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Takım U, Sarı S, Gokcay H. 'The Relationship Between Childhood Traumas and Social Cognition Through Theory of Mind and Alexithymia in Bipolar Disorder'. Psychol Rep 2024:332941241269549. [PMID: 39099179 DOI: 10.1177/00332941241269549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
This study aimed to investigate the potential differences in childhood trauma (CT), theory of mind (ToM), a significant component of social cognition, and alexithymia in bipolar disorder (BD) patients and healthy controls. The study included 50 BD patients who met the study criteria and were under follow-up at our clinic along with 50 healthy controls. The two groups were matched for age, gender, and educational status. A sociodemographic questionnaire, Childhood Trauma Questionnaire (CTQ), Toronto Alexithymia Scale (TAS), Dokuz Eylul Theory of Mind Index (DEZIKO), Hamilton Depression Rating Scale (HDRS), and Young Mania Rating Scale (YMRS) were applied to all participants. The CTQ-Total, TAS total, and DEZIKO total scores were significantly higher in the BD group compared to the healthy group (p < .001). A significant positive correlation was identified between the TAS total score and CTQ physical neglect (r = 0.472, p = .001), CTQ emotional neglect (r = 0.449, p = .001) and CTQ total scores (r = 0.5, p < .001) in the BD group. A statistically significant negative correlation was identified between the DEZIKO faux pas score and the CTQ physical neglect score (r = -0.437, p = .002). BD patients had more adverse childhood experiences, lower ToM abilities despite being in remission, and more pronounced alexithymic personality features compared to healthy controls. We also identified a relationship between ToM, alexithymia, and adverse childhood experiences in BD.
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Affiliation(s)
- Uğur Takım
- Department of Psychiatry, Erzurum City Hospital, Unıversıty of Health Scıences, Erzurum, Turkey
| | - Serap Sarı
- Department of Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Hasan Gokcay
- Department of Psychiatry, Sarkisla State Hospital, Sivas, Turkey
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Utas-Akhan L, Avci D, Basak I. Art Therapy as a Nursing Intervention for Individuals With Schizophrenia. J Psychosoc Nurs Ment Health Serv 2024; 62:29-38. [PMID: 37956349 DOI: 10.3928/02793695-20231025-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The aim of the current study was to determine the effects of group art therapy on clinical symptoms, alexithymia, and quality of life among people with schizophrenia. This single-blinded, randomized controlled trial was performed with 66 individuals with schizophrenia from a community mental health center in western Turkey between September 2021 and February 2022. Following art therapy, the intervention group had lower severity of positive, negative, and general psycho-pathology symptoms; lower levels of alexithymia; and higher levels of psychological health, social relationships, and total quality of life than the control group; and the difference between groups was statistically significant (p < 0.05). Results reveal that art therapy combined with pharmacological therapy contributes to good clinical outcomes among individuals with schizophrenia. This evidence can guide psychiatric nurses to use art therapy to reduce psychopathology severity and increase functionality and quality of life among individuals with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 29-38.].
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Khedr MA, El-Ashry AM, El-Sayed MM, Elkot MA, Hussein RM. The effect of physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders: A randomized control trial. Arch Psychiatr Nurs 2024; 49:83-92. [PMID: 38734459 DOI: 10.1016/j.apnu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 02/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Despite evidence that physical exercises have been helpful in the treatment of various psychiatric disorders, it is unclear whether these data can be generalized to bipolar disorder. The use of physical exercises is challenging and hopeful among patients with bipolar disorders. Few studies have examined the efficacy of physical exercise for patients with bipolar disorders. OBJECTIVE Investigate the effect of applying physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders. METHODS This study followed a randomized control trial design "pre and post-test." Patients were randomly allocated to intervention (n = 25) and control groups (Waiting list) (n = 25). The Social Functioning Scale, Toronto Alexithymia Scale, and Sense of Coherence scales were applied in the study. Pre-test and post-tests were administered to investigate the effect of applying the physical exercises program between December 2022 to March 2023. RESULTS A statistically significant increase in the mean sense of coherence and social functioning scores among the study group. Mean alexithymia scores were significantly decreased among the study group between pre, immediately after, and after a three-month follow-up period. CONCLUSION Physical exercises are an adjunctive treatment modality that is helpful for patients with bipolar disorders. Nurse educators and service providers should reconsider the physical health care requirements for patients with bipolar disorders to equip them to manage the common comorbidities in people with mental illness.
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Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
| | - Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mona Metwally El-Sayed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mohamed Ali Elkot
- Department of Exercises, Faculty of Sports Education for Men, Alexandria University, Egypt.
| | - Rash Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt; Department of Community and Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia.
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Knopp M, Burghardt J, Oppenauer C, Meyer B, Moritz S, Sprung M. Affective and cognitive Theory of Mind in patients with alcohol use disorder: Associations with symptoms of depression, anxiety, and somatization. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209227. [PMID: 37992810 DOI: 10.1016/j.josat.2023.209227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Theory of Mind (ToM) is the ability to ascribe thoughts (cognitive ToM) and feelings (affective ToM) to others. Ample evidence exists for impairments of affective and cognitive ToM in individuals with alcohol use disorder (AUD); however, evidence regarding changes of these impairments during AUD treatment and their possible relationship to comorbid symptoms is ambiguous. The current study analyzed changes in ToM during treatment and tested associations with comorbid symptoms of depression, anxiety, somatization, and social functioning. METHODS We analyzed data from 175 individuals with AUD. The study assessed ToM and comorbid symptoms of depression, anxiety, somatization, and social functioning at the time of admission and at the time of discharge from an approximately 60 days long abstinence-oriented inpatient treatment. We assessed affective and cognitive ToM using the Movie for the Assessment of Social Cognition, a measure with high ecological validity. RESULTS All symptoms, total and cognitive ToM improved following treatment; however, affective ToM did not improve. Moreover, cognitive ToM at the beginning of treatment was associated with improved symptoms of depression and somatization, while affective ToM was not. CONCLUSIONS Our study shows improvements in total and cognitive ToM as well as symptoms of depression, anxiety, somatization, and social functioning following long-term treatment. Furthermore, cognitive ToM was related to improvements in comorbid symptoms. This finding suggests that ToM may be an important treatment target in patients with AUD.
