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Dong L, Liang HB, Du J, Wang Y, Zhou Q, Xin Z, Hu Y, Liu YS, Zhao R, Qiao Y, Zhou C, Liu JR, Du X. Microstructural Differences of the Cerebellum-Thalamus-Basal Ganglia-Limbic Cortex in Patients with Somatic Symptom Disorders: a Diffusion Kurtosis Imaging Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:840-851. [PMID: 35986875 DOI: 10.1007/s12311-022-01461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Somatic symp tom disorders (SSDs) are a group of psychiatric disorders characterized by persistent disproportionate concern and obsessive behaviors regarding physical conditions. Currently, SSDs lack effective treatments and their pathophysiology is unclear. In this paper, we aimed to examine microstructural abnormalities in the brains of patients with SSD using diffusion kurtosis imaging (DKI) and to investigate the correlation between these abnormalities and clinical indicators. Diffusion kurtosis images were acquired from 30 patients with SSD and 30 healthy controls (HCs). Whole-brain maps of multiple diffusion measures, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), mean kurtosis (MK), radial kurtosis (RK), and axial kurtosis (AK), were calculated. To analyze differences between the two groups, nonparametric permutation testing with 10,000 randomized permutations and threshold-free cluster enhancement was used with family-wise error-corrected p values < 0.05 as the threshold for statistical significance. Then, the correlations between significant changes in these diffusion measures and clinical factors were examined. Compared to HCs, patients with SSD had significantly higher FA, MK, and RK and significantly lower MD and RD in the cerebellum, thalamus, basal ganglia, and limbic cortex. The FA in the left caudate and the pontine crossing tract were negatively correlated with disease duration; the MD and the RD in the genu of the corpus callosum were positively correlated with disease duration. Our findings highlight the role of the cerebellum-thalamus-basal ganglia-limbic cortex pathway, especially the cerebellum, in SSDs and enhance our understanding of the pathogenesis of SSDs.
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Affiliation(s)
- Liao Dong
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai, 200062, China
| | - Huai-Bin Liang
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jiaxin Du
- Centre for Advanced Imaging, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Yingying Wang
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Qichen Zhou
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Ziyue Xin
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Yue Hu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Sheng Liu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Rong Zhao
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuan Qiao
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chenglin Zhou
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China
| | - Jian-Ren Liu
- Department of Neurology &Jiuyuan Municipal Stroke Center, Shanghai 9Th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xiaoxia Du
- Department of Psychology, Shanghai University of Sport, Shanghai, 200438, China.
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Affiliation(s)
- Heike Künzel
- Psychosomatische Beratungsstelle / Ambulanz, Klinikum Innenstadt d. LMU München, Pettenkoferstraße 8 a, 80336, München, Deutschland.
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Establishing a role of the semantic control network in social cognitive processing: A meta-analysis of functional neuroimaging studies. Neuroimage 2021; 245:118702. [PMID: 34742940 DOI: 10.1016/j.neuroimage.2021.118702] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/01/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022] Open
Abstract
The contribution and neural basis of cognitive control is under-specified in many prominent models of socio-cognitive processing. Important outstanding questions include whether there are multiple, distinguishable systems underpinning control and whether control is ubiquitously or selectively engaged across different social behaviours and task demands. Recently, it has been proposed that the regulation of social behaviours could rely on brain regions specialised in the controlled retrieval of semantic information, namely the anterior inferior frontal gyrus (IFG) and posterior middle temporal gyrus. Accordingly, we investigated for the first time whether the neural activation commonly found in social functional neuroimaging studies extends to these 'semantic control' regions. We conducted five coordinate-based meta-analyses to combine results of 499 fMRI/PET experiments and identified the brain regions consistently involved in semantic control, as well as four social abilities: theory of mind, trait inference, empathy and moral reasoning. This allowed an unprecedented parallel review of the neural networks associated with each of these cognitive domains. The results confirmed that the anterior left IFG region involved in semantic control is reliably engaged in all four social domains. This supports the hypothesis that social cognition is partly regulated by the neurocognitive system underpinning semantic control.
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Jie J, Fan M, Yang Y, Luo P, Wang Y, Li J, Chen W, Zhuang M, Zheng X. Establishing a Counter-Empathy Processing Model: Evidence from Functional Magnetic Resonance Imaging. Soc Cogn Affect Neurosci 2021; 17:nsab097. [PMID: 34415030 PMCID: PMC8881639 DOI: 10.1093/scan/nsab097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022] Open
Abstract
Counter-empathy significantly affects people's social lives. Previous evidence indicates that the degree of counter-empathy can be either strong or weak. Strong counter-empathy easily occurs when empathizers are prejudiced against the targets of empathy (e.g., prejudice against outgroup members) and activates brain regions that are opposite to those activated by empathy. Weak counter-empathy may have different neural processing paths from strong one, but its underlying neural mechanisms remain unclear. In this work, we used an unfair distribution paradigm, which can reduce participants' prejudice against persons empathized with, and functional magnetic resonance imaging (fMRI) to explore the neural mechanisms underlying counter-empathy. Here, empathy and counter-empathy shared a common neural mechanism, induced by unfair distribution, in the right middle temporal gyrus. Counter-empathy activated distinct brain regions that differed from those of empathic responses in different situations. The functions of these brain regions, which included the middle frontal, middle temporal and left medial superior gyri, were similar and mostly related to emotional regulation and cognitive processing. Here, we propose a process model of counter-empathy, involving two processing paths according to whether or not prejudice exists. This study has theoretical significance and broadens our understanding of the cognitive neural mechanisms underlying empathy and counter-empathy.
