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Lindberg O, Li TQ, Lind C, Vestberg S, Almkvist O, Stiernstedt M, Ericson A, Bogdanovic N, Hansson O, Harper L, Westman E, Graff C, Tsevis T, Mannfolk P, Fischer H, Nilsonne G, Petrovic P, Nyberg L, Wahlund LO, Santillo AF. Altered empathy processing in frontotemporal dementia A task-based fMRI study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.21.586051. [PMID: 38585830 PMCID: PMC10996471 DOI: 10.1101/2024.03.21.586051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
A lack of empathy, and particularly its affective components, is a core symptom of behavioural variant frontotemporal dementia (bvFTD). Visual exposure to images of a needle pricking a hand (pain condition) and Q-tips touching a hand (control condition) is an established functional magnetic resonance imaging (fMRI) paradigm used to investigate empathy for pain (EFP; pain condition minus control condition). EFP has been associated with increased blood oxygen level dependent (BOLD) signal in regions known to become atrophic in the early stages in bvFTD, including the anterior insula and the anterior cingulate. We therefore hypothesized that patients with bvFTD would display altered empathy processing in the EFP paradigm. Here we examined empathy processing using the EFP paradigm in 28 patients with bvFTD and 28 sex and age matched controls. Participants underwent structural MRI, task-based and resting-state fMRI. The Interpersonal Reactivity Index (IRI) was used as a measure of different facets of empathic function outside the scanner. The EFP paradigm was analysed at a whole brain level and using two regions-of-interest approaches, one based on a metanalysis of affective perceptual empathy versus cognitive evaluative empathy and one based on the controĺs activation pattern. In controls, EFP was linked to an expected increase of BOLD signal that displayed an overlap with the pattern of atrophy in the bvFTD patients (insula and anterior cingulate). Additional regions with increased signal were the supramarginal gyrus and the occipital cortex. These latter regions were the only ones that displayed increased BOLD signal in bvFTD patients. BOLD signal increase under the affective perceptual empathy but not the cognitive evaluative empathy region of interest was significantly greater in controls than in bvFTD patients. The controĺs rating on their empathic concern subscale of the IRI was significantly correlated with the BOLD signal in the EFP paradigm, as were an informantś ratings of the patientś empathic concern subscale. This correlation was not observed on other subscales of the IRI or when using the patient's self-ratings. Finally, controls and patients showed different connectivity patterns in empathy related networks during resting-state fMRI, mainly in nodes overlapping the ventral attention network. Our results indicate that reduced neural activity in regions typically affected by pathology in bvFTD is associated with reduced empathy processing, and a predictor of patientś capacity to experience affective empathy.
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Affiliation(s)
- Olof Lindberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Tie-Qiang Li
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Sweden
- Department of Medical Radiation and Nuclear Medicine, Karolinska University Hospital, Sweden
| | - Cecilia Lind
- Department of community medicine and rehabilitation, geriatrics Umeå university, Umeå university, Sweden
| | | | - Ove Almkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Department of Psychology, Stockholm, Sweden
| | - Mikael Stiernstedt
- Umeå center for Functional Brain Imaging (UFBI), Umeå University, Sweden
| | - Anita Ericson
- Department of community medicine and rehabilitation, geriatrics Umeå university, Umeå university, Sweden
| | - Nenad Bogdanovic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Lund, Sweden
| | - Luke Harper
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Caroline Graff
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Karolinska university hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - Theofanis Tsevis
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Karolinska university hospital, Stockholm, Sweden
| | - Peter Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Fischer
- Department of Psychology, Stockholm, Sweden
- Stockholm University Brain Imaging Centre (SUBIC), Stockholm, Sweden
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Nilsonne
- Department of Psychology, Stockholm, Sweden
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Predrag Petrovic
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
- Center for Cognitive and Computational Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Lars Nyberg
- Umeå center for Functional Brain Imaging (UFBI), Umeå University, Sweden
