The concept of affective temperament has been extensively discussed throughout the history of psychopathology and represents a cornerstone in the study of mood disorders. This review aims to trace the evolution of the concept of affective temperaments (ATs) from Kraepelin's seminal work to the present day. In the 1980s, Akiskal redefined Kraepelin's concept of affective temperaments (ATs) by integrating the five recognized ATs into the broader framework of the soft bipolar spectrum. This conceptualization viewed ATs as non-pathological predispositions underlying psychiatric disorders, particularly mood disorders. Epidemiological and clinical studies have validated the existence of the five ATs. Furthermore, evidence suggests that ATs may serve as precursors to various psychiatric disorders and influence clinical dimensions such as disease course, psychopathology, and treatment adherence. Additionally, ATs appear to play a significant role in moderating phenomena such as suicide risk and stress coping. Incorporating an evaluation of temperamental bases of disorders into the multidimensional psychiatric diagnostic process could enhance treatment optimization and prognosis estimation. 

Synthesising 30 years of clinical experience and scientific insight on affective temperaments in psychiatric disorders: State of the art

Depression and infertility are major medical and social problems. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) serves as an innovative and reliable lipid marker for cardiovascular disease risk assessment. Previous research has indicated a potential correlation among lipid metabolism, depression, and infertility. Nonetheless, the exact involvement of lipid metabolism in modulating the pathological mechanisms associated with depression-induced infertility remains to be fully elucidated. The aim of this study was to explore the connection between depression and infertility and to assess whether the NHHR mediates this association. 

pdf/association-between-depression-and-infertility-risk-among-8p66mqcvvf.pdf

Association between depression and infertility risk among American women aged 18–45 years: the mediating effect of the NHHR

Abstract Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analysed using multi-variate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores &gt;4 (OR = 0.51 CI: 0.35–0.74, p &lt; 0.001), depressive scores &gt;9 (OR = 0.59 CI: 0.4–0.87, p = 0.009) and anxious scores &gt;9 (OR = 0.45 CI: 0.31–0.66, p &lt; 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively.Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments robustly influence the outcome of the infertility treatment. Thus, screening for affective temperaments may help identify high risk patient groups and offer patient tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment. 

/pdf/affective-temperaments-show-stronger-impact-on-infertility-l95qcsd7.pdf

Affective temperaments show stronger impact on infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

Abstract Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn’t have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment. 

pdf/adherence-to-dietary-recommendations-mediates-the-effect-of-9w22vjbpmc.pdf

Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes


 Bevezetés: Biopszichoszociális szemléletben a meddőség hátterében a biológiai hajlam, egyes lelki tényezők, különösen a krónikus stressz, valamint környezeti és társas faktorok összetett együttjárását feltételezzük. Kutatási eredmények egyértelműen bizonyítják, hogy a meddőség maga is gyakran okoz pszichológiai problémákat, különösen az asszisztált reprodukcióban részt vevő pácienseknél, akik 15–20%-a mentális zavart mutat. E komorbiditás szakszerű kezelése bizonyítottan emeli a teherbe esés esélyét, a leginkább azzal, hogy mentális állapotuk javulásával a páciensek jobb együttműködést mutatnak, és képesek lehetnek fenntartani egy, a reprodukciónak is kedvező egészségesebb életmódot. Célkitűzés: A pszichológiai segítségnyújtásra vonatkozó ajánlások meglétének és tartalmának áttekintése a meddőségkezelés főbb nemzetközi irányelveiben. Módszer: Az angol nyelven hozzáférhető irányelvek beszerzése és leíró elemzése. Eredmények: Az infertilis páciensek mentális szempontú szűrése és ellátása kivétel nélkül előírásként jelenik meg az áttekintett nemzetközi meddőségi orvosi irányelvekben, akár azokba beépített, akár különálló formában, jellemzően mindkét nemre vonatkozóan. Megbeszélés: A pszichológiai ellátás ma már elengedhetetlen része a korszerű meddőségkezelésnek. Ez a legcélszerűbben lépcsőzetes módon zajlik, a következő sorrendben: szűrés, edukáció, alacsony küszöbű, majd intenzív kezelési stratégiák. Az utóbbiak célja a meddőségspecifikus stressz csökkentése, a megküzdés és ezzel az életminőség javítása, mely indirekt módon nagyobb sikerarányhoz is vezethet. Következtetés: Időszerűvé vált a reproduktív pszichológiai szempont, ismeretanyag és módszertan beépítése a megújuló magyar szakmai irányelvbe. Orv Hetil. 2024; 165(12): 455–463.


