Effect of the 5-HTTLPR polymorphism on affective temperament, depression and body mass index in obesity.

BACKGROUND AND AIM: Many studies show high prevalence of affective disorders in obese patients. Affective temperament is a subclinical manifestation of such conditions. The 5-HTT gene encoding the serotonin transporter may be involved in both mood and eating dysregulation. The aim of this study was to investigate the influence of a polymorphism in the 5-HTT gene on affective temperament types, depressive symptoms and Body Mass Index (BMI) in obese patients. METHODS: This study involved 390 patients (237 females, and 153 males) with obesity. The TEMPS-A questionnaire, Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were used to evaluate affective temperaments and prevalence of depression. DNA was obtained for serotonin transporter gene-linked polymorphism (5-HTTLPR) genotyping. RESULTS: In obese patients S/S genotype was associated with depressive and L/L with cyclothymic temperament. Subjects with L/L genotype presented significantly higher BMI and greater intensity of depressive symptoms in BDI and HDRS. Females scored higher in anxious and depressive, while males in hyperthymic, cyclothymic and irritable temperaments. Females scored higher in BDI (subjective depression) while males in HDRS (objective depression). LIMITATIONS: TEMPS-A, BDI and HDRS are frequently used in studies on affective disorders. However, these methods do not examine all dimensions of mood and personality. CONCLUSIONS: In obese patients S allele of 5-HTTLPR was associated with development of depressive temperament while L allele corresponded with greater obesity and prevalence of depression. Different mechanisms may be involved in manifestation of depression in males and females with obesity.

Post-traumatic stress disorder in DSM-5: estimates of prevalence and criteria comparison versus DSM-IV-TR in a non-clinical sample of earthquake survivors.

BACKGROUND: The latest edition of DSM (DSM-5) introduced important revisions to PTSD symptomatological criteria, such as a four-factor model and the inclusion of new symptoms. To date, only a few studies have investigated the impact that the proposed DSM-5 criteria will have on prevalence rates of PTSD. METHODS: An overall sample of 512 adolescents who survived the L'Aquila 2009 earthquake and were previously investigated for the presence of full and partial PTSD, using DSM-IV-TR criteria, were reassessed according to DSM-5 criteria. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR). RESULTS: A DSM-5 PTSD diagnosis emerged in 39.8% of subjects, with a significant difference between the two sexes (p<0.001), and an overall 87.1% consistency with DSM-IV-TR. Most of the inconsistent diagnoses that fulfilled DSM-IV-TR criteria but not DSM-5 criteria can be attributed to the subjects not fulfilling the new criterion C (active avoidance). Each DSM-5 symptom was more highly correlated with its corresponding symptom cluster than with other symptom clusters, but two of the new symptoms showed moderate to weak item-cluster correlations. Among DSM-5 PTSD cases: 7 (3.4%) endorsed symptom D3; 151 (74%) D4; 28 (13.7%) both D3 and D4; 75 (36.8%) E2. LIMITATIONS: The use of a self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment; the rates of DSM-IV-TR qualified PTSD in the sample was only 37.5%. CONCLUSIONS: This study provides an inside look at the empirical performance of the DSM-5 PTSD criteria in a population exposed to a natural disaster, which suggests the need for replication in larger epidemiological samples.

Validation of the Temps-A in university student population in Serbia.

BACKGROUND AND AIMS: The TEMPS-A scale is a self-evaluation measure which assesses five affective temperaments. This study is a comparative analysis of affective temperament types in different educational fields, and the first validation of the Serbian version of the TEMPS-A. METHODS: The TEMPS-A questionnaire has been adapted following the translation-back translation methodology from English to Serbian. It was then administered to 770 undergraduate students from eight different faculties. RESULTS: Five factors were extracted through Principal Component Analysis (Varimax rotation), each including ten items with loadings above 0.40. The internal consistency of this abbreviated 50-item scale was α=0.77 and the average test-retest coefficient (rho=0.82) indicates a stable reliability. The correlations among the temperaments ranged from weak to moderate, with the highest positive correlations obtained between the depressive and cyclothymic, and, depressive and anxious scales. The highest score was detected among the hyperthymic (0.64) and lowest among the depressive temperament (0.15). The male participants attained significantly higher scores for the hyperthymic temperament, while female scored significantly higher on the depressive and anxious temperaments. The students of physical education showed significantly lower results on the depressive and anxious subscales and higher on the hyperthymic, in comparison to other educational fields. LIMITATIONS: The student sample is not representative of the general population, therefore further investigation in older population would be necessary for the evaluation of norms in additional age categories. The external validation with other personality scales has not been the subject of this research, but will be a part of some future studies. CONCLUSIONS: The Serbian 50-item version of the TEMPS-A showed good overall internal consistency and reliability, and the results generally cohere with those from previously validated versions in other languages.

