An evaluation of the absolute and relative stability of alexithymia over 11years in a Finnish general population.

OBJECTIVE: We investigated if alexithymia, a personality construct with difficulties in emotional processing, is stable in the general population. METHODS: Altogether 3083 unselected subjects aged 30 and older in Finland completed the 20-item Toronto Alexithymia Scale (TAS-20) in the longitudinal Health 2000 and Health 2011 general population surveys (BRIF8901). The stability of alexithymia at the 11-year follow-up was assessed with t-tests, correlations, and separate linear regression models with base-line and follow-up age, gender, marital status, education, and 12-month depressive and anxiety disorders as confounders. RESULTS: The mean score (SD) of the TAS-20 for the whole sample was 44.2 (10.4) in 2000 and 44.2 (10.9) in 2011 (p=0.731). The mean score of the TAS-20 subscale Difficulty Identifying Feelings increased by 0.3 points, Difficulty Describing Feelings decreased by 0.6 points and Externally Oriented Thinking increased by 0.3 points. The effect sizes of the changes varied from negligible to small. Age had little effect except for the group of the oldest subjects (75-97years): the TAS-20 mean (SD) score was 49.1 (10.1) in 2000 and 53.1 (10.3) in 2011 (p<0.001), the effect size for the increase was medium. TAS-20 score in 2000 explained a significant proportion of variance in TAS-20 score in 2011. Controlling for all baseline confounders improved the model incrementally; the same applied to controlling for confounders at follow-up. Baseline depression or anxiety disorders were not associated with the TAS-20 scores in 2011, whereas current diagnoses were. CONCLUSIONS: According to our large longitudinal study both the absolute and relative stability of alexithymia assessed with the TAS-20 are high in the adult general population.

Alexithymia behaves as a personality trait over a 5-year period in Finnish general population.

OBJECTIVE: Temporal stability is a basic assumption underlying any personality trait construct. Previous research on the stability of alexithymia has led to a controversy over whether alexithymia should be viewed as a state-dependent phenomenon or as a stable personality trait. The aim of this 5-year longitudinal study was to examine the temporal stability of alexithymia in the general population in Finland. METHODS: Alexithymia was measured with the 20-Item Toronto Alexithymia Scale (TAS-20) at the baseline and 5 years later. RESULTS: The test-retest correlations of the TAS-20 total and factor-specific scores at the baseline and at the 5-year follow-up ranged from moderate to high in both genders, reflecting a rather high relative stability of the TAS-20 scores over a period of 5 years. CONCLUSIONS: The findings of our study suggest that alexithymia behaves like a stable personality trait in the general population.

Alexithymia: a facet of essential hypertension.

Two hundred thirty-seven newly diagnosed yet untreated hypertensive men and women, 35 to 54 years of age, were compared with an age- and gender-stratified random population sample of 146 normotensive men and women to find out whether psychological distress symptoms, anger expression, and alexithymia are associated with elevated blood pressure and whether the possible associations are independent of sodium and alcohol intake, body mass index, and physical fitness. The independent attributes of mean arterial pressure were studied by multivariate regression analyses after combining the subjects in the hypertensive and control groups. Three questionnaires were used: the Brief Symptom Inventory (BSI-37), a 31-item version of the Spielberger State-Trait Anger Expression Inventory (STAXI), and the Toronto Alexithymia Scale (TAS-26). Total scores of the TAS-26 were higher (P<0.001) in hypertensive men and women than in their normotensive control subjects (75.6+/-7.8 vs 64.1+/-9.8 in men and 72.9+/-7.1 vs 57.5+/-11.5 in women). There were no differences between the study and control groups in psychological distress symptoms, including anxiety, depression, and hostility, or in anger expression. In multivariate regression analyses, higher age, male gender, higher sodium intake, lower physical fitness, and alexithymia were independently and highly significantly (P<0.01 for male gender, P<0.0001 for other variables) associated with increased blood pressure, explaining altogether 39.5% of the cross-sectional variation in mean arterial pressure. We conclude that alexithymia, that is, poor ability to experience and express emotions, is associated with elevated blood pressure independent of sodium and alcohol intake, body mass index, and physical fitness.

