Evolution of genetic networks for human creativity.

The genetic basis for the emergence of creativity in modern humans remains a mystery despite sequencing the genomes of chimpanzees and Neanderthals, our closest hominid relatives. Data-driven methods allowed us to uncover networks of genes distinguishing the three major systems of modern human personality and adaptability: emotional reactivity, self-control, and self-awareness. Now we have identified which of these genes are present in chimpanzees and Neanderthals. We replicated our findings in separate analyses of three high-coverage genomes of Neanderthals. We found that Neanderthals had nearly the same genes for emotional reactivity as chimpanzees, and they were intermediate between modern humans and chimpanzees in their numbers of genes for both self-control and self-awareness. 95% of the 267 genes we found only in modern humans were not protein-coding, including many long-non-coding RNAs in the self-awareness network. These genes may have arisen by positive selection for the characteristics of human well-being and behavioral modernity, including creativity, prosocial behavior, and healthy longevity. The genes that cluster in association with those found only in modern humans are over-expressed in brain regions involved in human self-awareness and creativity, including late-myelinating and phylogenetically recent regions of neocortex for autobiographical memory in frontal, parietal, and temporal regions, as well as related components of cortico-thalamo-ponto-cerebellar-cortical and cortico-striato-cortical loops. We conclude that modern humans have more than 200 unique non-protein-coding genes regulating co-expression of many more protein-coding genes in coordinated networks that underlie their capacities for self-awareness, creativity, prosocial behavior, and healthy longevity, which are not found in chimpanzees or Neanderthals.

Who attracts whom to rural general practice? Variation in temperament and character profiles of GP registrars across different vocational training pathways.

INTRODUCTION: The ongoing rural doctor workforce shortage continues to stimulate interest in new strategies to alleviate the situation. Alongside increasingly promising approaches is the notion that attracting and nurturing the 'right' individuals may be paramount to achieving long-term success in recruitment and retention. This study compares the patterns of demographic and temperament and character trait profiles of general practice registrars in training across three Australian vocational training pathways: the Australian College of Rural and Remote Medicine independent rural pathway, and the rural and general pathways of Australian general practice training. The aim is to describe the predominant personalities of existing trainees. At its foundation, this study strives to obtain more information about those individuals choosing rural practice, which may inform ways to enhance future recruitment and training into rural medicine. This rationale has been explored with medical students using intention as the dependent variable, but registrars are that much closer to their final career choice, and therefore may provide more practical and reliable indicators of the notion of who attracts whom into rural practice. METHODS: A cross-sectional design sampled four registrar training groups: one from the Australian College of Rural and Remote Medicine, one Australian general practice training rural only, and two Australian general practice training rural and general pathway regional training providers. Registrars (451) completed a questionnaire that gathered basic demographics and a personality trait profile using the Temperament and Character Inventory plus a measure of resilience. Statistical analysis explored the relationships between variables (multivariate analyses of variance) and compared levels of traits between registrar groups (analyses of variance). RESULTS: Registrars training via the Australian College of Rural and Remote Medicine pathway were more likely to be male, older, have a definite interest in or already practising in a rural area and were significantly (with moderate effect sizes) lower in levels of harm avoidance and higher in persistence, self-directedness and resilience compared to the other training pathways. CONCLUSIONS: The implications of the data to the recruitment and training of general practice registrars goes further than identifying groups of individuals with similar temperament and character trait patterns. This sample is portrayed as relatively homogenous in light of their overall trait levels as compared to population norms. However, it is the combination of the levels of individual traits that suggests a profile that differs between registrars on a rural or general training path. Importantly the combination of trait levels that tend to differentiate registrars (low harm avoidance, high self-directedness and persistence) correlates strongly with high levels of resilience. Doctors and medical students benefit from a high level of resilience to cope with and manage the challenges of the profession and arguably more so in rural practice. Along with certain demographic characteristics, the combination and levels of temperament (stable) and character (developmental) traits support the notion of a mixture of personal traits that may be indicative of individuals best suited to rural and remote medicine. Further investigation is needed to determine whether individuals with a certain pattern of personal traits are attracted to rural practice training or whether the training itself, in part by exposure to rural life and rural medical practice, selects for those who are most suited to and will eventually choose to practice in a rural location.

Temperament, character and serotonin activity in the human brain: a positron emission tomography study based on a general population cohort.