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Affiliation(s)
- Jing Jie
- School of Psychology, South China Normal University, Guangzhou 510631, China
- School of Biomedical Engineering, Hainan University, Haikou 570228, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Min Fan
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yong Yang
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
- School of Educational Science, Xinyang Normal University, Xinyang 414000, China
| | - Pinchao Luo
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yijing Wang
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Junjiao Li
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
- College of Teacher’s Education, Guangdong University of Education, Guangzhou 510303, China
| | - Wei Chen
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Mengdi Zhuang
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
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Frontotemporal dementia, music perception and social cognition share neurobiological circuits: A meta-analysis. Brain Cogn 2021; 148:105660. [PMID: 33421942 DOI: 10.1016/j.bandc.2020.105660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 01/18/2023]
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disease that presents with profound changes in social cognition. Music might be a sensitive probe for social cognition abilities, but underlying neurobiological substrates are unclear. We performed a meta-analysis of voxel-based morphometry studies in FTD patients and functional MRI studies for music perception and social cognition tasks in cognitively normal controls to identify robust patterns of atrophy (FTD) or activation (music perception or social cognition). Conjunction analyses were performed to identify overlapping brain regions. In total 303 articles were included: 53 for FTD (n = 1153 patients, 42.5% female; 1337 controls, 53.8% female), 28 for music perception (n = 540, 51.8% female) and 222 for social cognition in controls (n = 5664, 50.2% female). We observed considerable overlap in atrophy patterns associated with FTD, and functional activation associated with music perception and social cognition, mostly encompassing the ventral language network. We further observed overlap across all three modalities in mesolimbic, basal forebrain and striatal regions. The results of our meta-analysis suggest that music perception and social cognition share neurobiological circuits that are affected in FTD. This supports the idea that music might be a sensitive probe for social cognition abilities with implications for diagnosis and monitoring.
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Irorutola F, Gerhardt C, Hamouda K, Rose M, Hinkelmann K, Senf-Beckenbach P. Emotional and cognitive empathy in patients with non-epileptic seizures. Seizure 2020; 81:280-286. [DOI: 10.1016/j.seizure.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
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Changes in brain glucose metabolism and connectivity in somatoform disorders: an 18F-FDG PET study. Eur Arch Psychiatry Clin Neurosci 2020; 270:881-891. [PMID: 31720787 DOI: 10.1007/s00406-019-01083-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/05/2019] [Indexed: 01/18/2023]
Abstract
Somatoform disorders (SFD) are defined as a syndrome characterized by somatic symptoms which cannot be explained by organic reasons. Chronic or recurrent forms of somatization lead to heavy emotional and financial burden to the patients and their families. However, the underlying etiology of SFD is largely unknown. The purpose of this study is to investigate the changed brain glucose metabolic pattern in SFD. In this study, 18 SFD patients and 21 matched healthy controls were enrolled and underwent an 18F-FDG PET scan. First, we explored the altered brain glucose metabolism in SFD. Then, we calculated the mean 18F-FDG uptake values for 90 AAL regions, and detected the changed brain metabolic connectivity between the most significantly changed regions and all other regions. In addition, the Pearson coefficients between the neuropsychological scores and regional brain 18F-FDG uptake values were computed for SFD patients. We found that SFD patients showed extensive hypometabolism in bilateral superolateral prefrontal cortex, insula, and regions in bilateral temporal gyrus, right angular gyrus, left gyrus rectus, right fusiform gyrus, right rolandic operculum and bilateral occipital gyrus. The metabolic connectivity between right insula and prefrontal areas, as well as within prefrontal areas was enhanced in SFD. And several brain regions were associated with the somatic symptoms, including insula, putamen, middle temporal gyrus, superior parietal gyrus and orbital part of inferior frontal gyrus. Our study revealed widespread alterations of the brain glucose metabolic pattern in SFD patients. Those findings might elucidate the neuronal mechanisms with glucose metabolism and shed light on the pathology of SFD.
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Kogler L, Müller VI, Werminghausen E, Eickhoff SB, Derntl B. Do I feel or do I know? Neuroimaging meta-analyses on the multiple facets of empathy. Cortex 2020; 129:341-355. [PMID: 32562973 PMCID: PMC7390692 DOI: 10.1016/j.cortex.2020.04.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/15/2019] [Accepted: 04/22/2020] [Indexed: 01/10/2023]
Abstract
Empathy is a multidimensional construct including affective and cognitive components while maintaining the distinction between one-self and others. Our meta-analyses focused on shared and distinct networks underlying cognitive (taking somebody else's perspective in emotional/painful situations) and affective (self-referentially feeling somebody else's emotions/pain) empathy for various states including painful and emotional situations. Furthermore, a comparison with direct pain experience was carried out. For cognitive empathy, consistent activation in the anterior dorsal medial frontal gyrus (dmPFG) and the supramarginal gyrus (SMG) occurred. For affective empathy, convergent activation of the posterior dmPFG and the inferior frontal gyrus (IFG) was found. Consistent activation of the anterior insula (AI), the anterior dmPFG and the SMG was observed for empathy for pain, while convergent recruitment of the temporo-parietal junction, precuneus, posterior dmPFG, and the IFG was revealed in the meta-analysis across empathy for emotion experiments. The AI and the dmPFG/mid-cingulate cortex (MCC) showed overlapping as well as distinct neural activation for pain processing and empathy for pain. Taken together, we were able to show difference in the meta-analytic networks across cognitive and affective empathy as well as for pain and empathy processing. Based on the current results, distinct functions along the midline structures of the brain during empathy processing are apparent. Our data are lending further support for a multidimensional concept of empathy.
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Affiliation(s)
- Lydia Kogler
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Tübingen, Tübingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.
| | - Veronika I Müller
- Institute of Neuroscience und Medicine, INM-7, Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Elena Werminghausen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience und Medicine, INM-7, Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Tübingen, Tübingen, Germany; Center for Integrative Neuroscience, University of Tübingen, Tübingen, Germany; LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
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Empathy, social and emotional competencies, bullying perpetration and victimization as longitudinal predictors of somatic symptoms in adolescence. J Affect Disord 2020; 271:145-151. [PMID: 32479310 DOI: 10.1016/j.jad.2020.03.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/20/2020] [Accepted: 03/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Somatic symptoms are an important adolescent health problem that affects individuals and the society as a whole. Although research focused on somatic symptoms has been very fruitful, studies about their longitudinal predictors are still in their early stages. The present study focuses on the relations between social and emotional competencies, empathy and bullying, and the presence of somatic symptoms concurrently and one year later. METHOD The sample consisted of 384 Spanish adolescents, who participated in a longitudinal study with a one-year follow-up. Validated questionnaires were used to assess social and emotional competencies, bullying, empathy and somatic complaints. RESULTS High scores in social and emotional competencies were related to low scores in somatic symptoms one year later. High affective empathy predicted more somatic symptoms concurrently and one year later. Bullying victimization was related to more somatic symptoms concurrently and one year later. LIMITATIONS Other-reports could be useful to further validate the results obtained with self-reports. Non-linear relations could be tested. Representative samples could be used in future studies. CONCLUSIONS These results suggest that it may be important to promote social and emotional competencies and reduce bullying to decrease somatic symptoms. More studies are needed to understand the impact of high affective empathy on somatic symptoms.
