Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients

Background: Recent studies have suggested that clinicians may under diagnose bipolarity in a substantial proportion of depressive patients, and proposed that affective temperaments particularly cyclothymic temperament (CT), may predict bipolarity in these patients. The objectives of this study were to assess CT in patients with recurrent depressive disorder (RDD) and to explore its associations with clinical predictors of bipolarity. Methods: 98 patients (43 men and 55 women, mean age = 46.8 ± 9.9 years), followed for RDD according to DSM-IV-TR criteria, were recruited. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale with the threshold score of 10/21. Results: The mean score of CT was 6.5 ± 5.2. One-third of patients (33.7%) had a CT score ≥ 10. These patients with high CT scores had significantly early age at onset of first depressive episode and high number of previous depressive episodes, and had more psychotic and melancholic features and suicidal ideations and attempts during the last depressive episode compared to patients with low CT scores. The multiple regression analysis showed an association between CT scores and psychotic, melancholic and atypical features and suicide attempts during the last depressive episode. Limitations: This is a cross-sectional study with a relatively small number of patients. The Tunisian version of the CT subscale was not yet validated. Conclusions: CT was associated with some clinical predictive factors of bipolarity. These results suggest the relevance of the CT screening in RDD, considering the change of polarity risk and misdiagnosis of unipolar depression. © 2011 Elsevier B.V. All rights reserved.