Relation between central cerebral atrophy, memory defects and prolactin secretion.

Concentrations of prolactin in cerebrospinal fluid (CSF) and in serum were determined from 26 neurological patients with or without minor central cerebral atrophy. Neuropsychological memory tests also were performed on these patients. Twenty-eight neurological patients with peripheral nervous lesions and without endocrine dysfunctions served as controls for prolactin levels. Patients with central cerebral atrophy had significant loss of recall capacity, though they did not differ significantly from the normal population in their intellectual performances. CSF and serum prolactin levels in the patients with central cerebral atrophy and/or memory defects did not differ from the values obtained in the patients without cerebral atrophy. Thus, prolactin levels do not appear to reflect either central cerebral atrophy or memory dysfunctions, most likely due to the minor degree of neuronal atrophy around the third ventricle that occurs in patients with these findings.

Effect of smoking on neuroleptics in schizophrenia.

OBJECTIVE: The effect of smoking on daily doses and plasma levels of neuroleptics prescribed for schizophrenic patients was studied. METHODS: 90 outpatients with schizophrenic disorder (DSM-III-R) who were on a stable regimen of psychotropic medication and showed a stable clinical state were included in a double-blind placebo-controlled trial. Data were collected and blood tests taken at the baseline interview. The plasma levels were obtained for 52 patients. RESULTS: Daily neuroleptic doses converted to chlorpromazine equivalents correlated significantly (r = 0.436) with the plasma levels of their unmetabolised fractions. The neuroleptic doses increased with age in smokers, while in nonsmokers they decreased. Neither sex, age nor smoking had a significant association with the neuroleptic plasma levels. CONCLUSIONS: Smoking seems to lead to increased neuroleptic dosages in postmenopausal schizophrenics by increasing hepatic metabolism and renal excretion of the drugs and possibly enhancing dopamine release. It is also possible that older smoking patients form a selected group of heavy smoker and they, therefore, need exceptionally high neuroleptic doses.

Marital satisfaction and distress in chronic low-back pain patients and their spouses.

This study examined the relation between marital satisfaction, psychological distress, self-reported pain, disability, and clinical findings in 63 chronic low-back pain (CLBP) patients from primary health care centers. The relation between marital satisfaction and psychological distress in their spouses was also studied. Marital dissatisfaction in female CLBP patients was significantly associated with psychological distress, as well as with patient self-reported pain and disability. Marital dissatisfaction in their male spouses was also strongly related to psychological distress. In male CLBP patient couples, marital dissatisfaction and psychological distress were much less significantly related. This gender difference should be taken into account in the treatment of CLBP couples.

Alexithymic features do not predict compliance with psychotherapy in consultation-liaison patients.

A 1-year follow-up study on 54 general hospital psychiatric consultation outpatients was carried out in order to determine whether alexithymic features, measured by the Toronto Alexithymia Scale (TAS) are predictive of psychotherapy recommendations and whether alexithymia is associated with patients' compliance with these recommendations. Contrary to what we expected, the presence of alexithymic features predicted neither treatment recommendations nor compliance. Psychological distress as measured by the Brief Symptom Inventory (BSI) proved to be a better predictor.

Alexithymia in psychiatric consultation-liaison patients.

Alexithymic characteristics were assessed by the Toronto Alexithymia Scale (TAS), a self-report measure of alexithymia, in 230 consecutive outpatients referred to a psychiatric consultation-liaison service. The prevalence of alexithymia was 37.8% (50.5% in men and 28.2% in women). Alexithymia was significantly associated with the following variables: male gender, low socioeconomic status, the presence of psychiatric disorder, especially depression, with old age and with a high level of psychological distress. No significant association between alexithymia and the presence of somatic illness was found.

