This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.

Substance abuse comorbidity is highly prevalent and is linked to detrimental outcomes in individuals with psychotic disorder, but the role of personality traits as the underlying mechanism is being increasingly underscored. This study aimed to profile temperamental risks of comorbid substance use disorder in psychotic disorders by performing meta-analyses on personality trait differences between psychotic disorders with comorbidity (dual diagnosis; DD) and without it (psychotic disorders; PSD). Methods: A systematic review of English articles using PubMed, MEDLINE, Scopus, Google Scholar, and ProQuest Dissertation and Theses. Only original empirical studies including participants with diagnosis of psychotic disorders based on structured diagnostic interviews, with and without substance use disorder evaluated with reliable and valid tests were included. Articles were independently extracted by two authors using predefined data fields, including study quality indicators. All pooled analyses were based on random-effect models. Thirteen studies (N = 885) met our inclusion criteria. All effect-size estimates were calculated based on means and standard deviations of included measures. Separate effect size estimates were obtained for four traits in the UPPS model (negative urgency, low premeditation, low perseverance, sensation seeking), four traits in the HS model (unconscientious disinhibition, negative affect, disagreeable disinhibition, positive affect) and trait anhedonia. Results: Negative urgency (four studies with 262 participants; ES = 0.59; 95% confidence interval [CI] [0.34, 0.84]), low premeditation (five studies with 349 participants; ES = 0.60; 95% CI [0.39, 0.80]), sensation seeking (seven studies with 550 participants; ES = 0.63; 95% CI [0.17, 1.09]) and unconscientious disinhibition (five studies with 291 participants; ES = 0.36; 95% CI [0.13, 0.59]) were elevated in DD than PSD. Heterogeneity of sensation seeking was significant (I² = 86.2%). Conclusions: The findings of the current meta-analysis highlight a unique profile of impulsive and externalizing trait personality domains pertaining to DD. The study emphasizes the importance of emotion regulation interventions targeting impulsivity or negative affect (i.e. negative urgency, low premeditation) in substance abuse comorbidity patients.

Personality is considered as an important aspect that can affect symptoms and social function in persons with schizophrenia. The personality questionnaire Swedish universities Scales of Personality (SSP) has not previously been used in psychotic disorder.

To investigate if SSP has a similar internal consistency and factor structure in a psychosis population as among healthy controls and if patients with psychotic disorders differ from non-psychotic individuals in their responses to the SSP.

Patients with psychotic disorders (n = 107) and healthy controls (n = 119) completed SSP. SSP scores were analyzed for internal consistency and case-control differences by Cronbach's alfa and multiple analysis of covariance, respectively.

Internal consistencies among patients were overall similar to that of controls. The patients scored significantly higher in seven (Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Lack of assertiveness, Detachment, Embitterment, Mistrust) and lower in three (Physical trait aggression, Verbal trait aggression, Adventure seeking) of the 13 scales of the inventory. In three scales (Impulsiveness, Social desirability and Trait irritability) there was no significant difference between the scoring of patients and healthy controls.

The reliability estimates suggest that SSP can be used by patients with psychotic disorders in stable remission. Patients score higher on neuroticism-related scales and lower on aggression-related scales than controls, which is in accordance with earlier studies where other personality inventories were used.

Impulsivity is a variable that has been associated with drug use. This study analyzes impulsivity from two different paradigms, one considering it as a trait and the other based on its behavioral correlates, such as disinhibition and impulsive decision-making in the treatment prognosis (maintain abstinence, relapse and dropout) of smokers after outpatient treatment. The participants in the study were 113 smokers who requested treatment for nicotine addiction. They were assigned to three groups according to whether or not they remained abstinent one month after beginning treatment; thus, group 1 was abstinent, group 2 had relapsed, and group 3 had dropped out of treatment. The participants filled out the Semi-structured Interview for Smokers, the Fargerström Test for Nicotine Dependence, the Temperament and Character Inventory-Revised (TCI-R) and the Delay Discounting Task (DDT). The Delay Discounting variable presents lower scores in the dropout group than in the relapse and abstinent groups, with the highest scores in the relapse group. Differences were also found on the Harm Avoidance (HA) variable, with lower scores in the dropout group compared to the relapse group. The importance of these results lies in the consideration of the smoker's personality profile in order to prevent both dropout and relapse.

Considerable data support phenomenological and temporal continuity between psychotic disorders and subclinical psychotic-like experiences (PLE's). Although numerous studies have found similar personality correlates for schizophrenia and schizotypal personality disorder patients, their unaffected first-degree relatives, and healthy adults characterized for schizotypal traits, no study has yet investigated personality correlates of PLE's measured by the Community Assessment of Psychic Experiences (CAPE). Our study sought to examine personality correlates of PLE's using the CAPE in healthy adults.

The CAPE and temperament and character inventory (TCI) were administered to 415 healthy adults. Regressions examined links between TCI traits and overall PLE levels as well as positive and negative PLE's separately.

Consistent with past studies, lower self-directedness (SD) and reward dependence (RD) and higher self-transcendence (ST) and harm avoidance (HA) significantly predicted overall PLE levels. Higher ST and persistence (P) and lower SD significantly predicted higher levels of positive PLE's while lower SD and RD and higher HA, ST, and cooperativeness (C) predicted higher levels of negative PLE's.

