Increased arterial stiffness parameters in panic disorder patients in long term treatment period.

BACKGROUND: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. METHODS: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. RESULTS: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). CONCLUSION: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.

Chronotype preference, sleep quality, and night-eating behaviors in patients with metabolic dysfunction-associated steatotic liver disease: Assessing the relationship with disease severity and fibrosis.

Background and Aim: Our primary objective is to examine the variance in chronotype, night-eating patterns, and sleep quality in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease. In addition, we aim to establish a correlation between these variables and the severity of the disease and fibrosis. Materials and Methods: Patients who were following up with biopsy-proven metabolic dysfunction associated steatotic liver disease (MASLD) were included in the study. Histologically severe disease is characterized by a Steatosis, Activity, and Fibrosis activity score of ≥3 or the presence of advanced fibrosis (≥F3). Participants who met the inclusion criteria were given the Morningness and Evening Questionnaire (MEQ), the Pittsburgh Sleep Quality Index, and the Night Eating Questionnaire to complete. Results: A total of 93 patients were included in this study. According to the MEQ, 48 patients were morning type (51.6%), and 42 (45.2%) were neither type. Sleep quality was determined to be inferior in the non-morningness group (p=0.002). A significantly higher proportion of patients with nocturnal eating syndrome had a non-morningness chronotype preference (n=22, 23.7%), compared to those with a morningness chronotype (n=9, 9.7%) (p=0.001). In the multivariate analysis, both age and poor sleep quality had significant impacts on advanced fibrosis, with odds ratios of 1.11 and 3.81, respectively. Conclusion: Despite the non-morningness chronotype demonstrating poorer sleep quality and a higher prevalence of night-eating behavior, our findings revealed no statistically significant differences in terms of sleep quality, nocturnal eating habits, or chronotype preferences among patients with varying degrees of MASLD severity. On the other hand, advanced fibrosis was significantly impacted by poor sleep quality.

Exploring the role of adult attachment, major depression and childhood trauma in arterial stiffness: A preliminary study.

OBJECTIVE: Prior research indicates a noteworthy and intricate connection between depression and subclinical atherosclerosis. Nevertheless, the biological and psychological mechanisms that underlie this association are not yet fully understood. To address this gap, this exploratory study aimed to examine the relationship between active clinical depression and arterial stiffness (AS), with a particular focus on the potential mediating roles of attachment security and childhood trauma. METHODS: In this cross-sectional study, we examined 38 patients with active major depression free of dyslipidemia, diabetes mellitus, hypertension, and obesity and 32 healthy controls. All participants underwent blood tests, psychometric assessments, and AS measurements using the Mobil-O-Graph arteriograph system. AS severity was evaluated using an augmentation index (AIx) normalized to 75 beats/min. RESULTS: In the absence of defined clinical cardiovascular risk factors, there was no significant difference in AIx between individuals with depression and healthy controls (p = .75). Patients with longer intervals between depressive episodes had lower AIx (r = -0.44, p < .01). Insecure attachment and childhood trauma did not significantly associate with AIx in patients. Whereas insecure attachment was positively correlated with AIx only in healthy controls (r = 0.50, p = 01). CONCLUSIONS: Our analysis of established risk factors for atherosclerosis revealed that depression and childhood trauma had no significant relationship with AS. However, we did identify a novel finding: insecure attachment was significantly associated with AS severity in healthy adults without defined cardiovascular risk factors for the first time. To our knowledge, this is the first study to demonstrate this relationship.

Long and short distance movements of ß(2)-adrenoceptor in cell membrane assessed by photoconvertible fluorescent protein dendra2-ß(2)-adrenoceptor fusion.

