A Machine Learning Approach to Relationships Among Alexithymia Components.

BACKGROUND: The aim of this paper is to explore the network structures of alexithymia components and compare results with relevant prior literature. SUBJECTS AND METHODS: In a large sample of university students, undirected and directed network structures of items from the Bermond Vorst Alexithymia Questionnaire form B are estimated with state-of-the-art network analysis and structure learning tools. Centrality estimates are used to address the topic of item redundancy and select relevant alexithymia components to study. RESULTS: Alexithymia components present positive as well as negative connections; poor fantasy and emotional insight are identified as central items in the network. CONCLUSIONS: The undirected network structure of alexithymia components reports new features with respect to prior literature, and the directed network structures offers new insight on the construct.

Risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression: A study on 703 individuals.

BACKGROUND: Since few studies have investigated the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression, the aim of this study was to examine this risk in a large sample of individuals with major depression. METHODS: Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. High blood pressure status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg during at least two medical examinations. Logistic regression analyses were conducted to examine the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression. RESULTS: After adjustment for major confounding factors associated with high blood pressure, multivariate logistic regression analysis revealed that severe objective insomnia, low complaints of repeated nighttime awakenings or early morning awakening, and intermediate or low self-reported insomnia complaints were significant risk factors of high blood pressure in major depression. CONCLUSION: In major depression, severe objective insomnia and lower self-reported insomnia complaints are associated with higher risk of high blood pressure, which justifies a better management of objective insomnia and a better assessment of insomnia complaints in this particular subpopulation to avoid the negative consequences related to the co-occurrence of high blood pressure and major depression. Abbreviations: AHI, Apnea-Hypopnea Index; BDI, Beck Depression Inventory; BMI, Body Mass Index; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition - Text Revision; ESS, Epworth Sleepiness scale; ISI, Insomnia Severity Index; HBP, High Blood Pressure; OSA, Obstructive Sleep Apnea Syndrome; REM, rapid eye movement sleep.

Prevalence and Risk Factors of Type 2 Diabetes in Major Depression: A Study on 703 Individuals Referred for Sleep Examinations.

BACKGROUND: Several studies have investigated the prevalence and risk factors of depression in individuals with type 2 diabetes. However, few studies have investigated the prevalence and risk factors for type 2 diabetes in major depression. OBJECTIVE: The aim of this study was to examine the prevalence and risk factors of type 2 diabetes in a large sample of individuals with major depression. METHODS: Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. Only individuals with a diagnosis of type 2 diabetes according to the diagnostic criteria of the American Diabetes Association were included in the diabetes group. Logistic regression analyses were conducted to examine clinical and demographic risk factors of type 2 diabetes in major depression. RESULTS: The prevalence of type 2 diabetes in major depression is 21.2%. Multivariate logistic regression analysis revealed that male sex, high blood pressure, hypertriglyceridemia, BMI ≥30kg/m², age ≥50 years, sleep duration <6.5 hours, C-reactive protein ≥4.5mg/L, Beck Depression Inventory >12, and apnea-hypopnea index ≥5/h were significant risk factors of type 2 diabetes in major depression. CONCLUSION: Type 2 diabetes is a common condition in major depression. In this subpopulation, most of the risk factors for type 2 diabetes are reversible, which justifies better prevention and management of this disorder to avoid its negative consequences.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects.

BACKGROUND: Several studies have investigated the prevalence and risk factors of insomnia in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of insomnia sufferers. METHODS: Data from 1311 insomnia sufferers who were recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as the cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers. RESULTS: The prevalence of moderate to severe obstructive sleep apnea syndrome in our sample of insomnia sufferers was 13.88%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower maintenance insomnia complaint, presence of metabolic syndrome, age ≥ 50 & <65 years, age ≥ 65 years, BMI ≥ 25 & <30 kg/m2, BMI >30 kg/m2, and CRP >7 mg/L were significant risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers. CONCLUSION: Moderate to severe obstructive sleep apnea syndrome is a common pathology in insomnia sufferers. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.

Similar polysomnographic pattern in primary insomnia and major depression with objective insomnia: a sign of common pathophysiology?