Associations between TCI and PLE's using the CAPE are strikingly similar to past work in non-clinical and patient samples and provide additional support for phenomenological continuity between psychotic disorders and sub-syndromal psychotic symptoms.

Chronic schizophrenia patients have personality abnormalities and cognitive deficits that are associated with poor clinical, social, and vocational outcomes. Very few studies have examined relationships between personality and cognitive function, and chronic illness effects may have confounded those studies. In this study personality traits in clinically stable first episode schizophrenia patients (21M, 9F) and psychiatrically healthy controls (38M, 24F) were measured with the NEO-FFI, a self-report measure of neuroticism, extraversion, openness, agreeableness, and conscientiousness. All subjects completed the Information, Digit Span, Vocabulary, and Digit Symbol subtests of the Wechsler Adult Intelligence Scale; and Trails A and B. Standard statistical techniques were used to quantify relationships between personality and symptom levels and/or task performance, and relative contributions of diagnosis and task performance to personality variance. Patients showed elevated mean neuroticism and openness, and reduced mean extraversion, agreeableness and conscientiousness. Task performance and negative symptoms contributed significantly and uniquely to most personality dimensions in patients. Task performance accounted for significant amounts of personality variance even after accounting for diagnosis, and it also contributed to personality variance in controls. These results suggest that cognitive deficits and negative symptoms contribute to consistently observed personality abnormalities in this disorder, and that the contribution of neuropsychological performance to personality variance may be independent of diagnostic classification. Personality abnormalities in schizophrenia may stem from the neurocognitive deficits associated with this disorder, and add to their adverse effects on social and vocational functioning.

We previously noted increased shyness in stable community outpatients with schizophrenia compared to healthy controls and that shyness may be a risk factor for social functioning impairment in this population (Goldberg & Schmidt, 2001).

We attempted to replicate and extend these findings by comparing the use of a brief trait measure of shyness and sociability (SS; Cheek, 1983; Cheek & Buss, 1981) with the longer Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) used traditionally in work to measure personality dimensions in this population.

A group of stable outpatients with schizophrenia (n = 41) and healthy controls (n = 41) matched on age and gender were compared on the SS and TCI measures. Patients were assessed on clinical symptoms using the Positive and Negative Symptom Scale (PANSS) and on social functioning measures using a Quality of Life Scale (QLS).

Patients reported significantly higher shyness, retrospective inhibition and harm avoidance, and lower novelty seeking, self-directedness and cooperativeness than healthy adults, replicating previous findings. Shyness and sociability were related to conceptually linked dimensional sub-scales of the TCI and were predictive of social functioning in the patient group. Importantly, scores on these measures were unrelated to symptom profiles and explained additional variance in social functioning beyond clinical symptoms.

These findings suggest that individual differences in trait shyness and sociability may influence social functioning in stable outpatients with schizophrenia. The results also support the use of the brief trait measures of shyness and sociability in this population.

Suicide is a major public health problem and the leading cause of premature death in patients with schizophrenia. Information about the patient's personality is helpful for assessing the risk of suicide attempts and suicidal ideation. The sample consisted of 120 outpatients with a diagnosis of schizophrenia, 29 of whom had previously attempted suicide. We used the Temperament and Character Inventory to assess personality differences between patients who had previously attempted and had not previously attempted suicide and between patients who had and did not have current suicidal ideation. Current suicidal ideation was assessed using the four-point severity scale, which is item nine from the Beck Depression Inventory. The character dimension Self-transcendence was shown by logistic regression to be a predictor of lifetime suicide attempts. Low Self-directedness was shown to be a predictor of current suicidal ideation. To prevent suicidal behaviour, it is important to better understand the personality traits associated with suicidal ideation and suicide attempts. Suicide attempts and suicidal ideation in schizophrenia may not represent the same phenomenon ranging on a single continuum. The importance of these results suggests that further study is needed.

This article reports on a meta-analysis of Cloninger's temperament dimensions (novelty seeking, harm avoidance, reward dependence, and persistence) in individuals with lifetime psychiatric disorders compared with controls and on interdisorder comparisons between these disorders. Nine disorders from 75 studies were included in the meta-analyses. The most consistent feature was elevated harm avoidance: compared with the controls, harm avoidance was higher in all diagnostic groups studied except for those with alcohol use disorders. The increase in effect sizes in harm avoidance scores varied from a very large (d = 2.66) in social phobia to a small effect (effect size, d = 0.29) in alcohol use disorders. In other dimensions, differences between cases and controls were relatively small. However, in pairwise comparisons, notable differences also in other dimensions emerged: in novelty seeking, the lowest scores were in social phobia (d = -0.87) and the highest in bulimia nervosa (d = 0.33); in reward dependence, the lowest scores were in schizophrenia (d = -0.36) and the highest in social phobia (d = 0.12); and in persistence, the lowest scores were in social phobia (d = -0.30) and the highest in anorexia nervosa (d = 0.49). The provided data should be taken into account in the future studies on suggestive vulnerability markers for psychiatric morbidity.

