1
|
Karpuz Seren B, Acikgoz M, Piri Cinar B, Aciman Demirel E, Celebi U, Atasoy HT. The relationship between alexithymia, reading the mind in the eyes and cognition in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104196. [PMID: 36223703 DOI: 10.1016/j.msard.2022.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 08/29/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
AIM The purpose of this study was to determine the frequency of alexithymia, difficulty in recognizing one's own and others' emotions, to determine the ability to read the mind in the eyes that evaluates the emotions of others, and to assess the relationship between these parameters and demographic characteristics, cognition, anxiety and depression in people with multiple sclerosis (PwMS). MATERIAL AND METHOD Seventy patients presenting to the neurology clinic and diagnosed with MS and 70 healthy volunteers with similar demographic characteristics were included in the study. The California Verbal Learning Test II (CVLT II), Symbol Digit Modalities Test (SDMT), Revised Brief Visuospatial Memory Test (BVMT-R), and Trail-Making Test (TMT) were applied to determine all participants' cognitive status. All participants were also administered Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale-20 (TAS-20), Reading the Mind in the Eyes Test (RMET), Fatigue Impact Scale (FIS) and Short Form 36 Health Survey (SF-36) for quality of life. RESULTS Alexithymia levels were higher in the PwMS than in the control group, 24.2% of the PwMS and 4.2% of the control group being alexithymic. The PwMS group exhibited poorer performance on all cognitive tests and in BDI, BAI, FIS and SF-36 scale scores than the control group. No difference was determined between the groups' RMET scores. Depression and anxiety levels increased in line with alexithymia levels in the PwMS group, while RMET scores decreased. No association was determined between alexithymia levels and age, sex, duration of disease, degree of disability, cognition, or fatigue. RMET scores were not affected by age, sex, duration of disease, degree of disability, anxiety, or fatigue, but were lower among individuals with poor cognition and in depressive patients. CONCLUSION Neuropsychiatric symptoms have been the subject of considerable research in MS in recent years and these clinical characteristics in patients have begun being closely monitored. PwMS are capable of experiencing difficulty in identifying emotions in themselves and others, and their social lives can be affected. In addition, the fact that this exhibits an association with cognition based on RMET is particularly noteworthy.
Collapse
Affiliation(s)
- Burcu Karpuz Seren
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Mustafa Acikgoz
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey.
| | - Bilge Piri Cinar
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Esra Aciman Demirel
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Ulufer Celebi
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| | - Hüseyin Tugrul Atasoy
- Zonguldak Bulent Ecevit University Faculty of Medicine Neurology Department, Zonguldak, Turkey
| |
Collapse
|
2
|
Conti C, Di Francesco G, Severo M, Lanzara R, Richards K, Guagnano MT, Porcelli P. Alexithymia and metabolic syndrome: the mediating role of binge eating. Eat Weight Disord 2021; 26:1813-1823. [PMID: 32920774 PMCID: PMC8292257 DOI: 10.1007/s40519-020-00964-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/11/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Alexithymia, a personality trait characterized by difficulties in emotional processing, has been associated with unhealthy behaviors and chronic medical conditions. This study aimed to further develop our understanding of this complex relationship by investigating whether alexithymia increases the risk of metabolic syndrome (MetS) in participants with obesity or overweight through the mediating role of binge eating (BE). METHODS A consecutive sample of 238 treatment-seeking patients with obesity or overweight were recruited. Alexithymia (TAS-20), binge eating symptoms (BES), body mass index (BMI), and depression and anxiety symptoms (HADS) were concurrently assessed. RESULTS Almost half of the participants met the criteria for MetS (44.12%). Compared to patients without MetS, those with MetS were older, had a longer duration of overweight, and had a higher BMI (p < 0.01). Individual with MetS also had higher HADS, BES, and TAS-20 scores, particularly difficulty identifying and describing feelings. The structural equation modeling (SEM) analysis revealed that BES levels exerted a significant direct effect on MetS (p < 0.01), and that TAS-20 levels exerted a significant direct effect on BES (p < 0.01), anxiety (p < 0.001) and depression (p < 0.001). Moreover, psychological distress (anxiety, p = 0.01, and depression, p = .05) indirectly affected MetS through the mediating effect of BES, and TAS-20 (p = 0.01) indirectly affected MetS through the mediating effect of HADS and BES. Finally, age had a significant direct effect on MetS (p < 0.001). CONCLUSION Our findings indicate that alexithymia is a concurrent causative factor to the development of MetS through the mediating role of BE and psychological distress. LEVEL OF EVIDENCE Level III, case-control analytic study.
