Psychopathology and clinical features in an Italian sample of patients with myofascial and temporomandibular joint pain: preliminary data

OBJECTIVE: Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures. METHODS: Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS). RESULTS: --Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. --HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. --SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales. CONCLUSIONS: TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.     

Psychopathological constellation in patients with PNES: A new hypothesis

Depression symptoms have often reported in patients with psychogenic nonepileptic seizures (PNES), although the underlying psychopathological symptomatology has been poorly understood. Our aim was to compare constellations of psychological and behavioral disturbance in PNES with respect to patients with mild-major depressive disorder (MDD), hypothesizing that the construct of depression might be different in the two groups.Ten patients with PNES and ten sex-/age-matched patients with mild-MDD newly-diagnosed, were enrolled in this study. A wide neuropsychiatric battery was employed including the following: symptoms checklist 90-R (SCL-90-R), Toronto alexithymia scale (TAS-20), Hamilton anxiety rating scale (HAMA), Beck depression inventory (BDI II), dissociative experiences scale (DES), traumatic experience checklist (TEC), somatoform dissociation questionnaire (SDQ-20), and temperament and character inventory-revised (TCI-R).No significant difference was detected in the large part of psychopathological examination including personality profile between the two groups. However, PNES showed high scores in alexithymia (p = 0.02); anxiety (p = 0.03), and somatoform symptomatology (p's < 0.03) with respect to patients with mild-MDD. Moreover, somatoform symptoms strongly correlated with depression scores in both groups, whereas alexithymia was influenced by high anxiety level only in the group with PNES. No significant relationship was found between traumatic experience (as measured by TEC) and construct of depression.Our proof-of-concept study suggests that patients with PNES are characterized by their inability to verbalize emotions when dealing with anxiety symptoms, therefore expressing them in a somatic dimension. Further researches, including the investigation of the relationship between anxiety status and emotional expression, are warranted to better understand the pathogenesis of PNES.     

躯体化症状为主抑郁症患者的述情障碍

目的:探讨以躯体化症状为主抑郁症患者和以情绪症状为主抑郁症患者述情障碍的差异。方法:50例以躯体化症状为主抑郁症患者(躯体症状组)、50例以情绪症状为主抑郁症患者(情绪症状组)和50名正常健康者(正常对照组)参加研究,采用90项症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)和多伦多述情障碍量表进行评定。结果:躯体症状组SCL-90总分、躯体化、焦虑、人际敏感、恐怖、偏执因子分及HAMD的焦虑/躯体化因子评分均高于情绪症状组(P<0.01或P<0.05),情绪症状组在强迫、抑郁因子评分及HAMD的认知障碍、阻滞、日夜变化、睡眠障碍及绝望因子分高于躯体症状组(P<0.05或P<0.01)。躯体症状组与情绪症状组仅在述情障碍因子II评分差异有统计学意义(P<0.05),而在述情障碍总分及因子分上均高于正常对照组(P<0.05或P<0.001)。结论:以躯体化症状为主和以情绪症状为主抑郁症患者均存在述情障碍,以前者更缺乏识别情绪和躯体感受能力。     

The Relationship between Alexithymia and General Symptoms of Patients with Depressive Disorders

Objective

Depression has been associated with alexithymic features. However, few studies have investigated the differences in the general symptoms of patients with depressive disorders according to the presence of alexithymia. Thus, the aim of this study was to evaluate the relationship between alexithymia and symptoms experienced by patients with clinically diagnosed depressive disorders.

Methods

A chart review of patients who were evaluated using the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20) and Symptom Checklist 90-Revised (SCL-90-R) at the same time between the years 2003 and 2007 was conducted. A total of 104 patients with depressive disorders were included and divided into two groups: alexithymia (n=52) and non-alexithymia (n=52). A direct comparison between the two groups was carried out. Regression analysis was also carried out for the TAS-20 total and subset scores in order to model the relationship between alexithymia and symptoms.

Results

The presence of alexithymia was confirmed in 50% of the patients with depressive disorders, and the symptoms of depressive patients with alexithymia were more severe than those of their non-alexithymic counterparts on all 9 symptom domains of the SCL-90-R. Furthermore, regression analysis revealed that the presence of alexithymia was positively associated with depression, phobic anxiety, and psychoticism but inversely associated with anxiety.

