Body illness and changes in verbal communication. Study of the alexithymic phenomenon in somatic disease

The Schalling--Sifneos Personality Scale was administered to several groups of subjects (patient suffering from chronic hepatitis or from ulcerative colitis, patients undergoing chronic periodic haemodialysis, encephalopathic patient and healthy subjects) in order to assess the presence of alexithymia in healthy subjects, in patients suffering from chronic organic pathologies and in psychosomatic patients. The results obtained permit one to distinguish the psychosomatic patients from other groups of subjects: compared to healthy subjects, patients suffering from ulcerous rectocolitis obtained higher average scores, while compared to patients suffering from other organic pathologies their scores showed a wider scatter. A distinction is therefore proposed between primary alexithymia, of a distinctive cognitive-affective kind which predisposes towards psychosomatic pathology, and secondary alexithymia which is associated with stressful situations, such as illness, and which is essentially defensive in origin.     

Alexithymia and temperament and character model of personality in patients with major depressive disorder

Alexithymia is thought to be a stable personality trait and a predisposing risk factor for depression. In this study, we aimed to identify the prevalence of alexithymia in a depressed and nondepressed sample and examined the relationship between Cloninger's psychobiological model of personality with alexithymia. The Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20), the Turkish version of the Temperament and Character Inventory, and the 21-item Beck Depression Inventory (BDI) were administered to 81 depressed patients and 51 controls. The mean age of the groups was 30.5 ± 7.7 and 32.75 ± 8.73, respectively. Depression severity was evaluated with the BDI. In the depressed group, 33.3% were alexithymic, and alexithymic subjects had significantly higher BDI scores. Depressed individuals were significantly more alexithymic than the controls on the total and all the 3 subscales of TAS-20. The TAS-20 total score was negatively correlated with the temperament dimension of Reward Dependence (RD) and the character dimension of Self-Directedness (SD). In the TAS-20 subscale, difficulties in identifying feelings was positively correlated with Self-Transcendence and negatively correlated with SD. The difficulties in expressing feelings subscale was negatively correlated with RD and SD. In the depressed patient group, the temperament dimension of RD was significantly lower in the alexithymic group. The rate of alexithymia is found high among this sample of Turkish depressed patients, and the results suggested a strong connection between alexithymia and depression. Alexithymia is explained by specific dimensions and subscale within Cloninger's psychobiological model of personality in this sample of depressed Turkish patients.     

Examination of Cloninger's basic dimensions of personality in fatiguing illness: chronic fatigue syndrome and multiple sclerosis

Relatively few studies have examined the personality characteristics of patients with chronic fatigue syndrome (CFS). The personality profiles of 38 CFS subjects were compared with 40 healthy controls and 40 subjects with multiple sclerosis (MS), a chronic illness that shares many symptoms with CFS (e.g., fatigue), but has a known neurological substrate. Subjects were examined within Cloninger's biosocial theory of personality, which delineates basic dimensions of temperament. Both illness groups displayed similarly elevated levels of Harm Avoidance, and lower levels of Reward Dependence as compared with healthy controls. The MS group showed a lower level of Persistence than controls and CFS subjects. Implications for the relationship between chronic illness and personality are discussed.     

Neurophysiological evaluation of late paraphrenia: Comparison with chronic schizophrenia and dementia of the Alzheimer type

Background: Late paraphrenia (LP) is a clinical entity first proposed by Roth in 1955. Recently, neuroimaging studies have described the organic changes in the brain that are associated with LP. We performed a neurophysiological study on patients with LP, chronic schizophrenics and patients with dementia of the Alzheimer type (DAT) to examine the cognitive function of patients with LP and to differentiate LP patients from these other groups. Methods: We investigated somatosensory‐evoked response (SER), contingent negative variation (CNV) and P300 in 30 LP patients, 22 chronic schizophrenics and 31 patients with DAT. Thirty‐four age‐matched healthy volunteers served as a control group. SER was performed by applying a mechanical stimulus to the right or left palm. CNV was performed by presenting a clicking sound (S1) and a flash of light (S2) to the subjects, with an interval between S1 and S2 of 2 s. P300 was performed using an auditory oddball paradigm. Results: The mean N3 peak latency of SER was significantly prolonged in patients with LP and in patients with DAT, compared with the control group. The mean CNV amplitude was significantly decreased in schizophrenics compared with the control group, but it did not decrease in patients with LP. The mean N200 and P300 latencies were significantly prolonged in patients with DAT compared with the control group, LP patients and schizophrenics, but the latencies of patients with LP were not prolonged compared with the control group. Conclusion: Based on these results, we propose that patients with LP have impaired cerebral reactivity to the stimulus, but their attention, motivation, recognition and differentiation are relatively intact. The present findings are consistent with former investigations, indicating that patients with LP are less likely to show negative symptoms, such as personality deterioration, and more likely to show organic changes in the brain relative to schizophrenics arising in early life.     

