The functional and structural characteristics of the emotion network in alexithymia

Art Therapy as a Nursing Intervention for Individuals With Schizophrenia

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.].

Personality traits related to cognitive functioning in patients with functional neurological disorder

Cognitive symptoms are prevalent in patients with functional neurological disorder (FND). Several studies have suggested that personality traits such as neuroticism may play a pivotal role in the development of FND. FND has also been associated with alexithymia: patients with FND report difficulties in identifying, analyzing, and verbalizing emotions. Whether or not alexithymia and other personality traits are associated with cognitive symptomatology in patients with FND is unknown. In the current study, we explored whether the Big Five personality model factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and alexithymia were associated with cognitive functioning in FND. Twenty-three patients with FND were assessed using a neuropsychological assessment and questionnaire assessment to explore personality traits (Neuroticism-Extraversion-Openness Five-Factor Inventory) and alexithymia (Bermond-Vorst Alexithymia Questionnaire). The results indicated that high conscientiousness was associated with lower planning scores (ρ = -0.52, p = .012) and high scores on alexithymia were associated with lower scores on verbal memory scores (ρ = -0.46, p = .032) and lower sustained attention scores (ρ = -0.45, p = .046). The results did not remain significant after controlling for multiple testing. The preliminary results of our study suggest that personality and cognitive symptomatology in patients with FND are topics that should be further explored in future studies, as cognitive symptomology can affect treatment results.

Alexithymia characteristics are associated with salience network activity in healthy participants: an arterial spin labeling study

BACKGROUND

Alexithymia, a personality trait characterized by difficulties in identifying and expressing their emotions despite having a range of emotional experiences, can impact individuals' stress coping mechanisms. While many studies have investigated brain functions associated with specific tasks in relation to emotion processing, research focusing on resting-state brain functions has been limited. Thus, the aim of this study was to investigate the relationship between alexithymia and brain function by analyzing arterial spin labeling (ASL) data obtained during the resting state.

METHODS

A brain structural and functional imaging study was conducted on 42 healthy adult men and women using ASL and the 20-item Toronto Alexithymia Scale (TAS-20) questionnaire survey. Cerebral blood flow and functional connectivity values were calculated for regions of interest in the default mode network, saliency network, and central executive network from the ASL data. Correlation analysis was performed with TAS20 scores, and partial correlation analysis was conducted to control for anxiety and depression.

RESULTS

The functional connectivity analysis revealed a negative correlation between the functional connectivity of the right insular cortex and left anterior cingulate cortex and the total score of TAS, as well as difficulty identifying feelings and difficulty describing feeling subscores, indicating that the higher the scores, the weaker the functional connectivity between these regions (T = -3.830, p = 0.0013, R = -0.5180). This correlation remained significant even after controlling for anxiety and depression using partial correlation analysis.

CONCLUSION

The present study revealed differences in the activity of the Saliency Network at rest as measured by ASL, which were independent of anxiety and depression, and varied depending on the severity of alexithymia. This functional change may underlie the neural basis of decreased emotional processing observed in alexithymia. These findings may contribute to the elucidation of the neural mechanisms of alexithymia, which can lead to social impairments, and suggest the usefulness of ASL measurement as a biomarker of alexithymia.

The relationship between alexithymia, interoception, and neural functional connectivity during facial expression processing in autism spectrum disorder

Neural processing differences of emotional facial expressions, while common in autism spectrum disorder (ASD), may be related to co-occurring alexithymia and interoceptive processing differences rather than autism per se. Here, we investigate relationships between alexithymia, interoceptive awareness of emotions, and functional connectivity during observation of facial expressions in youth (aged 8-17) with ASD (n = 28) compared to typically developing peers (TD; n = 37). Behaviorally, we found no significant differences between ASD and TD groups in interoceptive awareness of emotions, though alexithymia severity was significantly higher in the ASD group. In the ASD group, increased alexithymia was significantly correlated with lower interoceptive sensation felt during emotion. Using psycho-physiological interaction (PPI) analysis, the ASD group showed higher functional connectivity between the left ventral anterior insula and the left lateral prefrontal cortex than the TD group when viewing facial expressions. Further, alexithymia was associated with reduced left anterior insula-right precuneus connectivity and reduced right dorsal anterior insula-left ventral anterior insula connectivity when viewing facial expressions. In the ASD group, the degree of interoceptive sensation felt during emotion was positively correlated with left ventral anterior insula-right IFG connectivity when viewing facial expressions. However, across all participants, neither alexithymia nor interoceptive awareness of emotions predicted connectivity between emotion-related brain regions when viewing emotional facial expressions. To summarize, we found that in ASD compared to TD: 1) there is stronger connectivity between the insula and lateral prefrontal cortex; and 2) differences in interhemispheric and within left hemisphere connectivity between the insula and other emotion-related brain regions are related to individual differences in interoceptive processing and alexithymia. These results highlight complex relationships between alexithymia, interoception, and brain processing in ASD.