Conclusion

These results suggest that the clinical features of depression are partially dependent on the presence of alexithymia. Alexithymic patients with depressive disorders are likely to show more severe depressive, psychotic, and phobic symptoms. In other words, clinicians should suspect the presence of alexithymic tendencies if these symptoms coexist in patients with depressive disorders and address their difficulties in effective communication.     

Effects of inpatient psychotherapy on the stability of alexithymia characteristics

Background

Although alexithymia is associated with several psychiatric disorders, there has been little research into the effects of psychodynamic psychotherapies on this condition. Here, the influence of inpatient multimodal psychodynamic psychotherapy on alexithymia and symptom load was evaluated in a large sample of patients.

Methods

Alexithymia [measured with the Toronto Alexithymia Scale (TAS)-26] and psychological stress and depression [measured with the Symptom Checklist 90 Revised (SCL-90-R)] were evaluated at admission and after inpatient multimodal psychotherapy in patients with various psychosomatic and psychiatric disorders admitted to this unit between 2002 and 2005. Patients undergoing both short-term (up to 4 weeks) and long-term treatment (8-12 weeks) were studied. Analyses of covariance were used to analyse the data on depression (SCL-90-R) and psychological stress (SCL-90-R), and correlations between admission and discharge scores for the TAS-26 were computed to evaluate mean and relative stability of alexithymia.

Results

Data on 397 of the 568 patients admitted were analysed. Psychological stress and depression (SCL-90-R) decreased significantly during the study across all diagnostic groups. The TAS-26 total score also decreased significantly, showing that there was no mean stability of alexithymic characteristics. However, the significance of decrease was lost when psychological stress and depression were controlled for. Highly significant correlations between TAS-26 sores before and after treatment reflected high relative stability of alexithymia.

Conclusions

During inpatient multimodal psychodynamic treatment, the symptom load and alexithymia in our patients decreased. The high relative stability of alexithymia shown supports the view that alexithymia is a relative stable personality trait.     

Handedness,alexithymia, and focus laterality as risk factors for psychiatric comorbidity in patients with epilepsy

The aim of the current study was to evaluate the effect of seizure lateralization, handedness, and alexithymia on psychopathology in patients with temporal lobe epilepsy. One hundred five patients were included in the study. The Hopkins Symptom Checklist—90 (SCL-90) and Toronto Alexithymia Scale (TAS-26) were used for psychopathological assessment of patients. Handedness was evaluated using Annett’s scale. Among the patients studied were 74 right-handers and 31 left-handers, and 25 alexithymic and 80 nonalexithymic persons. Left-sided foci were observed in 52, and right-sided foci in 53 persons. MANOVA was used for analysis of the interrelationship between nominal fixed factors (handedness, alexithymia, and focus laterality) and the dependent variables SCL-90, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety. MANOVA revealed that alexithymia exerts maximal effect on psychopathological variables, and maximal values of SCL-90 constructs were observed for persons with alexithymia/left-handedness and alexithymia/right-sided seizure focus combinations.     

Alexithymia,empathy, and psychological symptoms in a family context

Levels of alexithymia were measured with the Toronto Alexithymia Scale (TAS-20) in families of women with borderline personality disorder (BPD), restricting anorexia nervosa (AN) and a nonclinical (NC) group. Measures were correlated with sociodemographic information, empathy (as measured by the Interpersonal Reactivity Index [IRI]), emotional distress (using the Symptom Checklist-90-R [SCL-90-R]), and experiences of abuse. We have found that male gender, age, and low socioeconomic status are correlated with factor 3 of the TAS-20; that women with BPD and AN are more alexithymic than control subjects; that women with AN are more alexithymic than their parents; and that alexithymia is inversely related to the capacity for empathy. Family members of women with BPD have the highest levels of alexithymia and in these families there seems to be a complementary association between alexithymia in one parent and low levels of empathy in the other. There may be an association between the general emotional distress, history of abuse, and high levels of alexithymia that occur in women with BPD.     

Preliminary evidence of riluzole efficacy in antidepressant-treated patients with residual depressive symptoms.

