Hyposmia and Disgust: Gender-Specific Effects.

Reduced olfactory function is associated with altered trait disgust in men. This study sought to determine whether hyposmic women show similar changes in disgust responsiveness. We compared patients with hyposmia (25 men, 23 women) and 50 normosmic individuals (25 men, 25 women) with regard to their tendency to experience disgust across different disgust domains (disgust proneness), their self-disgust and their tendency to perceive their own disgust feelings as difficult to control and embarrassing (disgust sensitivity). We replicated the finding that male patients reported elevated self-disgust and disgust proneness toward a specific disgust domain (poor hygiene), whereas female patients obtained comparable disgust scores as the female control group. Both men and women of the patient group indicated disgust regulation difficulties in social contexts. In conclusion, we found greater changes in trait disgust in men with hyposmia. This gender-specific effect, which might be a result of more efficient compensatory behaviors in women, needs further investigation.

Disgust-Related Personality Traits in Men with Olfactory Dysfunction.

Individuals differ in disgust-related personality traits, such as disgust proneness (DP: tendency to experience disgust), disgust sensitivity (DS: tendency to perceive one's own disgust experiences as difficult to control), and self-disgust (SD: strong dislike/aversion of yourself). Olfaction is one crucial input for the disgust system. The present study investigated disgust dispositions in individuals with persistent olfactory dysfunction. We studied 16 male patients with anosmia, 20 patients with hyposmia, and 20 normosmic men, and compared DP, DS, and SD scores between the groups. Dysosmic patients reported lowered DP toward spoilage, elevated DP toward poor hygiene, and elevated SD. There were no group differences with regard to DS. We assume that difficulties of perceiving one's own body odor and resulting challenges for personal hygiene are related to domain-specifically elevated trait disgust. Enhanced personal disgust may be related to a general social insecurity in people with olfactory malfunction. Future research should additionally use brain imaging methods to investigate associations between alterations of the disgust system and olfactory dysfunction.

Creativity and borderline personality disorder: evidence from a voxel-based morphometry study.

INTRODUCTION: Throughout the history, various examples of eminent creative people suffering from mental disorders along with some empirical research reports strengthened the idea of a potential link between creativity and psychopathology. METHODS: This study investigated different facets of psychometrically determined creativity in 20 females diagnosed with borderline personality disorder (BPD) relative to 19 healthy female controls. In addition, group differences in grey matter (GM) were examined. RESULTS: Behavioural findings revealed no significant differences between the BPD group and healthy controls with respect to verbal and figural-graphic creative task performance and creativity-related personality characteristics. Whole-brain voxel-based morphometry analyses revealed a distinct pattern of GM reductions in the BPD group (relative to controls) in a network of brain regions closely associated with various cognitive and emotional functions (including the bilateral orbital inferior frontal gyri and the left superior temporal gyrus), partly overlapping with creativity-related brain regions. Correlation analyses moreover revealed that in the BPD group GM reductions in the orbital parts of the inferior and middle frontal gyri were associated with lower levels of creativity. CONCLUSIONS: This study provides no indications in favour of the putative link between creativity and psychopathology, as sometimes reported in the literature.

Psychological factors associated with acute and chronic central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. METHODS: Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. RESULTS: Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. CONCLUSIONS: The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.

Role of disgust proneness in Parkinson's disease: a voxel-based morphometry study.

The knowledge about personality traits in Parkinson's disease (PD) is still limited. In particular, disgust proneness has not been investigated as well as its neuronal correlates. Although several morphometric studies demonstrated that PD is associated with gray matter volume (GMV) reduction in olfactory and gustatory regions involved in disgust processing, a possible correlation with disgust proneness has not been investigated. We conducted a voxel-based morphometry analysis to compare GMV between 16 cognitively normal male PD patients with mild to moderate symptoms and 24 matched control subjects. All participants had answered questionnaires for the assessment of disgust proneness, trait anger and trait anxiety. We correlated questionnaire scores with GMV in both groups. The clinical group reported selectively reduced disgust proneness toward olfactory stimuli associated with spoilage. Moreover, they showed GMV reduction in the central olfactory system [orbitofrontal cortex (OFC) and piriform cortex]. Disgust items referring to olfactory processing were positively correlated with OFC volume in PD patients. Our data suggest an association between PD-associated neurodegeneration and olfactory related facets of the personality trait disgust proneness.