The aim of this study was to investigate the associations between the temperament, character dimensions, and quality of life (QOL) of patients with schizophrenia; their first-degree, nonaffected relatives; and healthy control subjects. One hundred twenty patients, the same number of first-degree relatives, and the same number of control subjects were assessed using the Temperament and Character Inventory and the Quality of Life Enjoyment and Satisfaction Questionnaire. Patients were also assessed using the Positive and Negative Syndrome Scale. Patients and relatives had a significantly lower QOL than control subjects, controlled for temperament and character dimensions. Patients scored significantly higher than control subjects in harm avoidance and self-transcendence and lower in novelty seeking and self-directedness. First-degree relatives had lower results for novelty seeking and scored higher on self-transcendence than control subjects. Harm avoidance, self-directedness, and self-transcendence were the dimensions of Temperament and Character Inventory shown to be the most significant predictors of QOL. Psychopathology and age were also significant predictors of QOL. Our understanding of an individual patient's QOL must include personality evaluation.

We study the predictive power and associations of several psychopathology and temperament scales with respect to schizophrenia and other psychotic disorders. Measures of psychopathology (Physical and Social Anhedonia Scales, Perceptual Aberration Scale, Hypomanic Personality Scale, Bipolar II Scale, and Schizoidia Scale) and the Temperament and Character Inventory were included in the 31-year follow-up of the prospective Northern Finland 1966 birth cohort (N = 4926). The Perceptual Aberration Scale was the best scale for concurrent validity in psychoses, and also the best psychopathology scale in terms of discriminant validity. Participants scoring high in hypomanic personality were at the highest risk for developing psychosis during the 11-year follow-up. Harm avoidance was a dominant temperament dimension in individuals with psychosis compared with participants without psychiatric diagnoses. These scales are useful as vulnerability markers in studying psychoses.

The study explored the association between temperament and character and medication adherence in 76 patients with schizophrenia. Patients were assessed with the Temperament and Character Inventory, the Beck Depression Inventory, and the Positive and Negative Syndrome Scale. First-degree relatives were used as informants on adherence. The patients differed in their adherence based on the effect of gender, as males were found to be less adherent than females. Adherence differed based on novelty seeking. The temperament of the patient should be considered during the assessment of adherence.

Cloninger's neuropsychopharmacological theory identifies four temperament traits and three character traits that are largely heritable and are associated with addictions.

We tested whether these personality traits were associated with smoking behavior and predicted smoking cessation and tobacco withdrawal symptoms. We conducted an Internet cohort study in 2005-2009. The Temperament and Character Inventory (TCI, 226 items, French version) was assessed in 2,993 people (1,593 current, 969 former, and 419 never-smokers). Subsets of participants indicated their smoking status after 30 days (n = 1,452, 48.5%) and answered the TCI again and reported tobacco withdrawal symptoms after 61 days (n = 644, 21.5%).

Compared with never- and former smokers, daily smokers had higher scores of Harm Avoidance (HA) and lower scores of Persistence and Self-Directedness (SD). Daily smokers had higher scores of Novelty Seeking than never-smokers. In daily smokers, the level of tobacco dependence was associated with higher scores of HA and lower scores of SD. In the 60 daily smokers who had stopped smoking after 61 days, after adjustment for tobacco dependence level and baseline tobacco withdrawal ratings, SD predicted lower scores of depressed mood and anxiety at 61-day follow-up and HA predicted higher scores of depressed mood at 61-day follow-up. Personality ratings did not predict smoking cessation at follow-up in daily smokers or relapse in former smokers.

A consistent association was found between smoking and high HA and low SD. Knowledge about these associations may be useful to clinicians to tailor counseling.

To describe symptom expression and functional outcome in psychotic disorders in relation with temperament traits assessed with the Temperament and Character Inventory (TCI) in a population-based sample.

As part of the 31-year follow-up survey of the Northern Finland 1966 Birth Cohort, TCI temperament items were filled in by 4349 members of the cohort. In individuals with psychotic disorders, also positive and negative symptoms and outcome variables were assessed in a 35-year follow-up. Information of TCI and outcomes were available for altogether 41 individuals with psychosis.

Reward dependence (RD) (rho=-0.45) and Persistence (P) (rho=-0.52) were significantly correlated with Positive and Negative Syndrome Scale (PANSS) negative symptoms. Higher P scores predicted higher social and occupational functioning (as measured by Social and Occupational Functioning Assessment Scale [SOFAS]), and higher Harm avoidance (HA) predicted a higher likelihood of being on a disability pension.

Results indicate that understanding of personality dimensions support better understanding of outcome and symptom expressions in psychotic disorders.

Personality dimensions have been associated with symptoms dimensions in schizophrenic patients (SP). In this paper we study the relationships between symptoms of functional psychoses and personality dimensions in SP and their first-degree relatives (SR), in other psychotic patients (PP) and their first-degree relatives (PR), and in healthy controls in order to evaluate the possible clinical dimensionality of these disorders. Twenty-nine SP, 29 SR, 18 PP, 18 PR and 188 controls were assessed using the temperament and character inventory (TCI-R). Current symptoms were evaluated with positive and negative syndrome scale (PANSS) using the five-factor model described previously (positive [PF], negative [NF], disorganized [DF], excitement [EF] and anxiety/depression [ADF]). Our TCI-R results showed that patients had different personality dimensions from the control group, but in relatives, these scores were not different from controls. With regard to symptomatology, we highlight the relations observed between harm avoidance (HA) and PANSS NF, and between self-transcendence (ST) and PANSS PF. From a personality traits-genetic factors point of view, schizophrenia and other psychosis may be initially differentiated by temperamental traits such as HA. The so-called characterial traits like ST would be associated with the appearance of psychotic symptoms.

