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Background Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children, but adult-ADHD is still an under-diagnosed and untreated condition. Treating adult-ADHD is complex and requires effective strategies for ADHD symptoms and comorbidities. Because of its high comorbidity rate with mood disorders and the growing interest in symptoms of emotional dysregulation in these patients, our aim was to collect studies that investigated temperament correlates in adult people with ADHD, to better understand the association between them and the eventual role of temperament as a prognostic-therapeutic marker. Methods We performed a systematic review of the literature. We included only studies that measured temperament traits in ADHD adults using the Temperament Evaluation of Memphis, Paris and San Diego-Auto-questionnaire (TEMPS-A) or the Temperament and Character Inventory (TCI). Results We retrieved 15 papers that used the TCI and 6 papers that used the TEMPS-A. In the TCI studies, ADHD was associated with high scores on Novelty Seeking and Harm Avoidance and low scores on Persistence. For the TEMPS-A studies, ADHD and Bipolar Disorders share some similarities in temperament scores, except for the hyperthymic temperament score. Limitations A comparison between the TCI and TEMPS-A results was not possible. The number of papers included was small. Among them, the type of sample, the number of recruited subjects and the ADHD assessment were very different. Conclusions The majority of ADHD individuals share temperament traits such as lability, irritability and excessiveness of emotional responses. Further research is needed to better understand whether temperament influences the pharmacological response of ADHD patients and whether temperament scores affect the long-term therapeutic outcome.

BACKGROUND: Depression commonly co-occurs with alcohol use disorders but predictors of depression treatment outcome in patients with both conditions are not well established. METHODS: Outpatients with alcohol dependence and major depression (n=138) were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. General linear mixed models examined predictors of Montgomery Asberg Depression Rating Scale (MADRS) score over 24 weeks. Predictors included whether depression was independent or substance-induced, and demographic, alcohol use, and personality variables (Temperament and Character Inventory subscales). RESULTS: Most improvement in drinking and depression occurred between baseline and week 3. During follow-up, patients with substance-induced depression reduced their drinking more and they had better depression outcomes than those with independent depression. However, greater reduction in drinking was associated with better depression outcomes for both independent and substance-induced groups, while antidepressant therapy had no effect for either group. Baseline demographic and alcohol use variables did not predict depression outcomes. Among personality variables, high self-directedness was a strong predictor of better depression outcomes. LIMITATIONS: Subjects were not abstinent at baseline. The influence of naltrexone on depression outcomes could not be tested. CONCLUSION: Alcohol dependent patients with substance-induced depression have better short term depression outcomes than those with independent depression, but this is largely because they reduce their drinking more during treatment. Language: en

Objective Suicide is a major cause of death in university students. Personality traits have been suggested as possible risk factors for suicidal behaviors. This study looked at the relationship between the personality dimensions of the Temperament and Character Inventory (TCI) and suicidal behaviors. Method A total of 5644 college students took the TCI test and the suicidality module of the M.I.N.I. The students were divided into the suicidal ideation group (n = 302; 5.4%) and the suicide attempt group (n = 301; 5.3%). Each group's TCI dimension and sub-dimension scores were compared with one another. To find out which TCI dimension affects suicide risk when depressed, regression analysis and mediation analysis were conducted. Results First, we adjusted for age, sex and depressive mood and compared the TCI scores of the participants based on their suicide risk. After the adjustment, self-directedness decreased in the suicidal ideation group while novelty seeking and persistence increased in the suicide attempt group. It turned out that self-directedness has a partial mediating effect between depressive symptom and suicide risk (β = −0.068 P Conclusion We adjusted for depressive mood and it turned out that the suicidal ideation group is affected by character whereas the suicide attempt group is affected by temperament. Among the character dimensions, self-directedness was found to reduce the effect of depressive mood on suicide risk. Therefore, when evaluating suicide risk, assessing character dimensions, especially self-directedness along with depressive mood, a risk factor, will be helpful.

Background Previous studies have reported associations between Temperament and Character Inventory (TCI) dimension scores and the response to treatment in patients with major depressive disorder (MDD). We aimed to determine which TCI items could predict the response to treatment with paroxetine in patients with MDD. Methods Seventy-three patients were enrolled in this study. The participants were treated with 10–40 mg/day of paroxetine for six weeks; they then completed the TCI. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate the patients. The participants were divided into two groups (responders and non-responders). We used a chi-squared test to identify the 10 items with the strongest association with treatment response from among all 240 items on the TCI, and we used a multiple logistic regression analysis to confirm the validity of these 10 items. Results Among the TCI dimension scores, only the C score differed significantly between the two groups. We analyzed 10 models using each of the 10 best items. All the models significantly predicted treatment response. The TCI dimensions model also significantly predicted treatment response, but its predictive value was lower than those of the other 10 models. Limitations The responders included the early responders. The results lacked information about responders whose responses were not predicted by the logistic regression models and TCI items. Conclusions Some TCI items showed significant associations with the response to paroxetine treatment in the patients with MDD. Treatment response in patients with MDD may be predicted using only 10 items from the TCI.

Background Personality traits are associated with depressive symptoms and psychiatric disorders. Evidence for their value in predicting accumulation of future dysphoric episodes or clinical depression in long-term follow-up is limited, however. Methods Within a 15-year longitudinal study of a general-population cohort (N=751), depressive symptoms were measured at four time points using Beck׳s Depression Inventory. In addition, 93 primary care patients with DSM-IV depressive disorders and 151 with bipolar disorder, diagnosed with SCID-I/P interviews, were followed for five and 1.5 years with life-chart methodology, respectively. Generalized linear regression models were used to predict future number of dysphoric episodes and total duration of major depressive episodes. Baseline personality was measured by the Temperament and Character Inventory (TCI). Results In the general-population sample, one s.d. lower Self-directedness predicted 7.6-fold number of future dysphoric episodes; for comparison, one s.d. higher baseline depressive symptoms increased the episode rate 4.5-fold. High Harm-avoidance and low Cooperativeness also implied elevated dysphoria rates. Generally, personality traits were poor predictors of depression for specific time points, and in clinical populations. Low Persistence predicted 7.5% of the variance in the future accumulated depression in bipolar patients, however. Limitations Degree of recall bias in life charts, limitations of statistical power in the clinical samples, and 21–79% sample attrition (corrective imputations were performed). Conclusion TCI predicts future burden of dysphoric episodes in the general population, but is a weak predictor of depression outcome in heterogeneous clinical samples. Measures of personality appear more useful in detecting risk for depression than in clinical prediction.

Background As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients. Methods We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD). Results Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%. Limitations Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report. Conclusions Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.

Background Personality traits have been suggested as possible risk factors for suicidal behaviours. Cloninger's model of personality (TCI), given its neurobiological background, might provide an ideal tool for the identification of dimensions associated with suicide attempt. Methods A number of 1333 suicide attempters and 589 non-suicide attempters suffering from different DSM-IV Axis I disorders were assessed using either the temperament and character inventory (TCI) or the tridimensional personality questionnaire (TPQ), as well as other self-report questionnaires evaluating dimensions associated with suicidal behaviour, such as impulsivity and anger traits. The severity of suicide attempts and the methods used were also assessed. Subjects were genotyped for polymorphisms within the key genes involved in monoaminergic pathways and the HPA axis. Results Compared with non-suicide attempters, suicide attempters scored higher for harm avoidance (HA) and novelty seeking (NS), and lower for self-directedness (SD). The difference was independent of Axis I disorders. Higher HA and NS scores were associated with a greater severity of suicidal behaviour. A multivariate model showed that HA was the single temperamental dimension independently related to suicide attempt history, beside impulsivity and anger-related traits. The genetic factors investigated did not play a significant role in modulating these temperamental dimensions. Limitations The TCI was available for only half of the sample. Conclusions Early detection of subjects displaying high HA and low SD, associated with high impulsivity and poor anger control, may help to prevent suicidal behaviours. Physicians should therefore be aware of these risk factors so that they can offer the best primary care intervention.