Depressive personality dimensions and alexithymia in eating disorders

An association has been reported between high levels of alexithymia and depression in patients with eating disorders. This study has examined alexithymic features and depressive experiences in patients with DSM-IV eating disorder (restricting anorexia, n=105; purging anorexia, n=49; bulimia, n=98) and matched controls (n=279). The subjects were assessed with the Toronto Alexithymia Scale (TAS-20); the Beck Depression Inventory; and the Depressive Experiences Questionnaire, which defines two types of depressive personality style (dependent and self-critical). The patients had high levels of alexithymic features and depressive symptoms. Comparisons of alexithymic features between patients and controls after adjustment for depression showed a significant difference between bulimic patients and controls for the TAS Difficulty Identifying Feelings factor, and between restricting anorexic patients and controls for the TAS Difficulty Describing Feelings factor. With regard to depressive personality styles, only scores on the self-critical dimension were significantly higher in bulimic patients than in restricting anorexic patients and controls. In the entire group of eating disorders, dependency was associated with the TAS Difficulty Identifying Feelings factor only in anorexic patients. Self-criticism, on the other hand, was associated with the TAS Difficulty Identifying Feelings factor in all subtypes of eating disorders, although the relationship was significantly stronger in restricting anorexic than in bulimic patients. The results of this study suggest that people with restricting anorexia and bulimia show specific clinical profiles associating alexithymic features and depressive dimensions.     

The performance of diagnostic measures of depression in alexithymic and nonalexithymic subjects

OBJECTIVE: The objective of this study was to examine how the outcomes of a structured diagnostic interview for depression are related to the results of a self-report scale in alexithymic and nonalexithymic groups. MATERIALS AND METHODS: Subjects (N=389) recruited from primary care and psychiatric care completed the Depression Scale (DEPS) and the 20-item Toronto Alexithymia Scale. Major depression was diagnosed using the Composite International Diagnostic Interview-Short-Form by telephone. RESULTS: In the group without major depression, the DEPS scores of the alexithymic subjects were significantly higher than those of the nonalexithymic subjects. In the group with major depression, the ideal cutoff points of the DEPS, assessed by receiver operating characteristic analyses, were essentially higher for the alexithymic patients. CONCLUSIONS: Alexithymic subjects without major depression may be rated as depressive if the only criterion is the score on a self-report scale. Furthermore, alexithymic patients may require higher cutoff points in a self-report depression scale.     

Group-Analytic and Psychoeducational Therapies for Binge-Eating Disorder: An Exploratory Study of Efficacy and Persistence of Effects

Research has evaluated cognitive-behavioral therapy and interpersonal psychotherapy for the treatment of binge-eating disorder (BED); other therapies, however, have received less attention. The aim of our research was to analyze the efficacy of two group therapies for BED patients: analytic psychotherapy and psychoeducation. The psychotherapeutic intervention consisted of group-analytic psychotherapy of 14 sessions over a 28-week period; the group psychoeducational intervention involved 10 sessions over a 10-week period. The Eating Disorder Inventory-2, the 16-Personality Factors questionnaire, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale-20 were used for psychometric assessment. Two follow-up assessments were performed after 6 and 12 months, respectively. At the end of treatment, most patients were without eating disorders and had a lower rate of binge episodes. The psychoeducational group patients improved markedly in alexithymic traits related to the ability to describe feelings. At follow-up, most patients were still without eating disorders and had few binge episodes. Although psychoeducational group patients confirmed the amelioration on alexithymic traits, analytic psychotherapy group patients showed a trend toward an improvement in personality traits related to the ability to be at ease when communicating with others.     

