Affective Temperaments in Bipolar Disorder Have a Significant Effect on Functional, Clinical Outcomes of Mania

Bipolar patients with the dominant hyperthymic temperament experience a better functional outcome following manic episodes than patients with the cyclothymic-depressive-anxious temperament, according to a prospective longitudinal study published in Psychiatry Research.

A total of 194 adult patients with bipolar disorder who either initiated or changed treatment for a manic episode as defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition were included in the study. To evaluate temperamental characteristics, researchers used the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego brief-version (briefTEMPS-M) at week 12. 

In addition, the investigators used the Childhood Trauma Questionnaire (CTQ) to assess for childhood trauma; the Young Mania Rating Scale (YMRS) and the Montgomery and Asberg Depression Rating Scale (MADRS) to examine affective symptomatology severity; the Functioning Assessment Short Test (FAST) scale for evaluating social, occupational, psychological, and cognitive functioning; and the Clinical Global Impression Scale-Bipolar Illness (CGIBP) for assessing changes from the preceding and worst illness phases.

Anxious, cyclothymic, depressive, and irritable temperaments were found to significantly correlate with each other in this cohort. A significantly greater percentage of individuals with dominant hyperthymic temperament reported a family history of bipolar disorder than patients with dominant cyclothymic-depression-anxious temperament (P =.02). In addition, patients with dominant cyclothymic-depression-anxious temperament had higher MADRS scores (P =.03), as well as higher CTQ emotional neglect (P =.05) and abuse (P =.01) at final evaluation compared with patients with dominant hyperthymic temperament. Overall, patients with dominant hyperthymic temperament demonstrated a greater functional outcome than patients with cyclothymic-depression-anxious temperament at 12 weeks (P =.01).

The study’s small sample size limited the power of the findings and the non-randomized selection of participating centers may have introduced potential selection bias.

Based on these findings, the investigators suggest that “the pathoplastic effect on the acute symptomatology and the influence on the course of the illness of different temperamental dispositions should be considered for the choice of the treatment and the prognostic evaluation” in clinical practice.

Reference

Perugi G, Cesari D, Vannucchi G, et al. The impact of affective temperaments on clinical and functional outcome of Bipolar I patients that initiated or changed pharmacological treatment for mania. Psychiatry Res. 2018;261:473-480.