ABSTRACT
Temperaments in bipolar subjects, as observed by Kraepelin and later re-dynamized and operationalized by Akiskal, have given rise to various studies, which results are hereby synthesized. In the light of these studies, the evaluation of temperaments allows to define subgroups of bipolar subjects, in order to sharpen diagnosis and therefore be able to propose more accurate treatment. A depressive temperament is linked to more frequent thymic relapses, on a depressive slope and it is associated with more frequent comorbid anxiety disorder and with an increased suicidal risk. A hyperthymic temperament is linked to manic relapses and is more likely to switch mood when patients were treated with antidepressants. A thymic episode that appears in a temperament of the opposite polarity will result in a mixed episode. Temperament evaluation is also helpful in choosing drug treatments. Practical clinical benefits can be gained from the study and analysis of those temperaments. As a further development, it could be useful to characterize euthymic period by a dimensional approach.
Subject(s)
Bipolar Disorder/drug therapy , Bipolar Disorder/epidemiology , Temperament , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Bipolar Disorder/psychology , Comorbidity , Depressive Disorder/drug therapy , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Humans , Patient Compliance/statistics & numerical dataABSTRACT
The genes involved in the serotonin system are major candidates in association studies on affective disorders and responses to antidepressants. We studied a functional polymorphism of the serotonin transporter (5-HTT) gene (a 44 bp insertion/deletion in the 5-HTT-linked polymorphic region (5-HTTLPR)) and lifetime history of antidepressant-induced mania (AIM) in a population of 305 patients with bipolar affective disorder. AIM was defined using a broad definition and a restrictive definition. No association was found between the "s" allele of the 5-HTTLPR and AIM for either definition. However, we found an association between the 5-HTTLPR and lifetime history of rapid cycling in a subsample of patients (for allele and genotype distributions: exact probability, p=0.0009 and chi(2)=9.4; df=1; p=0.002, respectively). These results may help to explain the conflicting association results obtained with the 5-HTT gene polymorphism, in particular with AIM. Indeed, the precise phenotype associated with the 5-HTT gene is unclear. The association between the "s" allele and rapid cycling may provide further evidence for an association between the 5-HTTLPR "s" allele and a pattern of affective instability.