BACKGROUND: Excessive glutamatergic neurotransmission may contribute to the pathophysiology of major depressive disorder (MDD). Recent evidence suggests that riluzole and other agents that target glutamate neurotransmission may show antidepressant activity. METHODS: Ten patients with treatment-resistant depression had riluzole added to their ongoing medication regimen for 6 weeks, followed by an optional 6-week continuation phase. Depression and anxiety severity were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Linear mixed models were used to test for a linear trend in HDRS and HARS scores across time with treatment. RESULTS: Subjects' HDRS and HARS scores declined significantly following the initiation of riluzole augmentation therapy. The effect of riluzole was significant at the end of the first week of treatment and persisted for the 12-week duration of the study. CONCLUSIONS: These data suggest that riluzole augmentation produces antidepressant and anxiolytic effects in patients with treatment-resistant depression.     

Alexithymia and personality in relation to social anxiety among university students

The aims of the present study were to investigate the relationship of social anxiety symptoms with alexithymia and personality dimensions in university students and to control the effects of depression and anxiety on this relationship. A total of 319 university students (85 males and 234 females) from two different universities in Ankara were investigated with the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Toronto Alexithymia Scale (TAS-20) and the Temperament and Character Inventory (TCI). We found that subscales of the LSAS (fear or anxiety and avoidance) were positively correlated with depression and alexithymia and “difficulty in identifying feelings” (DIF) and “difficulty in describing feelings” (DDF) subscales of the TAS-20. Harm avoidance (HA) showed positive correlations with subscales of the LSAS, whereas self-directedness (SD) showed negative correlations with these subscales. High TAS-20 DDFand HA and low SD predicted fear or anxiety LSAS subscale scores, whereas high TAS-20 DDF, HA and depression scores were predictors for LSAS avoidance subscale scores. Although our sample is not representative of the whole Turkish university student population, we conclude that both fear or anxiety and avoidance were mainly interrelated with DDF and HA, although the causal relationship is not clear.     

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression,panic disorder,eating disorders and substance use disorders

Background

This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression.

Methods

Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D).

Results

The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels.

Conclusions

Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.     

Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder

OBJECTIVE: The objective of this study was to examine the effectiveness of a meditation-based stress management program in patients with anxiety disorder. METHODS: Patients with anxiety disorder were randomly assigned to an 8-week clinical trial of either a meditation-based stress management program or an anxiety disorder education program. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Symptom Checklist--90-Revised (SCL-90-R) were used to measure outcome at 0, 2, 4, and 8 weeks of the program. RESULTS: Compared to the education group, the meditation-based stress management group showed significant improvement in scores on all anxiety scales (HAM-A, P=.00; STAI state, P=.00; STAI trait, P=.00; anxiety subscale of SCL-90-R, P=.00) and in the SCL-90-R hostility subscale (P=.01). Findings on depression measures were inconsistent, with no significant improvement shown by subjects in the meditation-based stress management group compared to those in the education group. The meditation-based stress management group did not show significant improvement in somatization, obsessive-compulsive symptoms, and interpersonal sensitivity scores, or in the SCL-90-R phobic anxiety subscale compared to the education group. CONCLUSIONS: A meditation-based stress management program can be effective in relieving anxiety symptoms in patients with anxiety disorder. However, well-designed, randomized, and controlled trials are needed to scientifically prove the worth of this intervention prior to treatment.     

Predictors of somatic symptoms in depressive disorder

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.     

Combined treatment of major depression in patients with borderline personality disorder: a comparison with pharmacotherapy.

OBJECTIVE: Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD). METHODS: There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment. RESULTS: Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone. CONCLUSIONS: Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning.     

The relationship between alexithymia and salivary cortisol levels in somatoform disorders

The purpose of this study was to investigate cortisol levels as a function of the hypothalamic-pituitary-adrenal axis (HPA) in relation to alexithymia in patients with somatoform disorders (SFD). Diurnal salivary cortisol was sampled in 32 patients with SFD who also underwent a psychiatric examination and filled in questionnaires (Toronto Alexithymia Scale, TAS scale; Screening for Somatoform Symptoms, SOMS scale; Hamilton Depression Scale, HAMD). The mean TAS total score in the sample was 55.6+/-9.6, 32% of patients being classified as alexithymic on the basis of their TAS scores. Depression scores were moderate (HAMD=13.2, Beck Depression Inventory, BDI=16.5). The patients' alexithymia scores (TAS scale "Difficulty identifying feelings") correlated significantly positively with their somatization scale scores (Symptom Checklist-90 Revised, SCL-90-R); r=0.3438 (P<0.05) and their scores on the Global Severity Index (GSI) on the SCL-90-R; r=0.781 (P<0.01). Regression analysis was performed with cortisol variables as the dependent variables. Cortisol levels [measured by the area under the curve-ground (AUC-G), area under the curve-increase (AUC-I) and morning cortisol (MCS)] were best predicted in a multiple linear regression model by lower depressive scores (HAMD) and more psychopathological symptoms (SCL-90-R). No significant correlations were found between the patients' alexithymia scores (TAS) and cortisol levels. The healthy control group (n=25) demonstrated significantly higher cortisol levels than did the patients with SFD; in both tests P<0.001 for AUC-G and AUC-I. However, the two groups did not differ in terms of their mean morning cortisol levels (P>0.05). The results suggest that pre-existing hypocortisolism might possibly be associated with SFD.     