Increased p50 gating but intact prepulse inhibition in borderline personality disorder

The authors explore sensory gating deficits in borderline personality disorder patients, such as those described in schizophrenia, in patients with borderline personality disorder. Gating of the P50, N100, and P200 auditory evoked potentials and prepulse inhibition of the startle response (PPI) were measured in borderline patients and a group of healthy comparison subjects. Borderline patients did not show lower sensory gating, but showed higher P50, N100, and P200 gating than comparison subjects. This was mainly due to the increased response after the first stimulus. There were no group differences in PPI. Unlike in other major psychiatric disorders, such as schizophrenia, sensory (motor) gating is intact in borderline personality disorder. The higher early preattentive and mid-latency evoked potentials suggest a higher response tendency in borderline personality disorder, but this needs further replication.     

脐血及血浆输注治疗肝炎：分组对照1年随访

背景：研究资料证明脐血干细胞移植能改善患者肝功能和免疫功能,修复肝损伤,促进肝细胞再生,但具体分化机制及生物学特性尚不明了,远期治疗前景有待分析。 目的：对照分析脐血输注与血浆输注对慢性乙型重型肝炎患者的远期治疗效果。 方法：2003-01/2004-01中南大学湘雅二医院住院的慢性重型肝炎患者50例,随机分为治疗组、对照组,25例/组,两组患者均接受护肝、对症、支持等综合治疗,在年龄、病情、用药等方面无明显差异,具有可比性。脐血来源于产前检查HBsAg、抗HCV、抗HIV、KT阴性,无血液病的健康足月顺产产妇,应用一次性采血袋,以封闭式采血法采血。脐血离心后,保留有核细胞及脐血浆,24 h内使用。治疗组输注脐血干细胞悬液,200 mL/次,每周一两次,每例患者输注4~8次,平均5次;对照组输注成人新鲜血浆。检测两组患者治疗前后血象和肝功能各项指标的变化。 结果与结论：两组患者全部完成1年随访。治疗前两组患者肝功能和血象各项指标均基本相似(P > 0.05)。脐血治疗1年后,两组患者血象各项指标无明显差异(P > 0.05),但治疗组谷丙转氨酶、总胆红素明显低于对照组(P < 0.05),血清白蛋白明显高于对照组(P < 0.05)。与治疗前比较,脐血治疗1年后治疗组血小板无明显变化,谷丙转氨酶、总胆红素均明显下降(P < 0.05),血清白蛋白明显升高(P < 0.05);对照组血小板明显下降(P < 0.05),血清白蛋白明显下降(P < 0.05)。提示脐血输注可改善重型肝炎患者的肝功能和血象,可作为其辅助治疗措施。     

Headache and hemodialysis: evaluation of the possible triggering factors and of the treatment

A growing number of patients have been undergoing dialysis procedures all around the world. Around 70% of the patients receiving dialysis treatment complain about headaches. In spite of this, headache is not well studied in this group of patients. The aims of this study are: to evaluate possible triggering factors related to hemodialysis headache and to evaluate the analgesic treatments used under this situation. We prospectively studied 50 patients with chronic renal failure attending to three dialysis services from the town of Ribeir?o Preto, State of S?o Paulo, Brazil, from January 1998 to December 1999. All of them presented headaches strictly related to the hemodialysis sessions. Headache occurred mainly in the second half of the hemodialysis (86%). Arterial hypertension (38%), arterial hypotension (12%) and changes in the weight during the hemodialysis sessions (6%) were the most consistently triggering situations. In 28% of the cases no factors were identified. Dipyrone was, by far (56%), the most frequently analgesic used. Despite being so common it noteworthy how scarce are studies in literature concerning headaches in patients with chronic renal failure. These patients, besides having to bear the burden of living with a painful and boring procedure to keep them alive, many of them have the additional burden, to live with a headache in most of the sessions. The identification of possible triggering factors and further evaluations of the treatment might increase our knowledge and contribute to reduce the burden of the headaches in patients with chronic renal failure.     