[The role of psychological screening and care in assisted reproduction].

Predominant affective temperament may affect adherence to prescribed pharmacotherapeutic interventions, warranting systematic review and meta-analysis.The Scopus, Web of Science, PubMed, and OVID MedLine databases were inquired since inception up to 31st of March 2022 for records of any study design documenting quantitative evidence about affective temperaments as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) questionnaire and treatment adherence measured by the means of major rating scales on the matter. People with low vs. high levels of treatment adherence, matched for otherwise clinically relevant variables, were deemed as cases and controls, respectively, using standardized mean differences (SMDs) in pertinent scores under random-effects meta-analysis.Nine studies encompassing 1138 subjects pointed towards significantly higher cyclothymic (SMD = -0.872; CI: [-1.51 to -0.24]; p = 0.007), irritable (SMD = -0.773; CI: [-1.17 to -0.37]; p < 0.001) and depressive (SMD = -0.758; CI: [-1.38 to -0.14]; p = 0.017) TEMPS-A scores both for psychiatric and nonpsychiatric samples with poorer adherence.Intrinsic limitations of the present report include the heterogeneity of the operational definitions documented across different primary studies, which nonetheless reported on the sole medication-treatment adherence, thus limiting the generalizability of the present findings based on a handful of comparisons.Though further primary studies need to systematically account for different clinical and psychosocial moderators across different clinical populations and operational definitions, cyclothymic, depressive, and irritable temperament scores may nonetheless predict treatment adherence and, thus, overall treatment outcomes. 

/pdf/a-bitter-pill-to-swallow-impact-of-affective-temperaments-on-7aaqgw7a.pdf

A bitter pill to swallow? Impact of affective temperaments on treatment adherence: a systematic review and meta-analysis

INTRODUCTION
The bidirectional relationship between diabetes and depression results in severe disease burden. Co-occurring depression is associated with a higher rate of diabetes complications. These complications impair quality of life, however, their impact on depressive symptoms is controversial.


OBJECTIVE
In our cross-sectional study, we aimed to investigate whether the presence of diabetes complications is associated with depressive and anxiety symptoms among patients with type 2 diabetes in general practice.


METHOD
We obtained patient history, anthropometric, socioeconomic, laboratory parameters. For symptom assessment, the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. We collected data between September 2018 and February 2020.


RESULTS
We included 338 consecutive patients with type 2 diabetes. The mean age of the sample was 63.98 ± 11.51 (years ± SD), 61.2% of participants were female. We found significant univariate association between diabetes complications and older age, less physical activity, higher body mass index, insulin therapy, higher HbA1c, higher creatinine and carbamide concentrations, worse depressive and anxiety symptoms. In multivariate analysis, diabetes complications and certain socio-demographic factors (female gender, lower education, rural-dwelling) were the determinants of higher BDI and HAM-A scores.


CONCLUSION
Among primary care patients with type 2 diabetes, the prevalence of depressive and anxiety symptoms was higher and more severe in patients with diabetes complications. The recommended screening for affective disorders among patients with diabetes is especially justified if complications are present. Orv Hetil. 2023; 164(3): 79-87.

[The association between diabetes complications and symptoms of depression and anxiety].

http://www.valueinhealthjournal.com/article/S1098301522037196/pdf

HTA54 Incorporating Value of Health System Impact in Economic Evaluations of Therapies of Chronic Diseases

Inadequate adherence to long-term therapies significantly affects the course and outcome of the disease, and therefore poses a serious threat to both the effectiveness and success of treatment and the long-term well-being of patients. Therapeutic adherence is an extremely complex process, with a number of risk and protective factors identified, many of which underlie the psychological characteristics of the patient. A number of medication adherence models have been developed to take into account the psychological characteristics of patients, and recent research has examined the relationship between different personality models and adherence to therapeutic recommendations. In this review we aim to summarize current knowledge, adherence models, research findings on the relationship between personality and adherence, including implications for future research.

The relationship between therapeutic adherence and personality.

Hyperthymic temperament may protect against medication non-adherence among male but not female patients – results from a metaanalysis

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