Background While major depressive disorder (MDD) is considered to be a heterogeneous disorder, the nature of the heterogeneity remains unclear. Studies have attempted to classify patients with MDD using latent variable techniques, yet the empirical approaches to symptom-based subtyping of MDD have not provided conclusive evidence. Here we aimed to identify homogeneous classes of MDD based on personality traits, using a latent profile analysis. Methods We studied 238 outpatients with DSM-IV MDD recruited from our specialized depression outpatient clinic and assessed their dimensional personality traits with the Temperament and Character Inventory. Latent profile analysis was conducted with 7 dimensions of the Temperament and Character Inventory as indicators. Relationships of the identified classes with symptomatology, prescription pattern, and social function were then examined. Results The latent profile analysis indicated that a 3-class solution best fit the data. Of the sample, 46.2% was classified into a “neurotic” group characterized by high harm avoidance and low self-directedness; 30.3% into an “adaptive” group characterized by high self-directedness and cooperativeness; and 23.5% into a “socially-detached” group characterized by low reward dependence and cooperativeness and high self-transcendence. The 2 maladaptive groups, namely neurotic and socially-detached groups, demonstrated unique patterns of symptom expression, different classes of psychotropic medication use, and lower social functioning. Limitations Generalizability of the findings was limited since our patients were recruited from the specialized depression outpatient clinic. Conclusions Our personality-based latent profile analysis identified clinically meaningful 3 MDD groups that were markedly different in their personality profiles associated with distinct symptomatology and functioning.

A recent genome-wide association study on Major Depressive Disorder (MDD) identified a specific association with a non-synonymous polymorphism (rs2522833) of a gene encoding the presynaptic protein piccolo (PCLO). A high percentage of patients who develop MDD have particular temperamental traits, such as passivity, pessimism, indecisiveness, and low self-esteem, which are related to the subsequent development of depression. The aims of this study were to perform a replicate case-control study and to conduct the first association study between the rs2522833 polymorphism and depression-related personality traits using the Temperament and Character Inventory (TCI) in a healthy subject sample.A total of 522 MDD patients and 375 healthy volunteers were enrolled in the study. Two hundred and forty-six controls agreed to fill out the TCI.The results showed that rs2522833 CC homozygotes were more frequent among the depressed patients than in the controls (p0.01). The C allele distribution showed a trend in the same direction (p=0.08). Among controls, we found that the C allele carriers were associated with personality traits increasing vulnerability to depression, including higher Harm Avoidance (HA) and lower in Novelty Seeking (NS). In particular, C allele carriers were more fearful (HA2) and fatigable (HA4), and less impulsive/more deliberate (NS2) and less extravagant/more frugal (NS3).The absence of possible epistatic interaction effect.These results provide further support for the involvement of the PCLO gene in MDD and show that this effect may be mediated by influencing personality traits that increase the risk of major depression.

Background The personality trait of Persistence is highly valued by conscientious overachievers, but it has both psychological costs and benefits. The interactions among multiple personality factors influencing the development of mood and anxiety disorders have been confounded in prior clinical samples, but can be disentangled in terms of their underlying brain circuitry and influence on perception of emotional stimuli. Methods 285 individuals who represented the full range of personality variation in a large sample of adult volunteers from the general community of Israel were selected for follow-up by psychiatric interviews, cognitive testing, and medical examinations. The Temperament and Character Inventory (TCI) measured profiles of traits that distinguished individuals with diagnoses of mood and/or anxiety disorders using linear discriminant analysis and non-linear profile analysis. Results High Harm Avoidance and low Self-directedness strongly distinguished people with mood and/or anxiety disorders from those with neither. High Persistence distinguished people with only anxiety disorders from those with mood disorders. High Persistence was associated with greater health and happiness overall, but also led to more negative emotions than in people with low Persistence unless they were both unusually tolerant of frustration (i.e., low in Harm Avoidance) and self-accepting of personal limitations (i.e. high in Self-directedness). Limitations Subjects were volunteers over 40 years of age at assessment. Conclusions People who are highly persistent (i.e., persevering, ambitious, perfectionistic) are more likely to have anxiety disorders than mood disorders, even when they have other traits increasing risk for both (i.e., high Harm Avoidance and low Self-directedness). High Persistence increases both positive and negative emotions in most people. However, high Persistence reduces negative emotions and increases positive emotions if a person is easy-going (i.e., “happy-go-lucky” when low in both Harm Avoidance and Self-directedness).

Background Determining the factors that predict antidepressant response and offering suitable treatments to people who suffer from major depressive disorder (MDD) is important. We investigated the personality factors that influence paroxetine treatment response by dividing antidepressant responders into two groups. Methods We treated 93 patients with MDD using 40 mg/day of paroxetine for six weeks. We used the Cloninger's Temperament and Character Inventory (TCI) to evaluate each participant's personality before the treatment. Of the 93 patients, 75 completed the protocol. The Montgomery Asberg Depression Rating Scale (MADRS) was used to evaluate depressive symptoms before the treatment and at one-, two-, four-, and six-week intervals. We divided the patients into four groups: later responders (LRs), early responders (ERs), nonresponders (NRs), and dropouts (DOs). Results Compared with 91 normal control participants, patients with MDD had less novelty seeking and self-directedness and greater harm avoidance. ERs showed less harm avoidance and more self-directedness than the other groups. LRs’ TCI scores did not differ from the other groups. Conclusions These results suggest that ERs’ personality characteristics are different from those of other patients with MDD and that evaluating patients’ personality using the TCI at baseline may predict their antidepressant response. Limitations Our sample of patients with MDD was small. Some of the patients with severe MDD had difficulty completing the TCI.

Background Behavioural inhibition and more specifically harm avoidance temperament dimension (HA) has been found to be associated with depression. Temperament and Character Inventory (TCI) by Cloninger et al. is the most widely used instrument in the assessment of temperament. The aims of the present study were to explore 1) if current or future depressive symptoms in non-clinical adult sample can be explained by TCI temperament dimensions, and 2) if recovery from major depression (MDD) during the acute phase of treatment is predictable by TCI temperament dimensions. Method Literature search from eight databases. Systematic review and meta-analysis. Results High HA was associated with current depressive symptoms in 11/12 studies and with depressive trait in 3/4 studies. In MDD studies, a consistent negative change in HA was found during treatment and this change was even more clearly associated with treatment response. Limitations The studies with general population samples were heterogeneous in methodology. Most of the intervention studies were of case–control design. Conclusions HA is indisputably associated with the risk and treatment response in depression.