Age, gender and epicenter proximity effects on post-traumatic stress symptoms in L'Aquila 2009 earthquake survivors.

BACKGROUND: Earthquakes are among the most frequently occurring natural disasters affecting the general population and inducing Post-Traumatic Stress Disorder (PTSD). Thus, increasing effort has been devoted to explore risk factors for PTSD onset after exposure. The aim of the present study was to investigate the impact of gender, degree of exposure and age on PTSD and post-traumatic stress symptoms in the general population exposed to the L'Aquila 2009 earthquake (Richter Magnitude 6.3). METHODS: A total sample of 1488 subjects (721 women and 767 men) was assessed by means of the Trauma and Loss Spectrum Self Report (TALS-SR): 939 subjects have been directly and 549 not-directly exposed to the earthquake. We performed a random extraction of units from the population in order to have 8 homogenous comparable subgroups. RESULTS: A main significant effect of exposure (exposed>non exposed subjects) and gender (women>men) emerged on the TALS-SR domain scores. Further significant interaction effects of exposure(⁎)age and gender(⁎)age emerged with significantly more TALS-SR symptoms being reported in younger with respect to older non-exposed subjects and in younger with respect to older women. LIMITATIONS: Social support was not examined systematically as well as major depression. Further limitations are the relatively small sample size and the use of lifetime instruments. CONCLUSIONS: Our results corroborate literature on female gender and proximity to the epicenter being correlated to PTSD after earthquake exposure and suggest a possible secondary effect of age.

Suicidal ideation and temperament: an investigation among college students.

BACKGROUND: Suicide is a major health problem accounting for up to 1.5 percent of all deaths worldwide and represents one of the most common causes of death in adolescents and young adults. A number of studies has been performed to establish risk factors for suicide in patients with psychiatric disorders including temperamental features. This study set out to assess the relationship between suicidal ideation and temperament in young adults. METHODS: A cross-sectional sample of healthy college students (n=1381) was examined using a self-rating questionnaire. Suicidal ideation, social background, educational status, substance abuse, and affective temperament according to TEMPS-M were assessed. Predictors of lifetime suicidal ideation were examined in multivariate logistic regression analyses. RESULTS: Suicidal ideation was reported by 12.5% of all subjects at some point in their life and was higher in nicotine dependents, youth with alcohol related problems and users of illicit substances as well as in youth with lower educational status. Lifetime suicidal ideation was associated with the anxious, depressive and cyclothymic temperament in both sexes and the irritable temperament in males. These results remained significant after adjustment for smoking status, frequency of alcohol consumption, drug experience and educational status in a multivariate logistic regression analysis. LIMITATIONS: The use of self-rating instruments always reduces objectivity and introduces the possibility of misreporting. CONCLUSIONS: Considering the fact that many subjects completing suicide have never been diagnosed with mental disorders it might be reasonable to include an investigation of temperament in screenings for risk of suicide. This might be especially useful for health care professionals without mental health care background.

Hyperthymic temperament may protect against suicidal ideation.