Local movements of receptors in the plasma membrane have been extensively studied, as it is generally believed that the dynamics of membrane distribution of receptors regulate their functions. However, the properties of large-scale (>5µm) receptor movements in the membrane are relatively obscure. In the present study, we addressed the question as to whether the large-scale movement of receptor in the plasma membrane at the whole cell level can be explained quantitatively by its local diffusive properties. We used HEK 293 cells transfected with human ß2-adrenoceptor fused to photoconvertible fluorescent protein dendra2 as a model system; and found that 1) functional integrity of the dendra2-tagged receptor remains apparently intact; 2) in a mesoscopic scale (~4µm), ~90% of the receptors are mobile on average, and receptor influx to, and out-flux from a membrane area can be symmetrically explained by a diffusion-like process with an effective diffusion coefficient of ~0.1µm(2)/s; 3) these mobility parameters are not affected by the activity state of the receptor (assessed by using constitutively active receptor mutants); 4) in the macroscopic scale (4-40µm), although a slowly diffusing fraction of receptors (with D<0.01µm(2)/s) is identifiable in some cases, the movement of the predominant fraction is perfectly explained by the same effective diffusion process observed in the mesoscopic scale, suggesting that the large scale structure of the cell membrane as felt by the receptor is apparently homogeneous in terms of its mesoscopic properties. We also showed that intracellular compartments and plasma membrane are kinetically connected even at steady-state.

Functional Somatic Symptoms and Their Predictors in Patients with Major Depressive Disorder and Fibromyalgia Syndrome.

Introduction: Despite being different medical conditions, functional somatic symptoms (FSSs) are common in patients with major depressive disorder (MDD) and fibromyalgia syndrome (FMS). Higher levels of depression, anxiety, somatosensory amplification, hypochondriacal worry and alexithymia may be related to the severity of somatization in patients with MDD and FMS. We aimed to investigate the typology and severity of FSSs and the association between FSSs and these psychiatric symptoms in patients with MDD and FMS. Method: 56 MDD, 33 FMS, 21 CoMF (Comorbidity of MDD and FMS) patients, and 50 healthy participants were included in the study, respectively. Diagnosis of MDD and FMS was established according to DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Revised Text), and ACR (American College of Rheumatology) 2010 diagnostic criteria. All participants were evaluated with self-report questionnaires including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatosensory Amplification Scale (SSAS), Toronto Alexithymia Scale-20 (TAS-20), Whiteley Index-7 (WI-7), The Symptom Checklist-90-R (SCL-90-R) somatization subscale and Bradford Somatic Inventory-44 (BSI-44). Results: The severity of somatization was statistically significantly highest in the CoMF group, and similar in the FMS and MDD groups, and lowest in the control group according to the BSI-44 and SCL-90-R results. The typology of FSSs was quite similar in patients with MDD and FMS, and weakness, tiredness and neck pain were the most common FSSs in both groups. Independent predictors of FSSs were age, the severity of anxiety and alexithymia in the MDD group, however, it was only the severity of anxiety in the FMS group. Conclusions: Our results show that the typology and severity of FSSs are similar in MDD and FMS patients. Moreover, somatization appears to be more associated with anxiety in patients with MDD and FMS.

Alexithymia and temperament and character model of personality in patients with major depressive disorder.

Alexithymia is thought to be a stable personality trait and a predisposing risk factor for depression. In this study, we aimed to identify the prevalence of alexithymia in a depressed and nondepressed sample and examined the relationship between Cloninger's psychobiological model of personality with alexithymia. The Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20), the Turkish version of the Temperament and Character Inventory, and the 21-item Beck Depression Inventory (BDI) were administered to 81 depressed patients and 51 controls. The mean age of the groups was 30.5 +/- 7.7 and 32.75 +/- 8.73, respectively. Depression severity was evaluated with the BDI. In the depressed group, 33.3% were alexithymic, and alexithymic subjects had significantly higher BDI scores. Depressed individuals were significantly more alexithymic than the controls on the total and all the 3 subscales of TAS-20. The TAS-20 total score was negatively correlated with the temperament dimension of Reward Dependence (RD) and the character dimension of Self-Directedness (SD). In the TAS-20 subscale, difficulties in identifying feelings was positively correlated with Self-Transcendence and negatively correlated with SD. The difficulties in expressing feelings subscale was negatively correlated with RD and SD. In the depressed patient group, the temperament dimension of RD was significantly lower in the alexithymic group. The rate of alexithymia is found high among this sample of Turkish depressed patients, and the results suggested a strong connection between alexithymia and depression. Alexithymia is explained by specific dimensions and subscale within Cloninger's psychobiological model of personality in this sample of depressed Turkish patients.

