TEMPERAMENT IN INDIVIDUALS WITH PSYCHOTIC DISORDERS BEFORE AND AFTER THE ONSET OF ILLNESS Jouko Miettunen Department of Psychiatry, University of Oulu, Finland

Cloninger’s temperament dimensions novelty seeking tendency to respond with intense excitement to novel stimuli and thereby initiating behavior harm avoidance tendency to respond intensively to signals of aversive stimuli, thereby stopping behavior reward dependence tendency to respond intensely to signals of reward, especially social rewards, thereby continuing particular behaviors Persistence tendency to persevere in behaviors that have been associated with reward Temperament and Character Inventory (TCI) 107 temperament no/yes items potential intermediate phenotypes in different psychiatric disorders Cloninger et al. Arch Gen Psychiatry 1993;50:975–90.

P=0.061 P=0.048 P=0.037 P=0.147 Effect sizes (Cohen’s d): small, medium, and >0.8 large effect Comparisons between cases and controls in bipolar disorders and schizophrenia Meta-analysis Miettunen J & Raevuori A. Compr Psychiatry 2012; 53:

Northern Finland 1966 Birth Cohort Oulu live-born children in the provinces of Oulu and Lapland

31-year and 43-year follow-up studies psychotic individuals, with the onset of illness before the 31-year follow-up (n=16) Males/Females: 5/11, schizophrenia/other: 9/7 psychotic individuals, with the onset of illness after the 31-year follow-up (n=15, 5 males) Males/Females: 5/10, schizophrenia/other: 2/13 healthy controls (n=99; M/F: 49/50) Temperament items (TCI) psychotic symptoms (PANSS at age 43) Northern Finland 1966 Birth Cohort

 The 31-year and 43-year temperament scores correlated strongly among controls (0.54 to 0.68), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (0.17 to 0.53).  Individuals who had their onset of psychosis after the first follow-up had a significant (p=0.02) increase in harm avoidance from age 31 to 43-years when compared to controls. Results

 High harm avoidance before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS.  High novelty seeking before illness associated with a higher likelihood of remission according to the PANSS.  At the age of 43 years, harm avoidance correlated highly positively with the total PANSS score, especially among those with earlier onset of psychosis (r = 0.86), but also among those with onset after the age of 31 years (r=0.44). Results

Temperament was stable among controls, and more unstable in individuals with psychoses. In psychoses, increase in harm avoidance associated with getting ill, and it had a very strong positive association with the amount and severity of symptoms. Premorbid harm avoidance and novelty seeking may be used to predict clinical outcome in schizophrenia. When studying the temperament in psychoses, the duration of illness and symptom severity should be taken into account. Discussion

Acknowledgements: This study has been supported by the Academy of Finland, the NARSAD: the Brain and Behavior Research Fund, the Sigrid Jusélius Foundation, the Jalmari and Rauha Ahokas Foundation, and the US National Institutes of Health (NIMH). NO CONFLICT OF INTEREST Research team: Jouko Miettunen, Pauliina Juola, Eka Roivainen, Juha Veijola, Antti Alaräisänen, Matti Isohanni, Erika Jääskeläinen