Collapse
Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Melania Severo
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Roberta Lanzara
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Katie Richards
- Department of Psychological Medicine, King's College, London, UK
| | - Maria Teresa Guagnano
- Department of Medicine and Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| |
Collapse
|
3
|
Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals. J Affect Disord 2020; 263:428-436. [PMID: 31969274 DOI: 10.1016/j.jad.2019.10.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature. METHODS The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants. RESULTS Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = <.001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005). LIMITATIONS The study is limited by the small sample size and its cross-sectional nature. CONCLUSIONS Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.
Collapse
|
4
|
Oka T, Tanahashi T, Lkhagvasuren B, Yamada Y. The longitudinal effects of seated isometric yoga on blood biomarkers, autonomic functions, and psychological parameters of patients with chronic fatigue syndrome: a pilot study. Biopsychosoc Med 2019; 13:28. [PMID: 31709006 PMCID: PMC6836361 DOI: 10.1186/s13030-019-0168-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In a previous randomized controlled trial, we found that practicing seated isometric yoga regularly for 2 months improved the fatigue of patients with chronic fatigue syndrome (CFS) who are resistant to conventional therapy. The aim of this pilot study was to investigate the possible mechanisms behind this finding by comparing blood biomarkers, autonomic nervous function, and psychological indices before versus after an intervention period of seated isometric yoga practice. METHODS Fifteen patients with CFS who did not show satisfactory improvements after at least 6 months of conventional therapy practiced seated isometric yoga (biweekly 20-min sessions with a yoga instructor and daily practice at home) for 2 months. The longitudinal effects of seated isometric yoga on fatigue, blood biomarkers, autonomic function, and psychological state were investigated by comparing the following parameters before and after the intervention period: Fatigue severity was assessed by the Chalder fatigue scale (FS) score. Levels of the blood biomarkers cortisol, DHEA-S, TNF-α, IL-6, prolactin, carnitine, TGF-β1, BDNF, MHPG, HVA, and α-MSH were measured. The autonomic nervous functions assessed were heart rate (HR) and HR variability. Psychological indices included the 20-item Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Practicing seated isometric yoga for 2 months resulted in significant reductions in the Chalder FS (P = 0.002) and HADS-depression (P = 0.02) scores. No significant changes were observed in any other parameter evaluated. The change in Chalder FS score was not correlated with the change in HADS-depression score. However, this change was positively correlated with changes in the serum TNF-α levels (P = 0.048), the high frequency component of HR variability (P = 0.042), and TAS-20 scores (P = 0.001). CONCLUSIONS Regular practice of seated isometric yoga for 2 months reduced the fatigue and depressive symptom scores of patients with CFS without affecting any other parameters we investigated. This study failed to identify the markers responsible for the longitudinal fatigue-relieving effect of seated isometric yoga. However, considering that the reduced fatigue was associated with decreased serum TNF-α level and TAS-20 scores, fatigue improvement might be related to reduced inflammation and improved alexithymia in these patients. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN CTR) UMIN000009646. Registered Dec 27, 2012.
