{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:35:55Z","timestamp":1769607355815,"version":"3.49.0"},"reference-count":63,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Cystic Fibrosis Research Foundation","award":["FFC Grant Application 2021"],"award-info":[{"award-number":["FFC Grant Application 2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>The aim of this study was to investigate the association between Cystic Fibrosis (CF) and affective temperaments, considering the relevance of ionic balances in neural excitability, as a possible neurobiological basis for temperamental expression. A cross-sectional study involving 55 adult CF patients was conducted. Sociodemographic, clinical and therapeutic characteristics, temperamental and personality dispositions and depressive and anxiety symptoms were evaluated through standardized semi-structured and structured interviews. The majority of the enrolled CF patients were receiving Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) therapy (72.7%), and most of them had hyperthymic temperament predominance (29.1%). Different TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire) dimensions were not associated with the type of CF phenotype-related mutation or with the use of CFTR-modulator therapy. However, a tendency towards irritability was noted in patients not undergoing CFTR modulator therapy (6.7 \u00b1 4.72 vs. 4.7 \u00b1 4.33; p = 0.13). In light of the limitations imposed by the cross-sectional nature of the study, a hyperthymic temperament was found to be protective against current or lifetime psychopathologic events, whereas the other temperaments were associated with positive psychopathological anamnesis. Based on the measurement of temperament profiles and the study of their associations with clinically relevant variables, we argue that subjecting CF patients to such a temperament assessment could prove beneficial in the transition towards integrated and personalized care.<\/jats:p>","DOI":"10.3390\/brainsci13040619","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T05:42:44Z","timestamp":1680673364000},"page":"619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Expression of Affective Temperaments in Cystic Fibrosis Patients: Psychopathological Associations and Possible Neurobiological Mechanisms"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-340X","authenticated-orcid":false,"given":"Andrea","family":"Amerio","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-2021","authenticated-orcid":false,"given":"Luca","family":"Magnani","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Pathological Addictions, Genoa Local Health Authority, 16126 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1916-0963","authenticated-orcid":false,"given":"Carlo","family":"Castellani","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini\u2014Ospedale Pediatrico, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-2977","authenticated-orcid":false,"given":"Irene","family":"Schiavetti","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Section of Biostatistics, University of Genoa, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Sapia","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Sibilla","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Pescini","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini\u2014Ospedale Pediatrico, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosaria","family":"Casciaro","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini\u2014Ospedale Pediatrico, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2483-5374","authenticated-orcid":false,"given":"Federico","family":"Cresta","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini\u2014Ospedale Pediatrico, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Escelsior","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6387-6462","authenticated-orcid":false,"given":"Alessandra","family":"Costanza","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), 1211 Geneva, Switzerland"},{"name":"Department of Psychiatry, Adult Psychiatry Service (SPA), University Hospitals of Geneva (HUG), 1211 Geneva, Switzerland"},{"name":"Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2003-2101","authenticated-orcid":false,"given":"Andrea","family":"Aguglia","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6631-856X","authenticated-orcid":false,"given":"Gianluca","family":"Serafini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Amore","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy"},{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2912-1792","authenticated-orcid":false,"given":"Riccardo","family":"Ciprandi","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Center, IRCCS Istituto Giannina Gaslini\u2014Ospedale Pediatrico, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"ref_1","unstructured":"Eliade, M., and Jesi, F. (1995). Lo Yoga: Immortalit\u00e0 e Libert\u00e0, Rizzoli."},{"key":"ref_2","unstructured":"Fielding, H., and Garrison, M.L. (1926). Translated by Various Hands and Edited, with Foreword and Biographical Sketch, Books for Libraries Press."},{"key":"ref_3","unstructured":"Kagan, J. (1994). Galen\u2019s Prophecy: Temperament in Human Nature, Basic Books."},{"key":"ref_4","unstructured":"Lamb, M.E., and Brown, A.L. (1981). Advances in Developmental Psychology, Lawrence Erlbaum Associates."},{"key":"ref_5","unstructured":"Kessen, W. (1966). The Child, John Wiley & Sons."},{"key":"ref_6","first-page":"7","article-title":"Child temperament: An integrative review of concepts, research programs, and measures","volume":"2","author":"Zentner","year":"2008","journal-title":"Eur. J. Dev. Sci."},{"key":"ref_7","unstructured":"Schneider, K. (1958). Le Personalit\u00e0 Psicopatiche, Giovanni Fioriti Editore."