Studies of patients with schizophrenia or schizophrenia spectrum disorders and general population control groups consistently show differences regarding personality dimensions. However, the profile of personality dimensions in first-degree relatives of those patients is not well understood. We used Temperament and Character Inventory to explore personality dimensions in 61 clinically stable patients with schizophrenia or schizophrenia spectrum disorders, 59 of their first-degree relatives, and 64 healthy controls. Patients scored significantly higher than controls in harm avoidance and self-transcendence and lower in self-directedness and cooperativeness. First-degree relatives showed a tendency to lower novelty seeking and self-transcendence than controls. Interpretations of these findings include the possibility that lower novelty seeking and lower self-transcendence provide a protective influence in the relatives. Further studies are needed to go into this issue in greater depth.

Traditional models of co-occurring substance misuse in psychosis, including the vulnerability and coping (self-medication) hypotheses, have tended to focus on state-specific factors, such as the severity of substance misuse or psychotic symptoms. In contrast, more recent personality models posit that co-morbidity is related to individual differences in stable trait-specific personality variables that underlie affective outcomes, coping strategies and subsequent risk for substance use. This paper reviews the current evidence base for these three models, and suggests that future research examine the inter-relationships between trait and state-specific personality, affective and behavioural variables on co-morbidity.

Alcoholics who have developed alcoholism despite a strong negative risk factor, that is, the inactive form of aldehyde dehydrogenase-2 (ALDH2), are considered advantageous for studying predisposing factors for alcoholism. This study aimed to compare personality profiles and clinical characteristics between alcoholics with active and inactive ALDH2.

Subjects were 460 male Japanese alcoholics hospitalized in Kurihama Alcoholism Center. All patients underwent Cloninger's Tridimensional Personality Questionnaire and semi-structured interviews 4 to 8 weeks after admission to obtain data on personalities and clinical characteristics. ALDH2 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Sixty-six patients had the inactive form of ALDH2 (ALDH2*1/2*2) and 394 had the active form (ALDH2*1/2*1).

Alcoholics with inactive ALDH2 had significantly higher novelty-seeking (NS) and lower harm-avoidance (HA) scores compared with those with active ALDH2. The inactive ALDH2 group experienced delirium tremens significantly less frequently than the active ALDH2 group.

These results suggest that high NS and low HA scores in alcoholics with inactive ALDH2 are associated with an increased risk for developing alcoholism, despite a low enzymatic ability to eliminate toxic acetaldehyde in these subjects. A study of alcoholics with inactive ALDH2 is useful for detecting environmental or personality factors related to alcoholism.

This study aimed to investigate temperament and character correlates of panic disorder (PD) comorbidity in euthymic patients with bipolar disorder (BD) or unipolar depression (UD).

Temperament and character were assessed using the Temperament and Character Inventory Revised (TCI-R) in 181 patients (70 patients with BD-I, 51 patients with BD-II and 60 with UD) in a euthymic state for at least 2 months.

PD was diagnosed in 14.3% of BD-I patients, 31.4% of BD-II and 40% of UD. BD patients with PD, when compared with BD patients without PD, had higher scores on harm avoidance (OR=1.04; 95% CI=1.02-1.07; p=0.002). Patients with UD and PD, when compared to patients with UD without PD, had higher scores on social acceptance (OR=1.27; 95% CI=1.08-1.49; p=0.004).

Different temperament and character dimensions correlated with PD comorbidity in BD and UD patients, suggesting different underlying pathophysiological mechanisms.

This article reviews empirical studies of affective traits in individuals with schizophrenia spectrum disorders, population-based investigations of vulnerability to psychosis, and genetic and psychometric high-risk samples. The review focuses on studies that use self-report trait questionnaires to assess Negative Affectivity (NA) and Positive Affectivity (PA), which are conceptualized in contemporary models of personality as broad, temperamentally-based dispositions to experience corresponding emotional states. Individuals with schizophrenia report a pattern of stably elevated NA and low PA throughout the illness course. Among affected individuals, these traits are associated with variability in several clinically important features, including functional outcome, quality of life, and stress reactivity. Furthermore, evidence that elevated NA and low PA (particularly the facet of anhedonia) predict the development of psychosis and are detectable in high-risk samples suggests that these traits play a role in vulnerability to schizophrenia, though they are implicated in other forms of psychopathology as well. Results are discussed in terms of their implications for treatment, etiological models, and future research to advance the study of affective traits in schizophrenia and schizotypy.

