Affective temperaments in the bipolar and unipolar disorders: distinctive profiles and relationship with clinical features

Introduction. - Recent research postulated that temperaments represent the subclinical foundations of affective disorders, and an early clue for a recurrent, prebipolar disorder. Akiskal et at. operationalized five types of temperaments: depressive, hyperthymic, irritable, cyclothymic and anxious. The aims of this study were to compare the affective temperaments scores in patients with bipolar I, II and recurrent depression disorders and to explore the relation between temperaments scores and clinical features of those affective disorders. Methods. -This was a comparative cross-sectional study, concerning three groups: patients with bipolar I disorder (BIP I) (n = 31, 20 men and II women, mean age = 42.0 +/- 10.1 years), patients with bipolar II disorder (BIP II) (n = 18, 11 men and seven women, mean age = 40.7 +/- 10.8 years) and patients with recurrent depressive disorder (RDD) (n = 66, 28 men and 38 women, mean age = 45.0 +/- 9.3 years). All patients were in remission of a major depressive episode. The affective temperaments were assessed by the Akiskal and Mallya Affective Temperament questionnaires. Results. - Hyperthymic temperament mean scores were higher in BIP I (10.8 +/- 5.4) and BIP II (10.3 +/- 5.5) groups compared to RDD group (5.5 +/- 4.0) (p < 10(-3)). Depressive temperament mean score was significantly higher in RDD group (10.5 +/- 4.3), compared to BIP 1 (7.3 +/- 4.6) and BIP II (5.4 +/- 2.9) groups (p < 10-3). Cyclothymic temperament mean score was higher in BIP II group (4.7 +/- 5.8) compared to BIP 1 (3.3 +/- 3.9) and RDD (2.5 +/- 13.9) groups, but this difference was not significant (p = 0.08). No difference was found between the three groups concerning irritable temperament scores. Negative correlation was found between hyperthymic and depressive temperament scores in BIP I (r = -0.81, p < 0.001) and RDD (r = -0.73, p < 0.001) groups, but not in BIP II group. Concerning the clinical correlates with affective temperament scores, negative correlation was found between hyperthymic temperament score and number of depressive episodes in BIP II group (r = -0.53, p = 0.02). Hyperthymic temperament score was associated with psychotic features in the last depressive episode in BIP I (p = 0.01) and BIP II (p = 0.008) groups and seasonal features in BIP II group (p = 0.02). Moreover, cyclothymic temperament score was associated with psychotic (p = 0.009) and seasonal features (p = 0.03) in BIP II group. Conclusions. - Despite the small sample sizes for our study groups, we can conclude that hyperthymic and cyclothymic temperaments characterized bipolar disorders and are correlated with other markers of bipolarity such as psychotic and seasonal features. Thus, temperament assessment might become a useful tool to predict bipolarity in association with those markers. (C) L'Encephale, Paris, 2007.