Self-disgust in mental disorders -- symptom-related or disorder-specific?

BACKGROUND: Dysfunctional disgust experiences occur in a variety of mental disorders. Previous research focused on disgust proneness directed towards stimuli in the external environment. However, self-disgust, the devaluation of one' own physical appearance and personality (personal disgust) as well as one' own behavior (behavioral disgust) has hardly been investigated thus far, although it may play a crucial role in specific psychopathologies. METHODS: We investigated 112 patients diagnosed with different mental disorders (major depression, schizophrenia, borderline personality disorder (BPD), eating disorders, and spider phobia) and 112 matched mentally healthy individuals. Participants answered the Questionnaire for the Assessment of Self-Disgust (QASD) with two subscales 'personal disgust' and 'behavioral disgust', and the Brief Symptom Inventory (BSI) that provides an overview of patients' psychological problems and their intensity. RESULTS: Compared to healthy controls self-disgust was elevated in mental disorders. Personal disgust was more pronounced than behavioral disgust in patients, whereas there was no difference in controls. Patients with BPD and eating disorders reported the highest scores on both subscales. Findings also suggest that self-disgust is related to specific psychological problems. In mental disorders psychoticism and hostility were the best predictors for personal disgust, while anxiety and interpersonal sensitivity predicted behavioral disgust. Additionally, we found disorder-specific predictors for personal disgust (e.g., hostility in schizophrenia). Finally, traumatic events during childhood constitute a risk factor for self-disgust. CONCLUSIONS: The current study provides first evidence for the differential meaning of self-disgust for specific mental disorders and symptoms.

Cerebellar contribution to anger recognition deficits in Huntington's disease.

Although there is increasing evidence that cerebellar loss of grey matter volume (GMV) is associated with affective deficits, this has not been tested for patients suffering from Huntington's disease (HD), who show a pronounced impairment in the recognition of anger. We assessed GMV in 18 symptomatic HD patients and 18 healthy controls using voxel-based morphometry. The GMV of cerebellar subregions was correlated with participants' intensity and accuracy ratings for facial expressions of basic emotions from the Karolinska Directed Emotional Faces (Lundqvist et al. 1998). The patients gave lower and less accurate anger ratings for angry faces than controls. This anger recognition deficit was correlated with atrophy of selected hemispheric and vermal regions of the cerebellum. Furthermore, cerebellar volume reductions of the HD patients were associated with longer disease duration and greater functional impairment. The data imply that anger recognition deficits could potentially serve as indicators of disease onset and progression in HD. Furthermore, the patients might profit from specific affect trainings.

Altered state and trait disgust in borderline personality disorder.

Clinical experience suggests that the emotion disgust plays an important role in borderline personality disorder (BPD). We investigated 30 female patients with BPD and 30 healthy women who answered different measures of trait disgust, specifically disgust proneness, disgust sensitivity, and self-disgust. Moreover, all participants rated affective facial expressions as well as affective scenes according to perceived or elicited basic emotions. The patients with BPD reported elevated trait disgust, especially for the area of self-disgust. They also rated facial expressions of disgust as more intense than did the healthy women but only when the person who displayed this emotion was male. This sex-specific disgust bias was independent of depression and experienced sexual/physical abuse in the clinical group. Altogether, the patients with BPD showed a broad spectrum of altered disgust processes, which was positively correlated with disorder severity. Consequently, the assessment of disgust reactivity should be introduced as a diagnostic tool for this disorder.

Emotion recognition and experience in Huntington disease: a voxel-based morphometry study.

