AFFECTIVE TEMPERAMENTS IN MENTAL HEALTH AND MOOD DISORDERS
Abstract
Temperament includes genetic-biological components of behavior that include mood, the way of emotional reaction in terms of speed, intensity, duration and type of reaction, relationship to the environment, and sensitivity to external stimuli.
Attempts to classify temperaments date back to the time of Ancient Greece, while the modern concept of temperament is based on the work of Kraepelin and Kretschmer. Hagop Akiskal continued the development of the modern concept of temperament and divided the types of affective temperaments into: depressive, hyperthymic, cyclothymic, irritable and anxious temperament. In a healthy population, temperament represents an important, biological, basis of personality. However, dominant affective temperaments are thought to potentially lie on a continuum between healthy emotional reactivity and affective disorders. Also, dominant affective temperaments in an accentuated form can represent subclinical manifestations of affective disorders, as well as precursors for the emergence of these disorders. Based on strong genetic and neurochemical foundations, affective temperaments have developed and persisted throughout evolution because they carry distinct evolutionary and social advantages. Thus, in addition to pathological, temperamental characteristics can also have an adaptive value.
Additional research on understanding of affective disorders as a continuum as opposed to their categorical classification, with respect for the transitional forms they take from mental health to mental disorders, would contribute not only to a better understanding of the emotional life of a man, but also to timely, targeted and better treatment of various psychopathological forms.
References
1. Kagan J. Galen's Prophecy: Temperament In Human Nature. New York: Basic Books, 1998.
2. Biro M, Butollo W. Klinička psihologija. Novi Sad: Futura, 2003
3. Sudhoff K. Essays in the History of Medicine. Medical Life Press. New York: 1926; 67, 87, 104.
4. Akiskal HS. The temperamental foundations of affective disorders. In: Mundt C, Hahlweg K, Fiedler P, editors. Interpersonal factors in the origin and course of affective disorders. London: Gaskell, 1996:3-30.
5. Berrios GE. European views on personality disorders: a conceptual history. Compr. Psychiatry. 1993; 34: 14–30.
6. Akiskal HS, Akiskal KK. In search of Aristotle: temperament, human nature, melancholia, creativity and eminence. J. Affect. Disord. 2007; 100: 1–6.
7. Merenda, P. F. (1987). "Toward a Four-Factor Theory of Temperament and/or Personality". Journal of Personality Assessment. 51 (3): 367–374.
8. Steiner R. The Four Temperaments. Rudolf Steiner Press, 2008.
9. Kraepelin E. Manic-Depressive Illness and Paranoia. Edinburgh: Livingstone, 1921.
10. Kretschmer E. Physique and Character. London: Kegan, Paul, Trench, Trubner and Co. Ltd., 1936.
11. Akiskal HS, Brieger P, Mundt C, Angst J, Marneros A. Temperament and affective disorders. The TEMPS-A Scale as a convergence of European and US-American concepts. Nervenarzt. 2002;73(3):262-71.
12. Leźnicka, K.; Starkowska, A.; Tomczak, M.; Cięszczyk, P.; Białecka, M.; Ligocka, M.; Żmijewski, P.; Pawlak, M. Temperament 321 as a modulating factor of pain sensitivity in combat sport athletes. Physiol Behav 2017, 180, 131-136.
13. Białczyk, K.; Wyszkowska, Z.; Bieliński, M. Affective Temperament is Associated with Stress Coping Strategies and Work Stress 323 Perception Among Polish Bank Employees. Psychol Res Behav Manag 2020, 13, 1333-1342.
14. Akiskal HS, Akiskal K, Allilaire JF, et al. Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study. J Affect Disord 2005; 85(1-2): 29-36.
15. Dembińska-Krajewska, D., & Rybakowski, J. (2014). The Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPA-a) - an important tool to study affective temperaments. Psychiatria Polska, 48(2), 261–67.
16. Walsh, M. A., Brown, L. H., Barrantes-Vidal, N., & Kwapil, T. R. (2013). The expression of affective temperaments in daily life. Journal of Affective Disorders, 145(2), 179–186.
17. Rovai, L., Leonardi, A., Bacciardi, S., Giovanni, A., Maremmani, I., Rugani, F., . . . Akiskal, H. S. (2013a). Discriminant and convergent validity of TEMPS-A[P]. Correlation with Occupational Personality Questionnaire (OPQ32) during a stressful situation. Journal of Affective Disorders, 146 (1), 142–145
18. Karam, E. G., Salamoun, M. M., Yeretzian, J. S., Mneimneh, Z. N., Karam, A. N., Fayyad, J., . . . Akiskal, H. S. (2010). The role of anxious and hyperthymic temperaments in mental disorders: a national epidemiologic study. World Psychiatry, 9(2), 103–110.
19. Perugi G, Toni C, Maremmani I, et al. The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: A study on Bipolar I Italian National sample. J Affect Disord 2012; 136(1-2): e41-9.
20. Lazary, J., Gonda, X., Benko, A., Gacser, M., & Bagdy, G. (2009). Association of depressive phenotype with affective family history is mediated by affective temperaments. Psychiatry Research, 168(2), 145–152.
