Wendy Dávila

The Influence of the Val158Met Catechol-O-Methyltransferase Polymorphism on the Personality Traits of Bipolar Patients

Introduction Certain personality traits and genetic polymorphisms are contributing factors to bipolar disorder and its symptomatology, and in turn, this syndrome influences personality. The aim of the present study is to compare the personality traits of euthymic bipolar patients with healthy controls and to investigate the effect of the catechol-O-methyltransferase (COMT) Val158Met genotype on those traits. We recruited thirty seven bipolar I patients in euthymic state following a manic episode and thirty healthy controls and evaluated their personality by means of the Cloninger’s Temperament and Character Inventory (version TCI-R-140). We assessed the influence of the polymorphism Val158Met in the COMT gene on the personality of these patients. The patients scored higher than controls in harm avoidance (61.3±12.5 vs. 55.3±8.1) and self-transcendence (45.3±12.8 vs. 32.7±8.2) and scored lower than controls in self-directedness (68.8±13.3 vs. 79.3±8.1), cooperativeness (77.1±9.1 vs. 83.9±6.5) and persistence (60.4±15.1 vs. 67.1±8.9). The novelty seeking dimension associates with the Val158Met COMT genotype; patients with the low catabolic activity genotype, Met/Met, show a higher score than those with the high catabolic activity genotype, Val/Val. Conclusions Suffering from bipolar disorder could have an impact on personality. A greater value in harm avoidance may be a genetic marker for a vulnerability to the development of a psychiatric disorder, but not bipolar disorder particularly, while a low value in persistence may characterize affective disorders or a subgroup of bipolar patients. The association between novelty seeking scores and COMT genotype may be linked with the role dopamine plays in the brain’s reward circuits.

Por qué no hablamos de síntomas psicóticos negativos en el trastorno afectivo bipolar

The classifications of the psychiatric disorders that we manage1 contemplate the possibility of positive psychotic symptoms being present in bipolar disorder. They describe how these symptoms can appear in both the depressive and the manic and the mixed phases, how they can be congruent or incongruent with patient mood and, lastly, how they can adopt the form of delirium and/or hallucinations. These classifications also add that these symptoms cannot persist more than 2 weeks once the affective episode has been resolved, because we would have to change the diagnosis if they did last longer. We often notice that symptomatic recovery is not accompanied by functional recovery in the bipolar patient.2 Among other factors, this deficiency is attributed to the proven cognitive deterioration3 and to what are called interepisode subsyndromal depressive symptoms4 that these patients suffer. In this sense, it would be interesting to try to discriminate (which is sometimes quite complicated) whether these subsyndromal depressive symptoms are really negative psychotic symptoms in some cases. Perhaps we should consider a differential diagnosis of these symptoms that is the «inverse» of what we do with the schizophrenic patient and their negative symptoms.5 We feel that, in schizophrenic patients, it is useful to carry out a differential diagnosis of the negative psychotic symptoms with possible depressive symptoms and we also consider this fact to be important in treatment. Bipolar patients sometimes show a type of symptoms that, in a schizophrenic patient, would be called negative psychotic symptoms.6 In fact, the clinical presentation is identical and we do not know the aetiopathogenesis. Our reticence to speak about negative psychotic symptoms in bipolar disorder could be related to our fear of creating even more confusion than what already exists. If these symptoms are found even when the patient is euthymic and the symptoms persist over time, it is possible

La dificultad diagnóstica del paciente con síntomas afectivos y psicóticos

El diagnostico del paciente en el que coexisten sintomas afectivos y sintomas psicoticos entrana cierta dificultad. En primer lugar tenemos que ver si el paciente tiene un trastorno afectivo, y en Segundo lugar, si presenta sintomatologia psicotica, tenemos que decidir si esta es congruente o no con el estado de animo. En este articulo se revisa la situacion actual de este tema, y se contrastan las opiniones de distintos autores. Tambien se reflexiona sobre los puntos donde mas dificultades encontramos a la hora de diagnosticar a estos pacientes, como que presente delirios persecutorios o sintomas de primer rango de Schneider. Se concluye que son necesarias bases mas objetivas para clasificar a estos pacientes.