P2X7 receptor activates multiple selective dye-permeation pathways in RAW 264.7 and human embryonic kidney 293 cells.

P2X7 receptor has gained an increasing importance as a drug target. One important response to P2X7 receptor stimulation is the uptake of large molecular weight tracers into cells. However, mechanism for this response is not understood clearly, but it is generally believed that a nonselective large pore protein forms this P2X7 receptor-activated permeability pathway. We examined human embryonic kidney (HEK) 293 cells transfected with rat P2X7 receptors (HEK-rP2X7) and a macrophage derived cell line, RAW 264.7, that expresses an endogenous P2X7 receptor. We used confocal microscopy to investigate uptake of different types of dyes into these cells after ATP application. Stimulation of P2X7 receptors in HEK-rP2X7 cells activated two different dye uptake pathways. The first was permeable to the cationic fluorescent dyes YO-PRO-1 and TO-TO-1 but not to the anionic dyes lucifer yellow and calcein and did not require intracellular Ca2+ concentration ([Ca2+](i)) increase to be activated. The second pathway permeated only lucifer yellow and was completely dependent on [Ca2+](i) for activation. In RAW 264.7 cells, P2X7 receptor stimulation activated uptake of ethidium, YO-PRO-1, TO-TO-1, lucifer yellow, and calcein. Again, two different permeation pathways were discerned in RAW 264.7 cells: one permeated only ethidium and the other one, only lucifer yellow. We did observed no clear [Ca2+](i) dependence for these permeation pathways. Our results demonstrate that instead of a single nonselective pore, P2X7 receptor seems to activate at least two permeation pathways, one for cationic and one for anionic dyes with different activation properties.

Normative data and factorial structure of the Turkish version of the Temperament and Character Inventory.

Cloninger's dimensional psychobiological model of personality accounts for both normal and abnormal variation in 2 major personality components: temperament and character. Here, we examined the psychometric properties of the Turkish version of the Temperament and Character Inventory (TCI) in a healthy Turkish population, obtaining normative data for the Turkish TCI. The study was conducted in healthy volunteers at both Karadeniz Technical University School of Medicine and Atatürk University School of Medicine (n = 683). The Turkish sample had significantly lower mean scores on Novelty Seeking and Reward Dependence and higher mean scores on Harm Avoidance than the American sample. The Turkish sample had significantly lower scores on Self-Directedness, Cooperativeness, and Self-Transcendence. Self-Directedness and Harm Avoidance, Cooperativeness and Reward Dependence, and Cooperativeness and Self-Directedness were intercorrelated. The Cronbach coeficients were between 0.60 and 0.85 on temperament dimensions, and between 0.82 and 0.83 on character dimensions. The lowest Cronbach coefficients were found in Reward Dependence (0.60) and Persistence (0.62). A principal axis factor analysis with a 4-factor solution revealed the highest loadings on Novelty Seeking and Harm Avoidance and relatively weaker loadings on Reward Dependence and Persistence. A 3-factor solution for character subscales indicated the highest loadings on Cooperativeness and Self-Transcendence. The factorial structure was consistent with Cloninger's 7-factor model of personality, and test-retest indicated a good stability of scores over time. The reliability and factorial validity of the Turkish version of the TCI are therefore supported.

Cloninger's temperament and character dimensions of personality in patients with major depressive disorder.