BACKGROUND: The neuroanatomic basis of affective processing deficits in Huntington disease is insufficiently understood. We investigated whether Huntington disease-related deficits in emotion recognition and experience are associated with specific changes in grey matter volume. METHOD: We assessed grey matter volume in symptomatic patients with Huntington disease and healthy controls using voxel-based morphometry, and we correlated regional grey matter volume with participants' affective ratings. RESULTS: We enrolled 18 patients with Huntington disease and 18 healthy controls in our study. Patients with Huntington disease showed normal affective experience but impaired recognition of negative emotions (disgust, anger, sadness). The patients perceived the emotions as less intense and made more classification errors than controls. These deficits were correlated with regional atrophy in emotion-relevant areas (insula, orbitofrontal cortex) and in memory-relevant areas (dorsolateral prefrontal cortex, hippocampus). LIMITATIONS: Our study was limited by the small sample size and the resulting modest statistical power relative to the number of tests. CONCLUSION: Our study sheds new light on the importance of a cognitive-affective brain circuit involved in the affect recognition impairment in patients with Huntington disease.

N-terminal pro-B-type natriuretic peptide in early and advanced phases of obesity.

BACKGROUND: Increased plasma amino-terminal-cleavage-fragment of NP (NT-proBNP) is an established indicator for heart failure. Moreover, obese adults had low circulating NT-proBNP suggesting an obesity-related dysregulation (natriuretic handicap). Secretion and/or clearance of NT-proBNP were discussed to be impaired in obesity. As only older adults were investigated so far, it remains unclear when during the evolution of obesity the state of a natriuretic handicap develops, and whether NT-proBNP may still serve as a relevant cardiac marker in obese juveniles. METHODS: We analysed NT-proBNP in juvenile (n=274, 10-18 years) and middle-aged (n=277, 18-50 years) normal weight (n=213) and obese (n=338) probands together with complex anthropometry, carotis sonography, clinical, and laboratory parameters. RESULTS: NT-proBNP showed a significant gender and age interaction. Adult females had significant higher NT-proBNP than adult males, and higher levels than juvenile females. Adult males had lower levels than juvenile males. Only a weak age and weight interaction was seen with obese juveniles which showed higher NT-proBNP than obese adults. Moreover, normal weight probands had higher NT-proBNP than overweight and obese. In a multiple regression including all probands, gender, creatinine and uric acid were the best predictors for NT-proBNP. In adults, female gender is the strongest driver for increased NT-proBNP. CONCLUSIONS: These results argue against an essential influence of obesity to B-type cardiac natriuretic hormone system regulation in the absence of heart failure, and suggest NT-proBNP as a useful cardiac marker irrespective of age and obesity.

Emotion recognition and experience in Huntington's disease: is there a differential impairment?

Findings on affective processing deficits in Huntington's disease (HD) have been inconsistent. It is still not clear whether HD patients are afflicted by specific deficits in emotion recognition and experience. We tested 28 symptomatic HD patients and presented them with pictures depicting facial expressions of emotions (Karolinska-Set) and with affective scenes (International Affective Picture System; IAPS). The faces were judged according to the displayed intensity of six basic emotions, whereas the scenes received intensity ratings for the elicited emotions in the viewer. Patients' responses were compared with those of 28 healthy controls. HD patients gave lower intensity ratings for facial expressions of anger, disgust and surprise than controls. Patients' recognition deficits were associated with reduced functional capacity, such as problems with social interactions. Moreover, their classification accuracy was reduced for angry, disgusted, sad and surprised faces. When judging affective scenes for the elicitation of happiness, disgust and fear, HD patients had a tendency to estimate them as more intense than controls. This finding points to a differential impairment in emotion recognition and emotion experience in HD. We found no significant correlations between emotion experience/recognition ratings and CAG repeats, symptom duration and UHDRS Motor Assessment in the patient group.

Impaired ideomotor limb apraxia in cortical and subcortical dementia: a comparison of Alzheimer's and Huntington's disease.

