temperament in individuals with psychotic disorders before and after the onset of illness
DESCRIPTION
TEMPERAMENT IN INDIVIDUALS WITH PSYCHOTIC DISORDERS BEFORE AND AFTER THE ONSET OF ILLNESS. Jouko Miettunen [email protected] Department of Psychiatry, University of Oulu, Finland. Cloninger’s temperament dimensions. novelty seeking - PowerPoint PPT PresentationTRANSCRIPT
TEMPERAMENT IN INDIVIDUALS WITH
PSYCHOTIC DISORDERS BEFORE AND AFTER THE
ONSET OF ILLNESS
Jouko [email protected]
Department of Psychiatry, University of Oulu, Finland
Cloninger’s temperament dimensions
novelty seeking tendency to respond with intense excitement to novel stimuli and thereby initiating
behavior
harm avoidance tendency to respond intensively to signals of aversive stimuli, thereby stopping
behavior
reward dependence tendency to respond intensely to signals of reward, especially social rewards, thereby
continuing particular behaviors
Persistence tendency to persevere in behaviors that have been associated with reward
Temperament and Character Inventory (TCI) 107 temperament no/yes items
potential intermediate phenotypes in different psychiatric
disorders
Cloninger et al. Arch Gen Psychiatry 1993;50:975–90.
P=0.061
P=0.048
P=0.037
P=0.147
Effect sizes (Cohen’s d): 0.2-0.5 small, 0.5-0.8 medium, and >0.8 large effect
Comparisons between cases and controls in bipolar disorders and schizophrenia
Meta-analysis Miettunen J & Raevuori A. Compr Psychiatry 2012; 53:152-66.
Northern Finland 1966 Birth Cohort
Oulu
12 058 live-born children in the provinces of Oulu and Lapland
31-year and 43-year follow-up studies
• psychotic individuals, with the onset of illness before the 31-year follow-up (n=16)
• Males/Females: 5/11, schizophrenia/other: 9/7
• psychotic individuals, with the onset of illness after the 31-year follow-up (n=15, 5 males)
• Males/Females: 5/10, schizophrenia/other: 2/13
• healthy controls (n=99; M/F: 49/50)
• Temperament items (TCI)
• psychotic symptoms (PANSS at age 43)
Northern Finland 1966 Birth Cohort
The 31-year and 43-year temperament scores correlated
strongly among controls (0.54 to 0.68), whereas correlations
among psychotic individuals with the onset of psychosis
before first follow-up were weaker (0.17 to 0.53).
Individuals who had their onset of psychosis after the first
follow-up had a significant (p=0.02) increase in harm
avoidance from age 31 to 43-years when compared to
controls.
Results
High harm avoidance before the onset of illness (at age of 31
years) associated significantly with a lower likelihood of remission
and with more negative, disorganization and total symptoms in the
PANSS.
High novelty seeking before illness associated with a higher
likelihood of remission according to the PANSS.
At the age of 43 years, harm avoidance correlated highly positively
with the total PANSS score, especially among those with earlier
onset of psychosis (r = 0.86), but also among those with onset after
the age of 31 years (r=0.44).
Results
Temperament was stable among controls, and more unstable in individuals with psychoses.
In psychoses, increase in harm avoidance associated with getting ill, and it had a very strong positive association with the amount and severity of symptoms.
Premorbid harm avoidance and novelty seeking may be used to predict clinical outcome in schizophrenia.
When studying the temperament in psychoses, the duration of illness and symptom severity should be taken into account.
Discussion
Acknowledgements:This study has been supported by the Academy
of Finland, the NARSAD: the Brain and Behavior Research Fund, the Sigrid Jusélius Foundation, the Jalmari and Rauha Ahokas Foundation, and the US National Institutes of Health (NIMH).
NO CONFLICT OF INTEREST
Research team: Jouko Miettunen, Pauliina Juola, Eka Roivainen, Juha Veijola, Antti Alaräisänen, Matti Isohanni,
Erika Jääskeläinen