USE OF THE "TCI" PERSONALITY QUESTIONNAIRE IN BIPOLAR AFFECTIVE DISORDERS AND RECURRENT DEPRESSIVE DISORDERS

Mircea A. BIRT*., Aura VAIDA**


Rezumat

Lucrarea isi propune evidentierea unor posibile constelatii temperamental-caracteriale in tulburarile afective bipolare si tulburarile depresive recurente prin utilizarea Chestionarului de Personalitate TCI - Cloninger, 1994.
Au fost luati in studiu 27 de pacienti suferinzi de tulburare depresiva recurenta (UP) si 22 de pacienti cu tulburare afectiva bipolara (BP). Rezultatele obtinute prin evaluarea pacientilor ajutorul Chestionarului de Personalitate TCI (Temperament and Caracter Inventory - Cloninger, 1994), au fost analizate statistic prin calcularea mediilor si a abaterilor standard (analiza descriptiva) si analiza inferentiala (testul Student "t" si ANOVA).
Constelatia personalitatii pacientilor bipolari se caracterizeaza prin a fi: precauti, descurajati, pesimisti; astenici, mai putin energici; neajutorati, lipsiti de speranta, ineficienti, dependenti; scrupulosi, pedanti; insensibili, putin empatici, preocupati de propriile trairi; creativi, originali, meditativi; lupta impotriva injustitiei; nepretentiosi, tolereaza incertitudinea, naivi, cu o gandire magica, idealisti.
Profilul personalitatii bolnavilor unipolari se releva prin faptul ca acestia sunt: ingrijorati, precauti, tematori, indecisi, cu fatigabilitate cronica; pesimisti, in permanenta tensionati, nu-si asuma riscurile si evita schimbarile; timizi in societate, lipsiti de energie; ordonati, metodici; indiferenti, stoici, lipsiti de entuziasm, rezervati, lipsiti de curiozitate; nesociabili; imaturi, distructivi, ineficienti, lipsiti de incredere in propriile forte; tendinta de a-i invinovati pe ceilalti de propriile esecuri; nesiguri in legatura cu scopurile pe termen lung, reactioneaza in functie de circumstante, traiesc cu impresia ca viata lor este lipsita de sens; defetisti, cu o slaba vointa, intoleranti, neprietenosi, nerabdatori, critici fata de cei din jur; fara empatie; detasati, nepretentiosi, multumiti de situatia lor; idealisti.
Bipolarii fata de unipolari sunt mai: dinamici; plini de viata, vioi, cu un nivel energetic mai crescut; eficienti, cu un plus de initiativa; increzatori in propriile posibilitati; mai putin empatici si insensibili; creativi, originali; altruisti, idealisti; tolereaza mai bine ambiguitatea si incertitudinile. Unipolarii fata de bipolari apar mai: pesimisti; tensionati; culpabilitatea este proiectata asupra circumstantelor; nu-si accepta responsabilitatea.

Cuvinte cheie: chestionar de evaluare a temperamentului si caracterului (TCI); evaluare personalitate; tulburari afective bipolare; tulburare depresiva recurenta.
Abstract

This paper aims to evidence some possible temperament and character constellations in bipolar affective disorders and recurrent depressive disorders by using Cloninger's TCI personality questionnaire, 1994.
The study included 27 patients with recurrent depressive disorder (UP) and 22 patients with bipolar affective disorder (BP). The results of patient evaluation by means of Cloninger's TCI (Temperament and Character Inventory) personality questionnaire (1994), were statistically analyzed by the calculation of means and standard deviations (descriptive analysis), as well as by inferential analysis (Student "t" and ANOVA tests).
The personality constellation of bipolar patients is characterized by being: cautious, discouraged, pessimistic; asthenic, less energetic, helpless, hopeless, inefficient, dependent; scrupulous, pedantic; insensitive, low empathic, preoccupied with their own feelings; creative, original, meditative; they fight injustice; unpretentious, they tolerate uncertainty, naive, with a magical thinking, idealistic.
The personality profile of unipolar patients reveals the following traits: they are anxious, cautious, fearful, hesitant, with chronic fatigue; pessimistic, always tense, they do not take chances and avoid changes; shy in society, lacking energy; orderly, methodic; indifferent, stoic, non-enthusiastic, reserved, lacking curiosity; unsociable; immature, destructive, inefficient, lacking self-confidence; they tend to blame others for their own failures; hesitant about long-term goals, they react depending on circumstances, they live with the impression that their life has no meaning; defeatist, having a weak will, intolerant, unfriendly, impatient, critical about others, non-empathic; detached, unpretentious, satisfied with their situation, idealistic.
Compared to unipolar patients, bipolar patients are: more dynamic, lively, energetic; efficient, with more initiative; confident in their own abilities; less empathic and insensitive; creative, original; altruistic, idealistic; they tolerate ambiguity and uncertainties better. Compared to bipolar patients, unipolar patients are more pessimistic, tense; they tend to blame circumstances for the difficulties, they do not accept their responsibility.

