POLARIDAD PREDOMINANTE Y TEMPERAMENTO EN TRASTORNOS AFECTIVOS UNIPOLARES Y BIPOLARES

Predominant polarity and temperament in bipolar and unipolar affective disorders

MAZZARINI, L.; PACCHIAROTTI, I.; COLOM, F.; SAN, G.; KOTZALIDIS, G.D.; ROSA, A.R.; SANNA, L.; DEROSSI, P.; GIRARDI, N.; BONNIN, C.M.; SANCHEZMORENO, J.; VAZQUEZ, G.H.; GASTO, C.; TATARELLI, R.; VIETA, E


Abstract

Introduction: Recently, the concept of predominant polarity (two-thirds of episodes belonging to a single pole of the illness) has been introduced to further characterise subtypes of bipolar disorders. This concept has been proven to have diagnostic and therapeutic implications, but little is known on the underlying psychopathology and temperaments. With this study, we aimed to further validate the concept and explore its relationships with temperament.

Methods: This study enrolled 143 patients with bipolar or unipolar disorder. We analysed predominant polarity in the sample of bipolar I patients (N=124), focussing on those who showed a clear predominance for one or the other polarity, and distinguishing manic/hypomanic (MP) from depressive polarity (DP), and a unipolar major depression (UP) group (N = 19),. We also assessed temperament by means of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A).

Results: Over 55% of the bipolar I sample fulfilled predominant polarity criteria, with two-thirds of those meeting criteria for MP and one third for DR MP and DP were similar in scoring higher than UP on the hyperthymic/cyclothymic scales of the TEMPS-A; the UP group scored higher on the anxious/depressive scales.

Discussion: Our results show that both bipolar I MP and DP subgroups are temperamentally similar and different from UP. Depression in DP bipolar I patients should be viewed as the overlap of depression on a hyperthymic/cyclothymic temperament. These findings confirm the value of the predominant polarity concept as well as the importance of temperaments to separate bipolar from unipolar disorders.

© 2009 Elsevier B.V. All rights reserved.

Cigarette smoking is associated with suicidality in bipolar disorder
OSTACHER, M.J.; LEBEAU, R.T.; PERLIS, R.H.; NIERENBERG, A.A.; LUND, H.G.; MOSHIER, S.J.; SACHS, G.S.; SIMON, N.M.

Abstract

Objectives: Cigarette smoking in individuals with bipolar disorder has been associated with suicidal behavior, although the precise relationship between the two remains unclear.

Methods: In this prospective observational study of 116 individuals with bipolar disorder, we examined the association between smoking and suicidality as measured by Linehan’s Suicide Behaviors Questionnaire (SBQ) and prospective suicide attempts over a nine-month period. Impulsivity was measured by the Barratt Impulsiveness Scale. Results:

Smoking was associated with higher baseline SBQ scores in univariate and adjusted analyses, but was not significant after statistical adjustment for impulsivity in a regression model. A higher proportion of smokers at baseline made a suicide attempt during the follow-up period (5/31, 16.1%) compared to nonsmokers (3/85, 3.5%); p = 0.031, odds ratio = 5.25 (95% confidence interval: 1.2-23.5). Smoking at baseline also significantly predicted higher SBQ score at nine months.

Conclusions: In this study, current cigarette smoking was a predictor of current and nine-month suicidal ideation and behavior in bipolar disorder, and it is likely that impulsivity accounts for some of this relationship