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Affiliation(s)
- Magdalena Knopp
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria; Ludwig-Maximilians-Universität München, Faculty of Psychology and Educational Sciences, Department of Psychology, Leopoldstraße 13, 80802 München, Germany.
| | - Juliane Burghardt
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Claudia Oppenauer
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Bernhard Meyer
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany
| | - Manuel Sprung
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria; Ludwig-Maximilians-Universität München, Faculty of Psychology and Educational Sciences, Department of Psychology, Leopoldstraße 13, 80802 München, Germany; University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany; Psychiatric Rehabilitation Clinic Gars am Kamp, Psychosomatisches Zentrum Waldviertel, Kremserstraße 656, 3571 Gars am Kamp, Austria
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Peng P, Wang D, Wang Q, Zhou Y, Hao Y, Chen S, Wu Q, Liu T, Zhang X. Alexithymia in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates, and relationship with neurocognition and empathy. Asia Pac Psychiatry 2023; 15:e12547. [PMID: 37635651 DOI: 10.1111/appy.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Alexithymia is highly prevalent and strongly related to adverse consequences in patients with schizophrenia. However, its associated factors remain largely unexplored. The present study aimed to determine the prevalence of alexithymia and its association with sociocultural characteristics, clinical symptoms, neurocognition, and empathy in 854 Chinese patients with schizophrenia. METHOD Demographic information was collected through a self-designed questionnaire. Alexithymia was assessed by the Toronto Alexithymia Scale (TAS-20). We assessed clinical symptoms, neurocognition, and empathy via the following instruments: Positive and Negative Syndrome Scale, Repeatable Battery for the Assessment of Neuropsychological Status, and Interpersonal Reactivity Index. A multiple logistic regression model was conducted to determine the independent correlates of alexithymia. RESULTS Approximately one-third (n = 277, 32%) of patients with schizophrenia had alexithymia. Patients with alexithymia had significantly more severe negative symptoms, neurocognition, and empathy impairment than patients without alexithymia. Being male, negative symptoms, personal distress, empathic concern, and language functioning were independently associated with alexithymia. DISCUSSION Our findings demonstrate a high prevalence of alexithymia and its strong association with clinical symptoms, neurocognition, and empathy, which calls for timely screening and intervention for alexithymia in patients with schizophrenia. Targeting impaired language function, negative symptoms, and impaired affective empathy might help reduce alexithymia and its related negative consequences.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Sarman A, Tuncay S. The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model. J Pediatr Nurs 2023; 73:e372-e380. [PMID: 37806855 DOI: 10.1016/j.pedn.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
AIM The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents. METHODS This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data. RESULTS Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization. CONCLUSIONS This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia. PRACTICE IMPLICATIONS Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.
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Affiliation(s)
- Abdullah Sarman
- Bingöl University, Faculty of Health Science, Department of Pediatric Nursing, Bingöl, Turkey.
| | - Suat Tuncay
- Bingöl University, Faculty of Health Science, Department of Pediatric Nursing, Bingöl, Turkey
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Huo L, Qu D, Pei C, Wu W, Ning Y, Zhou Y, Zhang XY. Alexithymia in chronic schizophrenia and its mediating effect between cognitive deficits and negative symptoms. Schizophr Res 2023; 261:275-280. [PMID: 37866075 DOI: 10.1016/j.schres.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/01/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although cognition is known to impact clinical symptoms of schizophrenia, few studies investigate the potential mediators of this relationship. This study aimed to examine the relationship between cognitive deficits and negative symptoms in schizophrenia, considering the mediating role of alexithymia as an important psychological variable. Moreover, the prevalence of alexithymia in patients with schizophrenia was investigated. METHODS A total of 689 patients with schizophrenia were recruited from two psychiatric hospitals. All patients completed the Positive and Negative Syndrome Scale (PANSS), 20-item Toronto Alexithymia Scale (TAS-20), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We used structural equation modeling to examine the hypothesized mediated model. RESULTS In total, 31.5 % of patients with schizophrenia were classified as alexithymia. The path analyses showed that two factors of alexithymia (i.e., the difficulty in identifying feelings and difficulty in describing feelings), played a mediating role in the pathway from cognitive deficits to negative symptoms (all p < .001). LIMITATIONS Self-reported measurement for alexithymia may not be sufficiently reliable due to response bias. CONCLUSION Our findings demonstrated a high occurrence of alexithymia in patients with schizophrenia. Moreover, the mediating role of alexithymia suggests that targeting emotion processing and cognition may be a feasible way to mitigate negative symptoms.