Key words: temperament and character inventory (TCI) questionnaire; personality evaluation; bipolar affective disorder; recurrent depressive disorder.



AIM OF STUDY

This paper aims to evidence some possible temperament and character constellations in bipolar affective disorders and recurrent depressive disorders by using Cloninger's TCI personality questionnaire, 1994.

INTRODUCTION

The hypotheses of Kraepelin, E. Kretschemer, S. Freud, K. Schneider, Tellenbach, Krauss, Von Zerssen, who proposed some specific personality types in affec- tive disorders, have been partially rejected over time and have raised some methodological controversies (4,8,10,11,14, 15).

H. Akiskal (1,2) proposes instead of the concept of affective personality the concept of temperament and describes 5 temperament types predisposed to affective disorders: the hyperthymic character for depressions, characterized by lack of energy; the inhibited, shy temperament for anxiety depressions; the cyclothymic temperament for type I and II bipolar depressions; the unstable temperament for unstable and borderline depressions.

The study of personality by using Cloninger's psychobiological model opens new perspectives in the definition of some temperament and character patterns in patients with bipolar affective disorders (BP) and recurrent depressive disorders (UP), as well as in their therapeutic approach (7, 9,12,13,17).

TCI is a self-evaluation questionnaire with 240 items corresponding to the 4 dimensions of temperament and the 3 dimensions of character, as well as 25 subscores corresponding to the 3 up to 5 subscales of each of the main dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), persistence (P), self-directedness (S), cooperativeness (C), self-transcendence (ST) (9).

MATERIAL AND METHOD

The study included 27 patients with recurrent depressive disorder (UP) and 22 patients with bipolar affective disorder (BP) admitted to the department of Psychiatry-Ergotherapy of the Adult Clinical Hospital Cluj-Napoca.

The results obtained by the evaluation of patients using Cloninger's TCI (Temperament and Character Inventory) personality questionnaire (1994) were statistically processed by the calculation of means and standard deviations (descriptive analysis) for all dimensions depending on the diagnostic type. In order to identify the differences in some aspects between patients with recurrent depressive disorder and those with bipolar disorder, inferential analysis was performed using Student t and ANOVA tests. The results were compared with the normative data established in a group of 350 subjects of the general population (6).

RESULTS AND DISCUSSION

The distribution of patients in the two groups according to sex and education is presented below: The analysis of data shows significant differences in dimensions HA (subscales HA1, HA2, HA4) and S.

The mean HA scores are higher in subjects with recurrent depressive disorder compared to bipolar patients, while S scores are higher in bipolar patients.

The data obtained for each of the two groups of patients were compared with the control values obtained in a sample of 350 subjects by ANOVA variance analysis (Tables 4 and 5).

Table 5 includes the differences obtained following the application of variance analysis between patients with bipolar affective disorder and the general population, significant differences being found in the following dimensions and subdimensions of temperament: HA (HA4) and character: S3, S4, C2, ST (ST1, ST2).
APR - Distribution by sex Distribution by sex of patients with recurrent depressive disorder (N = 27)
APR - Distribution by education Distribution by education of patients with recurrent depressive disorder (N = 27)
APR- Distribution by sex Distribution by sex of patients with bipolar disorder (N = 22)
APR - Distribution by education Distribution by education of patients with bipolar disorder (N = 22)
APR - Table 1 TABLE 1. Descriptive analysis of the group of patients with recurrent depressive disorder (N = 27)
TABLE 2. Table 2
The means and standard deviations for each dimension obtained by the subjects of the two groups (UP and BP, respectively) are presented in Tables 1 and 2.