Collapse
Affiliation(s)
- Takakazu Oka
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582 Japan
- Department of Psychosomatic Medicine, International University of Health and Welfare Hospital, Iguchi 537-3, Nasushiobara-shi, Tochigi-ken, 329-2763 Japan
| | - Tokusei Tanahashi
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582 Japan
| | - Battuvshin Lkhagvasuren
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582 Japan
- Brain Science Institute, Mongolian National University of Medical Sciences, Zorig Street 3, Ulaanbaatar, 14210 Mongolia
| | - Yu Yamada
- Department of Psychosomatic Medicine, International University of Health and Welfare Hospital, Iguchi 537-3, Nasushiobara-shi, Tochigi-ken, 329-2763 Japan
| |
Collapse
|
5
|
Maroti D, Molander P, Bileviciute-Ljungar I. Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome. Scand J Psychol 2016; 58:52-61. [PMID: 27686801 DOI: 10.1111/sjop.12332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/03/2016] [Indexed: 11/27/2022]
Abstract
Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross-sectional study compared self-reported alexithymia and observer-rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self-reported alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20) and emotional awareness with an observer-rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self-reported alexithymia in the TAS-20 compared to HC, but had similar emotional awareness capacity in the observer-rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS-total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self-reported alexithymia and observer-rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.
Collapse
Affiliation(s)
- Daniel Maroti
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Peter Molander
- Department of Medical and Health Sciences, Linköping University and Region Östergotland, Linköping, Sweden.,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.,Department of Medical and Health Sciences, Linköping University and Region Östergotland, Linköping, Sweden
| |
Collapse
|
6
|
Wortinger LA, Endestad T, Melinder AMD, Øie MG, Sulheim D, Fagermoen E, Wyller VB. Emotional conflict processing in adolescent chronic fatigue syndrome: A pilot study using functional magnetic resonance imaging. J Clin Exp Neuropsychol 2016; 39:355-368. [PMID: 27647312 DOI: 10.1080/13803395.2016.1230180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Studies of neurocognition suggest that abnormalities in cognitive control contribute to the pathophysiology of chronic fatigue syndrome (CFS) in adolescents, yet these abnormalities remain poorly understood at the neurobiological level. Reports indicate that adolescents with CFS are significantly impaired in conflict processing, a primary element of cognitive control. METHOD In this study, we examine whether emotional conflict processing is altered on behavioral and neural levels in adolescents with CFS and a healthy comparison group. Fifteen adolescent patients with CFS and 24 healthy adolescent participants underwent functional magnetic resonance imaging (fMRI) while performing an emotional conflict task that involved categorizing facial affect while ignoring overlaid affect labeled words. RESULTS Adolescent CFS patients were less able to engage the left amygdala and left midposterior insula (mpINS) in response to conflict than the healthy comparison group. An association between accuracy interference and conflict-related reactivity in the amygdala was observed in CFS patients. A relationship between response time interference and conflict-related reactivity in the mpINS was also reported. Neural responses in the amygdala and mpINS were specific to fatigue severity. CONCLUSIONS These data demonstrate that adolescent CFS patients displayed deficits in emotional conflict processing. Our results suggest abnormalities in affective and cognitive functioning of the salience network, which might underlie the pathophysiology of adolescent CFS.
Collapse
Affiliation(s)
- Laura Anne Wortinger
- a Department of Pediatrics , Akershus University Hospital , Nordbyhagen , Norway.,b Department of Psychology , University of Oslo , Oslo , Norway
| | - Tor Endestad
- b Department of Psychology , University of Oslo , Oslo , Norway
| | - Annika Maria D Melinder
- c Cognitive Developmental Research Unit, Department of Psychology , University of Oslo , Oslo , Norway
| | - Merete Glenne Øie
- b Department of Psychology , University of Oslo , Oslo , Norway.,d Research Department , Innlandet Hospital Trust , Lillehammer , Norway
| | - Dag Sulheim
- e Department of Pediatrics , Oslo University Hospital , Oslo , Norway.,f Department of Pediatrics , Innlandet Hospital Trust , Lillehammer , Norway
| | - Even Fagermoen
- g Department of Anesthesiology and Critical Care , Oslo University Hospital , Oslo , Norway
| | - Vegard Bruun Wyller
- a Department of Pediatrics , Akershus University Hospital , Nordbyhagen , Norway
| |
Collapse
|
7
|
Robinson LJ, Durham J, MacLachlan LL, Newton JL. Autonomic function in chronic fatigue syndrome with and without painful temporomandibular disorder. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2015. [DOI: 10.1080/21641846.2015.1091152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|