FREQUENCY: The prevalence of cigarette smoking is significantly higher among patients with schizophrenia (60-90%) than in the general population (23-30%). While tobacco smoking decreases in the general population (from 45% in the 1960's to 23-30% in the 2000's), smoking in patients with schizophrenia remains high. Patients with schizophrenia smoke more cigarettes than control subjects. Patients smoke more deeply, thereby increasing their exposure to the harmful elements in tobacco smoke. IMPACT OF SMOKING IN SCHIZOPHRENIC PATIENTS: As in the general population, smoking contributes to the reduced life expectancy in patients with schizophrenia. Patients with schizophrenia are at increased risk for cardiovascular disease due to high rates of cigarette smoking. In the Department of Mental Health of the commonwealth of Massachusetts, cardiovascular disease was the factor the most strongly associated with excess mortality. Cardiac deaths were elevated more than six-fold. Weight gain, insulin resistance, metabolic syndrome and diabetes mellitus are frequent in patients with schizophrenia, and may worsen the risk of cardiovascular diseases. It has been reported that the risk for lung cancer in patients with schizophrenia is lower than that of the general population, despite increased smoking. However, in a study conducted in Finland, a slightly increased cancer risk was found in patients with schizophrenia. Half of the excess cases were attributable to lung cancer. IMPROVEMENT OF COGNITIVE DEFICITS: Patients with schizophrenia may use nicotine to reduce cognitive deficits and negative symptoms or neuroleptic side effects. Smoking may transiently alleviate negative symptoms in schizophrenic patients by increasing dopaminergic and glutamatergic neurotransmission in the prefrontal cortex. In patients with schizophrenia, nicotine improves some cognitive deficits: (1) sensory gating deficits and abnormalities in smooth pursuit eye movements associated with schizophrenia are transiently normalized with the administration of nicotine ; (2) high-dose nicotine transiently normalizes the abnormality in P50 inhibition in patients with schizophrenia and in their relatives; (3) in tasks that tax working memory and selective attention, nicotine may improve performance in schizophrenia patients by enhancing activation of and functional connectivity between brain regions that mediate task performance (Jacobsen et al. 2004; Paktar et al.2002); (4) cigarette smoking may selectively enhance visuospatial working memory and attentional deficits in smokers with schizophrenia. However, Harris et al., found that nicotine affects only the attention without effects of nicotine on learning, memory or visuospatial/constructional abilities. In addition, smoking could facilitate disinhibition in schizophrenic patients.

This study examined associations between three temperament dimensions measured by the Temperament and Character Inventory-125 [Cloninger, C.R. (1992). The Temperament and Character Inventory-125 (TCI-125; Version 1.)] and tobacco abstinence effects. Smokers (N=203, >/= 15 cigarettes/day) attended two laboratory sessions, one following 12 h of abstinence and the other following ad libitum smoking (order counterbalanced). Participants completed measures of withdrawal symptoms, cigarette urges, and affect. Smokers high in Novelty Seeking reported greater abstinence-induced increases in several nicotine withdrawal symptoms, negative affect, and cigarette craving. Smokers high in Harm Avoidance reported greater abstinence-induced increases in negative affect and urges to smoke to relieve distress. Reward Dependence was not associated with abstinence effects. Novelty Seeking and Harm Avoidance showed independent predictive associations with negative affect and urges, and their associations with abstinence effects persisted when controlling for FTND scores. Smokers with different temperaments display different patterns of acute tobacco withdrawal, and may benefit from treatments matched to their particular abstinence profile.

Since characterological characteristics of patients with schizophrenia and comorbid alcohol abuse are not well established, we compared outpatients with DSM-IV schizophrenia, with (n = 51) and without alcohol-abuse (n = 51), matched for sex, age, IQ, and symptom severity, using the Temperament and Character Inventory. Dual-diagnosis patients showed highly selective greater novelty seeking.

As substance use disorders (SUD) are common in schizophrenia patients, we tested the hypothesis that comorbid patients (SUD[+]) have more positive vs. negative symptoms than non-comorbid (SUD[-]) patients. From reports identified by literature-searching we compared Positive and Negative Syndrome Scale (PANSS) ratings in schizophrenia patients with and without SUD using meta-analytic methods. Among 9 comparisons (N=725 subjects), SUD[+] patients were more often men, and abused alcohol>cannabis>cocaine. SUD[+] patients had very significantly higher PANSS-positive, and lower PANSS-negative scores. Comorbid SUD in schizophrenia patients was associated with male sex and higher PANSS positive to lower negative scores. Cause-effect relationships remain to be clarified.

The Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) is a self-questionnaire developed to assess the 7 dimensions of personality described by Cloninger et al. (1994) with a total of 29 subscales. In 1999, a revised version was proposed by Cloninger (TCI-R). In this study, we present psychometric properties of the TCI-R from 958 French-speaking participants of Belgium. Women exhibited higher scores for harm avoidance, reward dependence, and cooperativeness dimensions. The proposed factorial structure of 4 temperament dimensions and 3 character dimensions was confirmed. The TCI-R inventory had good test-retest reliabilities as well as good alpha coefficients. The addition of 3 new subscales to the original scale for Persistence has produced a very reliable dimension in the TCI-R.

This study aimed to determine which temperament factors are associated with quality of life (QOL) in schizophrenia based on a triplet design comparing patients with their non-affected siblings and healthy control subjects. Forty-seven DSM-IV clinically stable schizophrenia outpatients, 47 non-affected siblings, and 56 non-patients matched for gender and age were evaluated using the Tridimensional Personality Questionnaire and the Quality of Life Enjoyment and Life Satisfaction Questionaire. As expected, schizophrenia patients reported significantly poorer QOL in most specific domains and in general. They also revealed significantly higher scores on harm avoidance and scored lower on reward dependence, than both their siblings and controls. Tridimensional Personality Questionnaire temperament factors revealed no differences between the controls and the siblings. When differences between patients, their siblings and controls were adjusted for gender, age at examination, and education, ANOVA demonstrated that temperament factors contributed to poor satisfaction with physical health, social relationships and subjective feelings in schizophrenia patients. Harm avoidance was associated with general QOL independent of severity of psychopathology. Thus, this study suggests that temperament factors that are not necessarily part of the deterioration process of the illness are associated with the quality of life of schizophrenia patients. These and other non-illness related factors should be considered when evaluating quality of life outcomes in intervention studies.