By comparing these data with those of a sample of 350 control subjects, lower scores are obtained for NS, S and higher scores for HA in both groups of patients with depressive disorders. Similar results have been obtained by other studies (3,7,12,13,17).
The inferential analysis for both groups of subjects (Student t test) reveals the following:
TABLE 3.Inferential analysis for the two groups of subjects (Student t test) APR -Table 3
The analysis of the significant differences obtained indicates the presence of positive and negative variations both between the two diagnostic groups and compared to the general population.
Following the results presented, the profile of patients with recurrent depressive disorder (UP) is defined as:
  • anxious, cautious, hesitant, undetermined, with chronic fatigue (HA+)
  • pessimistic, they tend to anticipate failures
TABLE 4. Mean score differences between patients with recurrent depressive disorder (N = 27) and subjects from the control group (N = 350) by (ANOVA) variance analysis APR - Tabel 4
TABLE 5. Mean score differences between patients with bipolar affective disorder (N = 22) and control subjects (N = 350) by (ANOVA) variance analysis APR - Table 5
and dangers, especially in ambiguous and difficult situa- tions, regardless of supportive circumstances or reassurances (HA1+)
  • they have difficulties in tolerating ambiguity and unfamiliar, potentially dangerous situations, being permanently tense, anxious, they do not take chances and avoid changes (HA2+)
  • shy in society, in particular with strangers (HA3+)
  • lacking energy, with early fatigue (HA4-)
  • organized, orderly, methodical and systematic (NS4-)
  • indifferent, stoic, non-enthusiastic, reserved, lacking curiosity (NS-)
  • uninterested in and detached from social relationships, unsociable (RD3-)
  • immature, fragile, destructive, inefficient, lacking confidence in their own abilities (S-)
  • they tend to blame others for their own failures, their behavior and choices are inefficient, they do not take responsibility for their actions (S1-)
  • uncertain about long-term goals, they react depending on circumstances, they live with the impression that their life is meaningless
  • helpless, hopeless and inefficient, lacking selfconfidence (S3-)
  • self-defeated, with a weak will (loosers) (S5-)
  • intolerant, unfriendly, impatient, critical about others (C1-)
  • insensitive, incapable of sharing their emotions or difficulties with others (C2-)
  • detached, unpretentious, satisfied with their situation (ST+)
  • idealistic (ST2-)
    In the constellation of patients with bipolar affective disorders (BP) these appear to be:
  • cautious, discouraged, pessimistic (HA+)
  • asthenic, less energetic, they need to rest, they have difficulties in recovering, helpless (HA4+)
  • helpless, hopeless, inefficient, dependent (S3-)
  • scrupulous, pedantic (S4+)
  • insensitive, low empathic, preoccupied with their own feelings (C2-)
  • creative, original, meditative (ST1+)
  • they are connected to nature, to the universe, they fight injustice (ST2+)
  • unpretentious, they tolerate uncertainty, naive, with a magical thinking, idealistic, they may interfere with material acquisitions, the need for power, adaptive abilities (ST+)

The differences in profile between unipolar and bipolar patients involve the following aspects:
Compared to bipolar patients, unipolar patients are:
  • more pessimistic,
  • they feel more tense,
  • they blame circumstances and the surrounding environment for their difficulties,
  • they do not accept responsibilities (HA1+ si HA2+ and S1-)
    Compared to unipolar patients, bipolar patients are:
  • more energetic, more dynamic (HA4-)
  • more lively, with a higher energy level (HA-)
  • more efficient, with more initiative in solving problems (S3+)
  • more confident in their own abilities, in accepting their limits and strengths (S4+)
  • less empathic, insensitive (C2-)
  • more creative, original, more involved in activities (ST1+)
  • more altruistic, idealistic (ST2+)
  • they tolerate ambiguity and uncertainties better (ST+)

The results obtained show that the profiles of BP and UP personalities have some common characteristics with the personality types described by Kurt Scheinder (16), Tellenbach (18) si Von Zerssen (19), without being identical to these. In contrast, these profiles could be correlated with the profiles described by Birt M., Iancu T. si Neica L. (5), by using MMPI, TAT and the FLF questionnaire (Folkman & Lazarus, 1980), which reveal the fact that bipolar subjects have higher scores for sadness, self-blaming, irritability, low selfesteem, querulousness, more marked social introversion, while in UP depressive patients, the association depression-solitude, suicidal thoughts, sensitivity, non-assertiveness, a high tendency to anxiety are dominant.
The results of this study express a static radiograph of the profile of the UP and BP personality; in order to reveal the premorbid personality traits of these patients, the dynamic evolution should have been monitored at the beginning and at the end of treatment.
Some features such as empathy, self-esteem, dependence, irritability, creativity, extroversion/introversion, obsessionality, anhedonia could be accepted as constant traits of the premorbid depressive personality.

CONCLUSIONS
1. The constellation of bipolar patient personality is characterized by being: cautious, discouraged, pessimistic; asthenic, less energetic; helpless, hopeless, inefficient, dependent; scrupulous, pedantic; insensitive, low empathic, preoccupied with their own feelings; creative, original, meditative; they fight against injustice; unpretentious, they tolerate uncertainty, naive, with a magical thinking, idealistic.

2. The profile of the unipolar patient personality is characterized by being: anxious, cautious, fearful, hesitant, with chronic fatigue; pessimistic, always tense, they do not take chances and avoid changes; shy in society, lacking energy, orderly, methodical; indifferent, stoic, non-enthusiastic, reserved, lacking curiosity, unsociable; immature, destructive, inefficient, lacking self-confidence; they tend to blame others for their own failures; the are uncertain about long-term goals, they react depending on circumstances, they live with the impression that their life is meaningless; defeatist, with a weak will, intolerant, unfriendly, impatient, critical about others; non-empathic; detached, unpretentious, satisfied with their situation; idealistic.

3. Compared to unipolar patients, bipolar patients are: more dynamic, lively, with a higher energy level; efficient, with more initiative; confident in their own abilities, less empathic and insensitive; creative, original; altruistic, idealistic; they tolerate ambiguity and uncertainties well.

4. Compared to bipolar patients, unipolar patients appear as: more pessimistic, tense; they blame circumstances for the difficulties; they do not accept responsibilities

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