder had lower quality of life in terms of physical functioning, general health perception, and physical component summary score than patients with single episode type major depressive disorder. CONCLUSION: All domains of quality of life were lower in patients with major depressive disorder and quality of life decreased as severity of depression increased. Physical health perception was impaired to a greater degree in patients with recurrent major depressive disorder when compared with single episode depressive patients.

Corrigendum to "CFC delta-beta is related with mixed features and response to treatment in bipolar II depression" [Heliyon 5 (6) (June 2019) e01898].

[This corrects the article DOI: 10.1016/j.heliyon.2019.e01898.].

[Anticipation in bipolar disorder: A comparison between two generations]. / Iki uçlu bozuklukta birikme etkisi: Iki nesil arasinda bir karsilastirma.

OBJECTIVE: The genetic phenomenon of anticipation is a pattern of inheritance that includes earlier age at onset and increased severity of symptoms in succeeding generations, and is a feature of some neurodegenerative diseases. This phenomenon is suggested to occur in bipolar disorder (BP) as well. METHOD: Anticipation in children with BP type 1 (s2) (n = 31) and their parents (s1) (n = 31) not-consecutive generations-was assessed by analyzing clinical characteristics and prognoses. RESULTS: Age at onset of BP type 1 in s2 (mean: 19.3 +/- 4.2 years) occurred earlier than in s1 (mean: 29.5 +/- 10.2 years) (u = 345, P < 0.001). There was a direct negative correlation between the s1 and s2 cases (r = -0.554, P < 0.001). The total number of episodes in s1 (13.9 +/- 12.3) was greater than in s2 (8.7 +/- 7), which had a higher frequency of episodes (0.6 +/- 0.3 and 1.5 +/- 1.2) (u = 357, P < 0.001). There was a direct correlation between total episodes and the frequency of manic episodes between s1 and s2 (r = 0.312, P < 0.001 and r = 0.365, P < 0.001, respectively). We observed that 72.7% of BP type 1 parents that had episodes with psychotic features had offspring that had episodes with psychotic features. CONCLUSIONS: Results of this study show that age at onset was earlier and the frequency of episodes was greater in s2 BP type 1 cases. In addition, episodes with psychotic features might be a marker for genetic anticipation.

Epigenetics of Metabolic Syndrome as a Mood Disorder.

Mood disorders comprise major depressive disorder (MDD), bipolar disorder (BD) and the milder forms of these two disorders. Reccurring MDD is also known as unipolar disorder. The distinction between unipolar and bipolar disorders was first suggested in 1957 by Leonard and was made official after support by several studies in 1980. Indeed, in 150 AD, Aretaeus of Cappadocia wrote "It seems to me that melancholia is the beginning and a part of mania". Additionally, Kraepelin, who proposed the first medical disease model in psychiatry a century ago, considered recurrent unipolar depression cases under the category of bipolar disorder and conceptualized spectrum disorders. Because today's classification systems conduct cross-sectional diagnosis, they do not consider family history, long-term characteristics and multidimensional approaches on symptoms. This method prioritizes reliability over validity and it rules out psychiatric disorders in etiology. Actually, a spectrum model which covers physical diseases is conceivable. The concept of epigenetics considers mood disorders, Alzheimer's disease, attention deficit and hyperactivity disorder, Carney syndrome, multiple endocrine neoplasia type I and II, breast and prostate cancers, carsinoid tumors, cerebrovascular and cardiovascular diseases and metabolic syndrome together. This review addressed the relationship between metabolic syndrome and mood disorders in this context along with genetic, clinical and environmental factors such as climate, geographic factors, migration and changeable lifestyles. Genetic and clinical variables are affective temperament, childhood trauma and use of antidepressants and antipsychotics.

QEEG in affective disorder: about to be a biomarker, endophenotype and predictor of treatment response.

