Free University of Brussels, Brugmann University Hospital, Psychiatry and Medical Psychology Department, Place Van Gehuchten 4, 1020 Brussels,
1 Free University of Brussels, Erasme University Hospital, Psychiatry Department, Route de Lennik 808, 1070 Brussels and
2 Free University of Brussels, Erasme University Hospital, Public Health Department, Route de Lennik 808, 1070 Brussels, Belgium
Received 27 November 2000; in revised form 29 April 2001; accepted 4 June 2001
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ABSTRACT |
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INTRODUCTION |
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We used the TCI (Cloninger et al., 1993; Svrakic et al., 1993
), a more precise and complete version of the TPQ, for assessing Temperament and Character. Character may be determined by genetic and biological factors but is more influenced by environmental factors than Temperament, and is therefore less stable over time. It is divided into three independent dimensions: Self-Directedness, which is the main predictive element of the presence of personality disorder, Cooperation, which modulates the probability of personality disorder obtained from Self-Directedness, and Self-Transcendence. The present study attempts first to show personality traits that differentiate an alcohol-dependent population from a non-psychiatric control population using the TCI. A second component of this work examines subgroups of alcohol-dependent patients through evaluation of several typology aspects of Cloninger's hypothesis. The criteria used in our search for subgroups based on TCI scores are age of onset, paternal dependence on alcohol, and familial antecedents of alcohol dependence.
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SUBJECTS AND METHODS |
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Controls, recruited using a public announcement in a general hospital, consisted of 47 healthy volunteers (27 male and 20 female). They had been screened using the same semi-structured interview (Spitzer et al., 1992). Exclusion criteria were present or previous alcohol dependence or misuse, significant somatic or psychiatric disorder at the time of the study, significant psychiatric disorder in the past and familial antecedents of affective or psychotic disorders. The mean age of this sample was 44 ± 13 years.
Patients taking part underwent the unit's standard regimen. This included tapered, individually titrated, doses of diazepam (up to 120 mg per day in severe cases), vitamin B complex and large amounts of sugared fluids, in order to keep the withdrawal process under control. Patients were requested to stop all consumption of alcoholic beverages and non-prescribed drugs from their first hospital day.
They were asked to fill in a written TCI Self-evaluation questionnaire (226 questions with forced binary answer) at the end of the second week of abstinence. At that time, they were fully abstinent and no longer needing medication to control withdrawal symptoms. We used a French translation of this test checked by retro-translation. Patients were asked about their age at the onset of alcohol-related problems, defined as their recall of the first occurrence of alcohol-related problems. Early onset was defined as 25 years, late onset as >25. Patients were asked whether alcohol-dependence had affected other family members.
Statistics
We used the program SPSS 7.5 for Windows. All dimension scores were normally distributed for all groups and subgroups of subjects (the KolmogorovSmirnov test was not significant for any main dimension). We applied unpaired t-test and 2-tests to compare dependent and non-psychiatric groups, alcoholics with and without paternal dependence on alcohol and with and without familial antecedents of alcohol dependence. To compare early-onset alcoholics, late onset alcoholics and non-psychiatric subjects, global one-way analysis of variance for the three groups was used and sex adjustment was tested. For multiple comparisons, the Scheffé procedure at the 5% significance level was applied (Scheffé, 1959
).
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RESULTS |
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DISCUSSION |
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We used Belgian healthy volunteers rather than published normative data, because TCI normative data may differ between countries (Pelissolo and Lepine, 2000) and TCI translations. However, our control sample could differ from the general population, as most were hospital employees (nurses, hospital technicians, etc.) and volunteered to take the test, but no other Belgian data (using the same TCI translation) were available to compare with the scores of our control sample.
In this relatively small study, our search for sub-types of alcoholics with different TCI personality profiles yielded only two subgroups, early-onset and late-onset. In our data, high Novelty-Seeking scores characterized early-onset patients and can be seen as predisposing to early-onset alcoholism. Lower character scores (Self-Directedness and Cooperation) indicating a higher probability of personality disorder were present in both subgroups, but more so in the early-onset subgroup.
These results agree partly with the Cloninger's typology (I and II), in that we found an association between early-onset and high Novelty-Seeking. However, our TCI data give new information suggesting more frequent personality disorder in early-onset alcoholism (in addition to that already published using the TPQ) and, as already found in previous studies (Irwin et al., 1990; Peterson et al., 1991
; Zaninelli et al., 1992
), we found no influence of paternal or family history of alcohol dependence on personality profile or on the age of onset of alcohol-related problems.
A possible limitation of our study was that the TCI data were not corrected for the influence of residual depressive symptoms, which may still be present after alcohol withdrawal, even when patients with major depressive disorder have been excluded. If depressive symptoms had been commoner in the late-onset group, this could have exaggerated some of the TCI differences we have reported. Our sample would, unfortunately, have been too small to make the appropriate adjustments.
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FOOTNOTES |
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