Alexithymic But Not Autistic Traits Impair Prosocial Behavior.

Social impairments are a core feature of autism-spectrum disorders. However, there is a considerable variability in these impairments. Most autistic individuals show large impairments in social functioning but some autistic individuals show small impairments in social functioning. The variability of these impairments has been attributed to the presence or absence of alexithymia. To address this issue, we capitalized on the fact that alexithymic and autistic traits are broadly distributed in the population. This allowed us to investigate how alexithymic and autistic traits affect social functioning in healthy individuals. Healthy individuals showed impairments on a resource-allocation task that were due to alexithymic but not autistic traits. These findings suggest that alexithymic rather than autistic traits impair prosocial behavior across the autism-spectrum.

Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial.

BACKGROUND AND AIMS: Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. DESIGN: Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. SETTING AND PARTICIPANTS: Primary and secondary care: four hospitals and community (1 million residents, 7600 km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1 : 1) to an SMS intervention and treatment as usual (SMS + TAU; n = 230; mean age: 45.4 years; 22.6% women) or TAU alone (n = 232 mean age: 44.5 years; 22.8% women). Planned, automated messages were sent to patients over 1 year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. MEASUREMENTS: The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men > 60 g/day; women > 40 g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12 months and frequency of abstinence. RESULTS: The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.11-2.54, P = 0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR = 1.13). These results were confirmed by models adjusting for randomization strata. CONCLUSIONS: In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1 year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.

Improving Medication Adherence With Telemedicine for Adults With Severe Mental Illness.

OBJECTIVE: The study evaluated a telephone call and text message intervention to improve adherence to medication among patients with severe mental illness. METHODS: A randomized clinical trial was conducted, and outpatients with schizophrenia or bipolar disorder were assigned to the intervention group or to a usual care control group. The intervention was provided by trained nurses. Medication adherence was measured with the Medication Adherence Report Scale. RESULTS: The study sample comprised 120 participants. Logistic regression analysis showed that intervention group participants were significantly more likely than control group participants to be medication adherent at 6 months (odds ratio=4.11, p=.007). The superiority of the intervention emerged during months 4 to 6. Social desirability, diagnosis, and medication did not affect the results. CONCLUSIONS: Telemedicine via telephone can deliver low-threshold support to patients who are otherwise at high risk of progressive nonadherence to their psychotropic medication after 6 months.

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder.

Attachment characteristics play a key role in understanding borderline-specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1-year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. Patients with higher scores in "synchrony" demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction.

Associations of trauma exposure and post-traumatic stress disorder with the activity of the renin-angiotensin-aldosterone-system in the general population.

BACKGROUND: Previous studies suggested that exposure to traumatic events during childhood and adulthood and post-traumatic stress disorder (PTSD) are associated with a dysregulation of different neuroendocrine systems. However, the activity of the renin-angiotensin-aldosterone-system (RAAS) in relation to trauma/PTSD has been largely neglected. METHODS: Traumatization, PTSD, and plasma concentrations of renin and aldosterone were measured in 3092 individuals from the general population. Subgroups according to the status of traumatization ('without trauma'; 'trauma, without PTSD', 'PTSD') were formed and compared regarding renin and aldosterone concentrations. Additionally, we calculated the associations between the number of traumata, renin, and aldosterone concentrations. Finally, associations of PTSD with renin/aldosterone levels were controlled for the number of traumata ('trauma load'). RESULTS: Levels of renin, but not aldosterone, were increased in traumatized persons without PTSD (p = 0.02) and, even stronger, with PTSD (p < 0.01). Moreover, we found a dose-response relation between the number of traumata and renin levels (ß = 0.065; p < 0.001). Regression analyses showed PTSD as a significant predictor of renin (ß = 0.38; p < 0.01). This effect was only slightly attenuated when controlled for trauma load (ß = 0.32; p < 0.01). CONCLUSIONS: Our results suggest that traumatization has lasting and cumulative effects on RAAS activity. Finding elevated renin levels in PTSD independent from trauma load supports the concept of PTSD as a disorder with specific neuroendocrine characteristics. Alternatively, elevated renin levels in traumatized persons may increase the risk for developing PTSD. Our findings contribute to explain the relationship between traumatic stress/PTSD and physical disorders.