White matter tracts associated with alexithymia and emotion regulation: A diffusion MRI study

BACKGROUND

Alexithymia is a cognitive-affective impairment, suggested to be associated with emotion regulation. Herein, we investigated white matter (WM) tracts with Diffusion Magnetic Resonance Imaging (DMRI) connectometry approach using quantitative anisotropy (QA) tractography to discover possible associations between the emotion identification and regulation patterns and WM tracts.

METHODS

DMRI data were acquired from 218 healthy subjects aging 39.15 ± 20.19 who filled the Toronto Alexithymia Scale (TAS) and emotion regulation questionnaire (ERQ) from the LEMON dataset. Connectometry analysis was applied on WM tracts in DMRI images.

RESULTS

DMRI connectometry analysis revealed a significant correlation between TAS identification score and increased microstructural connectivity in WM pathways, including the body of corpus callosum (CC), bilateral fornix, and left arcuate fasciculus (AF) in males (FDR = 0.028), and corticospinal and cingulum tracts in females (FDR = 0.026). Furthermore, we found a significant positive correlation between overall TAS score and fornix properties in men (FDR = 0.026) and corticospinal tracts in women (FDR = 0.028). Middle cerebellar peduncle negatively correlated with describing emotion (FDR = 0.025) and the splenium of the CC and corticospinal tracts negatively correlated with this subscale (FDR = 0.049) in male group. However, the splenium of the CC, corticospinal tracts, and left AF positively associated with this subscale (FDR = 0.029). The splenium of the CC was negatively related to externally-oriented thinking among men (FDR = 0.038). Our results showed marginally associations between ERQ and similar WM tracts.

CONCLUSION

Certain WM microstructures significantly correlate with emotion identification and regulation. These tracts are associated with specific somatosensory areas, language processing areas, and limbic area.

Aggression, Alexithymia and Sense of Coherence in a Sample of Schizophrenic Outpatients

Schizophrenia elevates the risk for aggressive behavior, and there is a need to better understand the associated variables predicting aggression for treatment and prevention purposes. The aim of the present study is to determine the relationship between alexithymia, sense of coherence and aggressive behavior in a sample of schizophrenic outpatients. Using a correlational research design, standardized self-report questionnaires assessed aggression (brief aggression questionnaire—BAQ), alexithymia (Toronto Alexithymia Scale—TAS) and sense of coherence (sense of coherence questionnaire—SOC) in a sample of 100 schizophrenic outpatients in clinical remission. Participants reported high levels of aggression and alexithymia along with reduced sense of coherence. Significant negative correlations were evidenced among scores on the SOC scale (p < 0.001) with both the TAS as well as with the BAQ scales. However, a positive correlation (p < 0.001) was observed between the TAS and BAQ scales. Regression indicated that 27% of the variation in the BAQ rating was explained by the TAS, while an additional 17.8% was explained by the sense of coherence. The difficulty identifying feelings of alexithymia and the comprehensibility and manageability components of sense of coherence significantly predicted anger, hostility and physical aggression. Sense of coherence mediated the relationship between alexithymia and aggression. From the path analysis, comprehensibility emerged as the key factor counterbalancing alexithymic traits and aggressive behaviors, and manageability effectuated higher anger control. The findings hold practical implications for the treatment and rehabilitation of schizophrenic patients.

Convergent and Divergent Structural Connectivity of Brain White Matter Network Between Patients With Erectile Dysfunction and Premature Ejaculation: A Graph Theory Analysis Study

Background

Sexual dysfunction, namely, erectile dysfunction (ED) and premature ejaculation (PE), has been found to be associated with abnormal structural connectivity in the brain. Previous studies have mainly focused on a single disorder, however, convergent and divergent structural connectivity patterns of the brain network between ED and PE remain poorly understood.