Background: Although some core personality variables are known to be characteristic of unipolar or bipolar depression, few studies have compared the personality profile between these two disorders. Methods: Temperament and Character Inventory (TCI) was employed to assess the personality of 36 depressed patients with bipolar II disorder (BPII), 90 patients with unipolar major depressive disorder (UP), and 306 healthy controls. The TCI was administered during the depressive episode in BPII and UP patients so that the results can be applied in a clinical setting. Results: Significantly higher scores in harm avoidance (p, Article, JOURNAL OF AFFECTIVE DISORDERS. 132(3):319-324 (2011)

Background The aim of this study was to characterize at the population level how innate features of temperament relate to experience of depressive mood and anxiety, and whether these symptoms have separable temperamental backgrounds. Methods The study subjects were 4773 members of the population-based Northern Finland Birth Cohort 1966, a culturally and genetically homogeneous study sample. Temperament was measured at age 31 using the temperament items of the Temperament and Character Inventory and a separate Pessimism score. Depressive mood was assessed based on a previous diagnosis of depressive disorder or symptoms of depression according to the Hopkins Symptom Check List – 25. Anxiety was assessed analogously. Results High levels of Harm avoidance and Pessimism were related to both depressive mood (effect sizes; d = 0.84 and d = 1.25, respectively) and depressive disorder (d = 0.68 and d = 0.68, respectively). Of the dimensions of Harm avoidance, Anticipatory worry and Fatigability had the strongest effects. Symptoms of depression and anxiety showed very similar underlying temperament patterns. Limitations Although Harm avoidance and Pessimism appear to be important endophenotype candidates for depression and anxiety, their potential usefulness as endophenotypes, and whether they meet all the suggested criteria for endophenotypes will remain to be confirmed in future studies. Conclusions Personality characteristics of Pessimism and Harm avoidance, in particular its dimensions Anticipatory worry and Fatigability, are strongly related to symptoms of depression and anxiety as well as to depressive disorder in this population. These temperamental features may be used as dimensional susceptibility factors in etiological studies of depression, which may aid in the development of improved clinical practice.

Background Health is a state of physical, mental, and social well-being. Personality traits measure individual differences in adaptive functioning and mental health, but little is known about how well personality accounts for health's affective aspects (i.e., “happiness”) and its non-affective aspects (i.e., “wellness”) in the general population. Methods 1102 volunteer representatives of the Sharon area of Israel completed the Temperament and Character Inventory (TCI), the Positive and Negative Affect Scale (PANAS), the Satisfaction with Life Scale (SWLS), the Multidimensional Scale of Perceived Social Support (PSS), and the subjective health assessment of the General Health Questionnaire (GHQ). Multidimensional personality profiles were used to evaluate the linear and non-linear effects of interactions among dimensions on different aspects of well-being. Results Self-directedness was strongly associated with all aspects of well-being regardless of interactions with other dimensions. Cooperativeness was strongly associated with perceived social support, and weakly with other aspects of well-being, particularly when Self-directedness was low. Self-transcendence was strongly associated with positive emotions when the influence of the other character dimensions was taken into account. Personality explained nearly half the variance in happiness and more than one-third of the variance in wellness. Limitations Our data are cross-sectional and self-reported, so they are subject to personal perceptual bias. Conclusions The emotional, social, and physical aspects of well-being are interdependent, but specific configurations of TCI Self-directedness, Cooperativeness, and Self-transcendence influence them differentially. Interactions among different combinations of character traits have strong effects on the perception of both wellness and happiness.

Background The aims of this study were to examine the relationships between Cloninger's psychobiological model of personality, defense styles, and severity of grief, and to identify the influential temperament and character dimensions that differentiate subjects with prolonged grief from those without prolonged grief. Method A sample of 72 bereaved elderly persons for whom the loss of a loved one occurred on average 2.58 years (SD = 1.92) prior to participation in this study were assessed using the Inventory of Complicated Grief-Revised, the Temperament and Character Inventory, and the Defense Styles Questionnaire. Using the algorithm developed by Prigerson et al. (2009) for diagnosing prolonged grief, 18 of our participants were identified as having this disorder. Results A multiple regression analysis revealed that time since loss, persistence, an immature defense style, and the age of the bereaved person positively predicted severity of grief, whereas cooperativeness and the age of the deceased loved one negatively predicted severity of grief. A binary logistic regression showed that gender, a close kinship relation to the deceased, time since loss, self-directedness (SD), and self-transcendence (ST) were predictors of prolonged grief, whereas the age of the deceased and cooperativeness (CO) were negatively related to prolonged grief. Limitations Our sample was small. Self-report measures of grief were not supplemented with clinical evaluation. Conclusion Our results suggest that only character dimensions (high SD and ST, and low CO) are involved in the psychopathology of prolonged grief. Also, according to Cloninger's character cube ( Cloninger, 2004 ), high SD and ST scores, and low CO scores are indicative of a fanatical character.

Background The Temperament and Character Inventory (TCI) was first described in 1993. It was designed to measure the character and temperament dimensions of Cloninger's model of personality using a true–false response format. The revised TCI (TCI-R) uses a five-point-Likert format and has multiple subscales for persistence to improve its reliability. We tested the clinical validity of an original Brazilian–Portuguese translation of the TCI-R. Methods The 595 volunteers completed the BrP version of TCI-R, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Satisfaction with Life Scale (SWLS). Results The internal consistency was satisfactory for all dimensions (Cronbach alpha coefficients above 0.7). The cumulative variances for temperament and character were 58% and 60%. BAI was positively correlated with harm avoidance and negatively with persistence, self-directedness and cooperativeness. SWLS was correlated negatively with harm avoidance and positively with self-directedness and cooperativeness. The congruence coefficients between each facet of BrP TCI-R and the US TCI-R original data were 95% or higher (except NS1). Limitations The main limitation of this study is the convenience sampling. Conclusions The BrP version of the TCI-R had good psychometric properties regardless of the cultural and educational backgrounds of subjects. The present study supported the validity of the BrP translation of the TCI-R, which encourages its use in both clinical and general community samples.

Background Psychopathological vulnerability may be related to certain personality traits. The aim of this study was to explore the association of minor affective psychopathology and the regular use of psychotropic medication with temperament and character profiles from Cloninger's personality model, in a sample of active professional people. Methods This cross-sectional study included 498 non-clinical subjects, teachers in a local school system. Instruments used included the self-administered General Health Questionnaire (GHQ-28) to measure psychiatric morbidity; the Center for Epidemiologic Studies Depression scale (CES-D) to measure depressive symptoms; documentation of regular use of psychotropic medication; and the Temperament and Character Inventory (TCI-125) for personality traits self-assessment. Results The proportion of subjects presenting psychiatric morbidity (GHQ-28 > 6) or depressive symptoms (CES-D > 20) was significantly higher among explosive, passive–aggressive, and obsessional temperament profiles, and among schizotypal, moody, melancholic and dependent character profiles. Similar results were observed with the scores on each of the four GHQ-28 subscales (depression, anxiety, social dysfunction, and somatic symptoms). The regular use of psychotropic medications was significantly higher among the passive–aggressive and explosive temperament types, and among the schizoptypal and moody character types. Limitations Being a cross-sectional study, no causal attributions can be inferred. Subjects on sick leave were excluded, so the sample was not representative of the general population. The data were collected using self-reporting questionnaires, and no specific psychiatric diagnoses were obtained. Conclusions It is possible to identify certain personality configurations associated with minor psychopathology and concomitant use of psychotropics, among active professional people.