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Cruyt E, De Vriendt P, De Geyter N, Van Leirsberghe J, Santens P, De Baets S, De Letter M, Vlerick P, Calders P, De Pauw R, Oostra K, Van de Velde D. The underpinning of meaningful activities by brain correlates: a systematic review. Front Psychol 2023; 14:1136754. [PMID: 37179882 PMCID: PMC10169732 DOI: 10.3389/fpsyg.2023.1136754] [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: 01/03/2023] [Accepted: 03/29/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction Engaging in meaningful activities contributes to health and wellbeing. Research identifies meaningfulness by analysing retrospective and subjective data such as personal experiences in activities. Objectively measuring meaningful activities by registering the brain (fNIRS, EEG, PET, fMRI) remains poorly investigated. Methods A systematic review using PubMed, Web of Science, CINAHL, and Cochrane Library. Findings Thirty-one studies investigating the correlations between daily activities in adults, their degree of meaningfulness for the participant, and the brain areas involved, were identified. The activities could be classified according to the degree of meaningfulness, using the attributes of meaningfulness described in the literature. Eleven study activities contained all attributes, which means that these can be assumed to be meaningful for the participant. Brain areas involved in these activities were generally related to emotional and affective processing, motivation, and reward. Conclusion Although it is demonstrated that neural correlates of meaningful activities can be measured objectively by neurophysiological registration techniques, "meaning" as such has not yet been investigated explicitly. Further neurophysiological research for objective monitoring of meaningful activities is recommended.
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Affiliation(s)
- Ellen Cruyt
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
- Mental Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele De Geyter
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Janne Van Leirsberghe
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Stijn De Baets
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
- Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Peter Vlerick
- Department of Work, Organization and Society, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
- Lifestyle and Chronic Diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Kristine Oostra
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Research Group, Physiotherapy and Speech-Language Pathology/Audiology, Ghent University, Ghent, Belgium
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Wang Y, Wang P, Wu Q, Wang Y, Lin B, Long J, Qing X, Wang P. Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19. J Gen Intern Med 2023; 38:428-433. [PMID: 36253633 PMCID: PMC9575631 DOI: 10.1007/s11606-022-07784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor-patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic. OBJECTIVE To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19. MAIN MEASURES Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients. RESULTS A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication. CONCLUSIONS During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor-patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs.
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Affiliation(s)
- Yanjiao Wang
- Faculty of Education, East China Normal University, Shanghai, China
- School of Teacher Education, Honghe University, Mengzi, China
| | - Peijuan Wang
- School of Foreign Languages, Tongji University, Shanghai, China
| | - Qing Wu
- College of Education, Lanzhou City University, Lanzhou, China
| | - Yao Wang
- Faculty of Education, East China Normal University, Shanghai, China
| | - BingJun Lin
- Psychological Counseling Center, Fujian Vocational College of Art, Fuzhou, China
| | - Jia Long
- Faculty of Education, East China Normal University, Shanghai, China
| | - Xiong Qing
- The Fourth People's Hospital of Huaihua, Huaihua, China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai, China.
- School of Teacher Education, Honghe University, Mengzi, China.
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Ljungvall H, Öster C, Katila L, Åsenlöf P. "Opioids are opioids" - A phenomenographic analyses of physicians' understanding of what makes the initial prescription of opioids become long-term opioid therapy. Scand J Pain 2022; 22:494-505. [PMID: 35172418 DOI: 10.1515/sjpain-2021-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore prescribers' understanding of what makes initial prescription of opioids become long-term opioid therapy (opioids >90 days). METHODS A qualitative research design, phenomenography, was used for this study. Fifteen attending physicians working within primary, secondary and tertiary care in Sweden in the fields of general practice, rehab medicine, orthopedic surgery, neurosurgery, or obstetrics and gynecology were purposively recruited consecutively until categorical saturation was reached. Semi-structured interviews were used for data collection. The transcripts were analyzed and categorized by two researchers. A third researcher checked for consistency between the data and the categories. An outcome space was constructed representing the logical relationship between the categories. RESULTS The analysis identified six categories: The addictive opioid, The deserving patient, The ignorant prescriber, The lost patient, The compassionate prescriber, and The exposed prescriber. The differences in conceptions among the categories were clarified through three main contributors related to opioid therapy: prescriber's characteristics, patient's characteristics, and the healthcare organization. CONCLUSIONS Opioids were understood as being addictive with long-term use promoting a downward spiral of tolerance and withdrawal driving the pain, leading to continued prescription. Long-term opioid therapy could be justified for patients who improved in function, and who were perceived as trustworthy. Inadequate follow-up of patients, poor training in pain management and addiction medicine, personal attitudes and beliefs about opioids, a perceived professional obligation to treat patients with pain, and lack of collegial support, were factors understood to promote clinically unindicated long-term opioid therapy.