Citalopram as an adjuvant in schizophrenia: further evidence for a serotonergic dimension in schizophrenia.

There is increasing evidence suggesting that symptoms of depression and anxiety may also be associated with serotonergic dysfunction in schizophrenic patients. The effect of the adjuvant selective serotonin reuptake inhibitor citalopram was assessed regarding the symptom dimensions of schizophrenia measured with the Positive and Negative Syndrome Scale (PANSS) and with the Hamilton Rating Scale for Depression (HRSD). Citalopram alleviated symptoms of the depression/anxiety dimension of the PANSS, but not the symptoms of the four other PANSS domains or depressive symptoms measured with the HRSD. The results support the hypothesis of a serotonergic dimension in schizophrenia.

A controlled study of couple therapy in chronic low back pain patients. Effects on marital satisfaction, psychological distress and health attitudes.

This was a controlled, prospective study on the effectiveness of couple therapy in 63 chronic low back pain patients (CLBP) from primary health care centers. They were randomly allocated to a couple therapy (T) group, N = 33, and to a control (C) group, N = 30. Couple therapy consisting of five monthly sessions was conducted by two family therapists. All patients and their spouses participated in a 12-month follow-up. Marital communication improved in CLBP patients of the T-group, whereas it worsened in the C-group. Psychological distress decreased in male patients of the T-group, whereas it increased in male patients of the C-group. However, due to high initial levels of distress in male patients of the T-group no firm conclusion of therapy effect can be done. The trends in health attitudes of the patients were similar during the study year. No significant differences in any of the measures were found in spouses. It is concluded that couple therapy improves the quality of life in CLBP patients by enhancing marital communication.

A controlled study of couple therapy in chronic low back pain patients. No improvement of disability.

Family-oriented approaches and consequent conjoint marital sessions have been widely accepted as ingredients of comprehensive treatment and rehabilitation of chronic pain patients. However, no controlled trials have been conducted to confirm the effectiveness of couple therapy in these patients. We examined 63 chronic low back pain (CLBP) patients identified in primary health care centres. They were randomly allocated to a couple therapy group (n = 33) and to a control group without couple therapy (n = 30). The therapy consisted of five monthly sessions and was attended by two family therapists. All patients attended an initial examination and a 12-month follow-up examination. Effects on self-reported pain, disability, and some clinical measures, as well as on the use of medical services were evaluated. The study groups did not differ significantly in any of the outcome measures. Hence, we conclude that couple therapy has no significant effect on disability in CLBP patients.

Alexithymia and depression: a 1-year follow-up study in outpatients with major depression.

OBJECTIVE: To examine the changes in alexithymic features and depressive and other psychological distress symptoms during a 1-year follow-up among patients with major depression. METHODS: The study population comprised 120 outpatients suffering from major depression. Diagnosis was made with Structured Clinical Interview (SCID-I) for DSM-III-R. The severity of depression was evaluated with the 17-item Hamilton Rating Scale for Depression (HAM-D), and self-reported depression with the Beck Depression Inventory (BDI-21). Alexithymic features were assessed with the Twenty-Item Toronto Alexithymia Scale (TAS-20). Self-reported psychological distress symptoms were evaluated with the Brief Symptom Inventory (BSI). RESULTS: Measures of depression and distress were significantly lower at the follow-up than at the baseline, while the total TAS-20 scores did not change significantly during the follow-up. A closer examination revealed that various TAS-20 factors behaved differently. Changes in Factors 1 and 2 were associated with changes in mood, whereas those in Factor 3 were not. Additionally, recovery from depression was associated with decrease in alexithymic features. CONCLUSION: Difficulties in identifying and in describing feelings are associated with changes in mood, while externally oriented thinking is not.

Chronic low back pain patient and spouse.