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Khosravani V, Samimi Ardestani SM, Alvani A, Amirinezhad A. Alexithymia, empathy, negative affect and physical symptoms in patients with asthma. Clin Psychol Psychother 2020; 27:736-748. [PMID: 32285550 DOI: 10.1002/cpp.2458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Alvani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Amirinezhad
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
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Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
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Peng W, Meng J, Lou Y, Li X, Lei Y, Yan D. Reduced empathic pain processing in patients with somatoform pain disorder: Evidence from behavioral and neurophysiological measures. Int J Psychophysiol 2019; 139:40-47. [DOI: 10.1016/j.ijpsycho.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 01/09/2023]
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Delvecchio G, Rossetti MG, Caletti E, Arighi A, Galimberti D, Basilico P, Mercurio M, Paoli R, Cinnante C, Triulzi F, Altamura AC, Scarpini E, Brambilla P. The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study. PSYCHOSOMATICS 2019; 60:278-288. [DOI: 10.1016/j.psym.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022]
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Bègue I, Adams C, Stone J, Perez DL. Structural alterations in functional neurological disorder and related conditions: a software and hardware problem? Neuroimage Clin 2019; 22:101798. [PMID: 31146322 PMCID: PMC6484222 DOI: 10.1016/j.nicl.2019.101798] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.
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Affiliation(s)
- Indrit Bègue
- Department of Psychiatry, University of Geneva, Switzerland; Service of Adult Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland; Laboratory for Behavioral Neurology and Imaging of Cognition, Geneva Neuroscience Center, University of Geneva, Switzerland
| | - Caitlin Adams
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Inpatient Psychiatry Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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Eger Aydogmus M, Hamilton JC. Ego Depletion as a Measure of Emotion Processing Deficits among MUS Patients. The Journal of General Psychology 2019; 146:234-257. [PMID: 30741112 DOI: 10.1080/00221309.2018.1562416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Previous studies have found a link between emotion processing deficits and medically unexplained physical symptoms (MUS). The majority of previous studies have used self-report measures of emotional processing, with the majority focusing on alexithymia, and have produced inconsistent and contradictory results. In the present study, we investigated the role of emotion-processing deficits in MUS by assessing emotion regulation performance and the effects of performance on ego depletion. Participants with high or low levels of self-reported MUS watched emotion-evoking videos under instructions to allow or suppress their emotional reactions, and then performed an anagram task to measure their effort and perseverance. Contrary to the research with self-report measures, experimental analysis of emotion-processing revealed that MUS is correlated with the inability to regulate negative emotions. Unexpected self-regulatory tendencies of the participants with high symptom levels were discussed.
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Goetzmann L, Siegel A, Ruettner B. The connectivity / conversion paradigm - A new approach to the classification of psychosomatic disorders. NEW IDEAS IN PSYCHOLOGY 2019. [DOI: 10.1016/j.newideapsych.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Li X, Zhang M, Li K, Zou F, Wang Y, Wu X, Zhang H. The Altered Somatic Brain Network in State Anxiety. Front Psychiatry 2019; 10:465. [PMID: 31312147 PMCID: PMC6613038 DOI: 10.3389/fpsyt.2019.00465] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
Highly anxious individuals often show excessive emotional arousal, somatic arousal, and characteristics of mental illness. Previous researches have extensively investigated the emotional and cognitive biases of individuals with high anxiety, but overlooked the spontaneous brain activity and functional connections associated with somatic arousal. In this study, we investigated the relationship between state anxiety and the spontaneous brain activity of the somatosensory cortex in a non-clinical healthy population with state anxiety. Furthermore, we also explored the functional connections of the somatosensory cortex. We found that state anxiety was positively correlated with the amplitude of low-frequency fluctuations (ALFFs) of somatic related brain regions, including the right postcentral gyrus (somatosensory cortex) and the right precentral gyrus (somatic motor cortex). Furthermore, we found that state anxiety was positively correlated with the connections between the postcentral gyrus and the left cerebellum gyrus, whereas state anxiety was negatively correlated with the connectivity between the postcentral gyrus and brain regions including the left inferior frontal cortex and left medial superior frontal cortex. These results revealed the association between the anxious individuals' body-loop and state anxiety in a healthy population, which revealed the importance of somatic brain regions in anxiety symptoms and provided a new perspective on anxiety for further study.
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Affiliation(s)
- Xianrui Li
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Meng Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang, China.,Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Kun Li
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Feng Zou
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Yufeng Wang
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Xin Wu
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Hongxing Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang, China.,Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Henan key Laboratory of Biological Psychiatry, Xinxiang, China
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18
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Williams B, Jalilianhasanpour R, Matin N, Fricchione GL, Sepulcre J, Keshavan MS, LaFrance WC, Dickerson BC, Perez DL. Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders. J Psychiatr Res 2018; 102:230-237. [PMID: 29702433 PMCID: PMC6005758 DOI: 10.1016/j.jpsychires.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/16/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insecure attachment and maladaptive coping are important predisposing vulnerabilities for Functional Neurological Disorders (FND)/Conversion Disorder, yet no prior structural neuroimaging studies have investigated biomarkers associated with these risk factors in FND populations. This magnetic resonance imaging study examined cortical thickness and subcortical volumes associated with self-reported attachment and coping styles in patients with FND. We hypothesized that insecure attachment and maladaptive coping would relate to limbic-paralimbic structural alterations. METHODS FreeSurfer cortical thickness and subcortical volumetric analyses were performed in 26 patients with motor FND (21 women; 5 men) and 27 healthy controls (22 women; 5 men). For between-group comparisons, patients with FND were stratified by Relationship Scales Questionnaire, Ways of Coping Scale-Revised, and Connor-Davidson Resilience Scale scores. Within-group analyses were also performed in patients with FND. All analyses were performed in the complete cohort and separately in women only to evaluate for gender-specific effects. Cortical thickness analyses were whole-brain corrected at the cluster-wise level; subcortical analyses were Bonferroni corrected. RESULTS In women with FND, dismissing attachment correlated with reduced left parahippocampal cortical thickness. Confrontive coping was associated with reduced right hippocampal volume, while accepting responsibility positively correlated with right precentral gyrus cortical thickness. These findings held adjusting for anti-depressant use. All FND-related findings were within the normal range when compared to healthy women. CONCLUSION These observations connect individual-differences in limbic-paralimbic and premotor structures to attachment and coping styles in FND. The relationship between parahippocampal thickness and dismissing attachment may indicate aberrant social-emotional and contextual appraisal in women with FND.