BACKGROUND: The psychobiological model of personality by Cloninger and colleagues originally hypothesized that interindividual variability in the temperament dimension 'harm avoidance' (HA) is explained by differences in the activity of the brain serotonin system. We assessed brain serotonin transporter (5-HTT) density in vivo with positron emission tomography (PET) in healthy individuals with high or low HA scores using an 'oversampling' study design. Method Subjects consistently in either upper or lower quartiles for the HA trait were selected from a population-based cohort in Finland (n = 2075) with pre-existing Temperament and Character Inventory (TCI) scores. A total of 22 subjects free of psychiatric and somatic disorders were included in the matched high- and low-HA groups. The main outcome measure was regional 5-HTT binding potential (BPND) in high- and low-HA groups estimated with PET and [11C]N,N-dimethyl-2-(2-amino-4-methylphenylthio)benzylamine ([11C]MADAM). In secondary analyses, 5-HTT BPND was correlated with other TCI dimensions. RESULTS: 5-HTT BPND did not differ between high- and low-HA groups in the midbrain or any other brain region. This result remained the same even after adjusting for other relevant TCI dimensions. Higher 5-HTT BPND in the raphe nucleus predicted higher scores in 'self-directedness'. CONCLUSIONS: This study does not support an association between the temperament dimension HA and serotonin transporter density in healthy subjects. However, we found a link between high serotonin transporter density and high 'self-directedness' (ability to adapt and control one's behaviour to fit situations in accord with chosen goals and values). We suggest that biological factors are more important in explaining variability in character than previously thought.

Neurogenetic adaptive mechanisms in alcoholism.

Clinical, genetic, and neuropsychopharmacological studies of developmental factors in alcoholism are providing a better understanding of the neurobiological bases of personality and learning. Studies of the adopted-away children of alcoholics show that the predisposition to initiate alcohol-seeking behavior is genetically different from susceptibility to loss of control after drinking begins. Alcohol-seeking behavior is a special case of exploratory appetitive behavior and involves different neurogenetic processes than do susceptibility to behavioral tolerance and dependence on the antianxiety or sedative effects of alcohol. Three dimensions of personality have been described that may reflect individual differences in brain systems modulating the activation, maintenance, and inhibition of behavioral responses to the effects of alcohol and other environmental stimuli. These personality traits distinguish alcoholics with different patterns of behavioral, neurophysiological, and neuropharmacological responses to alcohol.

Promoting healthy lives and well-being for all: The contribution of the International College of Person-Centered Medicine (ICPCM).

This article defines the scope of Person-Centered Medicine, traces its roots in ancient conceptions, explains the reasons for the revival of this perspective in our times, and highlights the contribution of the International College of Person-Centered Medicine (ICPCM) in the promotion of the personcentered perspective in health and disease. The value of communication is underlined with reference to both diagnosis and treatment. The concept of Health is considered historically and the inclusiveness, holistic vista and positive health orientation of the WHO definition of Health (1948) is underlined. It is emphasized that Mental Health Promotion is differentiated conceptually from Disease Prevention in that promotion deals with health and prevention deals with illness, the relationship of Health Promotion with Salutogenesis (Antonovsky 1996) is noted and it is pointed out that among the targets of health promotion, preservation of peace is also included (WHO, 2004). In line with this, the ICPCM has supported and co-signed the Athens Anti-War Declaration (2016). Evaluating the impact of Health Promotion efforts is a necessary but difficult task as it requires targeted research and there are many inherent confounding factors. The social or environmental contexts of health behaviors should be taken into account as well as the subjective indicators of health. In an attempt to resolve the difficulties arising from this issue, the ICPCM has developed a prototype "Person-centered Care Index" (Kirisci et al 2016). With reference to Education it is pointed out that it is necessary for the educators to speak with the students rather than speak to them. Concerning research, the ICPCM in its 2013 Geneva Declaration has identified the main research areas in the person-centered field. The importance of assuring healthy lives and well-being for ALL is underlined and the difficulties associated with the achievement of this goal are noted. Lastly, the need to apply the principles of Person-centered Medicine to victims of natural, human-made and economic disasters (Christodoulou et al 2016) is underlined, especially in view of the frequent occurrence of these disasters in our times. In conclusion, the contribution of the ICPCM during the ten years of its existence, with reference to the sensitization of health professionals in the Person-centered approach is noted. This contribution has been carried out in line with the principles of the ICPCM and with its Geneva Declarations.

Temperament and personality.

Recent efforts to integrate psychometric and neurobiological data about personality have stimulated diverse interdisciplinary applications. The dissociation of major brain systems linked to procedural and propositional memory and learning has clarified the clinical distinction between two components of personality: temperament and character. Temperament can be defined in terms of individual differences in percept-based habits and skills (i.e. related to procedural memory and learning), which are regulated by the amygdala, hypothalamus, striatum, and other parts of the limbic system. In contrast, character can be defined in terms of individual differences in concept-based goals and values (i.e. related to propositional memory and learning), which are encoded by the hippocampal formation and cerebral neocortex. Recent descriptive, developmental, genetic, and neurobehavioral studies indicate that at least four dimensions of temperament and three dimensions of character can be uniquely described and functionally dissociated.