Anxious and dysthymic personality traits were measured in a euthymic, familial sample of bipolar (BPD) individuals and their affectively ill and unaffected relatives. According to the quantitative genetic model of bipolar spectrum illness [Evans, L., Akiskal, H.S., Keck, Jr., P.E., McElroy, S.L., Sadovnick, A.D., Remick, R.A., Kelsoe, J.R., 2005. Familiality of temperament in bipolar disorder: support for a genetic spectrum. J. Affect. Disord. 85, 153-168], these traits should be normally distributed with the bipolar disorder I (BPD I) group showing the highest and the unaffected relatives the least "pathological" scores. Three hundred individuals from 47 bipolar disorder families were administered a battery of personality questionnaires (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego; Temperament and Character Inventory; Affective Neuroscience Personality Scale) as well as a self-rating depression (Beck Depression Inventory) and mania (Altman Self-Rating Mania) scale. Out of the 300 participants, 58 were diagnosed with BPD I, 27 with bipolar disorder II (BPD II), 58 with recurrent major depression (MDE-R), 45 had one previous depressive episode (MDE-S), and 88 were unaffected. The BPD I group scored significantly higher than their unaffected relatives on the Harm Avoidance and Sadness scales of the TCI and ANPS, respectively, while the MDE-R but not the BPD samples scored significantly higher than unaffected relatives on the Anxious Temperament (AT) subscale of the TEMPS-A. In general, the mean dysthymic personality scores were highest in the BPD sample, followed by the MDE-R, MDE-S, and unaffected relative groups. Nevertheless, no significant personality differences were found between the psychiatrically-ill groups. While dysthymic temperament traits conform relatively well to the quantitative genetic model of affective illness, anxious traits as defined by the AT scale, are equally salient in BPD and unipolar depression.

TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire) is a new self-assessed temperament 110-item scale with depressive (D), cyclothymic (C), hyperthymic (H), irritable (I) and anxious (A) subscales. To date, it has been translated into 25 languages, and validated in 10. The present Hungarian version provides the most complete external validation across the Beck Depression Scale (BDI), Profile of Mood States (POMS), the BarOn Emotional Quotient Inventory (BarOn EQ-i), Temperament and Character Inventory (TCI), and the NEO Personality Inventory - Revised (NEO-PI-R). We were particularly interested in concurrent validation against the TCI and the NEO-PI-R, the most important of the new personality instruments.1132 clinically-well subjects (27% male) from the general population and university students (16-81 years) were administered the above scales and instruments. The data were tested with standard psychometric batteries.Factor analysis revealed 5 factors approximating the original D, C, I, H, and A subscales, which in their superfactor confirmed an Emotional (D, C, I, A) vs. Hyperthymic structure. Except for the D (a=0.65), the Cronbach alpha for the remainder temperaments ranged from 0.75-0.81. Dominant temperaments ranged from the I (2.7%) to the C (4.2%); the highest prevalence was observed among men with C=6% and H=5.4%. The BDI and POMS correlated significantly with the relevant subscales, as did the BarOn. Of the many significant possible correlations with the TCI, the most noteworthy were novelty seeking and harm avoidance with D, A, C, as well as C, and persistence with H. As for the NEO-PI-R, we were struck by the positive correlation of openness with C, and conscientiousness negatively with C; most other positive correlations such as neuroticism with all temperaments but the hyperthymic were expected and strongly supportive of concurrent validity.Higher educational background of the subjects studied relative to that of the general population of Hungary. The distribution of the data may have in some instances deviated somewhat from the underlying assumptions for the standard psychometric tests for normality. We did not conduct test-retest reliability.The factorial structure of the TEMPS-A shows good reliability and internal consistency. Although the superstructure is reminiscent of neuroticism-extraversion, within it are embedded discernible classical affective temperaments. A provocative finding is the high prevalence of cyclothymia in Hungarian males (6%), which is rather unique when compared with the other 10 countries studied to date. This finding, coupled with high male hyperthymia (5.4%), may explain the high lifetime prevalence of bipolar disorders reported from Hungary. Inter alia, our psychometric data along with the foregoing epidemiologic considerations, are very much in line with the cyclothymic-bipolar spectrum model proposed by the senior author [Akiskal, H.S., Djenderedjian, A.H., Rosenthal, R.H., Khani, M.K., 1977. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am. J. Psychiatry 134, 1227-1233].

Background Personality assessment provides a description of a person's fundamental emotional needs and of the higher cognitive processes that modulate thoughts, feelings, and behavior. Prior studies by us examined personality and mood at the same time. Assessing personality may allow prediction of mood changes over time in a longitudinal study, as described in earlier prospective studies by Paula Clayton and others. Method A group of 631 adults representative of the general population completed the Temperament and Character Inventory (TCI) and Center for Epidemiological Studies depression scale (CES-D) at baseline and one year later. Results TCI scores at baseline accounted for gender differences in levels of depression. TCI personality scores were strongly stable (range in r = .78 to .85 for each of seven dimensions) whereas mood was only moderately stable ( r = .62) over the twelve-month follow-up. Baseline personality scores (particularly high Harm Avoidance and low Self-Directedness) explained 44% of the variance in the change in depression. Baseline levels and changes in Harm Avoidance and Self-Directedness explained 52% of the variance in the change in depression at follow-up. Limitations The follow-up sample was representative of the target population except for slightly lower Novelty Seeking scores. Clinical relevance Observable personality levels strongly predict mood changes. Personality development may reduce vulnerability to future depression.

BACKGROUND: The personality dimensions of harm avoidance (HA) and self-directedness (SD), as measured by the Temperament and Character Inventory (TCI), have been widely associated with depression and there is preliminary evidence that they may represent trait markers for depression. However, many studies in this area are limited by the use of heterogeneous samples of depressed patients and by the confounding effect of depressed mood during personality testing. The current study compares TCI personality dimension scores in a group of euthymic young adults with recurrent early-onset major depressive disorder (RE-MDD) to well-matched euthymic controls. METHODS: Fifty-two young adults with a past history of RE-MDD were recruited from consecutive referrals to a psychiatric clinic at a university health service. Eighty nine controls were also recruited. Euthymia was established in patients by a score of less than 9 on the Hamilton Rating Scale for Depression (HRSD) and in controls by a Becks Depression Inventory (BDI) score of less than 10. All participants completed the TCI-125. RESULTS: Patients and controls were well matched in terms of sociodemographic profile. Euthymic RE-MDD patients scored significantly higher than controls on the temperament dimension of harm avoidance (HA; mean score 14.5 versus 7.8, p

We sketch out putative evolutionary roles for affective temperaments within the theoretical framework of mood disorders conceptualized as extremes in an oligogenic model of inheritance, whereby the constituent traits in their dilute phenotypes confer adaptive advantages to individuals and/or their social group. Depressive traits, among other functions, would subserve sensitivity to the suffering of other members of the species, overlapping with those of the generalized anxious temperament, thereby enhancing the survival of not only kin but also other conspecifics. The pursuit of romantic opportunities in cyclothymia suggests that it may have evolved as a mechanism in reproductive success; cyclothymics' creative bent in poetry, music, painting, cooking or fashion design (among men, in particular) also appears useful for sexual seduction. Hyperthymic traits would lend distinct advantages in leadership, exploration, territoriality and mating. These are just some of the possibilities of the rich and complex temperamental traits subserving bipolarity within an evolutionary framework. We test selected aspects of these hypotheses with the use of correlations between the constituent traits of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS) and correlations between the TEMPS and the Temperament and Character Inventory (TCI). Such data support the counterbalancing protective influence of harm avoidance on the risk-taking behavior of cyclothymic individuals, in both men and women. Finally, we outline a hypothesis on the evolutionary function of anxious-depressive traits for women.