Amphetamine, psychosis, and cognition in the schizophrenia spectrum

We previously reported that subjects with a schizophrenia spectrum personality disorder (ie, an odd cluster personality disorder), of which the prototype is schizotypal personality disorder, show cognitive impairment in circumscribed areas (working memory) compared with healthy control subjects, and that amphetamine administration improves working memory in subjects with schizotypal personality disorder. In this larger series, we wanted to determine whether amphetamine treatment ameliorates working memory impairment using three groups: subjects with a schizophrenia spectrum personality disorder (ie, schizotypal, paranoid, or schizoid personality disorder), other (subjects with nonschizophrenia spectrum) personality disorder, and healthy volunteers. We hypothesized that amphetamine treatment would improve cognitive function in domains in which subjects with schizophrenia spectrum personality disorder show impairment compared with healthy volunteers and the other personality disorder group. Overall, amphetamine treatment did not improve performance in any task compared with placebo, and there was no group by drug interaction in the total sample. However, when the sample was restricted to the subjects who showed impairment at baseline, amphetamine treatment improved visuospatial working memory. In the total patient sample, amphetamine treatment reduced negative symptoms, whereas positive symptoms remained unchanged. Amphetamine treatment improves working memory in those subjects with cognitive impairment at baseline, most of whom meet criteria for a schizophrenia spectrum disorder.     

Personality and Alexithymic Disparity in Obsessive-Compulsive Disorder Based on Washing and Checking

The aim of this study was to investigate pathway relationship of personality characteristics and alexithymic traits in OCD symptoms of obsession, and compulsive behavior of washing and checking. Two-hundred and seventy patients diagnosed with OCD were consecutively recruited from the psychiatric outpatient department of a teaching hospital. Structural equation modeling showed those more neurotic, less extraverted and with higher levels of alexithymia difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT) were more likely to develop obsessive thoughts. Those less extraverted was more prone to develop washing compulsions, and those more neurotic were more likely to develop checking compulsions. EOT was the only alexithymic trait to have no gender difference within this group of patients with OCDs. The different personality and alexithymic trait pathways found between OCD obsession, washing and checking symptoms provide support that they may be different subtypes within the OCD diagnosis. Obsession was associated with washing, but not checking. Furthermore, no gender difference was found between the obsession and compulsive symptoms. Extraversion and neuroticism can be used to differentiate washing and checking, and alexithymia to differentiate washing and obsessions. This should be taken into consideration for intervention targeting patients with different OCD symptoms.     

Personality traits in migraine and tension-type headaches: a five-factor model study

Although abnormal personality traits have been frequently reported in patients with primary headaches, the overlaps between these domains need a clear standard definition, for example, by a five-factor personality model. Moreover, personality abnormalities in patients with episodic tension-type headache (ETH) and migraine with aura (MA) are less well studied. Therefore, we administered Zuckerman-Kuhlman's Personality Questionnaire to 72 patients suffering from chronic tension-type headaches (CTH), 33 with ETH, 15 with MA and 57 with migraine without aura (MO), as well as 58 healthy subjects. Depressive trends were measured with Plutchik-van Praag's Depression Inventory. Compared to healthy controls, the CTH, ETH and MO groups showed significantly greater neuroticism-anxiety and depression. In addition, the MO group scored significantly higher on aggression-hostility than healthy controls. No abnormal personality traits were found in patients with MA. This study, from the perspective of a five-factor model, confirms most previous reports about personality in patients with primary headaches and establishes elevated aggression-hostility only in MO sufferers.     

Effect of serotonergic antidepressant therapy on temperament and character scales in patients with chronic tension-type headache

The purpose of the present study was to assess a group of patients with chronic tension-type headache (CTTH) and control subjects using the personality questionnaire proposed by Cloninger and to determine possible changes in the Temperament and Character Inventory (TCI) patterns of CTTH patients after therapy with serotonergic antidepressants. Forty-five patients with CTTH filled out the TCI and Beck Depression Inventory (BDI) before and after 4-month prophylactic therapy with serotonergic antidepressants. A total of 50 age-, sex- and education level-matched healthy subjects were selected as a control group. During the pretreatment period patients were found to have higher harm avoidance and lower self-directedness scores than healthy comparison subjects. During the post-treatment period, although harm avoidance scores decreased and self-directedness scores increased, harm avoidance scores were still significantly higher and self-directedness scores significantly lower in CTTH patients than in controls. After using BDI score and age as covariates at the post-treatment period, harm avoidance scores were still higher in patients with CTTH while self-directedness scores did not differ between CTTH patients and controls. These findings suggest state and trait dependence of harm avoidance, and strong state dependence of self-directedness scores in CTTH patients. When interpreting data regarding personality measured by the TCI in CTTH patients, the effects of depressive symptomatology should be taken into account.     

