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

• Published in: Journal of affective disorders 2024-10, Vol.362, p.406-415
• Main Authors: Favaretto, E., Bedani, F., Brancati, G.E., De Berardis, D., Giovannini, S., Scarcella, L., Martiadis, V., Martini, A., Pampaloni, I., Perugi, G., Pessina, E., Raffone, F., Ressico, F., Cattaneo, C.I.
• Format: Article
• Language: English
• Subjects: Affect; Affective disorders; Bipolar disorder; Bipolar Disorder - psychology; Bipolar spectrum; Depression; Humans; Mental Disorders - psychology; Mood Disorders - psychology; Suicide; Temperament; Temperaments
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.07.011

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. •Research confirms affective temperaments are genetic factors underlying mood, substance use, and risky behavior disorders.•These temperaments contribute to psychiatric syndromes, personality disorders, and complex conditions like suicidal behavior.•Affective temperaments appear to influence the clinical presentation, course, and response to therapies, particularly in bipolar disorder and major depression.•In bipolar disorder, temperamental diathesis affects insight and impacts social, occupational, and family functioning differently across disorder phases.•Understanding hyperthymic temperament is crucial as it can both precede psychiatric disorders and offer protection against psychiatric and medical conditions.