Objective: Understanding of mood disorders can be enhanced through assessment of temperamental traits. We explored temperamental commonalities and differences among euthymic bipolar (BP) and unipolar (MDD) mood disorder patients, creative discipline graduate student controls (CC), and healthy controls (HC). Methods: Forty-nine BP, 25 MDD, 32 CC, and 47 HC completed self-report temperament/personality measures including: The Affective Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A); the Revised NEO Personality Inventory (NEO-PI-R); and the Temperament and Character Inventory (TCI). Results: Euthymic BP, MDD, and CC, compared to HC, had significantly increased cyclothymia, dysthymia and irritability scores on TEMPS-A; increased neuroticism and decreased conscientiousness on NEO-PI-R; and increased harm avoidance and novelty seeking as well as decreased self-directedness on TCI. TEMPS-A cyclothymia scores were significantly higher in BP than in MDD. NEO-PI-R openness was increased in BP and CC, compared to HC, and in CC compared to MDD. TCI self-transcendence scores in BP were significantly higher than in MDD, CC, and HC. Limitations: Most of the subjects were not professional artists, and represented many fields; temperament might be different in different art fields. Conclusions: Euthymic BP, MDD, and CC compared to HC, had prominent temperamental commonalities. However, BP and CC had the additional commonality of increased openness compared to HC. BP had particularly high Cyclothymia scores that were significantly higher then those of MDD. The prominent BP–CC overlap suggests underlying neurobiological commonalities between people with mood disorders and individuals involved in creative disciplines, consistent with the notion of a temperamental contribution to enhanced creativity in individuals with bipolar disorders.

Background: The nature of the relationship between personality and bipolar affective disorders is an important but unanswered question. Methods: We have studied personality in bipolar patients by using the Temperament and Character Inventory (TCI). TCI were administered to 100 euthymic bipolar patients and 100 controls from the normal population. Results: Bipolar patients were significantly higher in harm avoidance (HA) and lower in reward dependence (RD), self-directedness (SD), and cooperativeness (CO) than controls. Bipolar patients are more fatigable, less sentimental, more independent, less purposeful, less resourceful, less empathic, less helpful, less pure-hearted, and have less impulse control than controls. Bipolar II patients are more impulsive, more fatigable, less resourceful, and have less impulse control than bipolar I patients. Limitations: Our results are limited to euthymic bipolar patients and cannot be generalized to affective disorders. Conclusions: Even when clinically euthymic on lithium maintenance, bipolar patients continue to have a characteristic cognitive deficit. This is in agreement with cognitive theories about cognitive deficits in depression that are regarded as important vulnerability factors in mood disorders.

Personality structure obtained from the psychobiological Temperament and Character Inventory (TCI) was studied in relation to self-reported seasonal variations in mood and behavior measured by the Seasonal Pattern Assessment Questionnaire (SPAQ).The subjects comprised 1761 adults (57.6% women) in the age range 35-85 years, enrolled in the Betula prospective random cohort study of Umea, Sweden.Personality profiles of subjects who reported the occurrence of a high degree of seasonal variation as such were associated with a combination of high self-transcendence (ST) and high persistence (PS), irrespective of the level of harm avoidance (HA). Subjects who reported feeling worst in winter were associated with high HA, irrespective of the levels of ST and PS. Also, subjects feeling worst in summer or experiencing overall problems with seasonal variation were associated with high HA in their personality profiles. Using the SPAQ criteria to define seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD), subjects with these disorders often had combinations of high self-transcendence (ST) and high persistence (PS), but with different associations with HA.No evaluations were made for SAD or subsyndromal SAD according to the DSM-IV or ICD 10 criteria.Our results relating SPAQ with TCI give support for a dual vulnerability hypothesis for seasonal depression proposed in the literature, where it is attributed to a combination of a seasonal factor and a depression factor. Examining the literature regarding the relationships between the different TCI scales and monoamine neurotransmitter functions, those relationships suggest that these two vulnerability factors for seasonal depression may be modulated by different neurotransmitter systems.

Background: The relationship of temperamental aspects of personality to symptoms of depression in a community-based sample of 804 individuals was examined using a multi-dimensional approach to account for heterogeneity in symptom patterns. Method: The Temperament and Character Inventory (TCI) was used to assess personality and the Center for Epidemiologic Studies Depression scale (CES-D) was used to measure depressive symptoms. Canonical correlation analysis was used to relate CES-D item combinations to temperament traits in multiple dimensions. The relationships between temperament and various conditions correlated with depression were examined using logistic regression. Results: Temperamental aspects of personality are related not only to total CES-D score, but also to the patterns of CES-D items endorsed by subjects. High Harm Avoidance is related to total CES-D score; high Reward Dependence combined with high Persistence is associated with restless sleep and subjective symptoms; high Reward Dependence combined with low Persistence is negatively associated with appetite loss and low energy; high Novelty Seeking is related to maintenance of positive affect and inability to concentrate. High Novelty Seeking is also associated with past suicide attempts, after adjusting for total CES-D score. Limitations: Cross-sectional data prevent analysis of causation; the severest cases of clinical depression may not be represented in a general population sample. Depressive symptoms are self-reported. Conclusion: Substantial differences in level of symptoms and in symptom patterns exist among individuals in a continuum of depressed states and those differences are partially explained by temperament traits.

Background: Depression, hopelessness, impaired problem solving capacities and deficient serotonergic functions have been identified as major causes of suicidal behaviour. In general, the relation between biological markers of attempted suicide and psychological functions has been investigated using indirect peripheral markers of, e.g. the serotonergic system. Recently, functional neuroimaging techniques with radioligands allow direct in vivo assessment of the neurobiological status of the central nervous system. Methods: We studied the binding index of serotonin-2a (5-HT2a) receptors in the frontal cortex of attempted suicide patients (n=9) and normal controls (n=13) using [123I]5-I-R91150, a highly selective 5-HT2a receptor ligand. Moreover, we measured personality characteristics (using Cloninger’s Temperament and Character Inventory) and levels of hopelessness (using Beck’s Hopelessness Scale), and studied the association between 5-HT2a receptor binding index, hopelessness and these personality dimensions. Results: When compared to normal controls, attempted suicide patients had a significantly lower binding potential of frontal 5-HT2a receptors, a higher level of hopelessness, a higher score on the temperament dimension harm avoidance and lower scores on the character dimensions self-directedness and cooperativeness. A significant correlation was found between harm avoidance, hopelessness and binding index in the population of patients that attempted suicide. Limitations: The limited number of patients and potential ingestion of psychotropic drugs may influence the results of the study. Conclusions: Lower central serotonergic function, hopelessness and harm avoidance are interrelated phenomena, which may increase the probability of the occurrence of attempted suicide.

Background: Atypical depression is associated with elevated rates of personality disorders. Studies have confirmed the efficacy of a several antidepressants in the treatment of atypical depression. Whether their pathological dimensions of personality diminish after benefitting from effective medication treatment is unclear. Aims: To determine the extent that pathological dimensions of character improved among patients who benefitted from treatment. Method: One-hundred and fifty-four outpatients with DSM-IV Major Depression who met Columbia criteria for atypical depression were randomized to receive fluoxetine, imipramine or placebo for a 10-week double-blind clinical trial. The Temperament and Character Inventory (TCI) was administered at the initiation of treatment and 8 weeks later. Low scores on either of two Character dimensions (Self-Directiveness or Cooperativeness) indicate psychopathology. Results: Responders had a substantial reduction in Harm Avoidance, but post-treatment scores remained significantly higher than the normal control group (NCG). Fluoxetine and Imipramine did not produce different changes on personality, except for Self-Transcendence. Limitations: High proportion of missing data, inadequate sample size, post-hoc analysis. Conclusions: Among responders, Self-Directiveness improved and normalized; Harm Avoidance also improved but did not normalize. These data suggests that effective treatments reduce some pathological personality traits as well as improving mood.