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Affiliation(s)
- Lijuan Huo
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Chenran Pei
- Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China; Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, Guangzhou, China
| | - Weibin Wu
- Foshan Mental Health Center, The Third People's Hospital of Foshan, Foshan, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 5180005, China.
| | - Xiang Yang Zhang
- Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Jiang C, Jiang W, Chen G, Xu W, Sun T, You L, Chen S, Yin Y, Liu X, Hou Z, Qing Z, Xie C, Zhang Z, Turner JA, Yuan Y. Childhood trauma and social support affect symptom profiles through cortical thickness abnormalities in major depressive disorder: A structural equation modeling analysis. Asian J Psychiatr 2023; 88:103744. [PMID: 37619416 DOI: 10.1016/j.ajp.2023.103744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Childhood trauma, low social support, and alexithymia are recognized as risk factors for major depressive disorder (MDD). However, the mechanisms of risk factors, symptoms, and corresponding structural brain abnormalities in MDD are not fully understood. Structural equation modeling (SEM) has advantages in studying multivariate interrelationships. We aim to illustrate their relationships using SEM. METHODS 313 MDD patients (213 female; mean age 42.49 years) underwent magnetic resonance imaging and completed assessments. We integrated childhood trauma, alexithymia, social support, anhedonia, depression, anxiety, suicidal ideation and cortical thickness into a multivariate SEM. RESULTS We first established the risk factors-clinical phenotype SEM with an adequate fit. Cortical thickness results show a negative correlation of childhood trauma with the left middle temporal gyrus (MTG) (p = 0.012), and social support was negatively correlated with the left posterior cingulate cortex (PCC) (p < 0.001). The final good fit SEM (χ2 = 32.92, df = 21, χ2/df = 1.57, CFI = 0.962, GFI = 0.978, RMSEA = 0.043) suggested two pathways, with left PCC thickness mediating the relationship between social support and suicidal ideation, and left MTG thickness mediating between childhood trauma and anhedonia/anxiety. CONCLUSION Our findings provide evidence for the impact of risk factor variables on the brain structure and clinical phenotype of MDD patients. Insufficient social support and childhood trauma might lead to corresponding cortical abnormalities in PCC and MTG, affecting the patient's mood and suicidal ideation. Future interventions should aim at these nodes.
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Affiliation(s)
- Chenguang Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gang Chen
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University; Department of Medical Psychology, Huai'an No.3 People's Hospital, Huaian, China
| | - Wei Xu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University; Department of Clinical Psychology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Taipeng Sun
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University; Department of Medical Psychology, Huai'an No.3 People's Hospital, Huaian, China
| | - Linlin You
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Suzhen Chen
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yingying Yin
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoyun Liu
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhao Qing
- Shing-Tung Yau Center; School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jessica A Turner
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, OH, United States.
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.
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Bang L, Bahrami S, Hindley G, Smeland OB, Rødevand L, Jaholkowski PP, Shadrin A, Connell KSO, Frei O, Lin A, Rahman Z, Cheng W, Parker N, Fan CC, Dale AM, Djurovic S, Bulik CM, Andreassen OA. Genome-wide analysis of anorexia nervosa and major psychiatric disorders and related traits reveals genetic overlap and identifies novel risk loci for anorexia nervosa. Transl Psychiatry 2023; 13:291. [PMID: 37658054 PMCID: PMC10474135 DOI: 10.1038/s41398-023-02585-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023] Open
Abstract
Anorexia nervosa (AN) is a heritable eating disorder (50-60%) with an array of commonly comorbid psychiatric disorders and related traits. Although significant genetic correlations between AN and psychiatric disorders and related traits have been reported, their shared genetic architecture is largely understudied. We investigated the shared genetic architecture of AN and schizophrenia (SCZ), bipolar disorder (BIP), major depression (MD), mood instability (Mood), neuroticism (NEUR), and intelligence (INT). We applied the conditional false discovery rate (FDR) method to identify novel risk loci for AN, and conjunctional FDR to identify loci shared between AN and related phenotypes, to summarize statistics from relevant genome-wide association studies (GWAS). Individual GWAS samples varied from 72,517 to 420,879 participants. Using conditional FDR we identified 58 novel AN loci. Furthermore, we identified 38 unique loci shared between AN and major psychiatric disorders (SCZ, BIP, and MD) and 45 between AN and psychological traits (Mood, NEUR, and INT). In line with genetic correlations, the majority of shared loci showed concordant effect directions. Functional analyses revealed that the shared loci are involved in 65 unique pathways, several of which overlapped across analyses, including the "signal by MST1" pathway involved in Hippo signaling. In conclusion, we demonstrated genetic overlap between AN and major psychiatric disorders and related traits, and identified novel risk loci for AN by leveraging this overlap. Our results indicate that some shared characteristics between AN and related disorders and traits may have genetic underpinnings.
