Transcript Slide 1

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
 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.
Meta-analysis
Miettunen J & Raevuori A.
Compr Psychiatry 2012; 53:152-66.
Comparisons between cases and controls in bipolar disorders and schizophrenia
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
Northern Finland 1966 Birth Cohort
12 058 live-born children in the provinces of Oulu and Lapland
Oulu
Northern Finland 1966 Birth Cohort
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)
Results
 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).
Discussion
 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.
Research team:
Jouko Miettunen, Pauliina Juola, Eka Roivainen, Juha Veijola,
Antti Alaräisänen, Matti Isohanni, Erika Jääskeläinen
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