Patients admitted for pharmacological treatment of a non-bipolar major depressive episode completed the Temperament and Character Inventory (TCI) prior to and after at least 6 weeks of treatment. Treatment with various antidepressants resulted in a 43% reduction of symptomatology. Scores on the harm avoidance dimension before and after treatment appeared to be significantly higher as compared to Dutch normative data. TCI scores did not predict response to treatment or show a change during treatment. It is concluded that, in this group of patients, the personality dimension harm avoidance is a trait factor without predictive value for antidepressant responsiveness.

Background: Little is known as to whether or not the seven personality dimensions of Cloninger’s theory, particularly the three character dimensions newly included in the theory, are independent of the states of depression. Methods: One hundred and eight patients with major depression filled out the Temperament and Character Inventory (TCI) before and after a 16-week antidepressant treatment. Results: The level of depression, as assessed by the Hamilton Rating Scale for Depression, was correlated positively to the harm avoidance score and negatively to the self-directedness and cooperativeness scores. During the treatment, the scores on these three dimensions significantly changed toward normal values in treatment-responders, but were stable in treatment-nonresponders. The changes in these dimensions were significantly explained by the change in the depression severity during treatment. Scores on novelty seeking, reward dependence, persistence, and self-transcendence were not correlated significantly to the level of depression and did not change significantly during the treatment in either treatment-responders or nonresponders. Limitations: The changes in the TCI scores during treatment in this study may reflect a non-specific tendency for the scores to change on retest. Conclusions: The results suggest that a depressive state can significantly affect assessments of harm avoidance, self-directedness, and cooperativeness in major depression. The administration of the TCI during a depressive episode may elevate the HA score, and may lower the SD and C scores. These findings highlight the importance of considering the state of depression before drawing conclusions about the TCI personality traits, when a patient with major depression is still experiencing a depressive episode.

Background: Cloninger’s theory of personality, including 4 temperament dimensions and 3 character dimensions, is one of the most noteworthy theories in recent years. Several studies have explored temperament dimensions as a predictor of response to antidepressant treatments in major depression, but these have provided inconsistent results. The present study explored temperament as well as character dimensions, as measured by the Temperament and Character Inventory (TCI), as possible predictors of response to maprotiline, the most-widely prescribed antidepressant in Japan. Methods: 86 consecutive patients with major depression underwent a 16-week open trial of maprotiline. They filled out the TCI at baseline, and were followed up at weeks 8 and 16 by using the Hamilton Rating Scale for Depression. Results: Hierarchial logistic regression analyses demonstrated that response to maprotiline was significantly predicted by the cooperativeness score at the 8-week outcome assessment, and by the self-directedness score at the 16-week outcome assessment, after controlling the possible effects of clinical variables on the response. There was no evidence that either temperament dimensions or their 2-way interactions significantly predicted the response. Limitations: Large replication studies with other antidepressants are needed for generalizing the results in this study. Conclusions: The results in this study regarding temperament dimensions seem consistent with findings in previous studies, which are, as a whole, inconsistent with each other. It is suggested that character dimensions (particularly cooperativeness and self-directedness), rather than temperament dimensions, may be important predictors of response to antidepressants. Antidepressants may differ in the personality configurations that predict optimal responses.

Aim : To examine the relationship between dysfunctional attitudes and personality in depressed patients. Method : One hundred depressed patients completed both the Dysfunctional Attitudes Scale (DAS) and the Temperament and Character Inventory (TCI). Results : Scores on the DAS correlated with duration of depression, age of onset of depression, age, harm avoidance and self-directedness. In a multiple regression analysis three measures explained 45% of the DAS score. These were duration of depression, reward dependence and self-directedness. In both the univariate analyses and multiple regression the strongest predictor of dysfunctional attitudes was the character dimension of self-directedness. Conclusion : The character dimension of self-directedness in the TCI which assesses an individuals' self-concept, relates highly with the dysfunctional attitudes score on the DAS. Given that the TCI assesses personality within a broader framework of a psychobiologic and developmental model, self-directedness may have a wider application as a measure of self-concept than the DAS.

Background: Personality assessment may allow reliable measurement of risk of mood disorders. Methods: A group of adults (804) representative of the general population were assessed by questionnaire. Personality types were measured by the Temperament and Character Inventory (TCI). Results: Specific TCI configurations define personality types that can be described as hyperthymic, cyclothymic, irritable, and depressive. Each type had a unique profile of emotions, suicide attempts, and hospitalization. Conclusions: TCI traits are associated with mood disorders. Limitations: Different ways of measuring Kraepelinean subtypes may disagree. Whether differences in personality cause psychopathology, or vice versa, remains uncertain. Clinical relevance: Personality profiles help in assessing suicidality and planning treatment.

No antidepressant currently in use exerts a significant antidepressant effect for at least two to three weeks after the patient starts taking it. Open studies suggest that, for selective serotonergic re-uptake inhibitor (SSRI) antidepressants, this latency may be reduced when the drug is taken with the 5HT 1A receptor blocker pindolol. We have undertaken a randomised, placebo controlled, double blind trial of augmentation of the selective SSRI antidepressant paroxetine in combination with pindolol. All our patients ( n =54; mean age 36 [range 19–65]) met criteria for major depression and received a standard dose (20 mg o.d.) of paroxetine plus, randomly, either pindolol (2.5 mg t.d.s.) or placebo for six weeks. We examined personality variables in 48 consecutive subjects according to a short version (TCI-125) of Cloninger et al's self-rated Temperament and Character Inventory ( Cloninger et al., 1994 ) and correlated the results with clinical responses in the trial. The results suggest that personality can influence clinical outcome. After the double blind period patients were offered paroxetine 20 mg or 40 mg for up to 6 months. Twenty-six patients took this up. The results suggest that high scores in the temperament dimension of Reward Dependence and low scores in the temperament dimension of Harm Avoidance had a better outcome at 6 weeks. Patients who had received paroxetine and pindolol during the trial and who reported high Novelty Seeking and low Harm Avoidance scores had a better outcome at 6 weeks and 6 months. We suggest that temperament factors may influence outcome of antidepressant treatment.

Introduction: We hypothesized that the probability of personality disorder (`PROB') predicted by the Temperament and Character Inventory (`TCI') would decline after successful pharmacotherapy of depression. Methods: We administered a computerized version of the TCI to 15 patients with DSM-III-R major depression, before and after treatment with serotonergic antidepressants. Results: PROB declined from 58.9%±18.0% to 42.4%±22.8% (P

The many attempts that have been made to identify genes for bipolar disorder (BD) have met with limited success, which may reflect an inadequacy of diagnosis as an informative and biologically relevant phenotype for genetic studies. Here we have explored aspects of personality as quantitative phenotypes for bipolar disorder through the use of the Temperament and Character Inventory (TCI), which assesses personality in seven dimensions. Four temperament dimensions are assessed: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (PS). Three character dimensions are also included: self-directedness (SD), cooperativeness (CO), and self-transcendence (ST).We compared personality scores between diagnostic groups and assessed heritability in a sample of 101 families collected for genetic studies of BD. A genome-wide SNP linkage analysis was then performed in the subset of 51 families for which genetic data was available.Significant group differences were observed between BD subjects, their first-degree relatives, and independent controls for all but RD and PS, and all but HA and RD were found to be significantly heritable in this sample. Linkage analysis of the heritable dimensions produced several suggestive linkage peaks for NS (chromosomes 7q21 and 10p15), PS (chromosomes 6q16, 12p13, and 19p13), and SD (chromosomes 4q35, 8q24, and 18q12).The relatively small size of our linkage sample likely limited our ability to reach genome-wide significance in this study.While not genome-wide significant, these results suggest that aspects of personality may prove useful in the identification of genes underlying BD susceptibility.

