Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features
Yıl: 2020 Cilt: 57 Sayı: 1 Sayfa Aralığı: 27 - 32 Metin Dili: İngilizce DOI: 10.29399/npa.23610 İndeks Tarihi: 11-10-2020
Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features
Öz: Introduction: “Depressive disorder with mixed features” has been included in the official classification in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Hypothesizing that difficulties in emotion regulation and affective temperament scores arehigher in mixed depression comparing to pure depression, we aimed to evaluate the relationship between these phenomena and mixed symptoms.Methods: Depressive patients diagnosed by a psychiatrist according to the DSM-5 and had not received any psychiatric treatment for the last 3 months, were included in the study. The Hamilton Rating Scale (HDRS), modified Hypomania Checklist (mHCL), Difficulties in EmotionRegulation Scale (DERS), and the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) were applied to allparticipants.Results: Of the 63 participants, 40 (63.5%) were women. The mean age was 37.8±12.4 years while mean duration of education was 10.8±4.3 years. The proportion of mixed-depression assessed by the mHCL was 23.8% (n=15). No significant difference was found between the groupsconcerning gender, age, family history, age at onset of illness, the total number of episodes and temperament scores. Depressive patients with mixed features had significantly higher DERS nonacceptance subscalescores. Multiple regression analysis demonstrated that the cyclothymic temperament scale scores significantly affected the total mHCL scores.Conclusion: In mixed depression group, higher scores in nonacceptance subscale seems to reflect a tendency to fluctuations in the emotional reactions of a person to the stress. Association between mixed depression,DERS nonacceptance subscale and cyclothymic temperament support the spectrum view that mixed depression is placed between pure depression and bipolarity
Anahtar Kelime: Karma Belirtili Olan ve Olmayan Depresif Hastalarda Afektif Labilite ve Mizaç Özelliklerinin Karşılaştırılması
Öz: Amaç: Karma belirtili depresyon, Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı’nın son sürümü (DSM-5) ile resmi sınıflandırmaya dâhil edilmiştir. Bu araştırmada karma özellikli depresyon hastalarında afektif mizaç özelliklerinin ve duygu düzenleme bozukluklarının, karma belirtili olmayan depresyon hastalarından farklı olduğu hipotezinden hareketle, karma belirtiler ile bu fenomenler arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem: Araştırmaya bir klinisyen tarafından DSM-5 tanı ölçütlerine göre değerlendirilip Majör Depresif Bozukluk (MDB) tanısı konan ve son 3 aydır psikiyatrik tedavi görmeyen 63 hasta dâhil edilmiştir. Bu bireylere Hamilton Değerlendirme Ölçeği (HDÖ), değiştirilmiş Hipomani Kontrol Listesi (dHKL), Duygu düzenlemede Güçlükler Ölçeği (DDGÖ) ve affektif mizaç özelliklerini değerlendirmek için TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) ölçekleri uygulanmıştır. Bulgular: Çalışmaya katılan 63 kişinin 40’ı (%63,5) kadındı; ortalama eğitim süreleri 10,8±4,3 yıl idi. Katılımcıların yaş ortalaması 37,8±12,4 yıldı. Katılımcıların dHKL puanına göre karma özellikli depresyon oranı %23,8 (n=15) olarak saptanmıştır. Gruplar arasında cinsiyet, yaş, aile öyküsü, hastalık başlangıç yaşı, toplam dönem sayısı ve mizaç puanları açısından anlamlı bir fark bulunmamıştır (sırasıyla p değerleri 0,549, 0,827, 0,330, 0,680 ve 0,614). Karma depresyon grubunda saf unipolar depresyon grubuna göre DDGÖ kabul etmeme alt ölçek puanları daha yüksek bulunmuştur (p=0,035). Çoklu regresyon analizi sonucunda siklotimik mizaç ölçeği puanının anlamlı olarak dHKL toplam puanını etkilediği saptanmıştır. Her bir birim siklotimik ölçek puanı artışı, dHKL puanını 0,444 (%95 GA 0,035–0,853) kat artırmaktaydı. Sonuç: Karma depresyon grubunda kabul etmeme alt ölçek puanının yüksek olması, kişinin strese verdiği duygusal tepkilerde dalgalanmalara neden olabileceğini düşündürmektedir. Karma depresyonun DERS ölçeği kabul etmeme alt maddeleri ve siklotimik mizaç ile ilişkisi, karma depresyonun saf depresyon ve bipolarite arasındaki spektrumda yerleştiği görüşünü desteklemektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion regulation strategies across psychopathology: a meta-analysis. Clin Psychol Rev 2010;30:217–237. [CrossRef]
- 2. Hofmann SG, Sawyer AT, Fang A, Asnaani A. Emotion dysregulation model of mood and anxiety disorders. Depress Anxiety 2012;29:409–416. [CrossRef]
- 3. Lyubomirsky S, Nolen-Hoeksema S. Self-perpetuating properties of dysphoric rumination. J Pers Soc Psychol 1993;65:339–349. [CrossRef]
- 4. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), Washington DC, 2013.