In this present study, we examined the relationship between the Cloninger's dimensional psychobiologic model of personality and depression in an outpatient population with major depressive disorder. Eighty-one depressed outpatients (67 women, 14 men) and 51 healthy controls (35 women, 16 men) filled out the Turkish version of the Temperament and Character Inventory (TCI). Depression severity was evaluated by using the 17-item Hamilton Depression Rating Scale and the 21-item Beck Depression Inventory. Depressed patients exhibited statistically significant higher scores for harm avoidance and lower scores for self-directedness compared to healthy controls. Sentimentality (RD1) and dependence (RD4) subscale scores of reward dependence and spiritual acceptance (ST3) subscale of self-transcendence were significantly higher; attachment (RD3) subscale of reward dependence, responsibility (SD1), purposefulness (SD2), resourcefulness (SD3), and congruent second nature (SD5) subscales of self-directedness were significantly lower in the depressed group. In the depressed patient group, main effects of sex were significant for reward dependence and cooperativeness; the scores of both dimensions were higher for women. The Beck Inventory was positively correlated with harm avoidance and negatively correlated with novelty seeking and self-directedness dimensions (P < .05). The duration of depression (16.33 +/- 20.18 months) or the mean onset age of depression (28.68 +/- 8.11 years) did not show significant correlations with TCI scales. This study confirms the relationship between harm avoidance and depression and suggests a relationship between self-directedness and depression.

Assessment of autonomic dysfunction and anxiety levels in patients with mitral valve prolapse.

OBJECTIVES: This study aimed to assess autonomic dysfunction parameters and anxiety levels in patients with mitral valve prolapse (MVP). STUDY DESIGN: We evaluated 33 patients (mean age 25+/-5 years) with MVP and 14 healthy subjects (mean age 25+/-4 years). The patients were divided into two groups according to the presence (anatomical MVP, n=11) or absence (MVP syndrome, n=22) of abnormal leaflet thickening (>5 mm). Spielberger's Situational Anxiety Scale (SSAS) and Continuous Anxiety Scale (SCAS) were administered to all the subjects, and heart rates (HR) and arterial blood pressures (BP) were measured in the supine and standing positions. RESULTS: Mid-systolic click and late systolic murmur were significantly more frequent in patients with anatomical MVP, while nonspecific symptoms such as dyspnea, vertigo, and atypical chest pain were more frequent in patients with MVP syndrome (p<0.05). Mitral insufficiency (mild) was significantly more frequent in patients with anatomical MVP (72.7% vs. 22.7%; p<0.009). Patients with MVP syndrome had significantly higher SSAS and SCAS scores (41.0+/-15.6 and 38.5+/-15.5) compared to patients with anatomical MVP (15.8+/-7.5 and 17.0+/-9.1) and controls (14.9+/-7.4 and 16.9+/-8.7, respectively; for both p<0.001). Orthostatic differences in BP and HR were significantly greater in patients with MVP syndrome than those having anatomical MVP (p<0.001 and p=0.032, respectively). Orthostatic HR differences showed a significant correlation with SSAS in both MVP groups (r=0.536, p=0.001) and a significant correlation with SCAS in patients with MVP syndrome (r=0.523, p=0.002). There was an inverse correlation between orthostatic BP differences and anxiety parameters in all MVP patients (r=-0.391, p=0.025 for SSAS, and r=-0.320, p=0.048 for SCAS). CONCLUSION: Our data suggest that patients with MVP syndrome have increased autonomic dysfunction and anxiety scores compared to patients with anatomical MVP.

Exploring allosteric coupling in the alpha-subunit of heterotrimeric G proteins using evolutionary and ensemble-based approaches.

