TEMPERAMENT IN INDIVIDUALS WITH PSYCHOTIC DISORDERS BEFORE AND AFTER THE ONSET OF ILLNESS Jouko Miettunen firstname.lastname@example.org 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 Oulu 12 058 live-born children in the provinces of Oulu and Lapland
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