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Affiliation(s)
- Lasse Bang
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Shahram Bahrami
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Guy Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Piotr P Jaholkowski
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kevin S O' Connell
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Aihua Lin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Zillur Rahman
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Weiqiu Cheng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nadine Parker
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Chun C Fan
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Meyer K, Hindi Attar C, Fiebig J, Stamm T, Bassett TR, Bauer M, Dannlowski U, Ethofer T, Falkenberg I, Jansen A, Juckel G, Kircher T, Mulert C, Leicht G, Rau A, Rauh J, Ritter D, Ritter P, Trost S, Vogelbacher C, Walter H, Wolter S, Hautzinger M, Bermpohl F. Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder-A Randomized Controlled Trial. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:750-759. [PMID: 36898634 DOI: 10.1016/j.bpsc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND In bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neural function of the emotion network. The present study investigated the effects of an emotion-centered psychotherapeutic intervention on amygdala responsivity and connectivity during emotional face processing in BD. METHODS In a randomized controlled trial within the multicentric BipoLife project, euthymic patients with BD received one of two interventions over 6 months: an unstructured, emotion-focused intervention (FEST), where patients were guided to adequately perceive and label their emotions (n = 28), or a specific, structured, cognitive behavioral intervention (SEKT) (n = 31). Before and after interventions, functional magnetic resonance imaging was conducted while patients completed an emotional face-matching paradigm (final functional magnetic resonance imaging sample of patients completing both measurements: SEKT, n = 17; FEST, n = 17). Healthy control subjects (n = 32) were scanned twice after the same interval without receiving any intervention. Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala activation and connectivity. RESULTS Clinically, both interventions stabilized patients' euthymic states in terms of affective symptoms. At the neural level, FEST versus SEKT increased amygdala activation and amygdala-insula connectivity at postintervention relative to preintervention time point. In FEST, the increase in amygdala activation was associated with fewer depressive symptoms (r = 0.72) 6 months after intervention. CONCLUSIONS Enhanced activation and functional connectivity of the amygdala after FEST versus SEKT may represent a neural marker of improved emotion processing, supporting the FEST intervention as an effective tool in relapse prevention in patients with BD.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Stamm
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tyler R Bassett
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Thomas Ethofer
- University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Clinic for Radiology Tübingen, Tübingen, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Rau
- University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany
| | - Jonas Rauh
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Geriatric Psychiatry, Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
| | - Christoph Vogelbacher
- Translational Clinical Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Henrik Walter
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Wolter
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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11
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Vecchiotti R, Mansueto G, Marziali RA, Marconi M, Valchera A, Cosci F. The mediating role of alexithymia in the relationship between affective temperament and craving: Cross-sectional study conducted in a sample of bipolar and alcohol use disorder patients. J Affect Disord 2023; 325:110-118. [PMID: 36632847 DOI: 10.1016/j.jad.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bipolar disorder (BD) and alcohol use disorder (AUD) commonly co-occur and their interplay is influenced by several factors. Alexithymia is connected to BD and AUD; affective temperaments serve as risk factors for both; craving contributes to the development and maintenance of AUD. The present study tested whether alexithymia play a mediating role in the relationship between affective temperaments and craving in alcoholic bipolar patients. METHODS 151 alcoholic bipolar patients (38 % females, mean age: 45.69 ± 9.04 years) were enrolled. The Mini International Neuropsychiatric Interview (MINI), the Brief Psychiatric Rating Scale (BPRS), the Toronto Alexithymia Scale (TAS-20), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego scale (TEMPS-A), and the Typology Craving Questionnaire (CTQ) were administered. Correlations among TAS-20, TEMPS-A, CTQ were conducted. Regression analyses were applied to verify the mediating hypothesis. RESULTS Difficulty in identifying feelings mediated the association between anxious temperament and craving (Indirect effect: 0.42, BCaCI: 0.22-0.69), cyclothymic temperament and craving (Indirect effect: 0.55, BCaCI: 0.30-0.87), irritable temperament and craving (Indirect effect: 0.45, BCaCI: 0.19-0.80). TAS-20 difficulty in communicating feelings to others mediated the association between anxious temperament and craving (Indirect effect: 0.20, BCaCI: 0.06-0.41). LIMITATIONS The sample size did not allow subgroup analyses. Data were collected cross-sectionally and in a single center. We did not investigate whether BD or AUD occurred first, although it might influence the mediation role of alexithymia. CONCLUSION Among alcoholic bipolar patients, assessing and targeting alexithymia may be useful to modulate craving and, in turn improve, the general mental status of patients.
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Affiliation(s)
- Roberta Vecchiotti
- Villa San Giuseppe Hospital, Hermanas, Hospitalarias, Ascoli Piceno, Italy; Polyedra Research, Polyedra, Teramo, Italy.
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy; Pharmacopsychology Laboratory, University of Florence, Italy; Department of Psychology, Sigmund Freud University, Milan, Italy
| | | | - Massimo Marconi
- Villa San Giuseppe Hospital, Hermanas, Hospitalarias, Ascoli Piceno, Italy
| | - Alessandro Valchera
- Villa San Giuseppe Hospital, Hermanas, Hospitalarias, Ascoli Piceno, Italy; Polyedra Research, Polyedra, Teramo, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy; Pharmacopsychology Laboratory, University of Florence, Italy; Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, the Netherlands
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12
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The Relationship among Dyadic Adjustment and Disease Burden in Patients with Bipolar Disorder and Their Spouses. Behav Sci (Basel) 2023; 13:bs13020091. [PMID: 36829320 PMCID: PMC9952473 DOI: 10.3390/bs13020091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Spouses of individuals with bipolar disorder (BD) experience significant burdens, and the perception of the burden may affect dyadic adjustment. We aimed to investigate the sexual functions, alexithymic traits, marital satisfaction, and burden in patients with BD and their spouses. We also aimed to assess the mediating role of sexual functions and alexithymia in the relationship between burden and dyadic adjustment. (2) Methods: We included 81 patients with BD type 1 (40.69 ± 8.55 years, 65.4% female, and 34.6% male) and their healthy spouses (40.95 ± 7.30 years, 34.6% female, and 65.4% male) and 78 healthy controls (38.90 ± 5.88, 48.7% female, and 51.3% male). The participants were evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Dyadic Adjustment Scale (DAS), Hamilton Depression Rating Scale (HDRS), Toronto Alexithymia Scale-20 (TAS-20), and Burden Assessment Scale (BAS). (3) Results: The GRISS scores of the control group were significantly lower than the spouses and BD groups. The DAS total score of the control group was significantly higher than that of the spouses and BD groups. Regression analyses revealed that TAS, GRISS, and HDRS scores were associated with DAS scores in the BD group. In the spouse group, TAS and BAS scores were associated with DAS scores. The GRISS scores partially mediated the relationship between dyadic adjustment and burden in the spouses of patients with BD. (4) Conclusions: Mental health professionals should regularly scan caregivers' perceptions of burden. Appropriate psychosocial interventions could help spouses of patients with BD to cope better with the burden and improve dyadic adjustment.