A systematic method for clinical description and classification of personality variants. A proposal.

A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulus-response characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.

Replication of the Stockholm Adoption Study of alcoholism. Confirmatory cross-fostering analysis.

BACKGROUND: Two forms of alcoholism with distinct clinical features and mode of inheritance were first distinguished in the Stockholm Adoption Study. This involved a large sample of children born in Stockholm, Sweden, who were adopted at an early age and reared by nonrelatives. Type 1 alcoholism had adult onset and rapid progression of dependence without criminality, whereas type 2 had teenage onset of recurrent social and legal problems from alcohol abuse. METHODS: A replication study was carried out with 577 men and 660 women born in Gothenburg, Sweden, and adopted at an early age/by nonrelatives. The genetic and environmental backgrounds of the adoptees were classified by the exact procedures calibrated by discriminant analysis in the original study. RESULTS: Both type 2 and severe type 1 alcoholism were confirmed as independently heritable forms of alcoholism in male adoptees. The lifetime risk of severe alcoholism was increased 4-fold in adopted men with both genetic and environmental risk factors characteristic of type 1 alcoholism compared with the others (11.4% vs 3.0%). Neither genetic nor environmental risk factors for type 1 alcoholism by themselves were sufficient to cause alcoholism. In contrast, the risk of type 2 alcoholism was increased 6-fold in adopted sons with a type 2 genetic background compared with others; regardless of their postnatal environment (10.7% vs 2.0%). The sons with a type 2 genetic background in the replication sample had no excess of type 1 alcoholism, and vice versa. There was no increased risk of mild abuse in adopted men regardless of their genetic or environmental background. CONCLUSION: Type 1 and type 2 alcoholism are clinically distinct forms of alcoholism with causes that are independent but not mutually exclusive.

Maternal inheritance of alcohol abuse. Cross-fostering analysis of adopted women.

The inheritance of alcohol abuse was studied in 913 Swedish women adopted by nonrelatives at an early age. There was a threefold excess of alcohol abusers among the adopted daughters of alcoholic biological mothers compared with other daughters. In addition, there was an excess of alcohol abuse among the daughters of biological fathers with alcohol abuse that was mild and not associated with criminality. However, fathers with extensive treatment for both alcoholism and criminality had no excess of alcoholic daughters. This confirms the heterogeneity among alcoholics noted in earlier work with adopted sons, which found that the latter type of criminal alcoholics also had no excess of alcoholic mothers. Imitation of alcohol abuse by adoptive parents did not increase later alcohol abuse by adopted women. The importance of nonfamilial environments and maternal effects is demonstrated for alcohol abuse in women.

Inheritance of alcohol abuse. Cross-fostering analysis of adopted men.

The inheritance of alcoholism was studied in 862 Swedish men adopted by nonrelatives at an early age. Both the congenital and postnatal backgrounds of the adoptees modify their risk for alcohol abuse. We distinguish two forms of alcoholism that have distinct genetic and environmental causes and differ in their association with criminality, severity of alcohol abuse, and the frequency of expression in biological mothers. Postnatal milieu determines the frequency and severity of expression of the common type of susceptibility in both men and women. In contrast, the less common type is highly heritable in men but is seldom expressed in mothers of affected men.

A psychobiological model of temperament and character.

In this study, we describe a psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character. Previous research has confirmed four dimensions of temperament: novelty seeking, harm avoidance, reward dependence, and persistence, which are independently heritable, manifest early in life, and involve preconceptual biases in perceptual memory and habit formation. For the first time, we describe three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts. Self-concepts vary according to the extent to which a person identifies the self as (1) an autonomous individual, (2) an integral part of humanity, and (3) an integral part of the universe as a whole. Each aspect of self-concept corresponds to one of three character dimensions called self-directedness, cooperativeness, and self-transcendence, respectively. We also describe the conceptual background and development of a self-report measure of these dimensions, the Temperament and Character Inventory. Data on 300 individuals from the general population support the reliability and structure of these seven personality dimensions. We discuss the implications for studies of information processing, inheritance, development, diagnosis, and treatment.

Differential diagnosis of personality disorders by the seven-factor model of temperament and character.

We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low self-directedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Self-directedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor Neuroticism-Extraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.

Implications of sex differences in the prevalences of antisocial personality, alcoholism, and criminality for familial transmission.