BACKGROUND: Allosteric coupling, which can be defined as propagation of a perturbation at one region of the protein molecule (such as ligand binding) to distant sites in the same molecule, constitutes the most general mechanism of regulation of protein function. However, unlike molecular details of ligand binding, structural elements involved in allosteric effects are difficult to diagnose. Here, we identified allosteric linkages in the alpha-subunits of heterotrimeric G proteins, which were evolved to transmit membrane receptor signals by allosteric mechanisms, by using two different approaches that utilize fundamentally different and independent information. RESULTS: We analyzed: 1) correlated mutations in the family of G protein alpha-subunits, and 2) cooperativity of the native state ensemble of the Galphai1 or transducin. The combination of these approaches not only recovered already-known details such as the switch regions that change conformation upon nucleotide exchange, and those regions that are involved in receptor, effector or Gbetagamma interactions (indicating that the predictions of the analyses can be viewed with a measure of confidence), but also predicted new sites that are potentially involved in allosteric communication in the Galpha protein. A summary of the new sites found in the present analysis, which were not apparent in crystallographic data, is given along with known functional and structural information. Implications of the results are discussed. CONCLUSION: A set of residues and/or structural elements that are potentially involved in allosteric communication in Galpha is presented. This information can be used as a guide to structural, spectroscopic, mutational, and theoretical studies on the allosteric network in Galpha proteins, which will provide a better understanding of G protein-mediated signal transduction.

Cell adhesion modulates 5-HT(1D) and P2Y receptor signal trafficking differentially in LTK-8 cells.

In this study, we investigated adhesion-induced changes in cellular responses to serotonin 5-HT(1D) and purinergic P2Y receptor stimulation. We demonstrated that detachment of LTK-8 cells increased 5-HT(1D) receptor-mediated intracellular Ca(2+) and extracellular signal regulated kinase (ERK) phosphorylation responses without affecting the adenylate cyclase response. Additionally, detachment enabled 5-HT(1D) receptor stimulation to inhibit P2Y receptor-induced [Ca(2+)](i) mobilization. Such a cross talk between the two receptor systems was not observed in attached cells. P2Y receptor-induced Ca(2+) response was insensitive to adhesion state of the cells, while ERK phosphorylation response was enhanced upon detachment. Integrity of the actin cytoskeleton did not appear to play a role in adhesion sensitivity of 5-HT(1D)-mediated responses, as treatment of attached cells with cytochalasin D did not mimic detachment-induced effects. Effects of detachment were reversed immediately after re-attachment of the suspended cells on poly-l-lysine coated cover slips, suggesting that the involvement of integrins or focal adhesion complexes is unlikely. Taken collectively, our results demonstrate that not only cellular responses induced by different G protein-coupled receptors, but also different responses induced by a particular G protein-coupled receptor, can be affected differentially by the adhesion status of cells. This suggests an important role for cell adhesion in controlling the coupling of a single G protein-coupled receptor to different intracellular responses.

Alexithymia and temperament and character model of personality in alcohol-dependent Turkish men.

AIMS: Alexithymia, a personality trait characterized as having problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others, is only partly described within the context of personality. The aim of the present study was therefore to study the prevalence of alexithymia among male alcohol-dependent inpatients and investigate the relationship between alexithymia and the dimensions of Cloninger's psychobiological model of personality. METHODS: The Turkish version of the Toronto Alexithymia Scale (TAS-20) and the Turkish version of the Temperament and Character Inventory (TCI) were administered to 111 male alcohol-dependent inpatients. RESULTS: TAS-20 scores correlated positively with harm avoidance and self-transcendence and negatively with self-directedness and cooperativeness. Regression analysis identified high harm avoidance and self-transcendence and low self-directedness as independent predictors of alexithymia. Also harm avoidance and self-transcendence predicted alexithymia in a logistic regression model. CONCLUSIONS: Alexithymia can be explained by specific dimensions within Cloninger's psychobiological model of personality in alcohol-dependent Turkish men.

[The relationship between psychological factors and health care-seeking behavior in fibromyalgia patients]. / Fibromiyaljide Tedavi Arayisinin Psikolojik Etkenlerle Iliskisi.