BACKGROUND: Although ideomotor limb apraxia is often considered to occur only in dementia with cortical involvement like Alzheimer's disease (AD), it is also frequently seen in dementia with subcortical degeneration like Huntington's disease (HD). METHODS: To assess the occurrence of ideomotor limb apraxia, 46 patients with HD (27 men) and 37 patients with AD (16 men), matched for cognitive performance, were assessed with an apraxia test battery containing tests of the imitation of meaningless hand and finger gestures, the performance of meaningful gestures and of pantomimic movements. RESULTS: There was a high frequency of ideomotor limb apraxia in both AD and HD patients. For the assessment of hands' imitation 13.5% of the AD patients and 41.3% of the HD patients were apraxic, for fingers' imitation 21.6% (AD) and 41.3% (HD) were apraxic, for gestures 27.0% (AD) and 32.6% (HD), and for the assessment of pantomimic movements 24.3% (AD) and 52.2% (HD) showed apraxia. In the AD patients, disease severity was related to the occurrence of apraxia. CONCLUSIONS: Ideomotor limb apraxia is a common sign in both groups of patients, occurring in a high percentage. For particular neuropsychological deficits, including ideomotor limb apraxia, a division of dementia in a subcortical and cortical subtype seems to be clinically not meaningful.

Elevated disgust proneness in schizophrenia.

Schizophrenia is a mental disorder hardly investigated with regard to habitual disgust. We compared disgust propensity, trait anger, trait anxiety and disgust sensitivity in 69 patients with schizophrenia, 68 depressive patients and 70 mentally healthy controls. Patients with schizophrenia reported more pronounced overall disgust propensity than healthy individuals. Whereas food-related disgust was crucial for schizophrenia, depressed patients experienced elevated death-related disgust. Females reported greater disgust proneness than males. Both patient groups showed higher trait anxiety and trait anger than controls. Depressive patients additionally reported elevated anger expression and even higher anger suppression than the schizophrenia group. We found a positive relationship between disgust proneness and disgust sensitivity in controls and patients. The importance of disorder-specific disgust domains is discussed.

Ideomotor limb apraxia in Huntington's disease: a case-control study.

INTRODUCTION: Ideomotor limb apraxia is the disturbance of planning and of execution of motor activity,which is not caused by a dysfunction of the motor or sensory nervous system. Apraxia is a diagnostic criterion in dementialike Alzheimer's disease. However, this symptom may also occur in dementia with subcortical lesions like Huntington's disease (HD), a hereditary, devastating neurodegenerative disease leading to neurological and psychiatric dysfunction. The aim of our study is to determine the correlation between the occurrence of ideomotor limb apraxia and neuropsychological deficits in HD. METHODS: To assess the correlation between apraxia and neuropsychological abilities in HD, 41 patients with HD and 33 age- and sex-matched controls were examined. The De Renzi test for apraxia and an apraxia test battery containing tests of i) imitation of meaningless gestures of hands, ii) imitation of meaningless gestures of fingers, iii) performance of meaningful gestures on demand, and iv) pantomime of tool use were used to assess apraxia. Moreover, neuropsychological function was rated by the Mini Mental State Examination (MMSE), the Rey Complex Figure Memory Test, the Trail Making Test A and B, the California Verbal Learning Test (German version), the Stroop Color and Word Test, the Controlled Oral Word Association Test, and the Mehrfachwahl- Wortschatz-Intelligenztest for measuring verbal intelligence. Motor function was assessed in all HD patients by the Unified HD Rating Scale (UHDRS), rating oculomotor and orolingual function, fine motor tasks, parkinsonism, dystonia, chorea and statics and gait. RESULTS: Apraxic HD patients showed worse results than non-apraxic HD patients in three items of the Rey Complex Figure Memory Test (Organisation, short-term and longterm memory), but not in other assessed neuropsychological tests. In assessment of meaningful gestures on demand 39.3% of HD patients were apraxic, in assessment of pantomime of tool use 67.9% of HD patients showed apraxia. Patients with HD showed highly significant worse results than controls in the De Renzi test, in hands' and fingers' imitation, in performance of gestures on demand, in pantomime of tool use and every neuropsychological test except for the test measuring verbal intelligence. Apraxic HD patients showed worse results than non-apraxic HD patients in the UHDRS total motor score and the score for oculomotor function. CONCLUSION: This is the largest study on apraxia in HD. Ideomotor limb apraxia is a common sign in HD patients, occurring in a high percentage. In contrast to the opinion of several authors, occurrence of apraxia in HD is independent from neuropsychological decline and the severity of most neurological symptoms.

