Type A behaviour differentiates bipolar II from unipolar depressed patients

Abstract

Background: A relation between the type A behaviour pattern (TABP) and coronary heart disease has been found in many studies and the existence of a psychiatric coronary-prone mood profile has been suggested. TABP consist of fairly stable character traits such as time urgency, impatience, irritability and competitiveness, which in patients with affective disorders could be bipolar traits. The aim of this study was to compare TABP in depressed unipolar and bipolar II patients, and explore the relation between TABP, affective temperaments and migraine headaches, another disorder associated with bipolar II disorder.

Methods: The Jenkins Activity Survey (JAS) (Form C), a self-report multiple-choice questionnaire designed to measure TABP, was given to 99 patients diagnosed with a DSM-IV major affective disorder. Affective temperaments were diagnosed according to Akiskal's criteria and migraine diagnosed according to the criteria of the International Headache Society. The JAS was scored in the traditional manner, yielding scores for TABP and three factorially independent components, speed and impatiens (factor S), job involvement (factor J) and hard-driving and competitive (factor H).

Results: 65 patients diagnosed with a unipolar (n = 42) or bipolar II (n = 23) disorder had valid scores on the JAS. Patients with bipolar II diagnosis had significantly higher JAS scores than the unipolar patients (Wilks' lambda = 0.851, F = 2.62, df = 4, 60, p < 0.05). Type A behaviour differed (total JAS score: mean square 509.3, df = 1, F = 9.4, p < 0.005), mainly due to a divergence in factor S (mean square 465.5, df = 1, F = 6.0, p < 0.02). Higher JAS scores were significantly associated with having a cyclothymic temperament (Wilks' lambda = 0.728, F = 4.30, df = 4, p = 0.005) and lower JAS scores with having a depressive temperament (Wilks' lambda = 0.747, F = 3.13, df = 4, p = 0.026). TABP was not associated with migraine.

Limitations: Non-blind, cross-sectional assessment of affective disorders and migraine headaches and questionnaire-based type A behaviour assessment.

Conclusions: These results indicate that a well-established questionnaire designed to recognize the type A behaviour pattern, distinguishes depressed unipolar from depressed bipolar II patients as well.