OBJECTIVE: The aim of this study was to examine whether cognitive factors, such as attributions, expectations, and anger management style, contribute to the decision to seek medical care for fibromyalgia syndrome (FMS). METHOD: We recruited 3 groups of subjects; patients from a FMS tertiary care setting, community residents with FMS who had not sought medical care for their FMS symptoms (nonpatients), and healthy controls. In all, 38 FMS nonpatients were compared to 37 FMS patients and 41 healthy controls on measures of anxiety, depression, anger, locus of control (LOC), attributions, pain intensity, and disability, as well as demographic characteristics. RESULTS: The prevalence of FMS non-patients was 2%. There was a significant difference between the 3 groups on the measures of anxiety, depression, LOC, and somatic and normalizing subscale scores of the symptom interpretation questionnaire (SIQ). FMS nonpatients, relative to FMS patients and healthy controls, were characterized by a significantly higher measure of both LOC and normalizing subscale score on the SIQ. There were no differences between the 2 FMS groups in demographical percentage and other psychometric measures. A hierarchical logistic regression model showed that the number of tender points, normalizing attribution style, and depression were independent predictors of help-seeking behavior. CONCLUSION: The rate of psychiatric and medical history is not related to the FMS syndrome. Expectations and a normalizing attribution style may contribute to help-seeking behavior for FMS.

[Somatic symptoms of depression]. / Depresyonda Bedensel Belirtiler.

OBJECTIVE: The somatic component of depression is an important clinical phenomenon. The role of somatic amplification, alexithymia, anger and symptom attribution has been investigated in the genesis of the somatic symptoms of depression. METHOD: The study was carried out with 32 patients attending the outpatient psychiatry clinics of Karadeniz Technical University Medical School, meeting the diagnosis of depression according to DSM-IV, and 34 healthy subjects. The subjects were assessed with the Beck Depression Scale, the Beck Anxiety Scale, the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Somatosensory Amplification Scale, the 20-item Toronto Alexithymia Scale the Spielberger State-Trait Anger Expression Inventory, the Symptom Interpretation Questionnaire and a data form for recording sociodemographic characteristics. RESULTS: The sociodemographic characteristics of the sample were similar. The anxiety, alexithymia, and anger-in scores were significantly higher, while anger-control scores were significantly lower in the depressive subjects. Psychologizing attributes were positively correlated with depression and anxiety. Normalizing was negatively correlated with anxiety. Somatizating was correlated with the difficulty in identifying feelings subscale of alexithymia. DISCUSSION: These findings show that depressive patients are more alexithymic, have more difficulty in controlling their anger and introject their anger more compared to the healthy controls. Depressed and anxious subjects psychologize, and subjects with difficulty in identifying emotions somatize their symptoms.

Predictors of somatic symptoms in depressive disorder.

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.

Affective distress and fibromyalgia.

PRINCIPLES: Elevated rates of lifetime and current psychiatric disorders, elevations of psychological self-report measures assessing depression, anxiety and hypochondriasis have been reported in fibromyalgia syndrome (FMS) patients as well as studies refuting these findings. Studies comparing FMS patients with rheumatoid arthritis (RA) patients provide discrepant data. The aim of this paper is to compare FMS patients with RA patients and healthy controls with respect to psychological measures in a case control design. METHODS: Fifty subjects with FMS, 20 with RA and 42 healthy controls were assessed with respect to anxiety, depression, pain intensity and disability. Three logistical regression models were performed to test whether higher levels of a psychological measure (disability, depression or anxiety) are associated with one disease rather than another, or with one disease rather than with healthy controls. For each regression model, the best exploratory covariates were determined using receiver operating characteristic (ROC) curves. RESULTS: In the logistic regression, anxiety scores were the most important covariate determining the likelihood of having FMS whereas depression scores increased the chances of being an RA patient. Age and disability scores did not differ between FMS and RA. CONCLUSIONS: Affective distress is not specific to FMS patients, but the manner in which affective distress is incorporated into the patient's life is worth studying. FMS.seems to be associated with anxiety rather than depression.

Alexithymia and anger in patients with fibromyalgia.