21. Morvan, Y., Tibaoui, F., Chantal Bourdel, M., Loo, H., Akiskal, K. K., Akiskal, H. S., & Krebs, M.O. (2011). Confirmation of the factorial structure of temperamental autoquestionnaire TEMPS-A in non-clinical young adults and relation to current state of anxiety, depression and to schizotypal traits. Journal of Affective Disorders, 131(1–3), 37–44.
22. Akiskal HS, Akiskal KK. Cyclothymic, hyperthymic and depressive temperaments as subaffective variants of mood disorders. In: Tasman A, Riba MB, Eds. Annual Review, vol II. Washington, D.C.: American Psychiatric Press 1992; pp. 43-62.
23. Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry 2000; 33:3–7.
24. Akiskal, H.S., 2000. Dysthymia, cyclothymia and related chronic subthreshold mood disorders. In: Gelder, M., Lopez-Ibor, J., Andreasen, N. (Eds.), New Oxford Textbook of Psychiatry. Oxford University Press, London, pp. 736 – 749
25. Akiskal HS, Khani MK, Scott-Strauss A. Cyclothymic temperamental disorders. Psychiatr Clin North Am 1979; 2(527-54.
26. Akiskal HS, Mallya G. Criteria for the ‘soft’ bipolar spectrum: treatment implications. Psychopharmacol Bull 1987; 23:68–73.
27. Walsh MA, Brown LH, Barrantes-Vidal N, Kwapil TR. The expression of affective temperaments in daily life. J. Affect. Disord. 2013; 145: 179– 86.
28. Moore DJ, Atkinson JH, Akiskal H, et al. Temperament and risky behaviors: a pathway to HIV? J Affect Disord 2005; 85(1-2): 191- 200.
29. Akiskal HS. Personality and anxiety disorders. Psychiatr Psychobiol 1988; 3(161-6.
30. Akiskal HS. Toward a definition of generalized anxiety disorder as an anxious temperament type. Acta Psychiatr Scand Suppl 1998; 393(66-73.
31. Akiskal HS, Akiskal KK. TEMPS: Тemperament evaluation of Memphis, Pisa, Paris and San Diego.J.Affect.Disord. 2005; 85: 1–2.
32. Akiskal HS, Placidi GF, Signoretta S, Liguori A, Gervasi R, Maremmani I, Mallya G, Puzantian VR. TEMPS-I: delineating the most discriminant traits of cyclothymic, depressive, irritable and hyperthymic temperaments in a nonpatient population. J. Affect. Disord. 1998;51:7 – 19.
33. Placidi, G.F., Signoretta, S., Liguori, A., Gervasi, R., Maremmani, I., Akiskal, H.S., 1998. The semi-structured affective temperament interview (TEMPS-I): reliability and psychometric properties in 1010 14–26 year students. J. Affect. Disord. 47, 1 – 10
34. Akiskal, H.S., Mendlowicz, M.V., Lean-Louis, G., Rapaport, M.H., Kelsoe, J.R., Gillin, J.C., Smith, T.L., 2005b. TEMPSA: validation of a short version of a self-rated instrument designed to measure variations in temperament. J. Affect. Disord. 85, 45–52 (this issue)
35. Ristić-Ignjatović, D., Hinić, D., Bessonov, D., Akiskal, H. S., Akisakl, K. K., & Ristić, B. (2014). Towards validation of the short TEMPS-A in non-clinical adult population in Serbia. Journal of Affective Disorders, 164(1–3), 43–49.
36. Vázquez G, Tondo L, Mazzarini L, et al. Affective temperaments in general population: a review and combined analysis from national studies. J Affect Disord 2012, (139): 18-22.
37. Placidi, G.F., Maremmani, I., Signoretta, S., Liguori, A., Akiskal, H.S., 1998. A prospective study of stability and change over 2 years of affective temperaments in 14–18 year-old Italian high school students. J. Affect. Disord. 51, 199–208.
38. Blöink, R., Brieger, P., Akiskal, H.S., Marneros, A., 2005. Factorial structure and internal consistency of the German TEMPS-A scale: validation against the NEO-FFI questionnaire. J. Affect. Disord. 85, 77–83.
39. Karam, E.G., Mneimneh, Z., Salamoun, M., Akiskal, K.K., Akiskal, H.S., 2005. Psychometric properties of the Lebanese-Arabic TEMPS-A: a national epidemiologic study. J. Affect. Disord. 87, 169–183.
40. Rózsa, S., Rihmer, Z., Gonda, X., Szili, I., Rihmer, A., Ko, N., Németh, A., Pestality, P., Bagdy, G., Alhassoon, O., Akiskal, K.K., Akiskal, H.S., 2008. A study of affective temperaments in Hungary: internal consistency and concurrent validity of the TEMPS-A against the TCI and NEO-PI-R. J. Affect. Disord. 106, 45–53.
41. Vázquez, G.H., Nasetta, S., Mercado, B., Romero, E., Tifner, S., Ramón, Mdel L., Garelli, V., Bonifacio, A., Akiskal, K.K., Akiskal, H.S., 2007. Validation of the TEMPS-A Buenos Aires: Spanish psychometric validation of affective temperaments in a population study of Argentina. J. Affect. Disord. 100, 23–29.
