This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. Temperament and Mood Disorders in
Adulthood: Generalized Anixety Disorder
 William Sulis, M.D., FRCPC, Ph.D., Ph.D.
 Department of Psychiatry and Behavioral Neuroscience,
 McMaster University, Canada
 European Psychiatric Association, Florence, Italy 2017
 Trofimova I, Sulis W) Benefits of distinguishing between physical and social-verbal aspects of .
(2016 behaviour: an example of generalized anxiety. Frontiers in Psychology. 2016 7:338
DOI:103389psyg201600338

2. Motivation
 Temperament, Personality Disorders and Mental Illness appear
to lie along a continuum
Temperament  Personality Disorders  Mental Illness
 This may be due to their sharing underlying neurobiological
systems or possibly due to unidirectional or bidirectional causal
relationships.
 The coupling of temperament and mental illness thus provides
an opportunity to explore their biological roots and causal
relationships

3. DSM Criteria for Generalized Anxiety
Disorder (GAD)
GAD
Muscle tension
Sleep disturbanceRestlessness
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability

4. Previous Studies of Temperament and
Generalized Anxiety
Generalized Anxiety Disorder
Emotionality Traits
Elevated Harm Avoidance
Elevated Neuroticism
Non-emotionality traits
Elevated Behavioral Inhibition
Decreased Self-Directedness
Decreased Extraversion
Inconsistent findings related to other
traits

5. • Functional
aspects:
• Behav.
orientation to…
(NE+...)
• Speed of
integration
• (DA+…)
• Energetic
aspects
• (5-HT+…)
• Probabilisti
c/ intellectual
aspects
• ... to learning
probabilities, PRO
• NE-DA
• Plasticity,
• PL
• DA+5-HT
• Intellectual
Endurance, ERI
• 5-HT+NE, ACh
• Social-
verbal
• to others:
Empathy-Autism,
EMP
• NE, OXY, VSP
• Social Tempo,
• TMS
• DA+PRL,OXY,
• Social
Endurance, ERS
• 5-HT, NP, OXY
• Physical-
motor
• Determinist
ic aspects
• …to
sensations,
• SS
• NE, αAR,
Cortisol?
• Motor Tempo,
• TMM
• DA+PRL, NP
• Motor
Endurance ERM,
• 5-HT-ACh, GH
• Emotional
amplifier
Neuroticism, NEU
KOPr→NE-HPA
KOPr > MOPr
Impulsivity, IMP
DOPr→(DA, MOPr
BDNF, CREB)
Confidence, SLF
MOPr→(5-HT, DA)
MOPr > KOPr
Rusalov V.M., Trofimova I.N. (2007). Structure of temperament and its measurement. PSP Psychological Services Press: Toronto, Canada
Trofimova, I. (2015) Functional specialization of neurotransmitter systems converges with a taxonomy for non-emotionality traits of adult
temperament. Submitted to Frontiers in Human Neuroscience.
Trofimova, I. & Robbins, T.W. (2015) Temperament and arousal systems: a new synthesis of differential psychology and functional neurochemistry.
Submitted to Neuroscience and Biobehavioral Reviews.
Temperament and Neurochemistry

6. Neurochemistry of GAD
Serotonin,
Noradrenaline,
Dopamine,
GABA,
Glutamate
Kappa-opioid receptors
Neuropeptide Y
Substance P

7. Neurochemistry of Anxiolytics
 CRF antagonists
 GABAA agonists (subtype specific in future)
 5-HT1A agonist
 5-HT2A antagonist
 5-HT3 antagonist
 Glutamate antagonist
 Cholecystokinin antagonist

8. Method: Anxiety Study
 3 age groups 18-24, 25-45, 46-65
 152 patients were diagnosed with Generalized Anxiety Disorder
according to DSM-V criteria and supported on the basis of:
 Beck Anxiety Inventory (scores of 16 or higher)
 State Trait Anxiety Inventory (scores of 61 or higher)
 Detailed Assessment of Post-traumatic Stress inventory
 Post-Traumatic Stress diagnostic scale
 Symptom CheckList-90 (scores of 31 or higher on the Anxiety scale)
 DSM-IV structured clinical interview
 File review
 156 Normal controls without diagnosis of anxiety or depression