Alexithymia and personality in relation to dimensions of psychopathology

OBJECTIVE: The authors examined the capacity of alexithymia to predict a broad range of psychiatric symptoms relative to that of other personality dimensions, age, and gender. METHOD: The Toronto Alexithymia Scale, the Temperament and Character Inventory, and the SCL-90-R were administered to 254 psychiatric patients. Multivariate linear regression analyses were performed. RESULTS: The difficulties identifying feelings factor of the Toronto Alexithymia Scale significantly predicted all SCL-90-R subscale scores and was particularly effective, relative to the personality dimensions of the Temperament and Character Inventory, in predicting somatization. The Temperament and Character Inventory dimensions emerged as distinct and conceptually meaningful predictors for the different SCL-90-R subscales. CONCLUSIONS: A broad range of current psychopathology is associated with difficulties in cognitively processing emotional perceptions. Further research needs to clarify whether alexithymia represents a risk factor for mental illness and poorer outcome.     

Alexithymia and anxiety sensitivity in Turkish depressive,anxiety and somatoform disorder outpatients

Objective. To assess the relations between anxiety sensitivity, and dimensions of alexithymia in somatoform, anxiety and depressive disorder patients. Methods. The sample consisted of 124 patients with the diagnosis of depressive, anxiety, or somatoform spectrum disorders (DSM-IV). Toronto Alexithymia Scale (TAS-20), 16-item Anxiety Sensitivity Index (ASI), Hamilton Depression (HDRS), and Anxiety (HAS) scales were used. Results. The total sample (n=124) was divided into three diagnostic categories. There was one Depression Group (n=69). Due to small sample sizes, diagnoses in anxiety and somatoform spectrum disorders were combined in two relatively larger Anxiety (n=42) and Somatoform Groups (n=13) for statistical purposes. No statistically significant difference was found in the TAS-20 total or subscale scores between the three diagnostic groups. In all three diagnostic groups, there was a strong and significant positive correlation between ASI and TAS-20 total scores. In all three groups, there was a significant positive correlation between TAS-20 Factor 1 and ASI. In the Depression and Somatoform Groups, ASI scores were found to be significantly positively correlated with scores on TAS-20 Factor 2. Conclusion. This study reveals that alexithymia does not differentiate depressive, anxiety, or somatoform disorders, yet suggests a functional relation with anxiety sensitivity on a subscale basis.     

Aripiprazole in the treatment of patients with borderline personality disorder: a double-blind, placebo-controlled study

OBJECTIVE: Aripiprazole is a relatively new atypical antipsychotic agent that has been successfully employed in therapy for schizophrenia and schizoaffective disorders. A few neuroleptics have been used in therapy for patients with borderline personality disorder, which is associated with severe psychopathological symptoms. Aripiprazole, however, has not yet been tested for this disorder, and the goal of this study was to determine whether aripiprazole is effective in the treatment of several domains of symptoms of borderline personality disorder. METHOD: Subjects meeting criteria for the Structured Clinical Interview for DSM-III-R Personality Disorders for borderline personality disorder (43 women and 9 men) were randomly assigned in a 1:1 ratio to 15 mg/day of aripiprazole (N=26) or placebo (N=26) for 8 weeks. Primary outcome measures were changes in scores on the symptom checklist (SCL-90-R), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the State-Trait Anger Expression Inventory and were assessed weekly. Side effects and self-injury were assessed with a nonvalidated questionnaire. RESULTS: According to the intent-to-treat principle, significant changes in scores on most scales of the SCL-90-R, the HAM-D, the HAM-A, and all scales of the State-Trait Anger Expression Inventory were observed in the subjects treated with aripiprazole after 8 weeks. Self-injury occurred in the groups. The reported side effects were headache, insomnia, nausea, numbness, constipation, and anxiety. CONCLUSIONS: Aripiprazole appears to be a safe and effective agent in the treatment of patients with borderline personality disorder.     