42. Cloninger CR. Temperament and personality. Curr Opin Neurobiol 1994; 4(2): 266-73.
43. Bouchard TJ, Jr. Genes, environment, and personality. Science 1994; 264(5166): 1700-1.
44. Rothbart MK, Ahadi SA, Evans DE. Temperament and personality: origins and outcomes. J Personality Social Psychology 2000; 78(1): 122-35.
45. Chiaroni P, Hantouche EG, Gouvernet J, et al. The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies? J Affect Disord 2005; 85:135–145.
46. Evans L, Akiskal HS, Keck PE Jr, et al. Familiality of temperament in bipolar disorder: support for a genetic spectrum. J Affect Disord 2005; 85:153– 168.
47. Jacobs, B. L., and Azmitia, E. C. (1992). Structure and function of the brain serotonin system. Physiol. Rev. 72, 165–229.
48. Canli, T., Omura, K., Haas, B. W., Fallgatter, A., Constable, R. T., and Lesch, K. P. (2005). Beyond affect: a role for genetic variation of the serotonin transporter in neural activation during a cognitive attention task. Proc. Natl. Acad. Sci. U.S.A. 102, 12224–12229.
49. Gonda X, Rihmer Z, Zsombok T, et al. The 5HTTLPR polymorphism of the serotonin transporter gene is associated with affective temperaments as measured by TEMPS-A. J Affect Disord 2006; 91:125–131.
50. Kluger AN, Siegfried Z, Ebstein RP. A meta-analysis of the association between DRD4 polymorphism and novelty seeking. Mol Psychiatry 2002; 7:712–717.
51. Munafo MR, Yalcin B, Willis-Owen SA, Flint J. Association of the dopamine D4 receptor (DRD4) gene and approach-related personality traits: metaanalysis and new data. Biol Psychiatry 2008; 63:197–206.
52. Staner L, Hilger C, Hentges F, et al. Association between novelty-seeking and the dopamine D3 receptor gene in bipolar patients: a preliminary report. Am J Med Genet 1998; 81:192–194.
53. Kang JI, Namkoong K, Kim SJ. The association of 5-HTTLPR and DRD4 VNTR polymorphisms with affective temperamental traits in healthy volunteers. J Affect Disord 2008; 109:157–163.
54. Akiskal HS. Evolutionary psychiatry: the end of the beginning. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisko, California. Abstract S52D.
55. Akiskal KK,Akiskal HS. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and humannature.J.Affect.Disord;2005a:85,231–239.
56. Akiskal, H.S., Bourgeois, M.L., Angst, J., Post, R., Moller, H.J., Hirschfeld, R.M.A., 2000. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J. Affect. Disord. 59 (Suppl 1), 5s – 30s.
57. Akiskal, H.S., Bourgeois, M.L., Angst, J., Post, R., Moller, H.J., Hirschfeld, R.M.A., 2000. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J. Affect. Disord. 59 (Suppl 1), 5s – 30s.
58. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50(12): 975-90
59. Erfurth A, Gerlach AL, Hellweg I, et al. Studies on a German (Munster) version of the temperament auto-questionnaire TEMPSA: construction and validation of the brief TEMPS-M. J Affect Disord 2005; 85(1-2): 53-69.
60. Vellante M, Zucca G, Preti A, et al. Creativity and affective temperaments in non-clinical professional artists: an empirical psychometric investigation. J Affect Disord 2011; 135(1-3): 28-36.
61. Akiskal HS. Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. J Affect Disord 2001; 62(1-2): 17-31.
62. Akiskal HS. Proposal for a depressive personality (temperament). In: Tyrer P, Stein G, Eds. Personality Disorders Reviewed. London: Gaskell 1993; pp. 165-79.
63. Akiskal HS. Toward a definition of generalized anxiety disorder as an anxious temperament type. Acta Psychiatr Scand Suppl 1998; 393(66-73.
64. Rihmer Z, Akiskal KK, Rihmer A, et al. Current research on affective temperaments. Curr Opin Psychiatry 2010; 23(1): 12-8.
65. Gassab L, Mechri A, Bacha M, et al. [Affective temperaments in the bipolar and unipolar disorders: distinctive profiles and relationship with clinical features]. L'Encepha 2008; 34(5): 477-82.
66. Perugi G, Toni C, Travierso MC, et al. The role of cyclothymia in atypical depression: toward a data-based reconceptualization of the borderline-bipolar II connection. J Affect Disord 2003; 73(1-2): 87-98.
67. Mechri A, Kerkeni N, Touati I, et al. Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients. J Affect Disord 2011; 132(1-2): 285-8.
68. Kochman FJ, Hantouche EG, Ferrari P, et al. Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord 2005; 85(1-2): 181-9.
69. Henry C, Sorbara F, Lacoste J, et al. Antidepressant-induced mania in bipolar patients: identification of risk factors. J Clin Psychiatry 2001; 62(4): 249-55.