The relation of alexithymia, chronic perceived stress and declarative memory performance: Results from the general population.

Previous evidence showed associations of alexithymia with altered declarative memory performance. However, these findings were not fully consistent and the underlying mechanism remains unclear. Alexithymic subjects may be at specific risk for chronic psychosocial stress, which in turn represents a predictor for poorer memory performance. We investigated independent and interaction effects of alexithymia and chronic perceived stress on declarative memory performance. Data were used from two independent general-population samples from the Study of Health in Pomerania (SHIP). In sample 1 (N = 1981), the Auditory Verbal Learning Test, the Toronto Alexithymia Scale (TAS-20) and the Screening Scale for Chronic Stress (SSCS) were applied. In sample 2 (N = 3799), the word list of the Nuremburg Age Inventory and TAS-20 were administered to replicate findings. Alexithymia was significantly associated with poorer immediate and delayed word recall. Chronic stress negatively predicted immediate, but not delayed recall. Alexithymia and particularly "Difficulties Identifying Feelings" showed significant associations with chronic perceived stress. Our findings provide clear evidence for an association of alexithymia with impaired declarative memory performance for words. The strong association of alexithymia with perceived chronic stress could contribute to explain the association of alexithymia with stress-related disorders.

Predictors of medication adherence among patients with severe psychiatric disorders: findings from the baseline assessment of a randomized controlled trial (Tecla).

BACKGROUND: Schizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was to examine potential determinants of non-adherence for patients with severe mental disorders. METHODS: Baseline data of the study "Post stationary telemedical care of patients with severe psychiatric disorders" (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors. RESULTS: N = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011-1.024, p < 0.0001), being employed (OR 2.46, 95% CI 1.893-3.206, p < 0.0001), higher level of global functioning (overall measure of how patients are doing) (OR 1.02, 95% CI 1.012-1.028, p < 0.0001), having social support (OR 1.02, 95% CI 1.013-1.026, p < 0.0001), and intake of typical antipsychotics (OR 2.389, 95% CI 1.796-3.178, p < 0.0001). A negative determinant was (female) sex (OR 0.73, 95% CI 0.625-0.859, p = 0.0001). CONCLUSIONS: Especially employment, functioning and social support could be promising targets to facilitate adherence in patients with schizophrenia or bipolar disorder. TRIAL REGISTRATION: This study is retrospectively registered at the German Clinical Trials Register with the trial registration number DRKS00008548 at 21/05/2015.

Inter-individual Differences in Heart Rate Variability Are Associated with Inter-individual Differences in Empathy and Alexithymia.

In the present study, we investigated whether inter-individual differences in vagally mediated heart rate variability (vmHRV) would be associated with inter-individual differences in empathy and alexithymia. To this end, we determined resting state HF-HRV in 90 individuals that also completed questionnaires assessing inter-individual differences in empathy and alexithymia. Our categorical and dimensional analyses revealed that inter-individual differences in HF-HRV were differently associated with inter-individual differences in empathy and alexithymia. We found that individuals with high HF-HRV reported more empathy and less alexithymia than individuals with low HF-HRV. Moreover, we even found that an increase in HF-HRV was associated with an increase in empathy and a decrease in alexithymia across all participants. Taken together, these findings indicate that individuals with high HF-HRV are more empathetic and less alexithymic than individuals with low HF-HRV. These differences in empathy and alexithymia may explain why individuals with high HF-HRV are more successful in sharing and understanding the mental and emotional states of others than individuals with low HF-HRV.

[Young Academics in Neuropsychological Disciplines: Factors Affecting Career Aspiration in Psychiatry, Neurology and Psychosomatic Medicine]. / Nachwuchs in der Nervenheilkunde: berufswunschprägende Faktoren in Psychiatrie, Neurologie und Psychosomatik.

OBJECTIVE: Students with specialization preferences in psychiatry, neurology, or psychosomatic medicine were retrospectively compared with regard to aspects of motivation to choose medicine as their field of study. METHODS: To identify early predictors of specialization preferences, a nationwide online survey was conducted with 9079 medical students. The statements of those with a preference for neurology, psychiatry, or psychosomatic medicine were evaluated using analysis of variance (ANOVA). RESULTS: Prospective neurologists were motivated by scientific interest variables and less by the aspects of life management. On the other hand, students with preferences for one of the psychological disciplines reported comparatively higher degrees of desire to actively provide help and of the importance of their own medical history. There were no significant differences between future psychiatrists and psychosomatic professionals. CONCLUSION: The reported motives point to thematic orientations that might be useful in the subject-specific acquisition of young academics.