Psychological symptom patterns and vital exhaustion in outpatients with chronic obstructive pulmonary disease

Background

Several studies have reported high prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) outpatients. Moreover, these patients share psychological or psychopathological characteristics that inhibit their ability to cope with the disease. In the present study we aimed to record the prevalence of psychological symptom patterns in a sample of Greek COPD outpatients and to assess which psychological factors (and to which degree) contribute to vital exhaustion (VE).

Methods

The study included 139 COPD outpatients. We used the Symptom Checklist 90 - Revised (SCL-90-R) and the Maastricht Questionnaire (MQ) in order to evaluate psychological symptom patterns and VE, respectively.

Results

The mean MQ score was 19.6, which is significantly higher than the corresponding score in the general population. Regarding the SCL-90-R dimensions, depression was the highest followed by somatization, obsessive-compulsive and anxiety dimensions. Additionally, a positive correlation was observed between the MQ and the SCL-90-R dimensions. MQ failed to demonstrate correlation with age, gender, education level or the severity of the disease. Depression seems to be responsible for 57.9% of the variation of VE, while obsessive-compulsiveness is responsible for an additional 2.4%. All the remaining dimensions of SCL-90-R had no statistically significant contributions.

Conclusions

Our findings suggest the high prevalence of VE, together with high rates in most of the SCL-90-R dimensions with greater depression, somatization, obsessive-compulsiveness and anxiety in a Greek COPD group at various Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria stages. The coexistence of such symptoms should be further assessed as an eventual unfavorable prognostic factor.     

A clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R) in general population studies (Denmark,Norway, and Italy)

Background: Although the Symptom Checklist (SCL-90-R) is one of the most widely used self-reported scales covering several psychopathological states, the scalability of the SCL-90-R has been found to be very problematic. Aims: We have performed a clinimetric analysis of the SCL-90-R, taking both its factor structure and scalability (i.e. total scale score a sufficient statistic) into account. Methods: The applicability of the SCL-90-R has been found acceptable in general population studies from Denmark, Norway and Italy. These studies were examined with principal component analysis (PCA) to identify the factor structure. The scalability of the traditional SCL-90-R subscales (i.e. somatization, hostility, and interpersonal sensitivity) as well as the affective subscales (i.e. depression and anxiety and ADHD), were tested by Mokken’s item response theory model. Results: Across the three general population studies the traditional scaled SCL-90-R factor including 83 items was identified by PCA. The Mokken analysis accepted the scalability of both the general factor and the clinical SCL-90-R subscales under examination. Conclusion: The traditional, scaled, general 83 item SCL-90-R scale is a valid measure of general psychopathology. The SCL-90-R subscales of somatization, hostility, and interpersonal sensitivity as well as the affective subscales of depression, anxiety, and ADHD were all accepted by the Mokken test for scalability, i.e. their total scores are sufficient statistics.     

Are alexithymia, depression, and anxiety distinct constructs in affective disorders?

OBJECTIVE: the present study was undertaken to gain a better insight into the relationship between alexithymia, anxiety, and depression. Two hypotheses were tested: (1) whether a depressive or anxiety disorder is associated with an elevation of one or more dimensions of alexithymia; and (2) whether alexithymia is an independent construct from depression and anxiety in patients with depressive or anxiety disorders. METHOD: a total of 113 patients with depressive or anxiety disorders (DSM-IV) and 113 control subjects completed the 20-item version of the Toronto alexithymia scale (TAS-20) and the hospital anxiety and depression scale (HADS). RESULTS: the TAS-20 total score was higher in depressed and anxious patients than in controls. This finding mainly depended on an increased score for "difficulty identifying feelings"(DIF), and (only in depressed patients) on an increased score for "difficulty communicating feelings" (DCF). The factor analysis of the TAS-20 and HADS items showed that depression is a construct different from alexithymia, whereas some overlap exists between anxiety and DIF dimension. CONCLUSION: our results suggest that in depressive and anxiety disorders, alexithymia and depression are separate constructs that may be closely related; in contrast, there are some overlaps between the DIF dimension and anxiety.