Secondary alexithymia: an empirical validation

Alexithymia is described as both a primary personality trait and a secondary state reaction to medical illness. To empirically study secondary alexithymia, a series of medically ill patients seen in psychiatric consultation were compared with a healthy control population. Measured by the Toronto Alexithymia Scale (TAS), the medically ill were more alexithymic than the healthy population. Alexithymia was best predicted by both depressed mood and lowered quality of life, rather than by the categorical ranking of the severity of the medical illness. Alexithymia did appear to be separate from self-reported mood. These data support the concept of secondary alexithymia.     

Objective assessment of personality disorder in chronic fatigue syndrome

OBJECTIVES: This study aims to objectively assess the prevalence and nature of personality disorders in depressed and nondepressed chronic fatigue syndrome (CFS) patients and compare this to depressed and healthy control groups. METHODS: Sixty-one patients attending a tertiary referral clinic with chronic fatigue syndrome, 40 psychiatric inpatients with depressive disorder and 45 healthy medical students completed the Structured Clinical Interview for DSM-III-R Diagnoses (SCID-II) in addition to providing routine clinical and demographic information. RESULTS: Thirty-nine percent of the CFS group, 73% of the depressed group and 4% of the healthy group were diagnosed with personality disorders. Cluster C disorders were the most common in both the CFS and depressed group. The depressed CFS patients had more Cluster B personality disorders than nondepressed CFS patients. Overall for CFS patients there was no association between mood state and personality disorder. CONCLUSIONS: High levels of personality disorder are found on objective assessment of CFS patients attending a teaching hospital clinic. This cannot be accounted for by comorbid depression.     

The influence of affective state on sensory and emotional perception: Application of the Sense’n Feel™ method

Emotions play a key role in our daily life through their control over our thoughts and behaviors. While it is commonly accepted that depressive patients have emotional perception disorders, it is important to know how these disorders affect patients’ sensory perception to develop products to provide them with better support. In this study, we first examined the existence of modifications in the emotional perception of subjects with minor depressive symptoms (MDS, n = 80) compared with healthy controls (HC, n = 80) using a nonverbal method based on pictures to measure projected emotions and personality traits: the Sense'n Feel? method. The investigated stimuli were two unpleasant and two pleasant odors and one pleasant food product: a madeleine. Second, we investigated the hedonic, familiarity and intensity olfactory perceptions of the subjects using the same stimuli. No significant difference was found in any olfactory qualities between the two groups. Concerning the pleasant olfactory stimuli, however, we did note that the MDS subjects had a significantly lower score for the positive emotion of joy/happiness than the controls. Additionally, the MDS group's attribution of some positive personality traits for the three pleasant stimuli was significantly weaker than that in the HC group. These results could be explained by the affective state of the MDS subjects; they were more anxious and more alexithymic compared with the controls. Further research is needed to validate our study in clinically depressed individuals and to determine whether the modifications of the emotional olfactory perception are due to the disease and/or to neuropsychological alterations.     

Auditory brain-stem evoked potentials in patients undergoing dialysis

Auditory brain-stem evoked potentials (ABEPs) and pure-tone audiograms were obtained for 38 patients with renal failure, undergoing dialysis, before and after a dialysis session, and for 40 healthy normal subjects. Blood chemistry was also evaluated for each patient before and after dialysis. ABEP abnormality (using 10/sec click rate) was observed for 24% of the patients, rising to 44% when 55/sec measures were included. Abnormalities included prolongations of peak latencies for both click rates, and prolongation of interpeak latency differences. Pre-dialysis calcium was significantly different between patients with or without ABEP abnormality. In addition to this chronic effect on ABEPs, an acute effect of the dialysis session was found. Blood chemistry data, ABEP latencies and I-III interpeak latency differences were significantly different before, as compared to after dialysis. The acute effect of dialysis on blood calcium levels correlated with its effect on latencies of peaks III and V at 10/sec click rate, and on peaks I and V latency at 55/sec. These results may indicate the types of dysfunction revealed by increased stimulus rate measures.