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13
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Ayık B, Baş A, Usta Sağlam NG, İzci F, Izci F. The Relationship Between Emotional Dysregulation, Alexithymia and Somatization in Patients with Bipolar Disorder. ALPHA PSYCHIATRY 2023; 24:15-21. [PMID: 36879992 PMCID: PMC9985064 DOI: 10.5152/alphapsychiatry.2023.22974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/16/2022] [Indexed: 01/12/2023]
Abstract
Objective Emotional dysregulation is a basic feature found in patients with bipolar disorder. It was also reported that higher alexithymia scores are a predictive factor for a decrease in social functionality. It is known that patients with bipolar disorder experience more somatic symptoms than the general population. No study has yet been conducted on the interrelation of these 3 clinical domains, which are known to negatively affect the functionality and quality of life in bipolar disorder patients. Methods This study included 72 bipolar disorder-1 patients. The Difficulties in Emotion Regulation Scale was used to determine the emotional state of the patients, the Toronto Alexithymia Scale was used to determine the alexithymia scores, and the Somatization Scale was used to determine the somatization scores. Results As a result of hierarchical multiple linear regression analysis, the first model was found to be significant (P < .001), and the emotional dysregulation total scale score significantly predicted the Toronto Alexithymia Scale total scale score (P < .001). The second model was also found to be significant (P < .001), and the emotional dysregulation total scale score significantly predicted the somatization total scale score (P < .001). Conclusion This study found that ED predicted alexithymia and somatization in euthymic bipolar patients. The therapeutic approaches targeting these 3 clinical domains that negatively affect patients' quality of life and functionality may provide positive clinical outcomes.
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Affiliation(s)
- Batuhan Ayık
- Department of Psychiatry, İstanbul Erenköy Education and Research Hospital, İstanbul, Turkey
| | - Alper Baş
- Department of Psychiatry, İstanbul Erenköy Education and Research Hospital, İstanbul, Turkey
| | | | - Filiz İzci
- Department of Psychiatry, İstanbul Erenköy Education and Research Hospital, İstanbul, Turkey
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14
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The percentage and clinical correlates of alexithymia in stable patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 273:679-686. [PMID: 36239818 PMCID: PMC10085932 DOI: 10.1007/s00406-022-01492-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
Alexithymia is a common, but less-recognized affective deficit in patients with schizophrenia. To date, no definitive conclusions have been drawn about the relationship between alexithymia and the clinical symptoms or their clinical correlates, particularly in stable patients with schizophrenia. The purpose of this study was to investigate the link between alexithymia and psychopathological symptoms, as well as any associated correlates, in stable patients with schizophrenia. A total of 435 Chinese patients with schizophrenia were recruited. The Positive and Negative Symptoms Scale (PANSS) was used to evaluate each patient's psychopathological symptoms. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia. The percentage of alexithymia was 35.2% in stable patients with schizophrenia. Compared to non-alexithymia patients, patients with alexithymia had higher PANSS total scores, negative subscores, depressive subscores, and cognitive subscores (all p < 0.05). Multivariate regression analysis revealed that the following variables were positively associated with TAS-20 total scores: PANSS negative subscores (β = 0.274, t = 3.198, p = 0.001) and PANSS depressive subscores (β = 0.366, t = 2.500, p = 0.013). Education years (β = - 0.453, t = - 2.824, p = 0.005) was negatively associated with TAS-20 total scores. Our results suggest that the percentage of alexithymia was relatively higher in stable patients with schizophrenia. Education levels, negative symptoms, and depressive symptoms were independently associated with alexithymia in this specific population.
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15
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Relationships among inflammation, social cognition, and social functioning in schizophrenia. Schizophr Res 2022; 248:366-367. [PMID: 34561146 DOI: 10.1016/j.schres.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/24/2022]
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16
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Eddy CM. The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains. Front Psychiatry 2022; 13:797952. [PMID: 35360118 PMCID: PMC8960177 DOI: 10.3389/fpsyt.2022.797952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023] Open
Abstract
Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.
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Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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17
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Förster K, Kurtz M, Konrad A, Kanske P. Emotional Reactivity, Emotion Regulation, and Social Emotions in Affective Disorders. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. Affective disorders, specifically Major Depressive Disorder and Bipolar Disorders, show high prevalence, relapse rates, and a high likelihood to develop a chronic course. For the past two decades, research has investigated the neural correlates of emotion processing and emotion regulation in patients with affective disorders. Putative underlying causal mechanisms of dysregulated affect have been informed by knowledge from the intersection of neuroimaging and clinical psychology. More recent investigations also consider processing the role of mostly negative, self-blaming social emotions, which have been linked to treatment resistance and, hence, provide a prolific target for intervention. Several psychotherapeutic treatment approaches already focus on emotion, and here specific knowledge about the mechanisms underlying persistent changes in affect bears the potential to improve the treatment of affective disorders. In this narrative review, we delineate why and how our insights into the neural correlates of emotion processing and regulation can be applied to the treatment of patients with affective disorders.
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Affiliation(s)
- Katharina Förster
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Marcel Kurtz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
- Social Psychology, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Annika Konrad
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden (TU Dresden), Germany
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18
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Eslinger PJ, Anders S, Ballarini T, Boutros S, Krach S, Mayer AV, Moll J, Newton TL, Schroeter ML, de Oliveira-Souza R, Raber J, Sullivan GB, Swain JE, Lowe L, Zahn R. The neuroscience of social feelings: mechanisms of adaptive social functioning. Neurosci Biobehav Rev 2021; 128:592-620. [PMID: 34089764 PMCID: PMC8388127 DOI: 10.1016/j.neubiorev.2021.05.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/31/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023]
Abstract
Social feelings have conceptual and empirical connections with affect and emotion. In this review, we discuss how they relate to cognition, emotion, behavior and well-being. We examine the functional neuroanatomy and neurobiology of social feelings and their role in adaptive social functioning. Existing neuroscience literature is reviewed to identify concepts, methods and challenges that might be addressed by social feelings research. Specific topic areas highlight the influence and modulation of social feelings on interpersonal affiliation, parent-child attachments, moral sentiments, interpersonal stressors, and emotional communication. Brain regions involved in social feelings were confirmed by meta-analysis using the Neurosynth platform for large-scale, automated synthesis of functional magnetic resonance imaging data. Words that relate specifically to social feelings were identfied as potential research variables. Topical inquiries into social media behaviors, loneliness, trauma, and social sensitivity, especially with recent physical distancing for guarding public and personal health, underscored the increasing importance of social feelings for affective and second person neuroscience research with implications for brain development, physical and mental health, and lifelong adaptive functioning.