QEEG is a relatively easy to apply, cost effective method among many electrophysiologic and functional brain imaging techniques used to assess individuals for diagnosis and determination of the most suitable treatment. Its temporal resolution provides an important advantage. Many specific EEG indicators play a role in the differential diagnosis of neuropsychiatric disorders. QEEG has advantages over EEG in the dimensional approach to symptomatology of psychiatric disorders. The prognostic value of EEG has a long history. Slow wave EEG rhythm has been reported as a predictor and measure of clinical improvement under ECT. The induction level in delta band activity predicts the long term effect of ECT. Current studies focus on the predictive power of EEG on response to pharmacotherapy and somatic treatments other than ECT. This paper discusses either QEEG can be a biomarker and/or an endophenotype in affective disorders, if it has diagnostic and prognostic value and if it can contribute to personalized treatment design, through a review of relevant literature.

Predictors of metabolic syndrome in first manic episode.

OBJECTIVE: In the present study we aimed to investigate, whether an association between metabolic syndrome (MetS) and clinical features and affective temperaments exists or not in first manic episode of bipolar disorder (BD) and to clarify the prevalence and predictors of MetS. METHOD: A total of 150 patients who were received a diagnosis of bipolar disorder type I according to DSM-IV criteria and who were experiencing their first manic episode (FME) were screened consecutively for inclusion. NCEP ATP III formulated an operational definition of MetS based on the presence of three or more of the following characteristics: abdominal obesity (waist circumference), hypertriglyceridemia, low HDL or being on an antilipidemic agent, high blood pressure or being on an antihypertensive agent, and fasting hyperglycemia or being on antiglycemic agent. The patients who had been in remission period for at least 8 weeks were evaluated with SKIP-TURK and TEMPS-A. Remission was defined as YMRS score <5. RESULTS: 37 (32.5%) patients had a MetS. Previous depressive episode, seasonality, negative family history and childhood trauma are determined as the predictors of MetS. Anxious and irritable temperament scores were higher in MetS (+) patients. CONCLUSION: According to our results, links between MetS and BD may also have been predicted by genetic and environmental factors.

Cognitive Functions of Bipolar Disorder Patients in Remission on Monotherapy: A Follow-Up Study.

OBJECTIVE: Multiple sectional studies indicate that the cognitive functions of bipolar disorder (BD) patients in remission are damaged. These studies also suggest that cognitive functions get worse over time. Although the results are inconsistent, there are limited follow-up studies that reveal any contradictory results. Interestingly, there have been major difficulties in the interpretation related to this subject. In particular, scarcity of longitudinal studies and not eliminating the role of multidrug side effects on cognitive functions are just a few. Due to these aforementioned limitations, the longitudinal course of cognitive functions and their sectional differences were investigated in BD patients that underwent remission with monotherapy in this study. METHODS: In this study, the cognitive functions (premorbid IQ, attention, executive functions, memory, visual-spatial skills, and psychomotor speed) of BD patients (n=27) in remission and on monotherapy for at least 1 month were assessed at baseline and at an 18 (6-77) month follow-up period and compared to healthy controls (n=35). RESULTS: The BD group's performance was worse than those of the control group on tests that evaluated attention, executive functions including concept formation, mental flexibility, response inhibition, set shifting, and reasoning, verbal memory, and psychomotor speed. On the other hand, the BD group showed no significant differences at baseline and follow-up examinations. CONCLUSION: All cognitive functions of BD patients on monotherapy remained stable during the follow-up. This suggests that this group might be a sub-group of BD with good prognosis, and monotherapy may not be harmful on cognitive functions. On the other hand, it needs longer time to detect cognitive dysfunctions. Kewords: Bipolar disorder, neurocognition, euthymia, monotherapy, prospective design.

Temperament and Character Profiles and Psychiatric Comorbidities in Patients With Coronary Artery or Valvular Heart Disease: Relationship With Cardiac Disease Severity.