We describe three multifactorial models of disease transmission in which the prevalences of a disease differ in men and women. These models demonstrate explicitly how such sex differences may be caused by genetic factors, home environment, sociocultural, or other nonfamilial factors. Independent sets of family data about antisocial personality and alcoholism in the United States and criminality in Danish twins are analyzed according to these quantitative models. Relevant clinical and adoption data about these disorders are reviewed. The sex differences observed in the development of antisocial personality and of crime appear to be due to familial factors whereas the differences between male and female alcoholics are due to nonfamilial factors. The models and results are discussed in terms of their general implications for testing hypotheses about gender-related differences.

Female criminality and the prediction of recidivism. A prospective six-year follow-up.

A prospective, six-year follow-up investigation of 66 convicted female felons indicated that psychiatric, social, and familial factors defined and measured at the time of the index study affected the rate of criminal recidivism. Wide individual variation in the course of female criminality was observed. Prolonged supervision on parole or probation appeared to have therapeutic benefit. The most powerful predictors of recidivism were the diagnoses of drug dependence and antisocial personality, and a history of homosexuality. Familial criminality and maternal hysteria were also associated with an increased risk of serious and persistent recidivism. Educational, marital, and employment status contributed to a lesser extent, while race and type of index offense were only significant (P less than .05) when minor offenses were considered.

An adoption study of depressive disorders and substance abuse.

Registered psychiatric illness was studied in the biologic and adoptive parents of 115 adoptees with affective disorders or histories of substance abuse. The parents of these patients were compared with those of 115 control subjects who were pairwise matched for demographic and social variables and who had no psychiatric illness. Psychiatric patients had a fivefold excess of adoptive fathers who had psychiatric illness compared with fathers of their matched controls. This was due to an excess of affective disorders in adoptive fathers regardless of the sex or diagnosis of the adopted child. Biologic mothers of female patients had a threefold increase in psychiatric illness compared with mothers of their matched controls and a fourfold increase compared with mothers of male adoptees. However there was no significant concordance between specific diagnoses in biologic parents and their adopted-away children. Subdivision of depressive patients according to psychotic-nonpsychotic and reactive-nonreactive dichotomies did not yield subgroups with distinct family histories.

Predisposition to petty criminality in Swedish adoptees. I. Genetic and environmental heterogeneity.

The inheritance of criminality was studied in 862 Swedish men and adopted by nonrelatives at an early age. If type of offense and association with alcohol abuse were neglected, criminality was heterogeneous and appeared to be largely nonfamilial. Nevertheless, different genetic and environmental antecedents influenced the development of criminality, depending on whether or not there was associated alcohol abuse. Alcoholic criminals often committed repetitive violent offenses, whereas nonalcoholic criminals were characterized by commission of a small number of petty property offenses. These nonalcoholic petty criminals had an excess of biologic parents with histories of petty crime but not alcohol abuse. In contrast, the risk of criminality in alcohol abusers was correlated with the severity of their own alcohol abuse, but not with criminality in the biologic or adoptive parents. Unstable preadoptive placement was associated with increased risk for petty criminality, whereas low social status was associated with alcohol-related criminality. We discuss the significance of these results in relation to the classification of criminals and current concepts about antisocial personality.

Predisposition to petty criminality in Swedish adoptees. II. Cross-fostering analysis of gene-environment interaction.

The interaction of congenital and postnatal antecedents of criminality was studied in 862 Swedish men adopted at an early age by nonrelatives. Most explained variability was due to differences between the genetic predispositions of the adoptees, but substantial contributions were also made by postnatal environment, either alone or in combination with specific genetic subtypes. There was no overlap between the congenital antecedents of alcoholism and nonalcoholic criminality, but some postnatal variables were common to criminality and one type of alcoholism that is limited to expression in men, according to earlier studies. Low social status alone was not sufficient to lead to criminality, but did increase risk in combination with specific types of genetic predisposition. Unstable preadoptive placements contributed to the risks of both petty criminality and male-limited alcoholism, but not to other types of alcohol abuse. We discuss these results in terms of their clinical and social implications.

Predisposition to petty criminality in Swedish adoptees. III. Sex differences and validation of the male typology.

Sex differences in the inheritance of criminality were studied in 913 women and 862 men from the Stockholm Adoption Study. Our multivariate classification of genetic heterogeneity was validated in the female sample by confirmation of predictions derived from the men. The congenital antecedents of criminality were the same regardless of sex, but the congenital predisposition to criminality had to be more severe for a woman to be affected. Furthermore, the postnatal antecedents of criminality that were studied were qualitatively different in the two sexes. Prolonged institutional care and urban rearing increased the risk of criminality in women but not in men. In contrast, multiple temporary placements and low social status of the adoptive home increased the risk ot criminality in men but not women. The antecedents of petty criminality and alcohol abuse were distinct in both sexes. Cross-fostering analysis indicated that postnatal factors were more important for criminality than for alcoholism in women. We discuss the overall significance of this series of reports and make suggestions for future research.