Korean Clinical Psychology Association

Journal Archive

Korean Journal of Clinical Psychology - Vol. 35 , No. 4

[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 35 , No. 4 , pp.711-722
ISSN: 2466-197X (Online)
publication date Nov 2016
Received 29 Jun 2016 Revised 02 Sep 2013 Accepted 27 Sep 2016
DOI: https://doi.org/10.15842/kjcp.2016.35.4.001

우울장애 환자군 내의 기질 유형에 따른 임상 양상
최지영
인제대학교 상계백병원 정신건강의학과

Clinical Features according to Temperament Clusters in Depressive Disorder
Ji Young Choi
Department of Psychiatry, Sanggye Paik Hospital, Inje University, Seoul, Korea
Correspondence to : Ji Young Choi, Department of Psychiatry, Sanggye Paik Hospital, Inje University, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea; E-mail: haiminju@hanmail.net

Funding Information ▼

초록

본 연구는 우울장애 환자군 내의 구별되는 기질 유형에 따라 다른 임상 양상을 탐색하고자 하였다. 우울장애 환자 278명을 대상으로 하여 Cloninger (1994)의 기질 및 성격 검사(Temperament and Character Inventory, TCI)의 하위척도들 가운데 3가지 기질 차원(자극추구, 위험회피, 사회적 민감성)에 대하여 군집분석을 실시하였다. 군집분석 결과, 4개의 유형이 확인되었으며, 이렇게 구분된 기질 유형에 따라 임상 양상이 어떻게 다른지 파악하기 위하여, 공병진단과 MMPI-2-RF를 활용하여 다양한 정신병리를 비교하였다. ‘고립된-겁 많은 유형’으로 명명된 높은 위험 회피를 특징으로 하는 군집(98명)은 4개 군집 가운데 무쾌감증과 같은 전형적인 우울증상이 가장 유의하게 높았다. 3가지 기질 차원 모두 중등도 수준에 해당되어 ‘유연한 유형’으로 명명된 군집(40명)은 우울증의 심각도와 전반적인 정신병리에서 나머지 3개 유형에 비하여 모두 낮은 특성이 있었다. 높은 위험회피와 높은 자극 추구, 낮은 사회적 민감성을 특징으로 한 ‘폭발적 유형’(86명)은 전형적인 우울증상을 제외한 전반적인 정신병리에서 가장 심각한 양상을 보였다. 높은 위험회피와 높은 자극추구, 그리고 높은 사회적 민감성을 특징으로 하는 ‘민감한 유형’(86명)은 전형적인 우울증상에서는 ‘겁 많은 유형’보다 낮고, 전반적인 정신병리나 행동문제에 있어서는 ‘폭발적 유형’보다 낮은 특징이 있었다. 연구결과, 우울장애 환자군 내에 존재하는 기질 유형 간에 구별되는 임상 양상이 있음이 시사되었으며, 이와 관련된 구체적인 특징을 논의하였다. 본 연구 결과는 횡단적으로 수집된 자료를 바탕으로 하였기에 종단적 연구를 통해 확증할 필요가 있다.

Abstract

The purpose of this study was to examine whether different clinical features were associated with different combinations of temperament dimensions in patients with depressive disorder. A cluster analysis with three temperament dimensions in the Temperament and Characteristics Inventory subscales (Harm Avoidance, Novelty Seeking, Reward Sensitivity) was performed on 278 depressive disorder patients. Using diagnostic comorbidity and Minnesota Multiple Personality Inventory-2 Restructured Form, clinical features were compared in accordance with the different types of temperament. Four clusters were identified. The cluster 1 group (n=98) which is characterized by high harm avoidance and low reward dependence, have more severe typical depressive symptoms than remaining clusters. The cluster 2 group (n=40) which is characterized by not having any high dimensions, have significantly lower depressive symptoms and overall psychopathology. The cluster 4 group (n=86) who is characterized by high harm avoidance, high novelty seeking and low reward dependence, has more severe overall psychopathology except typical depressive symptoms. The cluster 3 group (n=54) which is characterized by high harm avoidance, high novelty seeking, and high reward sensitivity, have lower typical depressive symptoms than cluster 1, and have lower overall psychopathology than the cluster 4. The results implicate that there exists distinct clinical characteristics among the four different temperament types. However, the cross-sectional design did not allow for any definitive conclusion as to whether the TCI score was a premorbid trait or the result of illness.


Keywords: depressive disorder, temperament, cluster analysis, TCI, clinical features, MMPI-2-RF
키워드: 우울장애, 기질, 군집분석, TCI, 임상양상, MMPI-2-RF