BACKGROUND: The aim of this study was to investigate the role of hyperthymic temperament in suicidal ideation between a sample of patients with affective disorders (unipolar and bipolar). METHOD: We investigated affective disorders outpatients (unipolar, bipolar I, II and NOS) treated in eleven participating centres during at least a six-month period. DSM-IV diagnosis was made by psychiatrists experienced in mood disorders, using the corresponding modules of the Mini International Neuropsychiatric Interview (MINI). In addition, bipolar NOS diagnoses were extended by guidelines for bipolar spectrum symptoms as proposed by Akiskal and Pinto in 1999. Thereby we also identified NOS III (switch by antidepressants) and NOS IV (hyperthymic temperament) bipolar subtypes. All patients completed the Beck Depression Inventory (BDI). We screened a total sample of 411 patients (69% bipolar), 352 completed all the clinical scales without missing any item. RESULTS: No statistical significant difference in suicidal ideation (measure by BDI item 9 responses) was found between bipolar and unipolar patients (4.5% vs. 9.1%, respectively). On the group of bipolar patients, suicidal ideation was slightly more frequent among bipolar NOS compared with bipolar I and II (p value 0.094 and 0.086, respectively), interestingly we found a statistical significant less common suicidal ideation among bipolar subtype IV (with hyperthymic temperament) compared with bipolar NOS patients (p value 0.048). CONCLUSIONS: Our results indicate that those subjects with hyperthymic temperament displayed less suicidal ideation. This finding supports the hypothesis that this particular affective temperament could be a protective factor against suicide among affective patients. LIMITATION: The original objective of the national study was the cross validation between MDQ and BSDS in patients with affective disorders in our country. This report arises from a secondary analysis of the original data.

The Italian version of the validated short TEMPS-A: the temperament evaluation of Memphis, Pisa, Paris and San Diego.

BACKGROUND: TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a new self-report measure of the affective temperament with depressive (D), cyclothymic (C), hyperthymic (H), irritable (I), and anxious (A) subscales. To date, the original 110-item version has been translated into 25 languages, and validated in many countries with different cultural backgrounds. This study presents the Italian brief, 39-item version of the questionnaire, more suited for studies in populations and currently validated in the U.S., and in a French translation. METHODS: A new version was prepared for this study via translation and back-translation of the original brief scale. A pilot sample of 18 to 30 year-old undergraduate students of both genders (n=440, males=178) were invited to fill in the newly prepared brief version of TEMPS-A, as well as other self-report measures of psychopathology. RESULTS: Reliability as measured by Cronbach's alpha was good for all TEMPS-A subscales (>0.70). Most of the temperament subscales were associated with each other, with stronger links between the Depressive, the Cyclothymic, the Irritable and the Anxious subscales. Across the sample, measures of psychopathology in the domain of general distress and dysphoria (GHQ-12), or in the delusion/hallucinatory psychotic-like dimension (PDI-21; LSHS-R), were positively linked to the scores of the TEMPS-A subscales. Based on z-scores above 2 SD, the rate of the depressive (6.4%) was the highest in this population, followed by the cyclothymic (5%), the irritable (4.8%) and zero for the anxious and hyperthymic. The irritable temperament was higher in males compared with females (7.3% vs. 3.1%). LIMITATIONS: The study was limited to a young healthy volunteer sample. Data from clinical subjects will be necessary to fully appreciate the validity of this version. CONCLUSION: In its extended 110-item version, the TEMPS-A has proved its value in various populations: due to its ease of administration, its short version is interesting to screen larger samples. That the anxious subscale (which pertains largely to anxious people worrying about their family's welfare) and the hyperthymic subscales are within the normal curve is possibly due to the highly desirable nature of these traits in Italy.

Towards a genetically validated new affective temperament scale: a delineation of the temperament phenotype of 5-HTTLPR using the TEMPS-A.

BACKGROUND: Although it has been described that affective temperaments are associated with the 5-HTTLPR, less attention was paid to the association between this polymorphism and subscales and items related to each affective temperament. The aim of our study was to investigate the association of affective temperament subscales and individual items with the s allele of the 5-HTTLPR. METHOD: 138 psychiatrically healthy women completed the TEMPS-A questionnaire and were genotyped for 5-HTTLPR. Scores of subjects on the temperament scales, subscales and items in the three genotype and the two phenotype groups were compared using ANOVA. We selected items with significantly different mean scores between the three genotype groups and the two phenotype groups separately and performed item analysis. RESULTS: Subjects in the different 5-HTTLPR genotype and phenotype groups have significantly different score on scales measuring depressive, cyclothymic, irritable and anxious temperaments, and several subscales composing these temperamental scales. Subjects in the three genotype groups scored significantly different on 11 items, 8 of these remained in a derived genotype scale after item analysis. Subjects in the two phenotype groups had significantly different scores on 12 items, 9 of them were retained in a derived phenotype scale after item analysis. LIMITATIONS: Our sample was relatively small and included only women. CONCLUSIONS: Our data provide support for the association of affective temperaments with the s allele. Although the cyclothymic temperament shows the strongest association, all temperaments within the depressive superfactor have a similar share in this association. The newly derived 5-HTTLPR Phenotype Scale shows strong association with 5-HTTLPR genotype and phenotype, therefore this scale should be further investigated in relation to psychiatric disorders, as well as psychological traits and temperaments.