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Affiliation(s)
- Benjamin Williams
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rozita Jalilianhasanpour
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nassim Matin
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory L. Fricchione
- Department of Psychiatry, Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge Sepulcre
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W. Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island, USA
| | - Bradford C. Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L. Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Northoff G. The brain's spontaneous activity and its psychopathological symptoms - "Spatiotemporal binding and integration". Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:81-90. [PMID: 28363766 DOI: 10.1016/j.pnpbp.2017.03.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/27/2017] [Indexed: 01/11/2023]
Abstract
Neuroimaging provided much insight into the neural activity of the brain and its alterations in psychiatric disorders. However, despite extensive research, the exact neuronal mechanisms leading to the various psychopathological symptoms remain unclear, yet. In addition to task-evoked activity during affective, cognitive, or other challenges, the brain's spontaneous or resting state activity has come increasingly into the focus. Basically all psychiatric disorders show abnormal resting state activity with the relation to psychopathological symptoms remaining unclear though. I here suggest to conceive the brain's spontaneous activity in spatiotemporal terms that is, by various mechanisms that are based on its spatial, i.e., functional connectivity, and temporal, i.e., fluctuations in different frequencies, features. I here point out two such spatiotemporal mechanisms, i.e., "spatiotemporal binding and integration". Alterations in the resting state's spatial and temporal features lead to abnormal "spatiotemporal binding and integration" which results in abnormal contents in cognition as in the various psychopathological symptoms. This, together with concrete empirical evidence, is demonstrated in depression and schizophrenia. I therefore conclude that we need to develop a spatiotemporal approach to psychopathology, "spatiotemporal psychopathology:" as I call it.
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Affiliation(s)
- Georg Northoff
- Mind, Brain Imaging and Neuroethics, University of Ottawa, Institute of Mental Health Research, Canada.
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20
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Li R, Liu F, Su Q, Zhang Z, Zhao J, Wang Y, Wu R, Zhao J, Guo W. Bidirectional Causal Connectivity in the Cortico-Limbic-Cerebellar Circuit Related to Structural Alterations in First-Episode, Drug-Naive Somatization Disorder. Front Psychiatry 2018; 9:162. [PMID: 29755373 PMCID: PMC5932337 DOI: 10.3389/fpsyt.2018.00162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Anatomical and functional deficits in the cortico-limbic-cerebellar circuit are involved in the neurobiology of somatization disorder (SD). The present study was performed to examine causal connectivity of the cortico-limbic-cerebellar circuit related to structural deficits in first-episode, drug-naive patients with SD at rest. Methods: A total of 25 first-episode, drug-naive patients with SD and 28 healthy controls underwent structural and resting-state functional magnetic resonance imaging. Voxel-based morphometry and Granger causality analysis (GCA) were used to analyze the data. Results: Results showed that patients with SD exhibited decreased gray matter volume (GMV) in the right cerebellum Crus I, and increased GMV in the left anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), and left angular gyrus. Causal connectivity of the cortico-limbic-cerebellar circuit was partly affected by structural alterations in the patients. Patients with SD showed bidirectional cortico-limbic connectivity abnormalities and bidirectional cortico-cerebellar and limbic-cerebellar connectivity abnormalities. The mean GMV of the right MFG was negatively correlated with the scores of the somatization subscale of the symptom checklist-90 and persistent error response of the Wisconsin Card Sorting Test (WCST) in the patients. A negative correlation was observed between increased driving connectivity from the right MFG to the right fusiform gyrus/cerebellum IV, V and the scores of the Eysenck Personality Questionnaire extraversion subscale. The mean GMV of the left ACC was negatively correlated with the WCST number of errors and persistent error response. Negative correlation was found between the causal effect from the left ACC to the right middle temporal gyrus and the scores of WCST number of categories achieved. Conclusions: Our findings show the partial effects of structural alterations on the cortico-limbic-cerebellar circuit in first-episode, drug-naive patients with SD. Correlations are observed between anatomical alterations or causal effects and clinical variables in patients with SD, and bear clinical significance. The present study emphasizes the importance of the cortico-limbic-cerebellar circuit in the neurobiology of SD.
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Affiliation(s)
- Ranran Li
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qinji Su
- Mental Health Center of the First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Zhikun Zhang
- Mental Health Center of the First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jin Zhao
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Wang
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, Second Xiangya Hospital of Central South University, Changsha, China
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21
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Perez DL, Williams B, Matin N, LaFrance WC, Costumero-Ramos V, Fricchione GL, Sepulcre J, Keshavan MS, Dickerson BC. Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder. J Neurol Neurosurg Psychiatry 2017; 88:1052-1059. [PMID: 28844071 DOI: 10.1136/jnnp-2017-316359] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Affective symptoms influence health status (health-related quality of life) in functional neurological disorder (FND), and the salience network is implicated in the pathophysiology of FND and mood/anxiety disorders. We hypothesised that self-reported health status and affective symptoms would map onto salience network regions and that patients with FND would show decreased insular volumes compared with controls. METHODS This voxel-based morphometry study investigated volumetric differences in 26 patients with FND (21 women, 5 men; mean age=40.3±11.5) compared with 27 healthy controls (22 women, 5 men; mean age=40.5±10.8). Post hoc analyses stratified patients with FND by mental and physical health scores (Short Form Health Survey-36). Within-group analyses investigated associations with mental health, physical health, trait anxiety and depression in patients with FND. RESULTS There were no volumetric differences between the complete FND cohort and controls. In stratified analyses, however, patients with FND reporting the most severe physical health impairments showed reduced left anterior insular volume compared with controls. In within-group analyses, impaired mental health and elevated trait anxiety were associated with increased right amygdalar volumes in patients with FND. The relationship between amygdalar volume and mental health, driven by emotional well-being deficits and role limitations due to emotional problems, was independent of sensorimotor functional neurological symptom severity and motor FND subtype. In secondary within-group analyses, increased periaqueductal grey volume was associated with role limitations due to emotional problems. Impaired physical functioning correlated with decreased left anterior insular volumes. CONCLUSIONS These findings support roles for several regions of the salience network in the pathophysiology of FND.