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Affiliation(s)
- Hanna Ljungvall
- Department of Women's and Children's Health, Uppsala University, Sweden
- Department of Sociology, Centre for Social Work (CESAR), Uppsala University, Sweden
| | - Caisa Öster
- Department of Medical Sciences, Uppsala University, Sweden
| | - Lenka Katila
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Uppsala University, Sweden
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The Effects of Physicians' Communication and Empathy Ability on Physician-Patient Relationship from Physicians' and Patients' Perspectives. J Clin Psychol Med Settings 2022; 29:849-860. [PMID: 35089529 PMCID: PMC8795960 DOI: 10.1007/s10880-022-09844-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
Physician communication (PC) is central to influencing physician–patient relationship (PPR), and physician empathy (PE) is central to PC. A comprehensive and objective assessment of the mechanisms underlying PPR from the two-way perspective of physicians and patients are important for social development. However, the relationship between these three variables under the two-way perspective is not clear. To examine the effectiveness of PC in predicting PPR from a two-way perspective of physicians and patients and the underlying mechanisms that influence PPR. We selected 2665 physicians and 2983 patients in China and examined the effect of physician empathy on PPR and the mediating role of PC between PE and PPR using structural equation modeling. The results of the physician self-assessment showed that the link between PC and PPR was not significant, while the results of the patient other assessment showed that physician communication was not only effective in predicting the doctor–patient relationship but also mediated the relationship between physician empathy and PPR; further analysis of the underlying mechanisms affecting PPR revealed that the results of the physician self-assessment showed that PC mediated the relationship between perspective-taking and PPR; however, the results of the patient other assessment showed that physician However, patient ratings showed that PC mediated the relationship between perspective-taking and PPR, as well as between empathic concern and PPR. However, patient ratings indicate that PC mediates the relationship between perspective-taking and PPR and between empathic concern and the PPR.
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Cañas-Lerma AJ, Cuartero-Castañer ME, Mascialino G, Hidalgo-Andrade P. Empathy and COVID-19: Study in Professionals and Students of the Social Health Field in Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E338. [PMID: 33466348 PMCID: PMC7796130 DOI: 10.3390/ijerph18010338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 12/30/2022]
Abstract
Empathy plays a fundamental role in health related occupations. In this study, we analysed empathy levels in professionals (117) and students (170) from various healthcare fields in Ecuador during the COVID-19 pandemic. The Interpersonal Reactivity Index was used in an online survey. The results show high levels of empathy in both groups, influenced by age and gender. The students presented higher levels of personal distress, and their age was negatively correlated to empathy. Additionally, professionals working in physical health scored higher levels of personal distress compared to those in the field of emotional health. COVID-19 has placed social health systems in great stress. Despite this, the personal capacities for empathy of both students and health professionals have not been diminished.
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Affiliation(s)
- Ana J. Cañas-Lerma
- Philosophy and Social Work Department, Universitat de les Illes Balears, Crta. Valldemossa Km 7.5., 07122 Palma, Spain;
| | - M. Elena Cuartero-Castañer
- Philosophy and Social Work Department, Universitat de les Illes Balears, Crta. Valldemossa Km 7.5., 07122 Palma, Spain;
| | - Guido Mascialino
- School of Psychology, Universidad de Las Américas, Av. de los Granados E-12-41 y Colimes esq., Quito EC170125, Ecuador; (G.M.); (P.H.-A.)
| | - Paula Hidalgo-Andrade
- School of Psychology, Universidad de Las Américas, Av. de los Granados E-12-41 y Colimes esq., Quito EC170125, Ecuador; (G.M.); (P.H.-A.)
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