A mixed state core for melancholia: an exploration in history, art and clinical science.

OBJECTIVE: We argue for a mixed state core for melancholia comparing concepts of melancholia across centuries using examples from art, history and scientific literature. METHOD: Literature reviews focusing on studies from Kraepelin onward, DSM-IV classification and view-points from clinical experience highlighting phenomenologic and biologic features as predictors of bipolar outcome in prospective studies of depression. RESULTS: Despite the implied chemical pathology in the term endogenous/melancholic depression, frequently reported glucocortical and sleep neurophysiologic abnormalities, there is little evidence that melancholia is inherited independently from more broadly defined depressions. Prospective follow-up of 'neurotic' depressions have shown melancholic outcomes in as many as a third; hypomania has also been observed in such follow-up. CONCLUSION: These findings and considerations overall do suggest that melancholia as defined today is more closely aligned with the depressive and/or mixed phase of bipolar disorder. Given the high suicidality from many of these patients the practice of treating them with antidepressant monotherapy needs re-evaluation.

Is psychosis in DSM-IV mania due to severity? The relevance of selected demographic and comorbid social-phobic features.

OBJECTIVE: We tested whether factors other than episode severity contributed to psychosis in mania. METHOD: Psychiatrists collected systematic clinical data on 1090 hospitalized DSM-IV manic patients in France, and completed the Mania Rating Scale (MRS) and the Scale for the Assessment of Positive Symptoms (SAPS). RESULTS: Using DSM-IV specifiers, 21.9% were non-severe, 28.2% severe without psychosis, and 49.9% severe with psychosis. On the MRS, patients with psychosis scored significantly higher (P < 0.0001) than non-severe, but did not differ from the severe without psychosis. We found significant correlations between both the Hallucination and the Delusion subscores of the SAPS and the MRS, as well as correlations between age, single marital status, comorbid social phobia and psychotic mania. CONCLUSION: Apart from episode severity, social isolation - associated with younger age, single marital status and social phobia - seems to make a contribution to the origin of manic psychosis largely independent from such severity.

Validating the soft bipolar spectrum in the French National EPIDEP Study: the prominence of BP-II 1/2.