BACKGROUND: We aimed to investigate whether the psychopathological symptoms and temperament-character dimensions observed in patients operated due to coronary artery disease (CAD) or valvular heart disease (VHD) differ among the patients and from healthy individuals. METHODS: Study population was composed of subjects with CAD, VHD and healthy controls (n = 50 in each group). Socio-demographic questionnaire, temperament and character inventory (TCI) and symptom check list-90-R (SCL-90-R) were applied to all groups. Groups were compared about temperament-character dimensions and scores of subscales of SCL-90-R. RESULTS: Harm avoidance was found to be higher in VHD group than those with CAD and, lower in healthy controls than both patient groups (P = 0.004). Reward dependence was similar among both patient groups and, was higher than healthy group (P = 0.015). Depression, anxiety, somatization, obsession and interpersonal sensitivity were found to be similar in both patient groups but they were higher than those in controls (P < 0.001, P < 0.001, P < 0.001, P = 0.002 and P = 0.003, respectively). Phobia was seen equally in CAD group and healthy controls and, was found to be lower in these than in VHD (P = 0.009). Anger score was in descending order in patients with VHD, CAD and healthy controls group (P = 0.010 and 0.001). Paranoia was in descending order in patients with VHD, CAD and controls (P = 0.015 and 0.001). A weak and inverse correlation was found between ejection fraction (EF) and the persistence dimension of temperament scaled by TCI in patients with VHD (r = -0.276, P = 0.052). An inverse correlation was observed between EF and the reward dependence dimension in CAD group (r = -0.195, P = 0.044). In patients with VHD, EF demonstrated an inversely weak (r = -0.289, P = 0.042), moderate (r = -0.360, P = 0.010) and strong (r = -0.649, P < 0.001) correlation with inter-personal sensitivity, phobia and paranoia, respectively. There was an inverse and weak correlation between EF and depression and anger in VHD group (r = -0.302, P = 0.033 and r = -0.240, P = 0.054). CONCLUSION: VHD and CAD exhibit different psychopathological symptoms and temperament traits. There is a correlation between the aforementioned psychopathological symptoms and temperament traits, and EF.

Affective temperaments in clinically-well subjects in Turkey: initial psychometric data on the TEMPS-A.

BACKGROUND: This is a first attempt to evaluate the reliability and factor structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Turkish Version. The questionnaire is a self-report 110-item measure that postulates five affective temperaments-the depressive, cyclothymic, irritable, hyperthymic, and anxious-which embody both strengths and liabilities along affective lines. METHODS: The questionnaire was administered to 658 clinically-well subjects in a Turkish university circle. We undertook item analysis and test-retest reliability. We then examined internal consistency through factor analysis with PCA rotation. RESULTS: We found good to excellent test-retest reliability (0.73-0.91), and internal consistency (0.77-0.85). We deleted 10 items with factor loading <0.20 for their own subscales, resulting in a questionnaire with 99 items. Despite considerable overlap between depressive and cognitive anxiety traits, a distinct "nervous"-anxious factor emerged as well, and the hypothesized (original English) 5-factor structure of the TEMPS-A was supported. Cut-offs for each temperament were based on z-scores higher than +2S.D. Dominant irritable (3.7%), nervous-anxious (3.7%) and depressive (3.1%) temperaments were the most common in this population, whereas dominant cyclothymic (1.7%) and hyperthymic (1.2%) temperaments were relatively uncommon. These temperaments tended to lose their intensity with age. As expected, women scored significantly higher on the nervous-anxious, and men on the hyperthymic temperaments. LIMITATIONS: The sample was composed of younger subjects with higher education than the general population of Turkey. Although the distribution of the scores for each of the temperaments deviated somewhat from normal curves, for heuristic reasons we did attempt to provide prevalence rates based on z-scores. CONCLUSION: In this preliminary version of the TEMPS-A, we have retained 100 (of the original 110) traits loading >0.20. Some deleted items referred to sleep, others appeared socially desirability traits in the Turkish culture endorsed by many subjects. Nonetheless, item analyses within each factor revealed traits indicative of personal assets (specific to each temperament) along with those which might represent vulnerability to affective illness. This is in line with the hypothesized original theoretical framework of the senior authors. Even in this "first pass," in its Turkish version the TEMPS-A is a reliable and valid instrument. Further refinement of the instrument will require the study of a nationally representative sample in Turkey.