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Emil Kraepelin, E., and Livingstone, S. (1921). Manic-Depressive Insanity and Paranoia (Classics in Psychiatry), Ayer Co Pub.","DOI":"10.1097\/00005053-192104000-00057"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jad.2004.08.002","article-title":"The theoretical underpinnings of affective temperaments: Implications for evolutionary foundations of bipolar disorder and human nature","volume":"85","author":"Akiskal","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jad.2015.12.077","article-title":"A meta-analysis of temperament and character dimensions in patients with mood disorders: Comparison to healthy controls and unaffected siblings","volume":"194","author":"Zaninotto","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jad.2014.04.006","article-title":"A three-year longitudinal study of affective temperaments and risk for psychopathology","volume":"164","author":"Degeorge","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jad.2003.12.009","article-title":"Validating affective temperaments in their subaffective and socially positive attributes: Psychometric, clinical and familial data from a French national study","volume":"85","author":"Akiskal","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/YCO.0b013e32833299d4","article-title":"Current research on affective temperaments","volume":"23","author":"Rihmer","year":"2010","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jad.2011.11.011","article-title":"Cyclothymic-depressive-anxious temperament pattern is related to suicide risk in 346 patients with major mood disorders","volume":"136","author":"Pompili","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jad.2010.04.015","article-title":"Hyperthymic temperament may protect against suicidal ideation","volume":"127","author":"Gonda","year":"2010","journal-title":"J. Affect. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jpsychires.2021.10.004","article-title":"Examining the relationship between early childhood temperament, trauma, and post-traumatic stress disorder","volume":"144","author":"Wiseman","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"R986","DOI":"10.1016\/S0960-9822(01)00581-4","article-title":"Central pattern generators and the control of rhythmic movements","volume":"11","author":"Marder","year":"2001","journal-title":"Curr. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1523\/JNEUROSCI.3677-05.2006","article-title":"Block of Inferior Olive Gap Junctional Coupling Decreases Purkinje Cell Complex Spike Synchrony and Rhythmicity","volume":"26","author":"Blenkinsop","year":"2006","journal-title":"J. Neurosci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1109\/MEMB.2009.934619","article-title":"Hippocampal gamma oscillations in rats","volume":"28","author":"Akay","year":"2009","journal-title":"IEEE Eng. Med. Biol. Mag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1017\/S0924270800035468","article-title":"Dysregulation of ion fluxes in bipolar affective disorder","volume":"12","author":"Grunze","year":"2000","journal-title":"Acta Neuropsychiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S0193-953X(18)30995-X","article-title":"Cyclothymic Temperamental Disorders","volume":"2","author":"Akiskal","year":"1979","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jad.2012.07.028","article-title":"TEMPS-A and long-term lithium response: Positive correlation with hyperthymic temperament","volume":"145","author":"Rybakowski","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.3389\/fphar.2019.01662","article-title":"CFTR Modulators: The Changing Face of Cystic Fibrosis in the Era of Precision Medicine","volume":"10","year":"2020","journal-title":"Front. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"190112","DOI":"10.1183\/16000617.0112-2019","article-title":"Impact of CFTR modulator use on outcomes in people with severe cystic fibrosis lung disease","volume":"29","author":"Shteinberg","year":"2020","journal-title":"Eur. Respir. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/MCP.0000000000000617","article-title":"Prevention of anxiety and depression in cystic fibrosis","volume":"25","author":"Havermans","year":"2019","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1136\/thoraxjnl-2014-205983","article-title":"Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: Results of The International Depression Epidemiological Study across nine countries","volume":"69","author":"Quittner","year":"2014","journal-title":"Thorax"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1037\/hea0000136","article-title":"Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis","volume":"34","author":"Hilliard","year":"2015","journal-title":"Health Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jcf.2020.07.020","article-title":"Decreased survival in cystic fibrosis patients with a positive screen for depression","volume":"20","author":"Schechter","year":"2021","journal-title":"J. Cyst. Fibros."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1002\/ppul.24928","article-title":"Mental health and cystic fibrosis: Time to move from secondary prevention to predictive medicine","volume":"55","author":"Amerio","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jad.2007.07.031","article-title":"TEMPS-A (Rome): Psychometric validation of affective temperaments in clinically well subjects in mid- and south Italy","volume":"107","author":"Pompili","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_32","unstructured":"Sirigatti, S., and Faravelli, C. (2012). MMPI-2-RF: Adattamento Italiano. Taratura, Propriet\u00e0 Psicometriche e Correlati Empirici, Giunti O.S. Organizzazioni Speciali."},{"key":"ref_33","first-page":"235","article-title":"The Patient Health Questionnaire (PHQ) for the screening of psychiatric disorders: A validation study versus the Structured Clinical Interview for DSM-IV axis I (SCID-I)","volume":"9","author":"Mazzotti","year":"2003","journal-title":"J. Psychopathol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jad.2011.06.032","article-title":"Affective temperaments in general population: A review and combined analysis from national studies","volume":"139","author":"Tondo","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jad.2014.05.018","article-title":"Characterization of patients with mood disorders for their prevalent temperament and level of hopelessness","volume":"166","author":"Pompili","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jad.2006.11.028","article-title":"Validation of the TEMPS-A Buenos Aires: Spanish psychometric validation of affective temperaments in a population study of Argentina","volume":"100","author":"Nasetta","year":"2007","journal-title":"J. Affect. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.jad.2009.12.027","article-title":"The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: A study on bipolar I Italian national sample","volume":"136","author":"Perugi","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.biopsych.2012.01.018","article-title":"Genome-wide Association Study of Temperament in Bipolar Disorder Reveals Significant Associations to Three Novel Loci","volume":"72","author":"Greenwood","year":"2012","journal-title":"Biol. