Childhood temperament is associated with distress, anxiety and reduced quality of life in schizophrenia spectrum disorders

Abstract

Schizophrenia is conceptualized as a neurodevelopmental disorder and pre-morbid differences in social function and cognition have been well-established. Less is known about pre-morbid temperament and personality. Inhibited temperament-the predisposition to respond to novelty with wariness, fear, or caution-is a premorbid risk factor for anxiety, depression, and substance use but is understudied in schizophrenia. Participants were patients with schizophrenia spectrum disorders (n = 166) and healthy controls (n = 180). Patients completed measures of childhood inhibited temperament, clinical symptoms (anxiety, depression, PANSS factors), and quality of life. Patients had significantly higher levels of inhibited temperament relative to healthy controls. In patients with schizophrenia, higher inhibited temperament was significantly associated with comorbid anxiety disorders, greater anxiety and depression symptoms, higher PANSS Distress scores, lower PANSS Excitement scores, and lower quality of life. The current findings replicate and extend previous research with a larger sample and are consistent with vulnerability in an affective path to psychosis. In schizophrenia, higher inhibited temperament was associated with a cluster of mood and anxiety symptoms. Inhibited temperament was not associated with psychosis symptoms. Patients with high inhibited temperament may especially benefit from treatments that specifically target anxiety and depression.

Behavioral Inhibition in Childhood: European Portuguese Adaptation of an Observational Measure (Lab-TAB)

“…BI has been one of the most studied antecedents of Social Anxiety Disorder [ 7 , 8 , 9 ], and meta-analytic results suggest that behaviorally inhibited children have a seven-fold increase in risk for the later emergence of social anxiety symptoms [ 10 ]. BI has also gained relevance as one of the factors involved in the manifestation of other disorders, such as depression in young adulthood [ 11 , 12 ], schizophrenia [ 13 ], selective mutism [ 14 , 15 ], autism spectrum disorders [ 16 ], general substance abuse [ 17 ] and psychopathic-like personality [ 18 ]. Recently, its importance as a transdiagnostic factor across mood and psychotic disorders has been evidenced [ 19 ].…”

Temperament Profiles of Children and Adolescents with Psychotic and Mood Disorders

“…Another factor affecting this difference might be parents’ expectations, comparing their children’s social performance to the behaviour of the children’s peer groups (which still could be a valid source of information). Diminished socialization in delusional teenagers was noted previously in the literature [8, 9, 24, 40], with increasingly low self-image and low and irritable moods [11, 13, 25, 26]. Age-related differences in the impulsivity trait might be related to the gradual maturation of impulse control, which still might be weak in the 5–12 years age group but gets stronger in adolescence.…”

“…It has been found to be associated with many types of mental illness in adults [16] but is not a predictor of pathology in children [24]. More consistent predictors of psychopathology in children, including psychotic disorders and bipolar disorders, appear to be low self-image and low and irritable moods [10, 11, 25-27] and also low energetic traits of temperament [24] rather than anxiety. Psychotic disorders with an early onset often have comorbidity with depression, and the “signature” symptoms of depression are fatigue and lack of motivation.…”

“…Instead, in children these disorders mainly affected impulse control and self-esteem. For example, studies of children and teens with bipolar disorders or with parents suffering from bipolar disorders, showed that these children have lower moods and cooperativeness, higher impulsivity, higher rigidity, and compromised orientation on a task [8-11, 27-32], in comparison to controls. Mood disorders, according to the FET, are likely based on dysregulation within opioid receptor systems.…”

Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia

“…13 Moreover, the prominence of inhibited temperament that emerges in early childhood among individuals with schizophrenia affects anxiety and quality of life later in adulthood. 14 The World Health Organization (WHO) defines health as the absence of any disease and the presence of well-being from the physical, social, and mental perspectives. 15 The concept of quality of life, which encompasses personal satisfaction with life, interpretations of environmental living conditions, and assessments of functioning in life matters, has become a significant part of the medical management of individuals with schizophrenia.…”