Background Evidence shows that depression is associated with hypothalamic–pituitary–adrenal (HPA) axis hyperactivation, although such findings are not entirely unequivocal. In contrast, various psychiatric conditions, including atypical depression, are associated with hypocortisolism. Another line of research has demonstrated that personality is associated with HPA axis alteration. It is thus hypothesized that different personality pathology in depression would be associated with distinct cortisol reactivity. Methods Eighty-seven outpatients with DSM-IV major depressive disorder were recruited. Personality was assessed by the temperament and character inventory (TCI). HPA axis reactivity was measured by the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test. According to our previous studies, two subgroups were considered based on their cortisol responses to the DEX/CRH test: incomplete-suppressors whose cortisol response was exaggerated and enhanced-suppressors whose cortisol response was blunted. Results The analysis of covariance, controlling for age, gender and symptom severity, revealed that incomplete-suppressors scored significantly higher on cooperativeness than enhanced-suppressors ( p =0.002). A multivariate stepwise logistic regression analysis predicting the cortisol suppression pattern from the seven TCI dimensions, controlling for age, gender and symptom severity, revealed that lower cooperativeness ( p =0.001) and higher reward dependence ( p =0.018) were significant predictors toward enhanced suppression. Limitations The neuroendocrine challenge test was administered only once, based on a simple test protocol. Conclusions Our findings suggest that (personality-related) subtypes of depression might be differentiated based on the different pattern of cortisol reactivity. Future studies are warranted to further characterize the HPA axis alteration in relation to various subtypes of depression.

Background Well-being consists of affective and non-affective components. Personality traits measure individual differences in adaptive functioning and mental health. In a previous Israeli study personality was strongly associated with well-being. However, it is not well known which aspects of this association are culture-specific, and which are common to most cultures. Methods 1940 volunteer participants of the Cardiovascular Risk in Young Finns (CRYF) study completed the Temperament and Character Inventory (TCI), and the Multidimensional Scale of Perceived Social Support (PSS). Questions about positive and negative affect, satisfaction with life, and subjective health were also included. Multidimensional personality profiles were used to evaluate the linear and non-linear effects of interactions among dimensions on different aspects of well-being. Results Self-directedness was strongly associated with all aspects of well-being regardless of interactions with other dimensions. Cooperativeness was also associated with several aspects of well-being but especially strongly with perceived social support. Self-transcendence was associated with both positive and negative affect when the influence of the other character dimensions was taken into account. Personality explained half the variance in non-affective well-being and two thirds of the variance in affective well-being. Limitations The same assessment instruments were not used in the two countries we compared. Our data were cross-sectional. Conclusions Self-directedness and Cooperativeness are positively associated with well-being regardless of culture. The effect of Self-transcendence, however, seems to be culture-specific. Self-transcendence increases positive affect but, based on culture, it can also increase negative affect.

Background Cloninger's Temperament and Character Inventory (TCI) is a widely used measure of personality. Two scales of the TCI, harm avoidance (HA) and self directedness (SD), have been shown to be influenced by depressed mood. We examined how the seven TCI scales and their subscales are correlated with depression severity before and after treatment. We also examined whether changes in personality measures could be attributed to changes in depression severity. Methods Two clinical samples of depressed out-patients were recruited for trials to examine predictors of treatment response to antidepressants ( N = 195) and psychotherapies ( N = 177). Assessment included the Montgomery–Asberg depression rating scales (MADRS), Hopkins Symptom Checklist (SCL-90) and TCI at baseline and after treatment. Results After treatment, in both samples, depression severity correlated significantly with HA and negatively with SD. Multiple regression analysis revealed that changes in SD and HA over treatment were related to improvement in depression. In the psychotherapy trial baseline MADRS scores correlated with low SD and high HA. Limitations The trial results are applicable to mild-moderately depressed out-patients. Conclusions Depression severity influences the total scales and most of the subscale measures of HA and SD. Some personality traits, as measured by the TCI, were not impacted upon by mood. Clinically mood should be taken into account when assessing personality measures of negative affect using the TCI.

Background Patients with major depressive disorder (MDD) show suboptimal decision-making strategy in experimental game situations. The influence of personality traits and genetic variations on decision-making is not known. Methods Contingency learning based on the cumulative effect of reward and punishment was assessed in 124 patients with unipolar MDD using the ABCD (reward sensitivity) and EFGH (punishment sensitivity) versions of the Iowa Gambling Test. All patients were genotyped for serotonin transporter promoter polymorphism (5-HTTLPR) and received the Temperament and Character Inventory (TCI). Results Patients with the ll genotype achieved higher persistence scores and used more optimal decision-making strategy on the ABCD task compared with patients with the ss genotype. Higher persistence was associated with better performance on the ABCD task, and higher harm-avoidance was associated with worse performance on the EFGH task. Limitations Healthy control volunteers were not included. Personality traits and decision-making were not assessed with multiple questionnaires and tasks. Type I errors cannot be excluded. Conclusions Decision-making strategy is influenced by personality traits and genetic variations in patients with MDD. Patients carrying the ss variant of the 5-HTTLPR show less persistence and tend to be influenced by high immediate reward.

Objective To investigate temperament–creativity relationships in euthymic bipolar (BP) and unipolar major depressive (MDD) patients, creative discipline controls (CC), and healthy controls (HC). Methods 49 BP, 25 MDD, 32 CC, and 47 HC (all euthymic) completed three self-report temperament/personality measures: the Revised NEO Personality Inventory (NEO-PI-R), the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and the Temperament and Character Inventory (TCI); and four creativity measures yielding six parameters: the Barron–Welsh Art Scale (BWAS-Total, BWAS-Like, and BWAS-Dislike), the Adjective Check List Creative Personality Scale (ACL-CPS), and the Torrance Tests of Creative Thinking – Figural (TTCT-F) and Verbal (TTCT-V) versions. Factor analysis was used to consolidate the 16 subscales from the three temperament/personality measures, and the resulting factors were assessed in relationship to the creativity parameters. Results Five personality/temperament factors emerged. Two of these factors had prominent relationships with creativity measures. A Neuroticism/Cyclothymia/Dysthymia Factor, comprised mostly of NEO-PI-R-Neuroticism and TEMPS-A-Cyclothymia and TEMPS-A-Dysthymia, was related to BWAS-Total scores (r = 0.36, p

Background This study examined whether temperament dimensions, as indicated by Cloninger's psychobiological model [Cloninger, C.R., Svrakic, D.M., Przybeck, T.R., 1993. A psychobiological model of temperament and character. Arch. Gen. Psychiatry 50, 975–990.], predicted depressive symptoms across a 4-year follow-up. Methods Nine hundred ninety-three women and 583 men from the on-going population-based study of “Cardiovascular Risk in Young Finns” completed the Temperament and Character Inventory (TCI) [Cloninger, C.R., Svrakic, D.M., Przybeck, T.R., 1993. A psychobiological model of temperament and character. Arch. Gen. Psychiatry 50, 975–990.], a revised version of Beck's Depression Inventory [Beck, A.T., Steer, R.A., 1987. Manual for the Revised Beck Depression Inventory. Psychological Corporation, San Antonio, TX; Katainen, S., Raikkonen, K., Keltikangas-Jarvinen, L., 1999. Adolescent temperament, perceived social support and depressive tendencies as predictors of depressive tendencies in young adulthood. Eur. J. Pers. 13, 183–207] and the Perceived Social Support Scale-R [Blumenthal, J.A., Burg, M.M., Barefoot, J., Williams, R.B., Haney, T., Zimet, G., 1987. Social support, type A behavior, and coronary artery disease. Psychosom. Med. 49, 331–340]. Results Results of hierarchical linear regression models showed that the temperament subscales impulsiveness, shyness with strangers, fatigability, sentimentality, and persistence increased the risk of depressive symptoms independently of a wide variety of known risk factors for depression. The association between fatigability and depressive symptoms was stronger for participants with low social support than for those reporting high social support. Limitations The sample was restricted to men and women aged 20–35 at baseline and no clinically significant cut-point for depression was defined. Conclusions Our results strengthen the view that depressive symptoms are independently influenced by temperamental dispositions.