Marital adjustment, psychological distress, health attitudes and prevalence of musculoskeletal pain symptoms were studied and compared between 63 chronic low back pain (CLBP) patients and their spouses. The CLBP patients experienced somatization significantly more than their spouses, while other psychological distress scores did not reveal statistically significant differences between the couples. The CLBP patients experienced significantly more feelings of guilt at having pain than their spouses. The patients experienced significantly more internal control, while their spouses experienced more external locus control of health. The female spouses had had significantly more musculoskeletal pain symptoms in neck and shoulders during the past week than the male spouses. The prevalence of musculoskeletal pain symptoms in the CLBP patients did not differ significantly between sexes. The results of this study are compared to population studies where the same methods have been used.

Couple therapy improves mental well-being in chronic low back pain patients. A controlled, five year follow-up study.

Fifty-six chronic low back pain (CLBP) patients participated in a controlled, prospective 5-yr follow-up study evaluating the long-term effects of five-session couple therapy. Twenty-eight patients were included both in the treatment group and in the control group. Outcome measures were self-reported psychological distress, marital satisfaction, health locus of control, pain and disability as well as clinical examinations. The reliability of the outcome measures was statistically analysed and found acceptable. At the 5-yr follow-up assessments, psychological distress was found to be decreased in the treatment group and increased in controls. The difference between the groups was significant. No difference was found in the other self-reported or clinical outcome measures. We conclude that couple therapy has a prolonged beneficial effect on the mental well-being of CLBP patients.

Alexithymia--state or trait? One-year follow-up study of general hospital psychiatric consultation out-patients.

We carried out a 1-year follow-up study on 54 out of 80 general hospital psychiatric consultation out-patients. Alexithymic features were measured by the Toronto Alexithymia Scale (TAS), and self-reported psychological distress with the Brief Symptom Inventory (BSI). Men were more alexithymic and distressed than women both at the baseline and at the follow-up evaluations. The degree of alexithymia in both genders remained consistent, whereas psychological distress decreased significantly in both genders during the follow-up period. Therefore we conclude that alexithymia presents a constant trait in psychiatric consultation out-patients.

Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland.

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking). but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.

Smoking and cognitive deficits in schizophrenia: a pilot study.

The cross-sectional study assessed the associations among smoking status, number of cigarettes smoked per day, and psychiatric symptoms in 88 chronic schizophrenic outpatients with a stable psychic condition. Among the 49 smokers, the number of cigarettes smoked per day was associated with the severity of cognitive symptoms of the Positive and Negative Syndrome Scale. The authors suggest that smoking may alleviate cognitive deficits in schizophrenia by increasing dopaminergic neurotransmission in the prefrontal areas of the brain.

Citalopram causes no significant alterations in plasma neuroleptic levels in schizophrenic patients.

Steady-state plasma concentrations of commonly used neuroleptic drugs were measured in 90 schizophrenic patients before and after adding placebo or citalopram (40 mg/day) to their treatment regimen. Plasma concentrations of citalopram and its main metabolite, desmethylcitalopram, were also measured. In addition, patients with exceptionally high neuroleptic levels or an increase in adverse effects during the 12-week study period were evaluated for their debrisoquine/sparteine hydroxylase (CYP2D6) genotype, an enzyme responsible for oxidative metabolism of several neuroleptics and selective serotonin re-uptake inhibitors. There were no significant changes in plasma concentrations of haloperidol, chlorpromazine, zuclopenthixol, levomepromazine, thioridazine or perphenazine during the study. Plasma concentrations of citalopram and desmethylcitalopram were well within the levels reported previously with monotherapy, and remained stable throughout the study. None of the 15 patients analysed for the CYP2D6 genotype was a poor metabolizer. It is concluded that clinically important pharmacokinetic drug interactions do not play a crucial role when citalopram is used as an augmentation therapy in neuroleptic-treated schizophrenic patients.