The distinct temperament profiles of bipolar I, bipolar II and unipolar patients
The distinct temperament profiles of bipolar I, bipolar II and unipolar patients
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DOI：
10.1016/j.jad.2005.12.033
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发表时间：
2006-05-01
影响因子：
6.6
通讯作者：
Keller, Martin B.
中科院分区：
文献类型：
--
作者：
Akiskal, Hagop S.;Kilzieh, Nael;Keller, Martin B.
背景：尽管有大量的研究，但对于单相和双相患者的长期特征是否可以通过气质来区分，以及这些特征是否可以与阈值下的情感症状相区分，仍然存在争议。方法：对98例双相I(BP-I)、双相11(BP-II)和251例单相重度抑郁障碍(UP-MDD)患者(均为离散情感发作后的患者)和617名没有终生RDC诊断的亲属、配偶或熟人(对照组，CG)进行了17个自测人格量表的测试，以确定其与情绪障碍的理论相关性。结果：在436个人格项目中，103个对三组患者有显著差异的进行了主成分分析，得到了四个因素。反映“情绪不稳定”、“精力-自信”、“敏感-沉思”和“社交焦虑”的气质维度。大多数BP-I自称情绪稳定和外向接近正常；BP-II情绪不稳定，精力充沛和自信，但敏感和忧郁；MDD在社交上胆小、敏感和忧郁。性别和年龄对这些总体情况没有显著影响。在MDD组中，那些有基线恶劣心境的人是最病态的(即神经质、不安全感和内向的高度)。测量轻躁狂和双相情绪变化的精选GBI项目明显更多地得到BP-II的认可。最后，强调关于这些派生的气质因素给UP-BP区分带来的精确度的方法学发现是相关的。与神经质较低的BP-I不同，BP-II和UP在这一指标上的得分都很高：然而，在BP-II中，高度神经质的主要原因是情绪不稳定，在UP中，它反映了抑郁倾向。限制：我们使用了自我评估的人格测量，这可能是纸笔人格文献中普遍存在的局限性。因此，BP-I很可能高估了他们的“血统”；或者，人们是否应该将这种自我报告视为一个人性情的可靠反映？人们可以提出类似的无法回答的问题，比如“抑郁”和“情绪不稳定”。结论：与CG和已发表的常模相比，病态后自我描述的“正常”人格是1)在许多(但不是全部)BP-I中是乐观的；2)BP-II中是不稳定的或循环的；3)UP中是亚焦虑和亚抑郁的。进一步值得注意的是，除BP-II外，BP-I和MDD的气质得分均在已公布的常模的1 SD以内。与其说这些属性是病理性的，不如说它们是正常的亚临床气质变异，从而支持情感障碍间歇期和间歇期之间的连续性的概念。总体而言，这些发现与Kraepelin的观点一致，与DSM-IV关于AXIS-II结构的提法相反，认为AXIS-II是病理性的，与情感发作截然不同。(C)2005 Elsevier B.V.保留所有权利。
Background: Despite a plethora of studies, controversies abound on whether the long-term traits of unipolar and bipolar patients could be differentiated by temperament and whether these traits, in turn, could be distinguished from subthreshold affective symptomatology.Methods: 98 bipolar I (BP-I), 64 bipolar 11 (BP-II), and 251 unipolar major depressive disorder (UP-MDD) patients all when recovered from discrete affective episodes) and 617 relatives, spouses or acquaintances without lifetime RDC diagnoses (the comparison group, CG) were administered a battery of 17 self-rated personality scales chosen for theoretical relevance to mood disorders. Subsamples of each of the four groups also received the General Behavior Inventory (GBI).Results: Of the 436 personality items, 103 that significantly distinguished the three patient groups were subjected to principal components analysis, yielding four factors which. reflect the temperamental dimensions of "Mood Lability", "Energy-Assertiveness," "Sensitivity-Brooding," and "Social Anxiety." Most BP-I described themselves as near normal in emotional stability and extroversion; BP-II emerged as labile in mood, energetic and assertive, yet sensitive and brooding; MDD were socially timid, sensitive and brooding. Gender and age did not have marked influence on these overall profiles. Within the MDD group, those with baseline dysthymia were the most pathological (i.e., high in neuroticism, insecurity and introversion). Selected GBI items measuring hypomania and biphasic mood changes were endorsed significantly more often by BP-II. Finally, it is relevant to highlight a methodologic finding about the precision these derived temperament factors brought to the UP-BP differentiation. Unlike BP-I who were low on neuroticism, both BP-II and UP scored high on this measure: yet, in the case of BP-II high neuroticism was largely due to mood lability, in UP it reflected subdepressive traits.Limitation: We used self-rated personality measures, a possible limitation generic to the paper-and-pencil personality literature. It is therefore likely that BP-I may have over-rated their "sanguinity"; or should one consider such self-report as a reliable reflection of one's temperament? One can raise similar unanswerable questions about "depressiveness" and "mood lability."Conclusion: As contrasted to CG and published norms, the postmorbid self-described "usual" personality is 1) sanguine among many, but not all, BP-I; 2) labile or cyclothymic among BP-II; and 3) subanxious and subdepressive among UP. It is further noteworthy that with the exception of BP-II, the temperament scores of BP-I and MDD were within one SD from published norms. Rather than being pathological, these attributes are best conceived as subclinical temperamental variants of the normal, thereby supporting the notion of continuity between interepisodic and episodic phases of affective disorders. These findings overall are in line with Kraepelin's views and contrary to the DSM-IV formulation of axis-II constructs as being pathological and sharply demarcated from affective episodes. (c) 2005 Elsevier B.V. All rights reserved.