Objective: To validate a short English-language version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. Its constituent subscales and items were formulated on the basis of the diagnostic criteria for affective temperaments (cyclothymic, dysthymic, irritable, hyperthymic, and anxious), originally developed by the first author and his former collaborators. Further item wording and selection were achieved at a later stage through an iterative process that incorporated feedback from clinicians, researchers, and research volunteers. Method: A total of 510 volunteers (284 patients with mood disorders, 131 relatives of bipolar probands, and 95 normal controls) were recruited by advertisement in the newspapers, announcements on radio and television, flyers and newsletters, and word of mouth. All participants were interviewed using the Structured Clinical Interview for DSM-III-R, and completed the 110-item TEMPS-A and the Temperament and Character Inventory (TCI-125). The factorial structure, the α coefficients, and the item–total correlations coefficients of the TEMPS-A and the correlation coefficients between the dimensions of the TCI and the TEMPS-A subscales were then determined. Results: A principal components analysis with a Varimax rotation found that 39 out of the 110 original items of the TEMPS-A loaded on five factors that were interpreted as representing the cyclothymic, depressive, irritable, hyperthymic, and anxious factors. Coefficients α for internal consistency were 0.91 (cyclothymic), 0.81 (depressive), 0.77 (irritable), 0.76 (hyperthymic), and 0.67 (anxious) subscales. We found statistically significant positive correlations between all—but the hyperthymic—subscales and harm avoidance. Positive correlations with the hyperthymic and cyclothymic, and novelty seeking and negative correlations with the remaining subscales were also recorded. Other major findings included positive correlations between the hyperthymic and reward dependence, persistence and self-directedness; positive correlation between the self-transcendence and the cyclothymic, hyperthymic and the anxious; and negative correlations between the depressive, cyclothymic, irritable, anxious and cooperativeness. Limitation: As the full-scale anxious temperament was added after the four scales of the TEMPS-A were developed, it has only been evaluated in 345 subjects. Conclusions: These data indicate that the TEMPS-A in its shortened version is a psychometrically valid scale with good internal consistency. The proposed five subscale structure is upheld. Concurrent validity against the TCI is shown. Most importantly, for each of the temperaments, we were able to show positive attributes which are meaningful in an evolutionary context, along with traits which make a person vulnerable to mood shifts. This hypothesized dual nature of temperament, which is upheld by our data, is a desirable characteristic for a putative behavioral endophenotype in an oligogenic model of inheritance for bipolar disorder.

Objective: The first objective of this brief report is to examine the relationships between levels of interpersonal sensitivity and dimensions of personality, depression severity and early relationship with parents. An additional objective is to examine the differences between levels of interpersonal sensitivity in depressive subtypes. Method: One hundred and fifty four patients completed the Interpersonal Sensitivity Measure [IPSM], the Temperament and Character Inventory [TCI], and the Parental Bonding Instrument [PBI]. Other measures including Hamilton Depression Rating Scale [HDRS], DSM-IV atypical symptoms and DSM-IV melancholic symptoms were obtained using clinician rating scales. Results: There were strong Pearson correlations between both the total and subscale scores of the IPSM and both temperament and character scores of the TCI. A joint principal components analysis isolated two main underlying constructs, both consisting of IPSM and TCI subscales. Patients with rejection sensitivity, an aspect of atypical depression, scored higher on the IPSM and three of its subscales, but there were no other differences in score by subtype. Conclusions: Both the IPSM and dimensions of the TCI measure similar constructs. These two constructs may help us to understand differences in symptom profile and response to therapy in depressed patients.

Background: Central serotonin-2A (5-HT 2A ) receptor dysfunction is regarded as an important factor in the etiology of affective disorders. The relations between some personality traits and the vulnerability of affective disorders are also implicated. Moreover, there are several reports which describe the association between 5-HT 2A receptor gene polymorphisms and mental disorders. We therefore examined the relationship between personality traits, the 5-HT 2A receptor function, and 5-HT 2A receptor gene polymorphisms. Methods: 5-HT-induced intraplatelet calcium (Ca) mobilization, 5-HT 2A receptor gene polymorphisms (A-1438G, T102C, T516C, C1340T, C1354T), and Temperament and Character Inventory (TCI) scores were examined in 133 healthy subjects. Results: Neither 5-HT-induced Ca mobilization nor 5-HT 2A receptor gene polymorphisms (A-1438G, T102C) appear to be associated with seven personality dimensions including Harm Avoidance. There was no significant difference in the Ca response among the subjects with −1438A/A, A/G and G/G genotypes. Since the appearance of the other types of the 5-HT 2A receptor gene polymorphisms (T516C, C1340T and C1354T) was quite rare in our sample, we were unable to examine the relationship between these polymorphisms, and the TCI score or the Ca response. Limitations: Our failure to find a significant association may reflect the false negative results due to the small sample size and low statistical power. Further studies in depressed patients may clarify the complicated relationship between personality traits and the vulnerability of affective disorders. Conclusions: Personality traits detected by TCI may not be directly related to the 5-HT 2A receptor function or 5-HT 2A receptor gene polymorphism which may be involved in the vulnerability of affective disorders.

Background: We investigated whether melancholic and non-melancholic Japanese depressive patients differed in regard to a personality feature, interpersonal sensitivity, as measured by the Interpersonal Sensitivity Measure (IPSM). Methods: In addition to 154 normal controls, 66 remitted melancholic patients and 55 remitted non-melancholic patients filled out the IPSM and two widely-used comprehensive personality inventories, the Temperament and Character Inventory (TCI) and the Munich Personality Test (MPT). The subdivision of patients was made according to three major symptom-based criteria for melancholia (those of RDC, DSM-III, DSM-IV). Results: Multivariate and post-hoc univariate analyses of variance revealed significant differences among the three groups in several personality dimensions after Bonferroni’s adjustments of P values. While reported scores of both melancholic and non-melancholic patients deviated from normative scores on several personality dimensions, non-melancholic patients reported significantly higher scores on the total IPSM and the ‘fragile inner-self’ (a subscore of the IPSM) than did normal controls or melancholic depressives. The principal component analysis isolated two factors related to depressive disorders: one factor corresponding to the five IPSM scores; and the other corresponding to harm avoidance, neuroticism and frustration tolerance. The scores on the former factor differentiated non-melancholic depressives from melancholic depressives and normal controls. The scores on the latter factor differentiated both melancholic and non-melancholic depressives from normal controls. Limitations: Prospective studies in which depressive subjects are subdivided into melancholic and non-melancholic subjects will be required to see whether the personality deviations here related to depressive disorders strongly reflect the premorbid personality function. Conclusions: These results indicate that the IPSM scales (particularly, the fragile inner-self scale and the total IPSM scale) are relatively independent of all dimensions included in the two comprehensive personality inventories, and have a capability to describe personality differences between non-melancholic depression and melancholia.