Structural Alterations in the Corpus Callosum Are Associated with Suicidal Behavior in Women with Borderline Personality Disorder.

Structural alterations in the corpus callosum (CC), the major white matter tract connecting functionally related brain regions in the two hemispheres, have been shown to be associated with emotional instability, impulsivity and suicidality in various mental disorders. To explore whether structural alterations of the CC would be similarly associated with emotional instability, impulsivity and suicidality in borderline personality disorder (BPD), we used diffusion tensor imaging (DTI) to assess the structural integrity of the CC in 21 BPD and 20 healthy control (HC) participants. Our hypothesis-driven analyses revealed a positive correlation between BPD participants' suicidal behavior and fractional anisotropy (FA) in the splenium and genu of the CC and a negative correlation between BPD participants' suicidal behavior and mean diffusivity (MD) in the splenium of CC. Our exploratory analyses suggested that suicidal BPD participants showed less FA and more MD in these regions than HC participants but that non-suicidal BPD participants showed similar FA and MD in these regions as HC participants. Taken together, our findings suggest an association between BPD participants' suicidal behavior and structural alterations in regions of the CC that are connected with brain regions implicated in emotion regulation and impulse control. Structural alterations of the CC may, thus, account for deficits in emotion regulation and impulse control that lead to suicidal behavior in BPD. However, these findings should be considered as preliminary until replicated and extended in future studies that comprise larger samples of suicidal and non-suicidal BPD participants.

[Influence and Change of Self-Directedness in Dialectical Behavior Therapy]. / Einfluss und Veränderung der Selbstlenkungsfähigkeit in der Dialektisch-Behavioralen Therapie (DBT).

Objective Investigate influence and change of self-directedness (SD) in Dialectical-Behavior Therapy (DBT) for 26 female outpatients with borderline personality disorder (BPS). Method Variance analyses are used to evaluate psychopathology and interpersonal problems in 2 subgroups (low vs. high SD) with questionnaires at 3 measuring times over the period of 1 year. Results Low SD was associated with higher psychopathology, more interpersonal problems and lower symptomreduction. Over time of intervention the SD of all patients improved significantly. Conclusion DBT strengthens the SD of patients with BPD. A screening of SD before intervention, and systematic support should be considered.

From Childhood Trauma to Adult Dissociation: The Role of PTSD and Alexithymia.

BACKGROUND: The mechanism of how childhood trauma leads to increased risk for adult dissociation is not sufficiently understood. We sought to investigate the predicting effects and the putatively mediating roles of PTSD and alexithymia on the path from childhood trauma to adult dissociation. METHODS: A total of 666 day-clinic outpatients were administered the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Posttraumatic Diagnostic Scale (PDS), and the Dissociative Experiences Scale (DES) and controlled for sex, age, and the Global Symptom Index (GSI). Linear regression analyses and mediation analyses were applied. RESULTS: Independent predictive effects on dissociation were found for childhood trauma, alexithymia and PDS, even after adjusting for GSI. Effects of childhood neglect on dissociation were slightly stronger than of abuse. Alexithymia did not mediate the path from childhood trauma to dissociation. Mediation by PDS was specific for childhood abuse, with all PTSD symptom clusters being significantly involved. CONCLUSIONS: Childhood abuse and neglect are important predictors of dissociation. While the effects of abuse are mediated by PTSD, the mechanism of how neglect leads to dissociation remains unclear. The results further support the predictive value of alexithymia for adult dissociation above and beyond the effects of childhood trauma, PTSD, and GSI scores.

Tecla: a telephone- and text-message based telemedical concept for patients with severe mental health disorders--study protocol for a controlled, randomized, study.

