Évaluer les tempéraments affectifs chez des patients suivis pour troubles dépressifs récurrents et rechercher les corrélations avec les caractéristiques cliniques.

Il s’agit d’une étude transversale, portant sur 91 patients (40 hommes et 51 femmes, d’âge moyen : 46,8±10,1ans) répondant aux critères d’un trouble dépressif majeur récurrent selon le DSM-IV, en période de rémission partielle ou complète. L’évaluation des tempéraments affectifs a été réalisée par la passation des questionnaires semi-structurés des tempéraments affectifs d’Akiskal et Mallya.

Le tempérament dépressif avait le score moyen le plus élevé (12,3±4,7), suivi par les tempéraments hyperthymique (7,8±4,5), cyclothymique (5,9±5,8) et irritable (4,9±3,3). Une association significative a été trouvée entre le début en post-partum et le score de tempérament cyclothymique (p=0,04). La présence des caractéristiques psychotiques lors du dernier épisode dépressif a été associée aux scores des tempéraments hyperthymique (p=0,001), cyclothymique (p<10⁻³) et irritable (p<10⁻³). Les tentatives de suicide lors du dernier épisode ont été associées aux tempéraments cyclothymique (p<10⁻³) et irritable (p=0,01).

Ces résultats suggèrent l’intérêt de l’évaluation de ces tempéraments chez les patients suivis pour dépressions récurrentes, étant donné le risque de changement de polarité et de faux diagnostic d’unipolarité dépressive.

The current categorical split of mood disorders into bipolar disorders and depressive disorders has recently been questioned after the widening of the bipolar spectrum. Recent studies have suggested that clinicians may under-diagnose bipolarity in a substantial proportion of depressed patients, and have proposed the existence of a “pseudo-unipolar” depression. On the other hand, many studies were made to identify factors correlated to bipolarity in depressive disorders. They have shown that the main clinical factors correlated to bipolarity are: pharmacological hypomania, puerperal depression, early age of onset, psychotic features, hypersomnia and psychomotor inhibition. In this context, it should be interesting to study temperaments as predictive factors of bipolarity in depression and to explore their correlation with those clinical predictors.

The aims of this study were to assess affective temperaments in patients with recurrent depressive disorders, and to explore the correlations between these temperaments and clinical features of depressive disorders.

The study was a cross-sectional one bearing on 91 recurrent depressive patients (40 men and 51 women, mean age: 46.8±10.1years), who were interviewed using the DSM-IV Structured Clinical Interview during the partial or total recovery period. Data was collected using available medical records. The evaluation of affective temperaments consisted in filling in the Akiskal and Mallya semi-structured questionnaire.

The depressive temperament obtained the higher mean score (12.3±4.74), followed by the hyperthymic temperament (7.8±4.5), the cyclothymic temperament (5.9±5.8) and the irritable temperament (4.9±3.3). A significant association was found between the onset of the first depressive episode during the postpartum period and the cyclothymic temperament score (7.4±6.9 versus 3.3±3.6, p=0.04). The psychotic features in the last depressive episode were significantly associated with the hyperthymic (p=0,001), the cyclothymic (p<10⁻³) and the irritable temperament scores (p<10⁻³). A significant link was found between suicide attempts during the last depressive episode and the cyclothymic temperament on the one hand (p<10⁻³) and the irritable temperament on the other hand (p=0.01).

The recurrent depressive disorders with hyperthymic, cyclothymic and the irritable temperaments seem to have clinical features similar to those of bipolar disorders. These results point to the importance of evaluating these temperaments in depressed patients, considering the risk of polarity change and of misdiagnoses of unipolar depression.