Currently, HIV is one of the most widely spread epidemics in the world. The specificity of the mode of transmission, the well-known severity of the prognosis, and the kind of therapies used are peculiarities of this illness. Personality traits of individuals with HIV may influence conditions for the infection itself. On the other hand, it is possible that personality traits may influence the course of the illness and the willingness of the patients to adhere to treatment. The present study assessed the personality traits of a heterogeneous group of seropositive subjects compared with healthy controls to determine specific temperament and character traits of this population.

The Temperament and Character Inventory (TCI) was administered to 126 HIV-positive outpatients belonging to different risk categories for HIV infection and to a sample of healthy individuals matched for sex, age, and socioeconomic parameters.

Drug-dependent HIV-positive patients displayed higher scores in novelty seeking and harm avoidance and lower scores in self-directedness compared with healthy controls. Non-drug-dependent HIV-positive subjects scored significantly higher in self-transcendence.

Temperament and character features significantly differentiate the HIV-positive subjects from controls and those belonging to the different risk categories for HIV infection. Drug-dependent subjects with HIV display more impulsiveness, which possibly predates the HIV infection. They are also more fearful and lack self-directedness. Non-drug-dependent subjects express higher self-transcendence resources, possibly to overcome their difficulties. Both the temperament and character features may influence compliance with treatment and require specific interventions considering these subgroups.

The role of personality in nicotine use has been little studied in patients with schizophrenia. The objectives of the present study were to compare impulsivity, sensation seeking and anhedonia in a group of schizophrenic patients with and without current cigarette smoking. One hundred patients with schizophrenia or schizoaffective disorder (DSM-III-R criteria) were assessed with the Positive and Negative Syndrome Scale, the Fagerström Scale, the Barratt Impulsivity Scale, the Zuckerman Seeking Sensation Scale, and the Chapman Physical Anhedonia Scale. Among these patients, 67% were current smokers. The mean scores for sensation seeking were higher in the group of smokers than in the group of nonsmokers. The differences were found exclusively with the "disinhibition" subscale. No significant difference was found for impulsivity and physical anhedonia mean scores. The scores on the Sensation Seeking Scale were especially low in nonsmokers. Cigarette smoking could influence disinhibition and possibly help to normalize inhibition in schizophrenic patients.

Knowledge concerning temperament factors involved in vulnerability to schizophrenia is limited. We hypothesized that temperament and self-variables (emotional distress, coping styles, self-efficacy and self-esteem) might present a complex trait marker for underlying vulnerability to schizophrenia. We sought to (1) assess temperament dimensions and types in schizophrenia patients and healthy controls using the Tridimensional Personality Questionnaire (TPQ), and (2) explore their association with symptom dimensions, emotional distress, coping styles, self-constructs, demographic and background variables. We evaluated 90 consecutively recruited DSM-IV schizophrenia patients and 136 healthy controls matched for gender and age. We found that the harm avoidance (HA) factor was higher, while reward dependence (RD) was lower in schizophrenia patients than in healthy controls. Relationships of negative symptoms to novelty seeking (NS) and general psychopathology with both NS and HA show a confounding relation to self-variables. TPQ temperament types were defined by dichotomization into high and low according to medians of the three TPQ temperament dimensions. The odds ratios for the HA and HA/NS temperament types were significantly higher, while the NS/RD type was lower in schizophrenia patients than in healthy controls. HA/NS, HA/RD and high-HA/NS/RD types revealed higher scores for emotional distress, emotion-oriented coping and lower scores on self-constructs. No links were found between temperament types and schizophrenia symptom dimensions, task and avoidance oriented coping, or demographic and background variables. Thus, our findings strengthen the hypothesis that temperament types, when associated with elevated emotional distress, emotion-oriented coping and weak self-constructs, might represent a complex trait marker for underlying vulnerability to schizophrenia.

The aim of this study is to describe the personality disorders (PD) and personality profile of heroin-abusers and their quality of life (QoL), and to investigate the correlation between the two.

One hundred and eighty heroin-abusers during their residential treatment participated in the study. The Structured Clinical Interview-II (SCID-II) allowed the identification of two subgroups of heroin-abusers on the basis of presence/absence of a PD. All patients filled in the Temperament and Character Inventory (TCI), the McGill QoL Questionnaire (MQOL) and an anamnestic sheet. A control group of 63 non-clinical subjects was recruited.

Abusers with a PD differ in their personality profile from abusers without PD and score lower on the total MQOL. As regards TCI scales, novelty seeking (NS), reward dependence (RD) and self-directedness (SD) predict the age of onset of the abuse, while cooperativeness (C) is a predictor of the number of community admissions.

Low scores on self-directedness and cooperativeness in abusers support the hypothesis of an immature character and relational difficulties. Novelty seeking is the only dimension which is altered both in abusers with and without a PD and is not strictly dependent on Axis II comorbidity. QoL is lower in abusers than in controls, according to their physical, psychological and existential suffering. Last, an interesting link emerged between personality and perceived QoL.