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Affiliation(s)
- David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Benjamin Williams
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nassim Matin
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division, Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Alpert Medical School, Providence, Rhode Island, USA
| | - Victor Costumero-Ramos
- Department of Methodology, University of Valencia, Valencia, Spain.,Department of Basic and Clinical Psychology and Psychobiology, University Jaume I, Castellón de la Plana, Spain
| | - Gregory L Fricchione
- Department of Psychiatry, Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jorge Sepulcre
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bradford C Dickerson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Besteher B, Gaser C, Langbein K, Dietzek M, Sauer H, Nenadić I. Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. J Affect Disord 2017; 215:111-117. [PMID: 28319687 DOI: 10.1016/j.jad.2017.03.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dimensional approaches in highly prevalent psychiatric disorders like depression or anxiety could lead to a better understanding of pathogenesis and advantages in early detection and prevention. In an effort to better understand associations of brain structural variation across the depression/anxiety spectra, we investigated minor subclinical symptoms in a non-clinical healthy population. METHODS We studied 177 healthy subjects from the community, who underwent high-resolution T1-weighted 3T MRI and completed the symptom-checklist-90 (SCL-90-R). Using voxel-based morphometry (VBM) analysis with CAT12 software, we correlated SCL-90-R-subscales for depression, anxiety, and somatization with gray matter across the brain. RESULTS Significant positive gray matter correlations emerged across all three scales in different areas: the depression subscale correlated positively with gray matter in the Rolandic operculum, superior temporal gyrus (left) and postcentral gyrus (bilateral), the anxiety subscale correlated positively with middle temporal gyrus, Rolandic operculum, middle cingular gyrus and precuneus bilaterally, and the somatization subscale with left inferior prefrontal cortex. Somatization also showed negative correlations with cerebellar vermis and right supplementary motor area. LIMITATIONS Our study is limited to VBM and does not include surface-based measures. It also only contains subjects with very small psychological distress by partly overlapping symptoms. CONCLUSION Our findings are consistent with a non-linear relationship between symptom severity and cortical volume in several brain areas involved in both emotion regulation as well as altered in clinically manifest depressive/anxiety disorders.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Department of Neurology, Jena University Hospital, Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maren Dietzek
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Heinrich Sauer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Department of Psychiatry and Psychotherapy, Philipps-University Marburg/Marburg University Hospital - UKGM, Marburg, Germany
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23
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Li Q, Xiao Y, Li Y, Li L, Lu N, Xu Z, Mou X, Mao S, Wang W, Yuan Y. Altered regional brain function in the treatment-naive patients with somatic symptom disorder: a resting-state fMRI study. Brain Behav 2016; 6:e00521. [PMID: 27781136 PMCID: PMC5064334 DOI: 10.1002/brb3.521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/14/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Somatic symptom disorder (SSD) is an illness that occurs over a long time and results in significant disruption in daily life. Clinically, SSD patients typically express complaints that involve a variety of organ systems. However, the neural mechanism of SSD remains poorly understood. METHODS Using resting-state functional magnetic resonance imaging, we investigated the characteristics of the regional basal brain function during resting state in patients with SSD. Eleven treatment-naïve SSD patients and 12 age-matched healthy controls were recruited in this study. Between-group differences in regional homogeneity values were analyzed. RESULTS Compared with the healthy control group, the SSD group showed significant increases in regional homogeneity values in the right medial prefrontal cortex, anterior cingulate cortex and supramarginal gyrus, and significant decreases in the bilateral middle occipital gyrus, superior occipital gyrus and right cuneus and left postcentral gyrus and cerebellum. Meanwhile, the regional homogeneity value of the right medial prefrontal cortex positively correlated with the total duration of SSD. CONCLUSIONS The abnormal resting-state patterns in regional brain activity may contribute to understanding the mechanism of SSD.
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Affiliation(s)
- Qiang Li
- Department of Radiology Tangdu Hospital the Fourth Military Medical University Xi'an China
| | - Yong Xiao
- Department of Neurosurgery Fuzhou General Hospital Xiamen University Fuzhou China
| | - Yinghui Li
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Lei Li
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Na Lu
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Xiaodong Mou
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Shenqin Mao
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
| | - Wei Wang
- Department of Radiology Tangdu Hospital the Fourth Military Medical University Xi'an China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry Affiliated Zhongda Hospital Medical School of Southeast University Nanjing China
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Boeckle M, Schrimpf M, Liegl G, Pieh C. Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies. NEUROIMAGE-CLINICAL 2016; 11:606-613. [PMID: 27182487 PMCID: PMC4857221 DOI: 10.1016/j.nicl.2016.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 01/18/2023]
Abstract
Somatoform disorders (SD) are common medical disorders with prevalence rates between 3.5% and 18.4%, depending on country and medical setting. SD as outlined in the ICD-10 exhibits various biological, social, and psychological pathogenic factors. Little is known about the neural correlates of SD. The aims of this meta-analysis are to identify neuronal areas that are involved in SD and consistently differ between patients and healthy controls. We conducted a systematic literature research on neuroimaging studies of SD. Ten out of 686 studies fulfilled the inclusion criteria and were analyzed using activation likelihood estimation. Five neuronal areas differ between patients with SD and healthy controls namely the premotor and supplementary motor cortexes, the middle frontal gyrus, the anterior cingulate cortex, the insula, and the posterior cingulate cortex. These areas seem to have a particular importance for the occurrence of SD. Out of the ten studies two did not contribute to any of the clusters. Our results seem to largely overlap with the circuit network model of somatosensory amplification for SD. It is conceivable that functional disorders, independent of the clinical impression, show similar neurobiological processes. While overlaps do occur it is necessary to understand single functional somatic syndromes and their aetiology for future research, terminology, and treatment guidelines. Five neurobiological areas correlate with the occurrence of somatoform disorders (SD). Areas are crucial for emotional, evaluative and cognitive aspects of pain processing. Prefrontal areas indicate involvement of pain memory in SD. Functional disorders might have central sensitization as an underlying factor. Results do not support the classification of SD as medically unexplained symptoms.