BACKGROUND: Severe mental disorders like psychotic disorders including schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6, bipolar disorders of 1.5% in Germany. The relapse risk is high; so many patients need intensive monitoring and lifelong treatment. A high medication adherence is essential for a successful treatment. But in practice, medication adherence is low and decreases over time. Telemedical care concepts might improve treatment and bridge gaps between in- and outpatient treatment. A telemedical care concept based on regular telephone calls and short text messages was developed. The primary objective is to assess whether regular telephone calls and text messages can improve the medication adherence of patients. Secondary objectives are the reduction of rehospitalization rates, the improvement of quality of life and of the severity of symptoms. METHODS/DESIGN: The Tecla study (Post stationary telemedical care of patients with severe psychiatric disorders) is a two-armed prospective randomized controlled trial. The participants in the intervention group receive in addition to usual care regular telephone calls every 2 weeks and weekly text messages on patient-individual topics during a 6 months period. Patients in the control group receive only regular care. Inclusion criteria are a physician-diagnosed bipolar disorder, schizoaffective disorder or schizophrenia and a signed informed consent. Exclusion criteria are planned inpatient treatments within the next 6 months and being non-reachable by phone. After 3 and 6 months both groups receive follow up assessments. DISCUSSION: The primary objective of this study is the medication adherence that is measured with the Medication Adherence Report Scale, German version (MARS-D). The MARS-D is a self-report with five items. Adherent behaviour is mostly overestimated using self-reports. The strength of the MARS-D is to detect non-adherent behaviour. The original Medication Adherence Report Scale in English language (MARS-5) was developed to encourage the patient to answer truthfully to the questions that are asked in a non-threatening and non-judgmental way to minimize social desirability bias in admitting non-adherent behaviour. TRIAL REGISTRATION: This study is registered at 2015\05\21 at the German Clinical Trials Register DRKS00008548.

Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome.

OBJECTIVE: Alexithymia, a common personality style of patients seeking psychotherapeutic help, is associated with illness severity and negative treatment outcome in various mental disorders. Still, it remains unclear how alexithymia influences psychopathology and the therapeutic processes. In previous studies, a strong association of alexithymia with self-directedness (SD), a dimension of Cloninger's Temperament and Character Inventory (TCI) has been shown. In this study, we investigated the interaction of alexithymia and SD, and their impact on general psychopathology and on treatment outcome. METHOD: 716 consecutively admitted day-clinic outpatients were examined at admission (t0) and discharge (t1). The Toronto Alexithymia Scale 20 (TAS-20), the SD subscale of the TCI and the Symptom Checklist 90 (SCL-90-R) were administered. Linear regression analyses were performed to calculate associations and the predictive power of TAS-20 and SD on psychopathology at admission and treatment outcome. ANOVA was used to calculate interactions of TAS-20 and SD on treatment outcome. A general linear model was applied to compare the outcome of four subgroups, defined by high/low TAS-20 and SD scores. RESULTS: Regression analyses revealed significant prediction of the baseline General Severity Index (GSIt0) by TAS-20 (df=4, 711; Beta: 0.385; p<0.001) and SD (Beta: -0.365; p<0.001). The whole model accounted for 41% of the explained variance. On subscale level, the 'Difficulties in identifying feelings' facet (DIF) of TAS-20 was the strongest predictor of GSIt0 (Beta: 0.478, P<0.001) and GSIt1 (Beta: 0.072, p=0.049). Therapeutic outcome measured by GSIt1 was significantly predicted by SD (df=5, 710; Beta: -0.065; p=0.041), but not by TAS-20 (Beta: 0.042; p=0.179). Change scores (∆) of TAS-20 and SD predicted GSIt1 (df=5, 710; TAS-20∆ Beta: -0.268; p<0.001; SD∆ Beta: 0.191; p<0.001) as well as GSI∆ (df=5, 710; TAS∆ Beta: 0.384; p<0.001; SD∆: -0.274; p<0.001) significantly. ANOVA revealed no significant interactions of TAS-20 and SD at admission on the treatment outcome (p>0.05). CONCLUSION: Low SD was shown to be a common problem of alexithymic patients and both, alexithymia and SD were highly associated with general symptom severity. SD was found to have a greater impact on treatment outcome while adjusting for baseline GSI. Alexithymia and SD act as independent factors with no significant interaction in their impact on psychopathology at admission and discharge. As different interventions were shown to improve SD scores in previous studies, SD may represent a relevant psychotherapeutic target, worthy to be addressed especially in alexithymic patients. Future studies should investigate other dimensions of the TCI, especially harm avoidance and reward dependence.