Our objective was to delineate the relevance of the personality construct alexithymia and anger-in in patients with fibromyalgia syndrome. Fifty subjects with fibromyalgia syndrome were compared to 20 subjects with rheumatoid arthritis and 42 healthy controls on the measures of anxiety, depression, anger, alexithymia, pain intensity and disability. There was a significant difference on the measures of anxiety and anger between FMS and RA groups, and also between FMS patients and healthy controls. There was a significant difference between FMS patients and healthy controls on the measures of depression, difficulty in identifying feelings subscale of TAS (TAS-dif), and total alexithymia scores. When the severity of pain was controlled for, there was a significant difference on the measures of anger and alexithymia between the FMS and the RA groups. Fibromyalgia patients were more alexithymic than rheumatoid arthritis patients even when the level of depression was controlled for. Anger towards oneself, which is anger-in, was higher in patients with fibromyalgia patients than in the rheumatoid arthritis sample. A stepwise regression model showed that the anger-out scores and the anxiety scores predicted the level of pain severity, and this explained 32% of the variance in the fibromyalgia syndrome group. Although anger-in is consistently higher in fibromyalgia patients, it is the behavioral expression of anger, together with anxiety, that predicts the severity of the pain. The difficulty of identifying feelings, rather than other dimensions of alexithymia, seems to be associated with fibromyalgia.

Alexithymia and suicidal behavior.

A number of factors including hopelessness have been identified as amplifying suicide risk. Alexithymia has recently been investigated as a predictor of suicidal behavior. The prevalence of the personality trait alexithymia in suicide attempters as well as other predictors of suicidal behavior were investigated in this study. One hundred suicide attempters were compared to 60 healthy controls on the measures of hopelessness, alexithymia, depression and suicidal ideation. First-timers and repetitive suicide attempters, males and females, married and unmarried suicide attempters were compared to each other in the suicide attempter group. The correlations of hopelessness, depression and alexithymia with suicidal intent and suicide lethality were investigated. The suicide attempter group did not display significantly higher scores on the alexithymia measure, compared to healthy controls. Alexithymia neither seemed to be a prevalent personality trait in suicide attempters nor a sensitive predictor of suicidality. The subscales of Toronto Alexithymia Scale measuring difficulty in identification and expression of feelings also did not reveal a significant difference between the two groups. Suicide attempters were more depressive, more hopeless and displayed greater suicidal ideation than healthy controls. Severity of depression was a stronger predictor of suicidal intent than hopelessness in the suicide attempter group. The lethality of the suicide attempt did not correlate with any of the psychometric measures. These findings propose that difficulty in the identification and articulation of feelings does not comprise a risk factor for suicidal behavior.

[Medically unexplained symptoms]. / Tibben açiklanamayan belirtiler.

Patients with physical symptoms for which no medical explanation can be found are relatively common in general practice. Patients with medically unexplained symptoms are frequently frustrating to physicians both in primary and secondary care and utilize health sources disproportionately. They frequently attend both primary care units and hospitals and are usually not satisfied with the care they receive. Medically unexplained symptoms in patient populations are strongly associated with psychiatric pathology and with anxiety and depression in particular. They are also linked to personality pathology, childhood adversity, adult trauma or medically unexplained symptoms in childhood. The predictive value of alexithymia in determining these symptoms is controversial. Patients who have high negative affectivity or neuroticism tend to score high on measures of physical symptoms. These symptoms have a high degree of co-occurrence. The same person may meet the diagnostic criteria for several functional somatic syndromes simultaneously. The clinician should be aware of the cultural and social shaping of the bodily experience of these patients and hence acknowledge the somatic nature and reality of the symptoms. The clinician should make the person feel understood and establish a positive collaborative relationship. This would enable him/her to correct misconceptions about the disease and give a positive explanation of symptoms. Antidepressant therapy and cognitive-behavioural psychotherapy have been proved to be moderately effective in this group of patients. Because of the high disability that might be caused by these symptoms, psychiatrists and primary and secondary care physicians should pay careful attention to this clinical condition. These symptoms may also aid us in challenging the long-held idea of mind-body dualism which is inherent in Western biomedicine.