- 5. Verdolini N, Hidalgo-Mazzei D, Murru A, Pacchiarotti I, Samalin L, Young AH, Vieta E, Carvalho AF. Mixed states in bipolar and major depressive disorders: systematic review and quality appraisal of guidelines. Acta Psychiatr Scand 2018;138:196–222. [CrossRef]
- 6. Stahl SM, Morrissette DA, Faedda G, Fava M, Goldberg JF, Keck PE, Lee Y, Malhi G, Marangoni C, McElroy SL, Ostacher M, Rosenblat JD, Solé E, Suppes T, Takeshima M, Thase ME, Vieta E, Young A, Zimmerman M, McIntyre RS. Guidelines for the recognition and management of mixed depression. CNS Spect 2017;22:203–219. [CrossRef]
- 7. Akiskal HS, Mallya G. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull 1987;23:68–73.
- 8. Kesebir S, Vahip S, Akdeniz F, Yüncü Z. The relationship of temperament and clinical features in bipolar disorder. Turk Psikiyatri Derg 2005;16:164–169.
- 9. Evans L, Akiskal HS, Keck PE Jr, McElroy SL, Sadovnick AD, Remick RA, Kelsoe JR. Familiality of temperament in bipolar disorder: support for a genetic spectrum. J Affect Disord 2005;85;153–168. [CrossRef]
- 10. Ozer S. Depressive mixed conditions in bipolar disorder. Turkiye Klinikleri J Psychiatry-Special Topics 2013;6:52–57.
- 11. Akiskal HS. The temperamental foundations of affective disorders. In: Mund C, et al., editors. Interpersonal Origin and Course of Affective Disorders. London, Gaskell: Royal College of Psychiatrists; 1996. pp.3–30.
- 12. Akikal HS, Hantouche EG, Bourgeois ML, Azorin JM, Sechter D, Allilaire JF, Lancrenon S, Fraud JP, Châtenet-Duchêne L. Gender, temperament and the clinical picture in dysphoric mixed mania: findings from French national study (EPIMAN). J Affect Disord 1998;50:175–186. [CrossRef]
- 13. Brieger P, Roettig S, Ehrt U, Wenzel A, Blöink R, Marneros A. TEMPS-A scale in “mixed” and “pure” manic episodes: new data and methodological considerations on the relevance of joint anxious-depressive temperament traits. J Affect Disord 2003;73:99–104. [CrossRef]
- 14. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005;88:217–233. [CrossRef]
- 15. Altinbas K, Ozerdem A, Prieto ML, Fuentes ME, Yalin N, Ersoy Z, Aydemir O, Quiroz D, Oztekin S, Geske JR, Feeder SE, Angst J, Frye MA. A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression. J Affect Disord 2014;152:478–482. [CrossRef]
- 16. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 2004;26:41–54. [CrossRef]
- 17. Rugancı RN, Gençöz T. Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale. J Clin Psychol 2010;66:442–455. [CrossRef]
- 18. Akiskal HS, Placidi GF, Maremmani I, Signoretta S, Liguori A, Gervasi R, Mallya G, Puzantian VR. TEMPS-I. delineating the most discriminant traits of the cyclothymic, depressive and irritable temperaments in a non-patient population. J Affect Disord 1998;51:7–19. [CrossRef]
- 19. Vahip S, Kesebir S, Alkan M, Yazici O, Akiskal KK, Akiskal HS. Affective temperaments in clinically well subjects in Turkey: initial psychometric data on the TEMPS-A. J Affect Disord 2005;85:113–125. [CrossRef]
- 20. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62. [CrossRef]
- 21. Akdemir A, Örsel S, Dağ İ, Türkçapar H, İşcan N, Özbay H. Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ)’nin geçerliği, güvenirliği ve klinikte kullanımı. 3 P Dergisi 1996;4:251–259.
