The influence of alexithymia on persistent symptoms of dyspepsia after laparoscopic cholecystectomy

Relevant associations between alexithymia and health-literacy in persons with psoriasis

OBJECTIVE

To explore possible associations between alexithymia and health literacy (HL) in persons with psoriasis.

METHODS

We conducted a cross-sectional study, including 825 persons with moderate to severe psoriasis, using the Toronto Alexithymia Scale, and the Health Literacy Questionnaire. Descriptive statistics compare HL means between alexithymic and not alexithymic participants. Associations between alexithymia and HL are analyzed using a linear multiple regression model.

RESULTS

Twenty-six percent of the participants were characterized as alexithymic, and 26.8% had borderline alexithymia. Higher alexithymia scores were associated with lower education, biological medicines, and more comorbidities, together with lower self-efficacy. The HL domains with the strongest associations with alexithymia were those focusing on managing and getting support for health, as well as the ability to find health information.

CONCLUSION

A more elevated alexithymia score is associated with lower HL. Further studies of these associations may contribute to a more comprehensive perspective of psoriasis. To know a patient's alexithymia level and HL needs may guide health care personnel's understanding of possible associations between health status, clinical presentation, behavior, and response to treatment.

Etiologies of Long-Term Postcholecystectomy Symptoms: A Systematic Review

BACKGROUND

Cholecystectomy does not relieve abdominal symptoms in up to 40% of patients. With 700,000 cholecystectomies performed in the US, annually, about 280,000 patients are left with symptoms, making this a serious problem. We performed a systematic review to determine the different etiologies of long-term postcholecystectomy symptoms with the aim to provide guidance for clinicians treating these patients.

METHODS

A systematic search of the literature was performed using MEDLINE, EMBASE, and Web of Science. Articles describing at least one possible etiology of long-term symptoms after a laparoscopic cholecystectomy were included in this review. Long-term symptoms were defined as abdominal symptoms that were present at least four weeks after cholecystectomy, either persistent or incident. The etiologies of persistent and incident symptoms after LC and the mechanism or hypothesis behind the etiologies are provided. If available, the prevalence of the discussed etiology is provided.

RESULTS

The search strategy identified 3320 articles of which 130 articles were included. Etiologies for persistent symptoms were residual and newly formed gallstones (41 studies, prevalence ranged from 0.2 to 23%), coexistent diseases (64 studies, prevalence 1-65%), and psychological distress (13 studies, no prevalence provided). Etiologies for incident symptoms were surgical complications (21 studies, prevalence 1-3%) and physiological changes (39 studies, prevalence 16-58%). Sphincter of Oddi dysfunction (SOD) was reported as an etiology for both persistent and incident symptoms (21 studies, prevalence 3-40%).

CONCLUSION

Long-term postcholecystectomy symptoms vary amongst patients, arise from different etiologies, and require specific diagnostic and treatment strategies. Most symptoms after cholecystectomy seem to be caused by coexistent diseases and physiological changes due to cholecystectomy. The outcome of this research is summarized in a decision tree to give clinical guidance on the treatment of patients with symptoms after cholecystectomy.

Alexithymia in Gastroenterology and Hepatology: A Systematic Review

Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation. Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies. Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10-15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings. Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes.

Type D Personality and Alexithymia: Common Characteristics of Two Different Constructs. Implications for Research and Clinical Practice

In the last few decades, particular attention has been paid to the role of personality specific traits that can affect the loss of health, i.e., Type D personality and Alexithymia. They have been conceptualized in a different period, this means that they are different both for their theoretical positions and their empirical studies. Some authors have speculated that there is a potential conceptual overlap between Type D personality and alexithymia constructs but there is a shortcoming in the literature. The aim of the study was to examine the potential overlap between the constructs of type D personality and alexithymia, replicating previous two studies, to extend these findings to Italian population. The participants were 247 Italian adults (males = 43%), recruited in primary health care practices of Palermo. All participants did not have chronic diseases during tests administration. They ranged in age from 35 to 69 years old (M = 52.34 years, SD = 9.76). Participants were administered Type D Personality Scale (DS-14) and Toronto Alexithymia Scale (TAS-20). A series of confirmatory factor analyses was performed to evaluate the factorial structure underlying the TAS-20 and DS-14 items. Globally results showed that alexithymia and type D personality are distinct constructs, but they are also strictly positively related with each other. Negative affectivity (NA) was highly correlated with Difficulties in identifying feelings and Difficulties in describing feelings, while Social inhibition (SI) was highly correlated with Difficulties in describing feelings. These results are consistent with those of other studies conducted in this area. Future research should consider evaluating the relationship between a deficit of affect regulation and type D personality to improve the effectiveness of interventions of health cure.

Taxometric Analysis of the Toronto Structured Interview for Alexithymia: Further Evidence That Alexithymia Is a Dimensional Construct

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and describing feelings, externally oriented thinking, and impoverished imaginal processes. Previous taxometric investigations provided evidence that alexithymia is best conceptualized as a continuous dimension rather than a discrete type, at least when assessed with the self-report 20-Item Toronto Alexithymia Scale. The aim of the current study was to test the categorical versus dimensional structure of alexithymia using the recently developed Toronto Structured Interview for Alexithymia. Three nonredundant taxometric procedures (MAXCOV, MAMBAC, and L-Mode) were performed on the Toronto Structured Interview for Alexithymia subscale scores from a multinational sample of 842 adults. All taxometric procedures produced unambiguously dimensional solutions, providing further evidence that the core alexithymia features are continuously distributed in the population. Discussion focuses on the theoretical, assessment, and clinical implications of these findings for the alexithymia construct.

The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome

In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R²=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.

Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology

OBJECTIVE

To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria.

METHOD

Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis.

RESULTS

Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%).

CONCLUSIONS

The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.

A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program

OBJECTIVES

Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning.

DESIGN AND METHODS

Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms.

RESULTS

Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period.

CONCLUSIONS

The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.

Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review

Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.

Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV

Alexithymia, an impairment of affective and cognitive emotional processing, is often associated with human immunodeficiency virus (HIV) and may reflect effects of the virus on brain areas that are also important for multiple cognitive functions, such as the prefrontal and anterior cingulate cortices. We hypothesized that there would be a correlation between extent of alexithymia and cognitive performance associated with these brain areas, including attention, executive function, and visuospatial processing. Thirty-four asymptomatic HIV+ participants and 34 matched healthy HIV- volunteers were administered the Toronto Alexithymia Scale, a series of neuropsychological tests, and measures of apathy, depression, and quality of life (QoL). The HIV+ participants had significantly higher levels of alexithymia, depression and apathy than the HIV- group. The extent of alexithymia and two of its processing components (Difficulty Describing Feelings [DDF] and Externally Oriented Thinking), but not depression, correlated with performance on measures of executive and visuospatial abilities, consistent with dysfunction of the frontostriatal circuits and their cortical projections. Apathy was related to alexithymia and two processing components (Difficulty Identifying Feelings and DDF) but to only one cognitive measure. The higher rate of alexithymia, as well as cognitive dysfunction, in HIV may be a consequence of the infection on the frontostriatal system and its cortical connections. Our findings also demonstrated a dissociation of apathy and alexithymia in HIV, pointing to overlapping but distinct neural substrates within frontostriatal circuits. Alexithymia correlated strongly with QoL ratings, underscoring the importance of assessment and treatment of HIV-associated emotional and cognitive processing deficits.