Maier W, Minges J, Lichtermann D, Franke P, Gansicke M
Department of Psychiatry, University of Mainz, Germany.
Psychopathology. 1995;28 Suppl 1:59-72. doi: 10.1159/000284959.
The main conclusions of this study on the familial links between personality patterns and affective disorders are: (1) The personality features with the greatest degree of symptomatic overlap with unipolar depression were more common among the first-degree relatives of probands with this diagnosis: thus dysthymic temperament and neuroticism are enhanced in this group of relatives compared to controls. Likewise personality features with a high degree of symptomatic overlap with bipolar affective disorder were more common among the first-degree relatives of probands with this diagnosis. Thus levels of dysthymic and cyclothymic temperament were elevated in this group of relatives compared to controls, whereas a familial link between neuroticism and bipolar disorder was not observed. (2) In addition, personality traits with only limited similarity with the syndromes of depression and mania were also found to be linked with affective disorders (obsessive-compulsive PD to bipolar disorders, rigidity to both subtypes of affective disorders). These associations have different implications regarding the association between personality/temperament conditions and disorders depending on the degree of overlap between symptoms and the personality trait. Those with substantial overlap may indicate the presence of a unitary disease process in which the enhancement of subthreshold affective traits may result in aggravation of behavior characteristics fulfilling the criteria of fullblown episodes of the disease. This relationship was particularly stressed by Kraepelin, Kretschmer, Clayton et al. and Akiskal. In this view personality and temperament patterns represent minor variants of the associate acute disorders. On the other hand, the relationship between dissimilar conditions may indicate the presence of a risk of underlying vulnerability factors which led to affective disorder only in the presence of additional risk factors. An example of the latter relationship in the present study is the aggregation of obsessive-compulsive and anancastic traits in families with affective disorders. Tellenbach focussed on this particular constellation. Epidemiological and family studies including these personality traits are too rare to fully appreciate the relevance of this particular relationship. Future prospective studies and family genetic studies which investigate the relationship between temperament, personality traits and disorders and affective syndromes are clearly indicated by the results presented herein.
(1) 在患有单相抑郁症的先证者的一级亲属中，与单相抑郁症症状重叠程度最高的人格特征更为常见：因此，与对照组相比，这组亲属中的恶劣心境气质和神经质有所增强。同样，在患有双相情感障碍的先证者的一级亲属中，与双相情感障碍症状重叠程度高的人格特征更为常见。因此，与对照组相比，这组亲属中的恶劣心境和环性心境气质水平有所升高，而未观察到神经质与双相情感障碍之间的家族联系。(2) 此外，还发现与抑郁和躁狂综合征仅有有限相似性的人格特质也与情感障碍有关（强迫型人格障碍与双相情感障碍有关，僵化与情感障碍的两种亚型都有关）。这些关联对于人格/气质状况与障碍之间的关联具有不同的意义，这取决于症状与人格特质之间的重叠程度。那些有大量重叠的可能表明存在一种单一的疾病过程，其中阈下情感特质的增强可能导致符合该疾病完全发作标准的行为特征加重。克莱佩林、克雷奇默、克莱顿等人以及阿基斯卡尔特别强调了这种关系。按照这种观点，人格和气质模式代表了相关急性障碍的轻微变体。另一方面，不同状况之间的关系可能表明存在潜在易损因素的风险，这些因素只有在存在其他风险因素时才会导致情感障碍。本研究中后一种关系的一个例子是情感障碍家族中强迫和强迫性特质的聚集。特伦巴赫关注了这一特殊组合。包括这些人格特质的流行病学和家族研究太少了，无法充分认识到这种特殊关系的相关性。本文给出的结果清楚地表明，未来需要进行前瞻性研究和家族基因研究，以调查气质、人格特质与障碍以及情感综合征之间的关系。