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Affiliation(s)
- Markus Boeckle
- Department of Psychotherapy and Biopsychosocial Health, Donau-Universität Krems, Krems, Austria.
| | - Marlene Schrimpf
- Department of Psychotherapy and Biopsychosocial Health, Donau-Universität Krems, Krems, Austria
| | - Gregor Liegl
- Department of Psychotherapy and Biopsychosocial Health, Donau-Universität Krems, Krems, Austria; Medical Clinic, Department of Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | - Christoph Pieh
- Department of Psychotherapy and Biopsychosocial Health, Donau-Universität Krems, Krems, Austria; Karl Landsteiner University of Health Sciences, Krems, Austria; Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
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25
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Öztürk A, Kiliç A, Deveci E, Kirpinar İ. Investigation of facial emotion recognition, alexithymia, and levels of anxiety and depression in patients with somatic symptoms and related disorders. Neuropsychiatr Dis Treat 2016; 12:1047-53. [PMID: 27199559 PMCID: PMC4857827 DOI: 10.2147/ndt.s106989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The concept of facial emotion recognition is well established in various neuropsychiatric disorders. Although emotional disturbances are strongly associated with somatoform disorders, there are a restricted number of studies that have investigated facial emotion recognition in somatoform disorders. Furthermore, there have been no studies that have regarded this issue using the new diagnostic criteria for somatoform disorders as somatic symptoms and related disorders (SSD). In this study, we aimed to compare the factors of facial emotion recognition between patients with SSD and age- and sex-matched healthy controls (HC) and to retest and investigate the factors of facial emotion recognition using the new criteria for SSD. PATIENTS AND METHODS After applying the inclusion and exclusion criteria, 54 patients who were diagnosed with SSD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 46 age- and sex-matched HC were selected to participate in the present study. Facial emotion recognition, alexithymia, and the status of anxiety and depression were compared between the groups. RESULTS Patients with SSD had significantly decreased scores of facial emotion for fear faces, disgust faces, and neutral faces compared with age- and sex-matched HC (t=-2.88, P=0.005; t=-2.86, P=0.005; and t=-2.56, P=0.009, respectively). After eliminating the effects of alexithymia and depressive and anxious states, the groups were found to be similar in terms of their responses to facial emotion and mean reaction time to facial emotions. DISCUSSION Although there have been limited numbers of studies that have examined the recognition of facial emotion in patients with somatoform disorders, our study is the first to investigate facial recognition in patients with SSD diagnosed according to the DSM-5 criteria. Recognition of facial emotion was found to be disturbed in patients with SSD. However, our findings suggest that disturbances in facial recognition were significantly associated with alexithymia and the status of depression and anxiety, which is consistent with the previous studies. Further studies are needed to highlight the associations between facial emotion recognition and SSD.
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Affiliation(s)
- Ahmet Öztürk
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alperen Kiliç
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kirpinar
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Ruckmann J, Bodden M, Jansen A, Kircher T, Dodel R, Rief W. How pain empathy depends on ingroup/outgroup decisions: A functional magnet resonance imaging study. Psychiatry Res 2015; 234:57-65. [PMID: 26323252 DOI: 10.1016/j.pscychresns.2015.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/31/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022]
Abstract
Showing empathy is crucial for social functioning and empathy is related to group membership. The aim of the current study was to investigate the influence of experimentally generated groups on empathy for pain in a functional magnetic resonance imaging (fMRI) paradigm. Thirty healthy participants underwent a minimal group paradigm to create two groups. While BOLD contrast was measured using fMRI, subjects were instructed to empathize with ingroup and outgroup members, who were depicted in a picture paradigm of painful and neutral situations. Behavioral measure of state empathy was measured using a visual analog scale. Furthermore, self-reported trait empathy measures were obtained. Repeated-measures ANOVAs were conducted for fMRI and behavioral data. In addition to a main effect of pain in pain-related areas, a main effect of group in areas belonging to the visual cortex was found. Although there was no ingroup bias for empathy ratings, subjects showed altered neural activation in regions of the right fusiform gyrus, the cerebellum, the hippocampal and amygdala region during the pain×group interaction. Activation in the preceding structures, revealed by the interaction of pain by group, suggests that activation in the pallidum might reflect specific empathy for pain-related regulation processes.
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Affiliation(s)
- Judith Ruckmann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Marburg, Germany.
| | - Maren Bodden
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany; Department of Psychology and Psychotherapy, University of Bonn, Bonn, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Richard Dodel
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Marburg, Germany
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Lee S, Allendorfer JB, Gaston TE, Griffis JC, Hernando KA, Knowlton RC, Szaflarski JP, Ver Hoef LW. White matter diffusion abnormalities in patients with psychogenic non-epileptic seizures. Brain Res 2015; 1620:169-76. [DOI: 10.1016/j.brainres.2015.04.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/04/2015] [Accepted: 04/26/2015] [Indexed: 11/16/2022]
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Developing an Alternative Chinese Version of the Interpersonal Reactivity Index for Normal Population and Patients with Schizophrenia in Taiwan. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Interpersonal Reactivity Index (IRI) is a multidimensional individual-difference measure of empathy. The original IRI has been used in many studies to assess both normal and clinical samples. Because of its wide availability and convenience of use, the IRI has been translated into several languages. In Taiwan, the IRI was translated into traditional Chinese as a Chinese Version of the Interpersonal Reactivity Index (C-IRI) in 1987. Because the C-IRI was developed over 26 years ago and recent studies have shown some unsatisfactory psychometric properties on the C-IRI, there was a need to develop an alternative to the C-IRI and verify its psychometric properties again. In this study, we assessed the psychometric properties of an alternative C-IRI by administering it to 516 college students, 35 community residents and 70 schizophrenic patients, all of whom are adults. Exploratory factor analyses revealed a four-factor structure: Fantasy, Perspective Taking, Empathy and Personal Distress. Acceptable convergent and divergent validity supported the construct validity of the alternative C-IRI. Evidence was also found for its discriminant validity between patients with schizophrenia and normal controls on the Empathy subscale and Affective Empathy, while the full scale and its factors demonstrated good internal consistency and test–retest reliability. In the future, the alternative C-IRI should be validated with adolescent or elderly samples, and different clinical samples.