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Affiliation(s)
- Paul J Eslinger
- Departments of Neurology, Neural & Behavioral Sciences, Pediatrics, and Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
| | - Silke Anders
- Social and Affective Neuroscience, Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sydney Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Sören Krach
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Annalina V Mayer
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Jorge Moll
- Cognitive Neuroscience Unit, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Tamara L Newton
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Ricardo de Oliveira-Souza
- Cognitive Neuroscience Unit, D'Or Institute for Research and Education (IDOR), BR Hospital Universitario, Universidade do Rio de Janeiro, Brazil
| | - Jacob Raber
- Departments of Behavioral Neuroscience, Neurology, and Radiation Medicine, Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, USA
| | - Gavin B Sullivan
- International Psychoanalytic University, Berlin, Germany, Centre for Trust, Peace and Social Relations, Coventry University, UK
| | - James E Swain
- Department of Psychiatry and Behavioral Health, Psychology and Obstetrics and Gynecology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | | | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Scarpazza C, Zangrossi A, Huang YC, Sartori G, Massaro S. Disentangling interoceptive abilities in alexithymia. PSYCHOLOGICAL RESEARCH 2021; 86:844-857. [PMID: 34097132 PMCID: PMC8182733 DOI: 10.1007/s00426-021-01538-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia—a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience—remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants’ level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R2 = 0.29 and R2 = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R2 = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy.
| | - Andrea Zangrossi
- Department of Neuroscience, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy.,Padova Neuroscience Center (PCN), University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Yu-Chun Huang
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Giuseppe Sartori
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy
| | - Sebastiano Massaro
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Surrey Business School, University of Surrey, Guildford, Rik Medlik Building (MS), Guildford, GU2 7XH, UK
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20
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Luo H, Zhao Y, Fan F, Fan H, Wang Y, Qu W, Wang Z, Tan Y, Zhang X, Tan S. A bottom-up model of functional outcome in schizophrenia. Sci Rep 2021; 11:7577. [PMID: 33828168 PMCID: PMC8027854 DOI: 10.1038/s41598-021-87172-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/10/2021] [Indexed: 02/01/2023] Open
Abstract
Schizophrenia results in poor functional outcomes owing to numerous factors. This study provides the first test of a bottom-up causal model of functional outcome in schizophrenia, using neurocognition, vocal emotional cognition, alexithymia, and negative symptoms as predictors of functional outcome. We investigated a cross-sectional sample of 135 individuals with schizophrenia and 78 controls. Using a series of structural equation modelling analyses, a single pathway was generated among scores from the MATRICS Consensus Cognitive Battery (MCCB), vocal emotion recognition test, Toronto Alexithymia Scale (TAS), Brief Negative Symptom Scale, and the Personal and Social Performance Scale. The scores for each dimension of the MCCB in the schizophrenia group were significantly lower than that in the control group. The recognition accuracy for different emotions (anger, disgust, fear, sadness, surprise, and satire, but not calm was significantly lower in the schizophrenia group than in the control group. Moreover, the scores on the three dimensions of TAS were significantly higher in the schizophrenia group than in the control group. On path analysis modelling, the proposed bottom-up causal model showed a strong fit with the data and formed a single pathway, from neurocognition to vocal emotional cognition, to alexithymia, to negative symptoms, and to poor functional outcomes. The study results strongly support the proposed bottom-up causal model of functional outcome in schizophrenia. The model could be used to better understand the causal factors related to the functional outcome, as well as for the development of intervention strategies to improve functional outcomes in schizophrenia.
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Affiliation(s)
- Hongge Luo
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China ,grid.440734.00000 0001 0707 0296College of Psychology, North China University of Science and Technology, Tangshan, China
| | - Yanli Zhao
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Fengmei Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hongzhen Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunhui Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Wei Qu
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunlong Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Xiujun Zhang
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Shuping Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
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21
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Tamanaeifar S, Pirkashani NG, Nooripour R. How Mindfulness and Acceptance Could Help Psychiatrists Predict Alexithymia Among Students. J Nerv Ment Dis 2021; 209:297-301. [PMID: 33476108 DOI: 10.1097/nmd.0000000000001295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Mindfulness and acceptance have demonstrated associations with alexithymia facets. As a very limited body of research has explored the predictive strength among alexithymia-related constructs, this study aimed to investigate the prediction of alexithymia based on acceptance and mindfulness among students. The study group consisted of 586 university students, 237 (40.9%) females and 349 (59.1%) males. As for data collection, the five-factor mindfulness questionnaire, Acceptance and Commitment Questionnaire, and the Toronto Alexithymia Scale-2 were applied. A stepwise multiple linear regression was calculated to predict alexithymia based on components of commitment and action, mindfulness facets, and demographic variables (F[5,578] = 77.26, p ≤ 0.001), with an R2 of 0.41. The predictive variables including description (B = -0.59, t = -8.02, p < 0.001), commitment and action (B = -0.13, t = -4.38, p < 0.001), observation (B = -0.15, t = -2.94, p < 0.01), and no judgment (B = -0.16, t = -2.56, p < 0.05) exhibited significant prediction effects on the adjusted index of alexithymia. The findings contribute to the potential mechanism between mindfulness and alexithymia in intervention that seeks to improve mindfulness and acceptance skills and could prove more effective in treating patients with alexithymia.