BACKGROUND: Much of the current literature on bipolar disorder is focused on bipolar I (BP-I), and to a much lesser extent on bipolar II (BP-II). The French multi-center national EPIDEP study has, among its objectives, the feasibility of validating a broader spectrum of bipolarity (the so-called "soft spectrum") by practicing clinicians. In this report we test aspects of a bipolar schema proposed earlier by Akiskal and Pinto [Akiskal, H.S., Pinto, O., 1999. The evolving bipolar spectrum: Prototypes I, II, III, IV. Psychiatr. Clin. North Am. 22: 517-534.]. METHODS: EPIDEP was scheduled in three phases: Phase 1 to recruit DSM-IV major depressives; Phase 2 to assess hypomania and affective temperaments; and Phase 3 to obtain history on course of illness, family history, and comorbidity. Comparative analyses are presented between affective subgroups constructed on a hierarchical basis: spontaneous hypomania (BP-II), cyclothymic temperament (BP-II 1/2), antidepressant-associated hypomania (BP-III), hyperthymic temperament (BP-IV), versus "strict unipolar" (UP). RESULTS: We present data on 490 patients for whom we obtained full assessment during all three phases of the study, classified as BP-II 1/2 (N=164), II (N=61), III (N=28), IV (N=22), as well as UP (N=174) as the reference nonbipolar group. Systematic inter-group comparison among the soft spectrum showed significant differences along clinical, descriptive, course, pharmacologic response and familial affective disorder patterns, which confirm the heterogeneity of the soft bipolar spectrum, with special characteristics for each of the subgroups. In terms of external validation, familial bipolar loading characterized all soft bipolar subgroups except type IV. LIMITATION: Data collection conducted in a practice setting, clinicians cannot be entirely held "blind" to all measures. This is an exploratory attempt, with many variables examined, to help characterize the clinical terrain of soft bipolarity. CONCLUSION: This is nonetheless the first systematic clinical attempt to validate the bipolar spectrum beyond mania (BP-I). BP-II 1/2, BP-III and BP-IV appeared distinct from BP-II and strict UP -- along most of the variables examined. BP-II 1/2 -- with early onset complex temperament structure, and high mood instability, rapid switching, irritable ("dark") hypomania and suicidality -- emerged as the most prevalent and severe expression of the bipolar spectrum, and accounting for 33% of all MDE. These results, which are of great public health relevance, testify to the cyclic nature of bipolarity in its softest expressions. The soft phenotypes are also of interest for genetic investigations of bipolar disorder.

The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention.

BACKGROUND: Previous reports have shown a significant relationship between suicide ideation and mixed depression. The aim of this study was to explore the prevalence and clinical characteristics of mixed depression among non-violent suicide attempters. METHODS: Using a structured interview (modified Mini International Neuropsychiatric Interview) and assessing all the symptoms of 16 psychiatric diagnoses, the authors examined 100 consecutive nonviolent suicide attempters (aged 18-65) within 24 h after their attempts. Mixed depression was defined as a major depressive episode (MDE)/dysthymic disorder plus 3 or more co-occurring hypomanic symptoms, according to the definition validated by Akiskal and Benazzi [Akiskal, H.S., Benazzi, F., 2003a. Delineating depressive mixed states: Their therapeutic significance. Clin. Approaches Bipolar Disord. 2, 41-47, Akiskal, H.S., Benazzi, F., 2003b. Family history validation of the bipolar nature of depressive mixed states. J. Affect. Disord. 73, 113-122.]. RESULTS: Current mixed depression was present in 63.0% in the total sample, and in 70.8% among the 89 depressive suicide attempters. Irritability, distractibility and psychomotor agitation were present in more than 90% of the subjects with mixed depression. The rate of mixed depression was significantly higher among bipolar than non-bipolar depressive suicide attempters (90% vs. 62%). Patients with mixed depression had the following concurrent disorders: bipolar disorders 41.0%, panic disorder 30.0%, generalized anxiety disorder 89.0%, alcohol abuse/dependence 56.0%, and substance abuse 27.0%. Mixed depression versus non-mixed depression had the following significant associations (odds ratio=OR): females 2.4, bipolar II disorder 9.3, generalized anxiety disorder 41.3, irritability 101.6 and psychomotor agitation 61.1. LIMITATIONS: The study didn't include suicide attempters with very high risk of fatality. CONCLUSIONS: The important new finding of this study is the very high prevalence of mixed depression among depressed suicide attempters. The rates of mixed depression among bipolar and non-bipolar depressive suicide attempters were much higher than previously reported among nonsuicidal bipolar II and unipolar depressive outpatients, suggesting that suicide attempters come mainly from mixed depressives with predominantly bipolar II base. Irritability and psychomotor agitation were the strongest predictors of suicide attempt. From a public health standpoint, our data highlight the necessity of detecting and treating mixed (bipolar) depression in the prevention of suicidal behaviour.