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Grabe HJ, Wittfeld K, Hegenscheid K, Hosten N, Lotze M, Janowitz D, Völzke H, John U, Barnow S, Freyberger HJ. Alexithymia and brain gray matter volumes in a general population sample. Hum Brain Mapp 2014; 35:5932-45. [PMID: 25081815 DOI: 10.1002/hbm.22595] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/01/2014] [Accepted: 07/14/2014] [Indexed: 11/05/2022] Open
Abstract
Alexithymia is perceived as a personality construct involving deficits in the cognitive processing of emotion. Brain areas that process emotions might be structurally altered in affected people. Subjects from the Study of Health in Pomerania who underwent whole body magnetic resonance imaging were investigated. After quality control procedures 2,589 subjects with Toronto Alexithymia Scale 20 (TAS-20) data and interview-based information on major depressive disorder (MDD) were available. After exclusion of study participants who were older than 65 years or had MDD in their lifetime, 1,685 subjects were included in the voxel-based morphometric (VBM 8) analyses. In whole-brain analyses, the TAS-20 total score was associated with less gray matter (GM) volumes of the bilateral dorsal anterior cingulate cortex (dACC). The TAS-20 factor scale difficulty identifying feelings (DIF) was associated with less GM volume in three clusters: dACC, left middle and inferior temporal gyrus, left fusiform gyrus and cerebellum. The lower GM volume in the left fusiform gyrus was specific for females. Absolute GM volume analyses also revealed associations between the factor scales difficulty describing feelings, external orientated thinking and the dACC. Adjustment for current symptoms of anxiety and depression did not change the effects sizes substantially. In conclusion, lower GM volume in the dACC represents the major structural correlate of alexithymia. Associations with DIF suggest a prominent involvement of left temporal areas. These areas represent language and semantic processing and might be involved in the cognitive processing of emotions and the conscious identification of feelings.
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Affiliation(s)
- Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Helios Hospital Stralsund, Germany; German Center for Neurodegenerative Diseases (DZNE), Rostock/ Greifswald, Germany
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Tominaga T, Choi H, Nagoshi Y, Wada Y, Fukui K. Relationship between alexithymia and coping strategies in patients with somatoform disorder. Neuropsychiatr Dis Treat 2014; 10:55-62. [PMID: 24403835 PMCID: PMC3883553 DOI: 10.2147/ndt.s55956] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE A multidimensional intervention integrating alexithymia, negative affect, and type of coping strategy is needed for the effective treatment of somatoform disorder; however, few studies have applied this approach to the three different dimensions of alexithymia in patients with somatoform disorder. The purpose of this study was to determine the relationship between type of coping strategy and three different dimensions of alexithymia expressed in patients. PATIENTS AND METHODS A total of 196 patients with somatoform disorder completed the 20-item Toronto Alexithymia Scale, the Zung Self-Rating Depression Scale, the Spielberger State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, and the Lazarus Stress Coping Inventory. The relationships between alexithymia (Toronto Alexithymia Scale - 20 score and subscales), demographic variables, and psychological inventory scores were analyzed using Pearson's correlation coefficients and stepwise multiple regression analysis. RESULTS The mean Toronto Alexithymia Scale - 20 total score (56.1±10.57) was positively correlated with the number of physical symptoms as well as with psychopathology scores (Self-Rating Depression Scale, State-Trait Anxiety Inventory trait, state, and Somatosensory Amplification Scale), but negatively correlated with planful problem solving, confrontive coping, seeking social support, and positive reappraisal coping scores. With respect to coping strategy, multiple regression analyses revealed that "difficulty in identifying feelings" was positively associated with an escape-avoidance strategy, "difficulty in describing feelings" was negatively associated with a seeking social support strategy, and "externally oriented thinking" was negatively associated with a confrontive coping strategy. CONCLUSION Alexithymia was strongly associated with the number of somatic symptoms and negative affect. Patients with high "difficulty in describing feelings" tend to rely less on seeking social support, and patients with high "externally oriented thinking" tend to rely less on confrontive coping strategies. The coping skills intervention implemented should differ across individuals and should be based on the alexithymia dimension of each patient.
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Affiliation(s)
- Toshiyuki Tominaga
- Health Management Doctor's Office (Mental Health), Salary, Personnel Health, and Welfare Division, Kyoto Prefecture, Japan ; Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hyungin Choi
- Department of Psychiatry, Iwakura Hospital, Kyoto, Japan
| | - Yasuhide Nagoshi
- Department of Psychiatry (Psychosomatic Medicine), Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yoshihisa Wada
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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de Greck M, Bölter AF, Lehmann L, Ulrich C, Stockum E, Enzi B, Hoffmann T, Tempelmann C, Beutel M, Frommer J, Northoff G. Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy. Front Hum Neurosci 2013; 7:410. [PMID: 23966922 PMCID: PMC3744921 DOI: 10.3389/fnhum.2013.00410] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022] Open
Abstract
Somatoform disorder patients show a variety of emotional disturbances including impaired emotion recognition and increased empathic distress. In a previous paper, our group showed that several brain regions involved in emotional processing, such as the parahippocampal gyrus and other regions, were less activated in pre-treatment somatoform disorder patients (compared to healthy controls) during an empathy task. Since the parahippocampal gyrus is involved in emotional memory, its decreased activation might reflect the repression of emotional memories (which—according to psychoanalytical concepts—plays an important role in somatoform disorder). Psychodynamic psychotherapy aims at increasing the understanding of emotional conflicts as well as uncovering repressed emotions. We were interested, whether brain activity in the parahippocampal gyrus normalized after (inpatient) multimodal psychodynamic psychotherapy. Using fMRI, subjects were scanned while they shared the emotional states of presented facial stimuli expressing anger, disgust, joy, and a neutral expression; distorted stimuli with unrecognizable content served as control condition. 15 somatoform disorder patients were scanned twice, pre and post multimodal psychodynamic psychotherapy; in addition, 15 age-matched healthy control subjects were investigated. Effects of psychotherapy on hemodynamic responses were analyzed implementing two approaches: (1) an a priori region of interest approach and (2) a voxelwise whole brain analysis. Both analyses revealed increased hemodynamic responses in the left and right parahippocampal gyrus (and other regions) after multimodal psychotherapy in the contrast “empathy with anger”—“control.” Our results are in line with psychoanalytical concepts about somatoform disorder. They suggest the parahippocampal gyrus is crucially involved in the neurobiological mechanisms which underly the emotional deficits of somatoform disorder patients.