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jad.2003.10.013","article-title":"Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: A controlled study","volume":"85","author":"Kesebir","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1001\/archpsyc.1982.04290120066013","article-title":"Mechanisms in manic-depressive disorder: An evolutionary model","volume":"39","author":"Gardner","year":"1982","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jad.2003.10.012","article-title":"TEMPS-A: Validation of a short version of a self-rated instrument designed to measure variations in temperament","volume":"85","author":"Akiskal","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/j.2051-5545.2010.tb00287.x","article-title":"The role of anxious and hyperthymic temperaments in mental disorders: A national epidemiologic study","volume":"9","author":"Karam","year":"2010","journal-title":"World Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0924-9338(14)77886-1","article-title":"EPA-0478\u2014Hyperthymic temperament as a protective factor against suicidal risk","volume":"29","author":"Marinova","year":"2014","journal-title":"Eur. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/HRP.0000000000000153","article-title":"Suicidal Risk and Affective Temperaments, Evaluated with the TEMPS-A Scale: A Systematic Review","volume":"26","author":"Gonda","year":"2018","journal-title":"Harv. Rev. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.psychres.2018.01.035","article-title":"The impact of affective temperaments on clinical and functional outcome of Bipolar I patients that initiated or changed pharmacological treatment for mania","volume":"261","author":"Perugi","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Luciano, M., Steardo, L., Sampogna, G., Caivano, V., Ciampi, C., Del Vecchio, V., Di Cerbo, A., Giallonardo, V., Zinno, F., and De Fazio, P. (2021). Affective Temperaments and Illness Severity in Patients with Bipolar Disorder. Medicina, 57.","DOI":"10.3390\/medicina57010054"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jad.2013.03.026","article-title":"Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: A prospective follow-up study","volume":"150","author":"Pompili","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jad.2013.06.041","article-title":"Affective temperaments are associated with specific clusters of symptoms and psychopathology: A cross-sectional study on bipolar disorder inpatients in acute manic, mixed, or depressive relapse","volume":"151","author":"Iasevoli","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S0193-953X(05)70093-9","article-title":"The evolving bipolar spectrum. Prototypes I, II, III, and IV","volume":"122","author":"Akiskal","year":"1999","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Baertschi, M., Costanza, A., Canuto, A., and Weber, K. (2018). The Function of Personality in Suicidal Ideation from the Perspective of the Interpersonal-Psychological Theory of Suicide. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15040636"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.jad.2020.11.005","article-title":"Link between temperament traits, brain neurochemistry and response to SSRI: Insights from animal model of social behavior","volume":"282","author":"Murlanova","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00213-010-1999-0","article-title":"Biological aspect of hyperthymic temperament: Light, sleep, and serotonin","volume":"213","author":"Hoaki","year":"2011","journal-title":"Psychopharmacology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jad.2015.01.053","article-title":"Depressive mixed states: A reappraisal of Koukopoulos\u2019 criteria","volume":"176","author":"Faedda","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.4088\/JCP.14m09092","article-title":"Mixed features in patients with a major depressive episode: The BRIDGE-II-MIX study","volume":"76","author":"Perugi","year":"2015","journal-title":"J. Clin. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jad.2005.12.049","article-title":"The close link between suicide attempts and mixed (bipolar) depression: Implications for suicide prevention","volume":"91","author":"Benazzi","year":"2006","journal-title":"J. Affect. Disord."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1159\/000284608","article-title":"Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression","volume":"22","author":"Cassano","year":"1989","journal-title":"Psychopathology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.jad.2011.12.046","article-title":"Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes","volume":"138","author":"Judd","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"712","DOI":"10.4088\/JCP.v67n0504","article-title":"Agitated \u201cunipolar\u201d major depression: Prevalence, phenomenology, and outcome","volume":"67","author":"Maj","year":"2006","journal-title":"J. Clin. Psychiatry"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1440-1819.2011.02205.x","article-title":"Suicide in a large population of former psychiatric inpatients","volume":"65","author":"Sani","year":"2011","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1111\/j.1399-5618.2007.00553.x","article-title":"Differences in incidence of suicide attempts during phases of bipolar I and II disorders","volume":"10","author":"Valtonen","year":"2008","journal-title":"Bipolar Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jcf.2017.05.008","article-title":"Worsening anxiety and depression after initiation of lumacaftor\/ivacaftor combination therapy in adolescent females with cystic fibrosis","volume":"16","author":"McKinzie","year":"2017","journal-title":"J. Cyst. Fibros."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.psym.2017.04.001","article-title":"Cystic Fibrosis Transmembrane Regulator Modulators: Implications for the Management of Depression and Anxiety in Cystic Fibrosis","volume":"58","author":"Talwalkar","year":"2017","journal-title":"Psychosomatics"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/4\/619\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:10:26Z","timestamp":1760123426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/4\/619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,5]]},"references-count":63,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["brainsci13040619"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13040619","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,5]]}}}