9. Anxiety and Temperament
• Functional
aspects:
• Energetic aspects
• Dynamic
al aspects
• Behav.orientati
on to
• Physical
aspects
• Motor
Endurance, ERM
• Motor
Tempo,TMM
• .. to
sensations, SS
• Social-
verbal aspects
• Social
Endurance, ERS
• Social
Tempo, TMS
• ..to others–
Empathy,EMP
• Mental
aspects
• Intellectual
Endurance,ERI
• Plasticit
y, PL
• .. to
probabilities, PRO
• Emotionality
• Self-confidence,
SLF
• Impulsiv
ity, IMP
• Neuroticism,
NEU
Blue – decrease
Red - increase

10. Comorbid Depression and GAD
 2 age groups 25-45, 46-65
 96 patients were diagnosed with diagnoses of both
Major Depression and Generalized Anxiety Disorder
using the aforementioned criteria

11. Comorbid Depression and Anxiety and
Temperament
• Functi
onal
aspects:
• Energetic
aspects
• Dyn
amical
aspects
• Behav.ori
entation to
• Physic
al aspects
• Motor
Endurance,
ERM
• Mot
or
Tempo,T
MM
• .. to
sensations,
SS
• Social-
verbal
aspects
• Social
Endurance,
ERS
• Soc
ial
Tempo,
TMS
• ..to
others–
Empathy,EM
P
• Mental
aspects
• Intellectua
l
Endurance,ERI
• Pla
sticity,
PL
• .. to
probabilities,
PRO
• Emotio
nality
• Self-
confidence,
SLF
• Imp
ulsivity,
IMP
• Neurotici
sm, NEU

12. Comparisons of Effects among Diagnoses
 Depression - greatest decreases in ERM, TMM, SS
 Depression – least increase in NEU
 Comorbid – greatest decrease in ERS, TMS, ERI,
PL, Pro, SLF
 Comorbid - greatest increase in Imp
 Generalized Anxiety - least decrease overall in ERI,
PL, Pro, ERS, TMS
 Generalized Anxiety - least increase in Imp
 Generalized Anxiety - greatest increase in Neu

13. References:
Rusalov V.M., Trofimova I.N. (2007). Structure of temperament and its measurement. PSP Psychological Services Press: Toronto,
Canada (STQ manual, free for researchers or for work on its adaptation)
Trofimova (2009) Exploration of the benefits of an activity-specific test of temperament. Psychological Reports, 105, 643-658.
Trofimova, I. (2010). An investigation into differences between the structure of temperament and the structure of personality.
American Journal of Psychology. 123, 4, 467-480.
Trofimova, I. (2010). Exploration of the activity-specific model of temperament in four cultures. International Journal of Psychology and
Psychological Therapy. 10, 1, 79-95.
Trofimova, I. (2010) Questioning the “general arousal” models. Open Behavioral Science and Psychology, 4, 1-8.
Trofimova, I. & Sulis W. (2010). An investigation of temperament in adults with comorbid depression and anxiety. Advances in
Bioscience and Biotechnology, 1(3), 190-199. DOI: 10.4236/abb.2010.13027
Trofimova, I. & Sulis W. (2011). Is temperament activity-specific? Validation of the Structure of Temperament Questionnaire –
Compact. International Journal of Psychology and Psychological Therapy, 11(3), 389-400.
Trofimova, I. (2015b) Functional specialization of neurotransmitter systems converges with a taxonomy for non-emotionality traits of
adult temperament. Submitted to Frontiers in Human Neuroscience.
Trofimova, I. & Robbins, T.W. (2015) Temperament and arousal systems: a new synthesis of differential psychology and functional
neurochemistry. Submitted to Neuroscience and Biobehavioral Reviews.
Trofimova, I. & Sulis W. (2016). An investigation of coupling of temperament traits with anxiety symptoms gives new insights for
diagnostic criteria. Frontiers in Psychology 2016 7:338 DOI:103389psyg201600338
Trofimova, I. & Sulis W. (2016). Universality of the coupling of temperament traits with depression across the adult age spectrum.
Frontiers in Psychology DOI: 103389psyg201601848