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Affiliation(s)
- Shima Tamanaeifar
- Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan
| | - Nikzad Ghanbari Pirkashani
- Department of Psychology, Faculty of Educational Sciences and Psychology, Shahid Beheshti University, Tehran
| | - Roghieh Nooripour
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
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22
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Khosravani V, Berk M, Sharifi Bastan F, Samimi Ardestani SM, Wrobel A. The effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder: emotion dysregulation as a mediator. Int J Psychiatry Clin Pract 2021; 25:90-102. [PMID: 33559512 DOI: 10.1080/13651501.2021.1879867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The relations of childhood emotional maltreatment and alexithymia to the clinical course of bipolar disorder (BD) have been widely recognised. Difficulties in regulating emotions may explain these relationships. The current study evaluated the effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms as well as suicidal ideation in female patients with BD. Emotion dysregulation was evaluated as a mediating factor. METHODS Three hundred hospitalised female patients with a diagnosis of BD provided information regarding their history of childhood emotional maltreatment, alexithymia, difficulties in emotion regulation, depressive and manic symptoms, and suicidal ideation. A series of structural equation models (SEMs) were calculated to assess the associations between these variables. RESULTS Childhood emotional abuse and difficulty in identifying feelings were indirectly associated with depressive and manic symptoms as well as suicidal ideation. This association was mediated by emotion dysregulation. This association remained significant after depressive and manic symptoms were controlled in the model. CONCLUSIONS This study indicates that patients with BD who experienced emotional abuse during childhood and have difficulties identifying emotions report greater emotion dysregulation. These individuals, in turn, are more likely to experience more severe depressive and manic symptoms as well as suicidal ideation.Key pointsChildhood emotional maltreatment and emotional and clinical factors in bipolar disorder were assessed.Childhood emotional abuse indirectly affected clinical factors via emotion dysregulation.Difficulty in identifying feelings was linked to clinical factors via emotional dysregulation.Emotional dysregulation affected the links of childhood emotional maltreatment and difficulty in identifying feelings on suicidal ideation after controlling for clinical symptoms.Emotional dysregulation dimensions of impulse, strategies, and goals emerge in relation to suicidal ideation.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael Berk
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Australia
| | | | - Seyed Mehdi Samimi Ardestani
- Departments of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anna Wrobel
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Orygen, Parkville, Australia
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23
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Scheerer NE, Boucher TQ, Iarocci G. Alexithymia is related to poor social competence in autistic and nonautistic children. Autism Res 2021; 14:1252-1259. [PMID: 33616273 DOI: 10.1002/aur.2485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/21/2021] [Indexed: 11/11/2022]
Abstract
Alexithymia is characterized by difficulties identifying and describing one's own emotions and the emotions of others. These challenges with understanding emotions in people with alexithymia may give rise to difficulties with social interactions. Given that alexithymia frequently co-occurs with autism spectrum disorder (ASD), and that both populations have difficulties with social interactions, it is of interest to determine whether alexithymia can help to parse some of the heterogeneity in social competence in autistic and nonautistic individuals. The caregivers of 241 children (6-14 years old), including 120 autistic, and 121 nonautistic, rated their child's social competence using the Multidimensional Social Competence Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and alexithymia traits using the Children's Alexithymia Measure (CAM). Regression analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of the variance in autistic children's, and 68.2% of the variance in nonautistic children's, parent-reported social competence. Importantly, after controlling for age, IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of the variance in autistic children's, and 17.4% of the variance in nonautistic children's social competence. These results indicate that higher alexithymia traits predict lower levels of social competence, suggesting that increased difficulty in identifying and describing one's own emotions and the emotions of others is associated with poorer social competence. Furthermore, CAM scores were found to partially mediate the relationship between autistic traits and social competence, suggesting that comorbid alexithymia traits may be partially responsible for poor social competence in individuals with high autistic traits. This research contributes to the understanding of the factors associated with the development of social competence and highlights alexithymia as a potential target for identification and intervention to improve social competence. LAY SUMMARY: Alexithymia is a condition where people find it hard to think and talk about their (and others') feelings. About 50% of autistic people have alexithymia. This might be why they have social and emotional difficulties. Parents answered questions about alexithymia and social difficulties their children have. Children with more alexithymia problems had poorer social skills. Thus, alexithymia may be related to social problems faced by autistic and nonautistic children.
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Affiliation(s)
- Nichole E Scheerer
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,The Brain and Mind Institute, Western Interdisciplinary Research Building, University of Western Ontario, London, Ontario, Canada
| | - Troy Q Boucher
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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24
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Bøen E, Hummelen B, Boye B, Elvsåshagen T, Malt UF. Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study. Acta Psychiatr Scand 2020; 142:203-214. [PMID: 32594515 DOI: 10.1111/acps.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. METHODS Twenty-two patients with BPD; 22 patients with BIP-II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen-GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. RESULTS Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP-II only, there was a significant positive correlation between DIDF and GBB total score. In BIP-II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). CONCLUSION Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP-II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.
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Affiliation(s)
- E Bøen
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Hummelen
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Boye
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - T Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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25
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Backx R, Skirrow C, Dente P, Barnett JH, Cormack FK. Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study. J Med Internet Res 2020; 22:e16792. [PMID: 32749999 PMCID: PMC7435628 DOI: 10.2196/16792] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/15/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance. Objective This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments. Methods A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement. Results Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement. Conclusions Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings.