Proceso de adaptación al español de la Escala de temperamento de Memphis, Pisa, París y San Diego. Versión autoaplicada (TEMPS-A) / Process of asaptation to Spanish of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Scale. Self applied version (TEMPS-A)

Introducción. La investigación de los factores predisponentes para los trastornos afectivos ha demostrado que son necesarias medidas para la evaluación del temperamento afectivo. La TEMPS-A es una medida de autoevaluación para evaluar cuatro temperamentos afectivos (hipertímico, depresivo, ciclotímico e irritable) y el temperamento ansioso.Método. La versión del cuestionario TEMPS-A que incluye 110 preguntas se ha adaptado siguiendo la metodología de traducción-retrotraducción, incluyendo dos traducciones al español y la clasificación de equivalencia al inglés por un autor independiente.Resultados. Los resultados del estudio indicaron que se obtuvo una traducción satisfactoria, tal y como indica la validación de equivalencia por parte del asesor bilingüe. Todos los ítems mostraron una equivalencia perfecta (A) o satisfactoria (B).Conclusiones. La TEMPS-A, versión española, es un cuestionario comprensible y equivalente a la versión original en inglés, que permite la evaluación de los temperamentos afectivos

Introduction. Investigation of the predisposing factors for affective disorders has shown that measures to assess affective temperament are necessary. The TEMPS-A is a self-evaluation measure to assess four affective temperaments (hyperthymic, depressive, cyclothymic and irritable) and anxious temperament.Method. The TEMPS-A questionnaire version that includes 110 questions has been adapted following the translation-backtranslation methodology, including two translations to Spanish and the classification of equivalence to English by an independent author.Results. The study results indicated that a satisfactory translation was obtained, as indicated by the validation of equivalence by the bilingual consultant. All the items showed a perfect (A) or satisfactory equivalence (B).Conclusions. The TEMPS-A, Spanish version, is an understandable questionnaire that is equivalent to the original version in English, that allows for the evaluation of affective temperaments

Process of adaptation to Spanish of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Scale. Self applied version (TEMPS-A).

INTRODUCTION: Investigation of the predisposing factors for affective disorders has shown that measures to assess affective temperament are necessary. The TEMPS-A is a self-evaluation measure to assess four affective temperaments (hyperthymic, depressive, cyclothymic and irritable) and anxious temperament. METHOD: The TEMPS-A questionnaire version that includes 110 questions has been adapted following the translation-backtranslation methodology, including two translations to Spanish and the classification of equivalence to English by an independent author. RESULTS: The study results indicated that a satisfactory translation was obtained, as indicated by the validation of equivalence by the bilingual consultant. All the items showed a perfect (A) or satisfactory equivalence (B). CONCLUSIONS: The TEMPS-A, Spanish version, is an understandable questionnaire that is equivalent to the original version in English, that allows for the evaluation of affective temperaments.

Temperament and job stress in Japanese company employees.

BACKGROUND: This study aims to demonstrate the relevance of temperament to job stress. METHOD: The subjects were 848 male and 366 female Japanese company employees. Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A) and Munich Personality Test (MPT) were administered to assess temperaments, and the NIOSH Generic Job Stress Questionnaire (GJSQ) to assess job stress. We used hierarchical multiple linear regression analysis in order to demonstrate whether temperament variables added any unique variance after controlling the effects of other predictors such as gender, age and job rank. RESULTS: In all subscales of the GJSQ, temperament predicted a large share of the variance in job stress. Remarkably, for interpersonal relationship stressors, the temperament variables added greater variance than that predicted by gender, age and job rank. Summary of the hierarchical linear regression analysis showed that the irritable temperament was associated with the most prominent vulnerability, followed by cyclothymic and anxious temperaments. The schizoid temperament had difficulty in the area of social support. On the other hand, the hyperthymic temperament displayed significant robustness in facing most job stressors; the melancholic type showed a similar pattern to a lesser degree. LIMITATION: The findings may be different in a clinical Japanese sample, or a cohort of healthy employees from a different cultural background. CONCLUSIONS: Temperament influences job stress significantly-indeed, it impacts on such stress with greater magnitude than age, gender and job rank in most areas examined. Temperament influences interpersonal relationship stressors more than workload-related stressors. Interestingly, in line with previous clinical and theoretical formulations, the hyperthymic and melancholic types actually appear to be "hyper-adapted" to the workplace.

Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study.

BACKGROUND: One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions. METHODS: Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity. RESULTS: PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity. CONCLUSION: These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.

Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy.

OBJECTIVE: To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience. METHOD: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest. RESULTS: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3-7.5]). CONCLUSION: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.