Abstract:
:Current formal psychiatric approaches to nosology are plagued by an unwieldy degree of heterogeneity with insufficient appreciation of the commonalities of emotional, personality, behavioral, and addictive disorders. We address this challenge by building a spectrum model that integrates the advantages of Cloninger's and Akiskalian approaches to personality and temperament while avoiding some of their limitations. We specifically propose that "fear" and "anger" traits--used in a broader connotation than in the conventional literature--provide an optimum basis for understanding how the spectra of anxiety, depressive, bipolar, ADHD, alcohol, substance use and other impulse-control, as well as cluster B and C personality disorders arise and relate to one another. By erecting a bidimensional approach, we attempt to resolve the paradox that apparently polar conditions (e.g. depression and mania, compulsivity and impulsivity, internalizing and externalizing disorders) can coexist without cancelling one another. The combination of excessive or deficient fear and anger traits produces 4 main quadrants corresponding to the main temperament types of hyperthymic, depressive, cyclothymic and labile individuals, which roughly correspond to bipolar I, unipolar depression, bipolar II and ADHD, respectively. Other affective temperaments resulting from excess or deficiency of only fear or anger include irritable, anxious, apathetic and hyperactive. Our model does not consider schizophrenia. We propose that "healthy" or euthymic individuals would have average or moderate fear and anger traits. We further propose that family history, course and comorbidity patterns can also be understood based on fear and anger traits. We finally discuss the implications of the new derived model for clinical diagnosis of the common psychiatric disorders, and for subtyping depression and anxiety as well as cognitive and behavioral styles. We submit this proposed schema represented herein as a heuristic attempt to build bridges between basic and clinical science.
journal_name
J Affect Disordjournal_title
Journal of affective disordersauthors
Lara DR,Pinto O,Akiskal K,Akiskal HSdoi
10.1016/j.jad.2006.02.025subject
Has Abstractpub_date
2006-08-01 00:00:00pages
67-87issue
1-3eissn
0165-0327issn
1573-2517pii
S0165-0327(06)00129-7journal_volume
94pub_type
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:Journal of affective disorders
pub_type: 杂志文章
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journal_title:Journal of affective disorders
pub_type: 杂志文章
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pub_type: 杂志文章
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