Cyclothymic temperament linked to suicidality

By Eleanor McDermid, Senior medwireNews Reporter

The presence of a cyclothymic temperament in inpatients with bipolar disorder may indicate a high likelihood of hopelessness and suicidality, report researchers.

The same was true of inpatients with major depressive disorder (MDD), shows the study by Maurizio Pompili (Sapienza University of Rome, Italy) and colleagues.

The findings point to the need to screen inpatients with major mood disorders “for the cyclothymic temperament as a useful additional tool for better assessing mood disorders and predicting their outcome”, the team writes in the Journal of Affective Disorders.

There were 206 bipolar disorder patients in the study, 99 of whom met the criteria for a cyclothymic temperament on the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire).

Bipolar patients with a cyclothymic temperament had significantly higher (worse) scores on the Beck Hopelessness Scale (BHS) than other bipolar patients, at 11.27 versus 8.09. The differences were consistent for all BHS subscales: feelings about the future; loss of motivation; and future expectations.

Pompili et al note that research consistently identifies hopelessness “as a potent proximal risk factor for suicidal intent, and current suicidal ideation.”

Indeed, significantly more bipolar patients with than without a cyclothymic temperament scored at least 2 points on item 3 of the Hamilton Scale for Depression (HAMD), which assesses suicidality during the preceding 2 weeks, at 91.9% versus 82.1%.

This difference did not remain significant on multivariate analysis, however, whereas the difference in BHS scores remained independently associated with cyclothymic personality. Older age, high TEMPS-A scores for irritability and lower TEMPS-A scores for hyperthymic temperament were also independently associated with a cyclothymic temperament.

The team found similar differences between 29 MDD inpatients with and 46 without a cyclothymic temperament. By contrast, differences between bipolar and MDD patients with cyclothymic temperaments were few and related to their mood disorder diagnosis (eg, measures of depression and mania).

“The presence of cyclothymic temperament in patients with major mood disorders has to alert mental health providers for different clinical course of the illness, and probably different outcome and effectiveness of medical treatments”, the researchers conclude.

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