Affective Personality Traits in Olfactory Dysfunction: the Role of Dysthymia and Arousal.

INTRODUCTION: Olfactory dysfunction can have a negative impact on emotional well-being. The aim of the present study was to examine associations between olfactory deficits and two affective personality characteristics (trait anxiety/trait depression). METHODS: A questionnaire study was conducted with a total of 116 participants (33 classified as anosmic, 40 as hyposmic, and 39 as normosmic). All participants gave self-reports on two facets of trait depression (dysthymia, euthymia) and trait anxiety (arousal, worrying). Due to the fact that in all three groups, trait depression and anxiety were substantially correlated, analyses of covariance were conducted. RESULTS: After controlling for trait depression, anosmic and hyposmic patients showed lower trait arousal compared to normosmic controls (partial η2 = .05). After controlling for trait anxiety, patients scored higher on dysthymia (partial η2 = .06). CONCLUSIONS: This study underlines the importance of statistically isolating specific associations between each of these affective personality characteristics and olfactory dysfunction. IMPLICATIONS: The present findings suggest that olfactory dysfunction can have opposite effects on facets of trait depression and trait anxiety.

Influence of patient-related and surgery-related risk factors on cognitive performance, emotional state, and convalescence after cardiac surgery.

BACKGROUND: Cardiac surgery may account for complications such as cognitive impairment, depression, and delay of convalescence. This study investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence. METHODS: We included 83 patients undergoing cardiac surgery who had no indication of postoperative delirium. Psychometric testing was performed 1 day before and 7 days after surgery. Neuron-specific enolase (NSE) levels were measured 1 day before and 36 h after surgery. RESULTS: Depression score increased after surgery, but patients showed no clinically significant depression. Postoperative cognitive performance correlated with postoperative depression level and preoperative cognitive performance. Forty-three percent of patients showed postoperative decline. Older patients exhibited a higher postoperative increase in NSE concentrations. Patients undergoing coronary artery bypass grafts or combined procedures exhibited more medical risk factors than those undergoing valve surgery alone. The number of bypass grafts was associated with time of hospitalization, and the number of patient-related risk factors correlated with stay in intensive care unit. CONCLUSIONS: For elderly patients undergoing cardiac surgery, older age, total preexisting medical risk factors, and surgery duration seem to be the most important factors influencing cognitive outcome and convalescence. Results show that, also for patients without postoperative delirium, medical risk factors and intraoperative parameters can result in delay of convalescence.

Intact emotion recognition and experience but dysfunctional emotion regulation in idiopathic Parkinson's disease.

BACKGROUND: A specific non-motor impairment in Parkinson's disease (PD) concerns difficulties to accurately identify facial emotions. Findings are numerous but very inconsistent, ranging from general discrimination deficits to problems for specific emotions up to no impairment at all. By contrast, only a few studies exist about emotion experience, altered affective traits and states in PD. OBJECTIVE: To investigate the decoding capacity for affective facial expressions, affective experience of emotion-eliciting images and affective personality traits in PD. METHODS: The study sample included 25 patients with mild to moderate symptom intensity and 25 healthy controls (HC) of both sexes. The participants were shown pictures of facial expressions depicting disgust, fear, and anger as well as disgusting and fear-relevant scenes. Additionally, they answered self-report scales for the assessment of affective traits. RESULTS: PD patients had more problems in controlling anger and disgust feelings than HC. Higher disgust sensitivity in PD was associated with lower functioning in everyday life and lower capacity to recognize angry faces. Furthermore, patients reported less disgust towards poor hygiene and spoiled food and they stated elevated anxiety. However, the clinical group displayed intact facial emotion decoding and emotion experience. Everyday life functionality was lowered in PD and decreased with stronger motor impairment. Furthermore, disease duration was negatively associated to correct classification of angry faces. CONCLUSIONS: Our data indicate that problems with emotion regulation may appear already in earlier disease stages of PD. By contrast, PD patients showed appropriate emotion recognition and experience. However, data also point to a deterioration of emotion recognition capacity with the course of the disease. Compensatory mechanisms in PD patients with less advanced disease are discussed.