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Affiliation(s)
- Rosa Backx
- Cambridge Cognition Ltd, Cambridge, United Kingdom
| | - Caroline Skirrow
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | | | - Jennifer H Barnett
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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26
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Kimhy D, Lister A, Liu Y, Vakhrusheva J, Delespaul P, Malaspina D, Ospina LH, Mittal VA, Gross JJ, Wang Y. The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. NPJ SCHIZOPHRENIA 2020; 6:7. [PMID: 32210232 PMCID: PMC7093537 DOI: 10.1038/s41537-020-0096-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (mER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of mER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of mER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of mER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Amanda Lister
- New York State Psychiatric Institute, New York, NY, USA
| | - Ying Liu
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Chicago, IL, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University, New York, NY, USA
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27
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Lawlor C, Hepworth C, Smallwood J, Carter B, Jolley S. Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: A systematic literature review. Clin Psychol Psychother 2020; 27:107-135. [PMID: 31661593 DOI: 10.1002/cpp.2408] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self-reported emotion regulation difficulties in individuals with psychosis compared with non-clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal-directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self-reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self-reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.
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Affiliation(s)
- Caroline Lawlor
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Hepworth
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Smallwood
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne Jolley
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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28
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Högman L, Kristiansson M, Fischer H, Johansson AGM. Impaired facial emotion perception of briefly presented double masked stimuli in violent offenders with schizophrenia spectrum disorders. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100163. [PMID: 31832343 PMCID: PMC6890976 DOI: 10.1016/j.scog.2019.100163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022]
Abstract
Social interactions require decoding of subtle rapidly changing emotional cues in others to facilitate socially appropriate behaviour. It is possible that impairments in the ability to detect and decode these signals may increase the risk for aggression. Therefore, we examined violent offenders with schizophrenia spectrum disorders (SSD) and compared these with healthy controls on a computerized paradigm of briefly presented double masked faces exhibiting 7 basic emotions. Our hypotheses were that impaired semantic understanding of emotion words and low cognitive ability would yield lowest emotion recognition. SSD exhibited lower accuracy of emotion perception than controls (46.1% compared with 64.5%, p = 0.026), even when considering the unbiased hit rate (22.4% compared with 43%, Z = 2.62, p < 0.01). Raw data showed uncommon but significant misclassifications of fear as sad, disgust as sad, sad as happy and angry as surprise. Once guessing and presentation frequencies were considered, only overall accuracy differed between SSD and healthy controls. There were significant correlations between cognitive ability, antipsychotic dose, speed and emotion accuracy in the SSD group. In conclusion, that there were no specific emotion biases in the SSD group compared to healthy controls, but particular individuals may have greater impairments in facial emotion perception, being influenced by intellectual ability, psychomotor speed and medication dosages, rather than specifically emotion word understanding. This implies that both state and trait factors influence emotion perception in the aggressive SSD group and may reveal one source of potential misunderstanding of social situations which may lead to boundary violations and aggression.
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Affiliation(s)
- Lennart Högman
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | | | - Håkan Fischer
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Anette GM Johansson
- Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden
- Centre for Psychiatry Research, 113 64 Stockholm, Sweden
- Corresponding author at: Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
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29
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Abstract
One characteristic of human nature is the ability to align our behavior with others. Previous research has linked poor communication skills to alexithymia. This may suggest the possibility that individuals with high alexithymia do not adhere to the principles of social alignment. One form of cognitive alignment is consensus with a group. So far, little research attention has been given to the possible link between alexithymia and this form of cognitive social alignment. In this study, we address this gap by investigating the association between consensus-reaching abilities and alexithymia. A sample comprising of 122 participants completed the Toronto Alexithymia Scale and then played a specially designed game called "Consensus under a deadline". In each game, a participant played with either seven bots designed to act rationally and always seek a consensus, or with seven other participants. The participants were unaware who they were playing with. The results of the study confirm the link between alexithymia and impaired cognitive social alignment, showing that the alexithymia cognitive component (EOT) is associated with a deficit in reaching a consensus with humans (that sometimes act irrationally). However, this association was not evident when group members were bots (that always act rationally).
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Affiliation(s)
- Hila Zahava Gvirts
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
| | - Lihi Dery
- Department of Industrial Engineering and Management, Ariel University, Ariel, Israel
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30
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Piotrowska-Półrolnik M, Holas P, Krejtz I, Symonides B. Relationship between alexithymia and variability of blood pressure measured with ABPM in hypertensive patients. Gen Hosp Psychiatry 2019; 60:1-5. [PMID: 31229676 DOI: 10.1016/j.genhosppsych.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Studies indicates that dysregulation of emotions plays an important role in the etiology of elevated blood pressure (BP). One of the signatures of emotional dysregulation is alexithymia defined as an impaired ability to experience and express emotions. Previous work indicated that primary hypertension (HT) is marked by higher alexithymia, but little research examined the relationship between alexithymia and variability of evaluated BP with 24 h Ambulatory Blood Pressure Monitoring (ABPM) in HT patients. METHOD Fifty-five participants diagnosed with hypertension and a matched group of thirty-nine healthy participants filled in The Toronto Alexithymia Scale (TAS-20), a clinical-demographic questionnaire, and were assessed with 24 h ABPM. RESULTS After removing those with white coat HT, as expected, hypertensive individuals had a higher total score and all three alexithymia subscales. Furthermore, alexithymia was positively correlated with average values of systolic BP. CONCLUSION These findings provided support for the contention that alexithymia is associated with elevated BP, the higher level of alexithymia the higher systolic BP in 24 h BP measurement. Future studies may examine the causal relationship between alexithymia and HT and evaluate the effectiveness of emotional regulation training interventions to reduce BP in people suffering from primary hypertension.
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Affiliation(s)
| | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Warsaw, Poland.
| | - Izabela Krejtz
- Psychology Department, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Bartosz Symonides
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Warsaw, Poland
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31
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Eddy CM. What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations. Front Psychiatry 2019; 10:425. [PMID: 31354534 PMCID: PMC6636467 DOI: 10.3389/fpsyt.2019.00425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.
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Affiliation(s)
- Clare M. Eddy
- Research and Innovation, BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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