Methods

T1-weighted structural data and diffusion tensor imaging data of 28 patients with psychological ED, 28 patients with lifelong PE (LPE), and 28 healthy controls (HCs) were obtained to map the white matter (WM) brain networks. Then, the graph-theoretical method was applied to investigate the differences of network properties (small-world measures) of the WM network between patients with ED and LPE. Furthermore, nodal segregative and integrative parameters (nodal clustering coefficient and characteristic path length) were also explored between these patients.

Results

Small-world architecture of the brain networks were identified for both psychological ED and LPE groups. However, patients with ED exhibited increased average characteristic path length of the brain network when compared with patients with LPE and HCs. No significant difference was found in the average characteristic path length between patients with LPE and HCs. Moreover, increased nodal characteristic path length was found in the right middle frontal gyrus (orbital part) of patients with ED and LPE when compared with HCs. In addition, patients with ED had increased nodal characteristic path length in the right middle frontal gyrus (orbital part) when compared with patients with LPE.

Conclusion

Together, our results demonstrated that decreased integration of the right middle frontal gyrus (orbital part) might be a convergent neuropathological basis for both psychological ED and LPE. In addition, patients with ED also exhibited decreased integration in the whole WM brain network, which was not found in patients with LPE. Therefore, altered integration of the whole brain network might be the divergent structural connectivity patterns for psychological ED and LPE.

The effects of compassion-based feedback on wellbeing ratings during a professional assessment healthcare task

BACKGROUND

There is a need for higher education policy to consider how student nurses might be supported to help them to develop the resilience and mental wellbeing needed to cope with stressful environments. Reviews and qualitative research in this area suggest that compassion can improve wellbeing, however, compassion-based feedback is yet to be explored as a pedagogical intervention using quantitative methods.

PURPOSE

To explore the effect of different feedback types on subjective wellbeing.

METHODS

In this experimental design, nursing students were presented with three feedback types, 'compassion-based feedback, simple descriptive feedback, and utilitarian feedback' and were asked to provide post-trial ratings of subjective wellbeing, in relation to each type, whilst undertaking a nursing-related task. Participants also rated the helpfulness of 'Type of Feedback'.

RESULTS

We report a significant difference of 'Type of Feedback' with higher ratings of wellbeing when participants were presented with compassion-based feedback.

CONCLUSION

Compassion-based feedback could lead to higher wellbeing in educational tasks related to nursing.

Decreased Functional Connectivity in Insular Subregions in Depressive Episodes of Bipolar Disorder and Major Depressive Disorder

Objective: Clinically, it is very difficult to distinguish between major depressive disorder (MDD) and bipolar disorder (BD) in the period of depression. Increasing evidence shows that the insula plays an important role in depression. We aimed to compare the resting-state functional connectivity (rsFC) of insular subregions in patients with MDD and BD in depressive episodes (BDD), who had never experienced manic or hypomanic episodes when they were scanned to identify biomarkers for the identification of two diseases. Methods: We recruited 21 BDD patients, 40 MDD patients and 70 healthy controls (HC). Resting-state functional magnetic resonance imaging (rs-fMRI) was performed. BDD patients had never had manic or hypomanic episodes when they were scanned, and the diagnoses were determined by follow-up. We divided the insula into three parts including the ventral anterior insular cortex (v-AIN), dorsal anterior insular cortex (d-AIN), and posterior insula (PI). The insular-based rsFC was compared among the three groups, and an analysis of the correlation between the rsFC value and Hamilton depression and anxiety scales was carried out. Results: BDD and MDD patients demonstrated decreased rsFC from the v-AIN to the left superior/middle frontal gyrus compared with the HC group. Versus MDD and HC groups, BDD patients exhibited decreased rsFC from the v-AIN to the area in the left orbital frontal gyrus and left superior temporal gyrus (included temporal pole), from the PI to the right lateral postcentral gyrus and from all three insular subregions to the somatosensory and motor cortex. Meanwhile, a correlation between the rsFC value of the PI-right lateral postcentral gyrus and anxiety score was observed in patients. Conclusion: Our findings show BDD and MDD patients have similar decreases in insular connectivity in the dorsal lateral frontal regions, and BDD patients have specific decreased insular connectivity, especially in the somatosensory and motor cortex, which may be used as imaging evidence for clinical identification.