title: Comparative analysis of affective temperament in patients with difficult-to-treat and easy-to-treat major depression and bipolar disorder: Possible application in clinical settings.
abstract: BACKGROUND
  Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder.
  
  
  METHODS
  Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis.
  
  
  RESULTS
  Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively.
  
  
  CONCLUSIONS
  MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.
authors.affiliation: J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan; Department of Psychiatry, Kouseiren Takaoka Hospital, 5-10 Eiraku-cyou, Takaoka City, 933-8555, Japan. Electronic address: min-take@p2.tcnet.ne.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Takeshima
authors.affiliation: J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan. Electronic address: toka@jotoyasuragi.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oka
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D003527:Cyclothymic Disorder / Q000523:psychology; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011795:Surveys and Questionnaires; D013694:Temperament; D016896:Treatment Outcome; D055815:Young Adult