References
1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorder (4th ed.). Washington, DC: American Psychiatric Press.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorder (5th ed.). Washington, DC: American Psychiatric Press.
3. Asano, T., Baba, H., Kawano, R., Takei, H., Maeshima, H., Takahashi, & Arai, H. (2015). Temperament and character as predictors of recurrence in remitted patient with major depression: A 4-year prospective follow-up study. Psychiatry Research, 225, 322-325.
4. Ben-Porath, Y. S., & Tellegen, A. (2008). Minnesota Multiphasic Personality Inventory-2 Restructured Form. Minneapolis, MN: University of Minnesota Press.
5. Butcher, J. N., Graham, J. R., Ben-porath, Y. S, Tellegen, A., Dahlstrom, W. G., & Kaemmer, B. (2001). MMPI-2(Minnesota Multiphasic Personality Inventory-2): Mannual for administration, scoring, and interpretation, revised edition. Minneapolis, MN: University of Minnesota Press.
6. Choi, J. Y., Kim, K. H., & Park, E. H. (2016). Comparison of clinical characteristics among posttraumatic stress disorder, major depressive disorder, and co-occurring PTSD and depressive disorder with MMPI-2-RF. Korean Journal of Clinical Psychology, 35, 1-20.
7. Cloninger, C. R., Przybeck, T. R., Svrakic D. M., & Wetzel, R. D. (1994). The temperament and character inventory (TCI): A guide its development and use. Missouri: Washington University.
8. Cloninger, C. R., & Svrakic D. M. (1997) Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry, 60, 120-141.
9. Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (2006). Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects. Journal of Affective Disorder, 92, 35-44.
10. Goth, K., Cloninger, C. R., & Schmeck, K. (2003). Das Temperament and Character Inventar Kurzversion fur Erwachsene-TCi R Kurz. Fankfurt. Klinik fur Psychiatrie und Psychotherapie des Kindes-und Jugendalters der JW Goethe Universitat Frankfurt. German.
11. Han, K. H., Moon, K. J., Lee, J. Y., & Kim, J. H. (2011). The Korean Version of Minnesota Multiphasic Personality Inventory-2-RF Manual. Maumsarang, Co. Ltd. Seoul; Korea.
12. Hansenne, M., Reggers, J., Pinto, E., Kjiri, K., Ajamier, A., & Ansseau, M. (1999). Temperament and character inventory(TCI) and depression. Journal of Psychiatric Research, 33, 31-36.
13. Hwang, S., Jo, H., Park, M., & Lee, J. (2015). Personality disorders relationship with temperament and character. Korean Journal of Social and Personality Psychology, 29, 1-13.
14. Jyhai, P., Kerokivi, M., Mantere, O., Melartin, T., Suominen, K., Vuorilehro, M., & Isometsa, E. (2013). Temperament, character and personality disorders. European Psychiatry, 28, 483-491.
15. Kampman, O., & Poutanen, O. (2011). Can onset and recovery in depression be predicted by temperament? A systematic review and meta-analysis? Journal of Affective Disorder, 135, 20-27.
16. Lee, E. S., Sung, G., & Kim, K. H. (2016). Temperament and character in depressive disorders. The Korean Journal of Health Psychology, 21, 287-297.
17. Lee, Y. H., & Song, J. Y. (1991). A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean Journal of Clinical Psychology, 10, 98-112.
18. Miettunen, J., & Raevuori, A. (2012). A meta-analysis of temperament in axis I psychiatric disorders. Comprehensive Psychiatry, 53, 152-166.
19. Min, B. B., Oh, H. S., & Lee, J. Y. (2007). Temperament and Character Inventory - Family Manual. Maumsarang Co., Ltd. Seoul: Korea.
20. Moon, K., Yook, K., Han, K., & Kim, J. H. (2015). Diagnostic utility of MMPI-2-RF scales: Distingushing bipolar, major depressive disorder, and schizophrenia. Korean Journal of Clinical Psychology, 34, 101-123.
21. Nerry, F. G., Hatch, J. P., Micoletti, M. A., Monkul, S., Najt, P., Matsuo, K., & Soares, J. C. (2009). Temperament and character traits in major depressive disorder: Influence of mood state and recurrence of episodes. Depression and Anxiety, 26, 382-388.
22. Novick, J. S., Stewart, J. W., Wisniewski, S. R., Cook, I. A., Nierenberg, AA., ... Rush, A. J. (2005). Clinical and demographic features of atypical depression in outpatients with major depressive disorder: Preliminary findings from STAR*D. Journal of Clinical Psychiatry, 66, 1002-1011.
23. Paavonen, V., Kampman, O., Illi, A., Viikki, M., Setἅlἅ-Soikkeli, E., & Leinonen, E. (2014). A cluster model of temperament as an indicator of antidepressant response and symptom severity in major depression. Korean Neuropsychiatric Association, 11, 18-23.
24. Savitz, J. B., & Drevets, W.C. (2009). Imaging phenotypes of major depressive disorder: Genetic correlates. Neuroscience, 164, 300-330.
25. Selbon, M., Bagby, R., Kusher, S., Quilty, L. C., & Ayearst, L. E. (2012). Diagnostic construct validity of MMPI-2 Restructured Form(MMPI-2-RF) scale. Assessment, 19, 176-186.
26. Sharpley, C. F., & Bitsika, V. (2013). Differences in neurobiological pathways of four ‘clinical content’ subtypes of depression. Behavioural Brain Research, 256, 368-376.
27. ten Have, M., Lamers, F., Wardenaar, K., Beekman, A., de Jonge, P., van Dorsselaer, S., ... de Craaf, R. (2016). The identification of symptom-based subtypes of depression: A nationally representative cohort study. Journal of Affective Disorder, 190, 395-406.
28. Wardenaar, K. J., Monden, R., Cornradi, H. J., & Jonge, P. de. (2015). Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes. Journal of Affective Disorder, 17, 38-46.
29. Wessman, J., Schὅnauer, S., Miettunen, J., Turunen, H., Parviainen, P., Seppἅnen, J. K., ... Paunio, T. (2012). Temperament clusters in a normal population: Implications for health and disease. PLOS ONE, 7, 1-8.
30. Yoda, M., Yamashita, T., Wada, Y., Fukui, M., Hasegawa, G., Nakmura, N., & Fukui, K. (2008). Classification of adult patients with type 2 diabetes using the Temperament and Character Inventory. Psychiatry and Clinical Neurosciences, 62, 279-285.
31. Zaninotto, L., Solmi, M., Toffanin, T. Veronese, N., Cloninger, C. R., & Correll, C. U. (2016). A meta-analysis of temperament and character dimensions in patient with mood disorders: Comparison to health control and unaffected sibling. Journal of Affective Disorder, 194, 84-97.