J psyrh,ol Res Vol 26 No 4. PP 257-260 1992 Prmted I” Great Rr~tam (x)22-3956/92 $5 00 + WI Pergamon Pres Ltd THE IMPORTANCE OF MEASURES OF AFFECTIVE TEMPERAMENTS IN GENETIC STUDIES OF MOOD DISORDERS GIOVANNI B CASSANO,* HAGOP S. AKIsKAL,t GIULIO PERUGI,* LAURA MUSETTI* and MARIO SAWNO* ‘Umverstty of Ptsa, Ptsa, Italy and ‘fSectton of Affecttve Dtsorders, Umverstty of Tennessee, Memphts, U S A Summary-Collaboratton between the Umverstty of Ptsa, Italy, and the Umverstty of Tennessee, Memphis, U S A , on pattents presentmg wtth malor depresstve eptsodes (m the absence of nonaffecttve psychtatrtc Illness) focused on the detectton of depressive and hyperthymtc temperaments From our data on symptomatology, famtly htstory and course of 538 such patients, several fmdmgs emerge of cardmal relevance to genettc studtes Hyperthymtc temperament, observed more commonly m men, appears as one pole of an attenuated form of mamc-depresstve tllness Thus, maJor depresstves with this temperament have high rates of btpolar famtly htstory, even m the absence of hypomamc and mamc eptsodes The depresstve temperament, more prevalent m women, IS correlated wtth earher onset and htgher number of depresstve eptsodes, greater severity of the Hamtlton Ratmg Scale for Depresston (HAM-D), as well as htgher famthal loadmg for mood disorders, compared with maJor depressives without this temperament Bmldmg on Aktskal’s latest model on the multtfactortal ortgm of mood dtsorders, we submn that these temperamental dysregulattons constttute the mtermedrate step between predtsposmg famthal-genetic factors m affective tllness and gender-related chmcal expressions of mood disorders The authors recommend that tuture htgh-rusk prospecttve studies and genettc mvesttgattons should rnclude measures of affecttve temperament Introduction THE CONCEPT that depression often arises from a specific temperamental background was first hypothesized by Hippocrates, whose descriptions of melancholic, phlegmatic, choleric and sanguine temperaments largely comclde with modern concepts of affective types. In the early and middle years of this century, the psychiatric literature (Kraepehn, 1921; Kretschmer, 1936) chmcally charted the area of affective temperamental disturbances and suggested their links with manic-depressive psychosis Kraepelm (1921) considered the affective temperaments as mild expressions of mood disorders, “fundamental states” from which full-blown episodes of illness could develop Aklskal(1983a, 1989, 1990) has pointed out that both clinical and familial-genetic observations tend to support the concept of a common psychopathologlc mechanism that 1s genetlcally transmitted and 1s shared by affective temperaments and “major” mood disorders Thus, the two groups do, m fact, show a similar family history for mood disorders (Aklskal, 1984); furthermore, among monozygotlc twins of patients with Bipolar disorder who are not themselves so affected, over half suffer from temperamental disturbances (Bertelesen, Harvald, & Hauge, 1977). Author to whom correspondence should be addressed Professor Gtovanm B Cassano, Chmca Pstchtatrrca, Umversrta dt Ptsa, vta Roma, 67-56100 Ptsa, Italy 257