- 22. Xin LM, Chen L, Ji ZP, Zhang SY, Wang J, Liu YH, Chen DF, Yang FD, Wang G, Fang YR, Lu Z, Yang HC, Hu J, Chen ZY, Huang Y, Sun J, Wang XP, Li HC, Zhang JB, Si TM. Risk factors for anxiety in major depressive disorder patients. Clin Psychopharmacol Neurosci 2015;13:263–268. [CrossRef]
- 23. Perugi G, Angst J, Azorin JM, Bowden CL, Mosolov S, Reis J, Vieta E, Young AH; BRIDGE-II-Mix Study Group. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry 2015;76:e351–358. [CrossRef]
- 24. McIntyre RS, Soczynska JK, Cha DS, Woldeyohannes HO, Dale RS, Alsuwaidan MT, Gallaugher LA, Mansur RB, Muzina DJ, Carvalho A, Kennedy SH. The prevalence and illness characteristics of DSM-5-defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder:results from the International Mood Disorders Collaborative Project. J Affect Disord 2015;172:259–264. [CrossRef]
- 25. Perlis R, Uher R, Ostacher M, Goldberg JF, Trivedi MH, Rush AJ, Fava M. Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Arch Gen Psychiatry 2011;68:351–360. [CrossRef]
- 26. Serra G, Koukopoulos A, De Chiara L, Napoletano F, Koukopoulos AE, Curto M, Manfredi G, Faedda G, Girardi P, Baldessarini RJ. Features preceding diagnosis of bipolar versus major depressive disorders. J Affect Disord 2015;173:134–142. [CrossRef]
- 27. Rihmer Z, Gonda X, Torzsa P, Kalabay L, Akiskal HS, Eory A. Affective temperament, history of suicide attempt and family history of suicide in general practice patients. J Affect Disord 2013;149:350–354. [CrossRef]
- 28. Angst J. Temperament and personality types in bipolar patients a historical review. Marneros A, Angst J, editors. Bipolar Disorders. Dordrecht: Springer; 2000. pp.175–199.
- 29. Tondo L, Vázquez GH, Pinna M, Vaccotto PA, Baldessarini RJ. Characteristics of depressive and bipolar disorder patients with mixed features. Acta Psychiatr Scand 2018;138:243–252. [CrossRef]
- 30. Becerra R, Cruise K, Murray G, Bassett D, Harms C, Allan A, Hood S. Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders? Open J Psychiatr 2013;3:1–7. [CrossRef]
- 31. Van Rheenen TE, Murray G, Rossell SL. Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity. Psychiatry Res 2015;225:425–432. [CrossRef]
- 32. Frye MA, Helleman G, McElroy SL, Altshuler LL, Black DO, Keck Jr PE, Nolen WA, Kupka R, Leverich GS, Grunze H, Mintz J, Post RM, Suppes T. Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression. Am J Psychiatry 2009;166:164–172. [CrossRef]
| APA | TAŞ H, Altinbas K (2020). Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. , 27 - 32. 10.29399/npa.23610 |
| Chicago | TAŞ Halil İbrahim,Altinbas Kursat Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. (2020): 27 - 32. 10.29399/npa.23610 |
| MLA | TAŞ Halil İbrahim,Altinbas Kursat Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. , 2020, ss.27 - 32. 10.29399/npa.23610 |
| AMA | TAŞ H,Altinbas K Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. . 2020; 27 - 32. 10.29399/npa.23610 |
| Vancouver | TAŞ H,Altinbas K Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. . 2020; 27 - 32. 10.29399/npa.23610 |
| IEEE | TAŞ H,Altinbas K "Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features." , ss.27 - 32, 2020. 10.29399/npa.23610 |
| ISNAD | TAŞ, Halil İbrahim - Altinbas, Kursat. "Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features". (2020), 27-32. https://doi.org/10.29399/npa.23610 |
| APA | TAŞ H, Altinbas K (2020). Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Nöropsikiyatri Arşivi, 57(1), 27 - 32. 10.29399/npa.23610 |
| Chicago | TAŞ Halil İbrahim,Altinbas Kursat Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Nöropsikiyatri Arşivi 57, no.1 (2020): 27 - 32. 10.29399/npa.23610 |
| MLA | TAŞ Halil İbrahim,Altinbas Kursat Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Nöropsikiyatri Arşivi, vol.57, no.1, 2020, ss.27 - 32. 10.29399/npa.23610 |
| AMA | TAŞ H,Altinbas K Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Nöropsikiyatri Arşivi. 2020; 57(1): 27 - 32. 10.29399/npa.23610 |
| Vancouver | TAŞ H,Altinbas K Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features. Nöropsikiyatri Arşivi. 2020; 57(1): 27 - 32. 10.29399/npa.23610 |
| IEEE | TAŞ H,Altinbas K "Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features." Nöropsikiyatri Arşivi, 57, ss.27 - 32, 2020. 10.29399/npa.23610 |
| ISNAD | TAŞ, Halil İbrahim - Altinbas, Kursat. "Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features". Nöropsikiyatri Arşivi 57/1 (2020), 27-32. https://doi.org/10.29399/npa.23610 |