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Affiliation(s)
- Moritz de Greck
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine Mainz Mainz, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig Leipzig, Germany
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Frommer J. Contemporary perspectives on psychosomatics in Germany: A commentary on Karen Gubb's paper, "Psychosomatics today: a review of contemporary theory and practice". Psychoanal Rev 2013; 100:155-65. [PMID: 23421663 DOI: 10.1521/prev.2013.100.1.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Karen Gubb's (2013) review focuses on contemporary developments in psychoanalytic theory and practice in relation to psychosomatics, starting with some historical remarks, and Paris School with the Attachment approach. This paper examines the question of how the German scene fits into the issues raised in Gubb's discussion. From a historical point of view, psychosomatic thinking had already come into existence at the beginning of the twentieth century in internal medicine, influenced not only by Freud's ideas, but also by holistic philosophical approaches, anthropology, and semiotic systems theory as well. Psychosomatics is still under the influence of psychodynamic thinking, but as a required subject for all medical students, it is currently more involved in inpatient treatment settings than in psychoanalyses in the classical couch setting. Research projects using standardized questionnaires, neuroimaging, and other empirical methods have also proved that these treatments are as effective as therapy based on psychoanalytic concepts like alexithymia or the Attachment approach. In addition, qualitative methods have been implemented to grasp the fine-grained conscious and unconscious processes in the inner life of patients and in the verbal and nonverbal interaction phenomena of therapies. To sum up: Recent developments in psychoanalytic theory, which begin to overcome the differences among psychoanalytic schools in favor of re-erecting a common psychoanalytic understanding like that demonstrated in Gubb's article, fit together in bridging the gap between insights from classical psychoanalyses and results from empirical research.
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Affiliation(s)
- Jörg Frommer
- Clinic Centre, Otto-von-Guericke-University, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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Kano M, Fukudo S. The alexithymic brain: the neural pathways linking alexithymia to physical disorders. Biopsychosoc Med 2013; 7:1. [PMID: 23302233 PMCID: PMC3563604 DOI: 10.1186/1751-0759-7-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 12/13/2012] [Indexed: 01/18/2023] Open
Abstract
Alexithymia is a personality trait characterized by difficulties in identifying and describing feelings and is associated with psychiatric and psychosomatic disorders. The mechanisms underlying the link between emotional dysregulation and psychosomatic disorders are unclear. Recent progress in neuroimaging has provided important information regarding emotional experience in alexithymia. We have conducted three brain imaging studies on alexithymia, which we describe herein. This article considers the role of emotion in the development of physical symptoms and discusses a possible pathway that we have identified in our neuroimaging studies linking alexithymia with psychosomatic disorders. In terms of socio-affective processing, alexithymics demonstrate lower reactivity in brain regions associated with emotion. Many studies have reported reduced activation in limbic areas (e.g., cingulate cortex, anterior insula, amygdala) and the prefrontal cortex when alexithymics attempt to feel other people's feelings or retrieve their own emotional episodes, compared to nonalexithymics. With respect to primitive emotional reactions such as the response to pain, alexithymics show amplified activity in areas considered to be involved in physical sensation. In addition to greater hormonal arousal responses in alexithymics during visceral pain, increased activity has been reported in the insula, anterior cingulate cortex, and midbrain. Moreover, in complex social situations, alexithymics may not be able to use feelings to guide their behavior appropriately. The Iowa gambling task (IGT) was developed to assess decision-making processes based on emotion-guided evaluation. When alexithymics perform the IGT, they fail to learn an advantageous decision-making strategy and show reduced activity in the medial prefrontal cortex, a key area for successful performance of the IGT, and increased activity in the caudate, a region associated with impulsive choice. The neural machinery in alexithymia is therefore activated more on the physiologic, motor-expressive level and less in the cognitive-experiential domains of the emotional response system. Affects may play an important role in alleviating intrinsic physiologic reactions and adapting to the environment. Deficient development of emotional neural structures may lead to hypersensitivity to bodily sensations and unhealthy behaviors, a possible mechanism linking alexithymia to psychosomatic disorders.
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Affiliation(s)
- Michiko Kano
- Behavioral Medicine, Tohoku University Graduate School of Medicine, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan
| | - Shin Fukudo
- Behavioral Medicine, Tohoku University Graduate School of Medicine, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan
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Saxbe DE, Yang XF, Borofsky LA, Immordino-Yang MH. The embodiment of emotion: language use during the feeling of social emotions predicts cortical somatosensory activity. Soc Cogn Affect Neurosci 2012; 8:806-12. [PMID: 22798396 DOI: 10.1093/scan/nss075] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complex social emotions involve both abstract cognitions and bodily sensations, and individuals may differ on their relative reliance on these. We hypothesized that individuals' descriptions of their feelings during a semi-structured emotion induction interview would reveal two distinct psychological styles-a more abstract, cognitive style and a more body-based, affective style-and that these would be associated with somatosensory neural activity. We examined 28 participants' open-ended verbal responses to admiration- and compassion-provoking narratives in an interview and BOLD activity to the same narratives during subsequent functional magnetic resonance imaging scanning. Consistent with hypotheses, individuals' affective and cognitive word use were stable across emotion conditions, negatively correlated and unrelated to reported emotion strength in the scanner. Greater use of affective relative to cognitive words predicted more activation in SI, SII, middle anterior cingulate cortex and insula during emotion trials. The results suggest that individuals' verbal descriptions of their feelings reflect differential recruitment of neural regions supporting physical body awareness. Although somatosensation has long been recognized as an important component of emotion processing, these results offer 'proof of concept' that individual differences in open-ended speech reflect different processing styles at the neurobiological level. This study also demonstrates SI involvement during social emotional experience.
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Affiliation(s)
- Darby E Saxbe
- Assistant Professor of Education at the Rossier School of Education, Neuroscience Graduate Program Faculty, 3641 Watt Way, Suite B17, Los Angeles, CA 90089-2520, USA.
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