One of the primary personality dimensions or traits that has consistently been linked to substance abuse is impulsivity. However, impulsivity is not a homogenous construct and although many of the measures of impulsivity are correlated, the most recent review of published factor analytic studies has proposed two independent dimensions of impulsivity: reward sensitivity, reflecting one of the primary dimension of J. A. Gray's personality theory, and rash impulsiveness. These two facets of impulsivity derived from the field of personality research parallel recent developments in the neurosciences where changes in the incentive value of rewarding substances has been linked to alterations in neural substrates involved in reward seeking and with a diminished capacity to inhibit behavior due to chronic drug exposure. In this paper, we propose a model that integrates the findings from research into individual differences with recent models of neural substrates implicated in the development of substance misuse.

Research has indicated that stable individual differences in personality exist among persons with schizophrenia spectrum disorders predating illness onset that are linked to symptoms and self appraised quality of life. Less is known about how closely individual differences in personality are uniquely related to levels of social relationships, a domain of dysfunction in schizophrenia more often linked in the literature with symptoms and neurocognitive deficits. This study tested the hypothesis that trait levels of personality as defined using the five-factor model of personality would be linked to social function in schizophrenia.

A self-report measure of the five factor model of personality was gathered along with ratings of social function, symptoms and assessments of neurocognition for 65 participants with schizophrenia or schizoaffective disorder.

Univariate correlations and stepwise multiple regression indicated that frequency of social interaction was predicted by higher levels of the trait of Agreeableness, fewer negative symptoms, better verbal memory and at the trend level, lesser Neuroticism (R2 =.42, p <.0001). In contrast, capacity for intimacy was predicted by fewer negative symptoms, higher levels of Agreeableness, Openness, and Conscientiousness and at the trend level, fewer positive symptoms (R2 =.67, p <.0001).

Taken together, the findings of this study suggest that person-centered variables such as personality, may account for some of the broad differences seen in outcome in schizophrenia spectrum disorders, including social outcomes. One interpretation of the results of this study is that differences in personality combine with symptoms and neurocognitive deficits to affect how persons with schizophrenia are able to form and sustain social connections with others.

As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

The numerous reports on research involving the clinical assessment of personality in axis I disorders highlight the importance of temperament features in the current approach to all mental disorders. However, the available instruments of personality assessment have many limits. Self-administered questionnaires depend on the patient's insight, and projective instruments (i.e. the Rorschach test) often lack objectivity. This study compared the results of personality assessment with the Temperament and Character Inventory (TCI) and the Rorschach test to verify their validity.

TCI and Rorschach tests were administered to a wide sample of patients (n = 180) in a short period. The most common Rorschach siglatures were correlated with the TCI raw scores using the Pearson correlation test.

All TCI temperament dimensions and facets displayed at least two correlations with Rorschach siglatures. The description of each dimension and facet of the TCI obtained with the interpretation of Rorschach siglatures was consistent with its original meaning.

The TCI and Rorschach tests adequately validated each other. In the future, the administration and integration of these tests will overcome the biases of both. Further, the theoretical bases of the TCI could facilitate the study of psychological functions, whereas the psychodynamic bases of the Rorschach test provide an in-depth insight into temperament traits.

While individual differences in personality exist among persons with schizophrenia and predate the onset of illness, less is known about their relationship to outcome. This study examined whether levels of three personality dimensions-neuroticism, extraversion, and agreeableness-are associated with symptomatology and coping in persons with schizophrenia. Symptom, personality, and coping measures were obtained for 59 participants with schizophrenia. Personality and coping measures were obtained for 17 persons in a community comparison group. Relative to the community comparison groups, participants with schizophrenia had higher levels of neuroticism, lower levels of extraversion and agreeableness, and tended to employ more avoidant styles of coping. Participants with schizophrenia who had higher levels of neuroticism had greater positive and emotional discomfort symptoms and greater preferences for avoidant coping strategies. Participants with schizophrenia who had higher levels of agreeableness had lower levels of positive and excitement symptoms. No links were found between extraversion and outcome measures. Implications for understanding how personality may affect outcome are discussed.

The aim of this study was to assess dimensions of temperament as defined by Cloninger's neurobiological model using the tridimensional personality questionnaire (TPQ) in a sample of consecutively recruited schizophrenic patients.

We used the French version of the TPQ to compare 45 stable, euthymic schizophrenic patients with 126 controls with no personal or familial history of psychiatric disorder. After comparison of TPQ scores between groups, we also performed a multivariate analysis to avoid the confounding effects of age, gender, and alcohol and substance use disorder comorbidity.

Harm avoidance (HA) was higher in schizophrenic patients than in controls.

This replicates and extends the results of previous studies suggesting that schizophrenic patients have high HA and that HA might be a marker for underlying genetic vulnerability to schizophrenia.

