Page 55 - TRAMES-BP®

Temperamental Dimensions and

substrate and predominant treatment implications

polarity “Dysphoric or mixed mania”

(Hostility, uncooperativeness,suspiciousness)

Irritable temperament • Mood stabilizers from “above”: Lithium,
(non specific VPA, olanzapine, aripiprazole,

predominant polarity) ziprasidone, ECT

• High or intermediate “polarity index”

agents: aripiprazole, ziprasidone,
olanzapine
Unstable Cyclothymic • Avoid antidepressants

temperament “Mixicity”

(Anxiety, tension, motor hyperactivity, suicidality,
excitement, NO psychomotor retardation)

Anxious temperament • Mood stabilizers from “below”: Lithium,

(depressive lamotrigine, olanzapine, quetiapine, ECT

predominant polarity) • Intermediate or low “polarity index”
agents: Lithium, olanzapine, quietiapine,

lamotrigine
• BDZ for anxiety, psychomotor agitation
• Avoid antidepressants

Ketter and Calabrese, 2002; Popovic et al, 2011; Pacchiarotti et al, in preparation