Experience of negative emotions in Parkinson's disease: An fMRI investigation.

OBJECTIVE: Amygdala abnormalities have been discussed as a possible mechanism underlying reduced reactivity to negative stimuli in Parkinson's disease (PD). METHODS: The present investigation used functional magnetic resonance imaging (fMRI) in order to test this hypothesis. We compared brain activation of 17 nondepressed and nondemented PD patients with 22 healthy controls during the elicitation of negative affective states. The patients suffered from moderate motor symptoms for an average of 75 months and had stopped their antiparkinson medication 10-12h prior to the fMRI testing. All participants were shown images which depicted disgusting, fear-relevant and neutral contents and they answered self-report scales for the assessment of disgust proneness and trait anxiety. RESULTS: Both groups did not differ from each other in affective state and trait ratings. In line with the self-report, the fMRI data showed similar activation (including the amygdala) in both groups during disgust and fear elicitation. CONCLUSION: This fMRI investigation found no indication of diminished disgust and fear experience in PD. SIGNIFICANCE: Previously reported affective processing deficits in PD might be due to insufficiently controlled confounding variables (medication, depression, cognitive impairment).

Facial Emotion Recognition in Parkinson's Disease: An fMRI Investigation.

BACKGROUND: Findings of behavioral studies on facial emotion recognition in Parkinson's disease (PD) are very heterogeneous. Therefore, the present investigation additionally used functional magnetic resonance imaging (fMRI) in order to compare brain activation during emotion perception between PD patients and healthy controls. METHODS AND FINDINGS: We included 17 nonmedicated, nondemented PD patients suffering from mild to moderate symptoms and 22 healthy controls. The participants were shown pictures of facial expressions depicting disgust, fear, sadness, and anger and they answered scales for the assessment of affective traits. The patients did not report lowered intensities for the displayed target emotions, and showed a comparable rating accuracy as the control participants. The questionnaire scores did not differ between patients and controls. The fMRI data showed similar activation in both groups except for a generally stronger recruitment of somatosensory regions in the patients. CONCLUSIONS: Since somatosensory cortices are involved in the simulation of an observed emotion, which constitutes an important mechanism for emotion recognition, future studies should focus on activation changes within this region during the course of disease.

Determination of glycated hemoglobin in patients with advanced liver disease.

AIM: To evaluate the glycated hemoglobin (HbA(1c)) determination methods and to determine fructosamine in patients with chronic hepatitis, compensated cirrhosis and in patients with chronic hepatitis treated with ribavirin. METHODS: HbA(1c) values were determined in 15 patients with compensated liver cirrhosis and in 20 patients with chronic hepatitis using the ion-exchange high performance liquid chromatography and the immunoassay methods. Fructosamine was determined using nitroblue tetrazolium. RESULTS: Forty percent of patients with liver cirrhosis had HbA(1c) results below the non-diabetic reference range by at least one HbA(1c) method, while fructosamine results were either within the reference range or elevated. Twenty percent of patients with chronic hepatitis (hepatic fibrosis) had HbA(1c) results below the non-diabetic reference range by at least one HbA(1c) method. In patients with chronic hepatitis treated with ribavirin, 50% of HbA(1c) results were below the non-diabetic reference using at least one of the HbA(1c) methods. CONCLUSION: Only evaluated in context with all liver function parameters as well as a red blood count including reticulocytes, HbA(1c) results should be used in patients with advanced liver disease. HbA(1c) and fructosamine measurements should be used with caution when evaluating long-term glucose control in patients with hepatic cirrhosis or in patients with chronic hepatitis and ribavirin treatment.