Compelling evidence that tobacco-smoking is a form of drug addiction exists. The aim of this study is to determine the following: (1) prevalence of tobacco-smoking and of nicotine dependence in French psychiatric patients; (2) rates and patterns of tobacco smoking and of nicotine dependence according to diagnosis; (3) relationship between current smoking status and antipsychotic medications; and (4) relationship between cigarette smoking and neurological side effects induced by neuroleptics. A population of 711 psychiatric in- and outpatients was assessed using: (1) a detailed smoking self-questionnaire for smoking history and nicotine dependence; and (2) a questionnaire for staff covering treatments and DSMIII-R diagnoses. Data were analyzed using chi2 analysis of variance (ANOVA) tests (one factor) for quantitative comparisons between groups of patients, and analysis of covariance (ANCOVA) test with age covariate was performed for age-dependent variables. Prevalence of smoking in the population of psychiatric patients was significantly higher than in the French general population. Diagnoses among current smokers were mainly substance-related disorder and schizophrenia. The authors established correlations between prevalence of smoking and age, sex, marital and socioeconomic status, alcohol use, coffee consumption and other psychoactive substance use or abuse. The authors did not find relationship between smoking prevalence and institutionalization. Neuroleptic neurological side effects were significantly fewer among smokers compared to nonsmokers. However, the rate of smokers was significantly higher in psychiatric patients receiving neuroleptic drugs. Nicotine abuse in psychiatric patients, and especially in schizophrenic patients, could support the hypothesis that smoking is consistent with self-medication.

It is commonly held that substance use comorbidity in schizophrenia represents self-medication, an attempt by patients to alleviate adverse positive and negative symptoms, cognitive impairment, or medication side effects. However, recent advances suggest that increased vulnerability to addictive behavior may reflect the impact of the neuropathology of schizophrenia on the neural circuitry mediating drug reward and reinforcement. We hypothesize that abnormalities in the hippocampal formation and frontal cortex facilitate the positive reinforcing effects of drug reward and reduce inhibitory control over drug-seeking behavior. In this model, disturbances in drug reward are mediated, in part, by dysregulated neural integration of dopamine and glutamate signaling in the nucleus accumbens resulting form frontal cortical and hippocampal dysfunction. Altered integration of these signals would produce neural and motivational changes similar to long-term substance abuse but without the necessity of prior drug exposure. Thus, schizophrenic patients may have a predilection for addictive behavior as a primary disease symptom in parallel to, and in many, cases independent from, their other symptoms.

Lifetime substance abuse comorbidity is frequent in schizophrenic patients, but the clinical correlates remain unclear. We have explored the chronological relations between substance abuse and course of schizophrenia, and compared several clinical characteristics and personality dimensions in 50 schizophrenic patients with or without lifetime substance abuse or dependence. Abuse occurred mainly after the first prodromal symptoms and just before the first psychotic episode. Substance-abusing patients were not different from non-substance-abusing patients on the Chapman Physical Anhedonia Scale, PANSS total score, negative subscore or depression item, CGI, treatment response and demographic variables. In contrast, substance-abusing patients had higher scores on the Barratt Impulsivity Scale (total, cognitive and non-planning scores) and had attempted suicide more often. In patients with schizophrenia, as in the general population, substance abuse or dependence appears associated with higher impulsivity and suicidality. High impulsivity could facilitate substance abuse as a maladaptive behavior in response to prodromal symptoms, precipitating the onset of a characterized psychosis.

Epidemiologic studies in the general population and those based on the clinical assessment of schizophrenic populations have revealed a high degree of overlap between schizophrenia and addictive disorders. The abuse of psychoactive substances (including alcohol) throughout life is so frequent (50%) that the possibility of a specific link inevitably arises. Various hypotheses have been suggested to explain the high co-morbidity between schizophrenia and addiction: 1) The social-environmental hypothesis has been developed but studies have provided poor evidence to validate it. 2) The possible shared biological vulnerability between schizophrenia and addictions led researchers to explore common genetic determinants and study the involvement of the dopaminergic and opioid systems in the aetiology of both schizophrenia and the abuse of and dependence on psychoactive drugs. 3) Finally, the theory of self-medication suggests that schizophrenics may be attempting to counter the deficit linked to their disorders by using the substances they take or their dependency-type behaviour to cope with their emotional problems. The clinical profile of schizophrenic addicts does seem to display some distinctive features, such as the high level of depressive co-morbidity, very high nicotine and alcohol dependence, with a very poor prognosis. These patients are difficult to manage; the possibility of pharmacologic interactions between the substances they are taking and neuroleptic medication calls for prudence, and their compliance is also poor. Addictive disorders in schizophrenics are currently a topic of active research intended to lead to identifying specific treatments. The early identification of addictive disorders in schizophrenics should make it possible to limit their development and improve the prognosis.

The aim of this study was to assess the associations between substance use disorders and temperamental characteristics in subjects with non-affective psychotic disorders or mood disorders. Consecutively hospitalized patients were interviewed with a structured diagnostic interview to define DSM-IV diagnoses, including those of substance use. Temperamental characteristics were measured using the Sensation-Seeking Scale (SSS), the Barratt Impulsivity Scale (BIS) and the Physical Anhedonia Scale. Inpatients (n=103) with non-affective psychotic disorders (n=45) or mood disorders (n=58) were included. Among these patients, 25.2% presented with a lifetime (LT) history of alcohol abuse/dependence and 23.3% presented with a LT history of cannabis abuse/dependence. A LT history of alcohol misuse was independently associated with higher scores at the 'experience seeking' and 'disinhibition' subscales of the SSS. A LT history of cannabis misuse was independently associated with higher scores on the 'disinhibition' subscale of the SSS and on the 'non-planning activity' subscale of the BIS. These results suggest that sensation-seeking and impulsivity are temperamental characteristics that may favor substance use in patients with psychotic or mood disorders, independently from categorical diagnoses.

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerström test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.