Emociones

Salud Mental 2009;32:309-315 de temperamento y carácter en pacientes con primer episodio de depresión mayor Dimensiones

Dimensiones de temperamento y carácter en pacientes con primer episodio de depresión mayor
Omar Minaya,1 Ana Fresán,2 Cristina Loyzaga2
Artículo original

SUMMARY
Unipolar depression is considered as one of the main psychiatric diagnosis related to psychosocialfunctioning impairment. It has been documented that personality features exert a direct influence on how people with depression cope and adapt to the disorder. The relationship between personality traits and depression has been studied in several models. As depressed patients usually exhibit several personality features of more than one personality disorder, a multidimensional theoretical perspective mayincrease the clinical description of prototypical diagnosis provided by current categorical criteria. The psychobiological model of personality proposed by Cloninger takes into account the respective contribution of neurobiologically-based mechanisms related to adaptative behaviors in response to danger, avoidance and reward, formulating four main temperamental dimensions and threecharacterological dimensions centered in conscious learning about self-concepts. The four temperament dimensions are: Novelty Seeking (NS) is thought to be related to the behavioral activation system; Harm Avoidance (HA) to the behavioral inhibition system; Reward Dependence (RD) is defined as a bias toward the maintenance of ongoing behaviors; and Persistence (PE) is defined as a tendency to perseverance despitefrustration and fatigue. The character dimensions are: Self-directedness (SD) refers to the ability of an individual to control, regulate and adapt behavior to fit the situation in accordance with personal goals and values; Cooperativeness (CO), account for individual differences in identification with and acceptance of other people; and Selftranscendence (ST) refers to spiritual maturity,transpersonal identification and creativity. Several studies that used the psychobiological model or personality reported that personality differences are detectable among persons with a current major depressive disorder when compared to non-depressed. The most frequent finding reported is the association between higher scores in harm avoidance (HA) and depression. Nevertheless, other studies have foundthat depression is also related with high scores in the temperamental dimension: reward dependence (RD). In terms of character dimensions, it has been reported that depressed patients exhibit low self-directedness (SD) and low cooperativeness (CO). Objetive The aims of the present study were to determine the reliability of the Temperament and Character Inventory (TCI) in a sample of Mexican
1 2depressed patients and healthy controls and to compare TCI dimensions between both groups. Method A total of 40 first-episode depressed patients and 40 healthy controls matched by gender, age and length of education were recruited. All patients were recruited from the outpatient service at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Patients were excluded if they had received anypsychotropic medication for the treatment of depression, if they had concomitant medical or neurological illness, current substance abuse or a history of substance dependence, history of bipolar disorder; high risk for suicide or were agitated. Healthy controls were recruited from a public university and were not enrolled if they presented any psychiatric disorder or scored ≥ 2 points in anySCL-90 subscale, or verbally reported any aggressive behavior in the week prior to the assessment. Diagnosis of depression was done according to DSM-IV criteria and confirmed by clinical consensus. The Montgomery & Asberg Depression Rating Scale (MADRS) was used to measure depressive symptom severity. Personality dimensions were assessed using the Temperament and Character Inventory (TCI). Results...