BACKGROUND: Our aim is to verify empirically the existence of a major depressed subgroup with a similar polysomnographic pattern as primary insomnia, including at rapid eye movement sleep level. METHODS: The polysomnographic data from 209 untreated individuals (30 normative, 84 primary insomnia sufferers, and 95 major depressed patients with objective insomnia) who were recruited retrospectively from the Erasme hospital database were studied for the whole night and thirds of the night. RESULTS: Primary insomnia sufferers and major depressed patients with objective insomnia exhibit a similar polysomnographic pattern both for the whole night (excess of wake after sleep onset, deficit in slow-wave sleep/rapid eye movement sleep, and non-shortened rapid eye movement latency) and thirds of the night (excess of wake after sleep onset at first and last third, deficit in slow-wave sleep in first third, and deficit in rapid eye movement sleep in first and last third), including at rapid eye movement sleep level. CONCLUSION: In our study, we demonstrated that major depressed patients with objective insomnia showed a similar polysomnographic pattern as primary insomnia, including at rapid eye movement sleep level, which supports the hypothesis of a common pathophysiology that could be hyperarousal. This opens new avenues for understanding the pathophysiology of major depression with objective insomnia.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression: a observational and retrospective study on 703 subjects.

BACKGROUND: Several studies have investigated the prevalence and risk factors of depression in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in major depression. The aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of individuals with major depression. METHODS: Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in major depression. RESULTS: The prevalence of moderate to severe obstructive sleep apnea syndrome in major depression is 13.94%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower insomnia complaint, presence of metabolic syndrome, age ≥ 50 years, BMI >30 kg/m2, ferritin >300 µg/L, CRP >7 mg/L and duration of sleep ≥8 h were significant risk factors of moderate to severe obstructive sleep apnea syndrome in major depression. CONCLUSION: Moderate to severe obstructive sleep apnea syndrome is a common pathology in major depression. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in major depression.

Fraud, individuals, and networks: A biopsychosocial model of scientific frauds.

The problem of fraud, especially scientific fraud, is global and its identification risk is still in its infancy. Based on an in-depth analysis of several financial and scientific fraud trials, the authors propose a new and integrative model of scientific fraud. This model identifies two major levels for committing fraud: (i) at the personal skills level (micro-level) and (ii) at the network skills level (macro-level). Interacting continuously with each other, they form a dynamic, efficient, and integrative system: an integrative model of fraud. The micro-level refers to three factors: (i) personality organization, (ii) social competence, and (iii) the so-called triangle of fraud. The macro-level refers essentially to social network organization and social engineering. Then, the key to understanding and mostly controlling fraud is to consider both the individual and the environment in which they operate. Based on our model, several steps at the micro- and macro-levels can be proposed.

Beware of multiple traumas in PTSD assessment: the role of reactivation mechanism in intrusive and hyper-arousal symptoms.

OBJECTIVES: Post-traumatic stress disorder (PTSD) is a major public health problem defined by three symptom clusters: intrusion thoughts, avoidance mechanisms and hyper-arousal. Several authors have emphasized, that some or all of these symptoms related to a past traumatic experience could be reactivated, even after long asymptomatic periods. This study investigates the role of an additional trauma in the reactivation of a childhood trauma among a group of former hidden children (n = 65), the Jewish youths who spent World War II in various hideaway shelters in Nazi-occupied Europe. They were compared with a control group. METHOD: The presence or absence of an additional trauma in adulthood was assessed and PTSD symptoms were measured by using the Impact of Event Scale-Revised. RESULTS: An additional trauma reactivates PTSD symptoms of intrusion thoughts and, marginally, symptoms of hyper-arousal. At the opposite, symptoms of avoidance were not reactivated. CONCLUSION: Our results confirm the role of an additional trauma in the reactivation of traumatic memories, related to an earlier trauma, in later life. Clinical and theoretical implications are discussed and perspectives are proposed.

SELF-REPORT OF EMPATHY: A SHORTENED FRENCH ADAPTATION OF THE INTERPERSONAL REACTIVITY INDEX (IRI) USING TWO LARGE BELGIAN SAMPLES.

For more than 30 years, the Interpersonal Reactivity Index (IRI) has been used to measure the multidimensional aspects of empathy. But the 28-item, 4-factor model of Davis (1980 ) is currently contested because of methodological issues and for theoretical reasons. Confirmatory (CFA) and exploratory factor analyses (EFA) were applied in two French-speaking Belgian student samples (1,244 participants in the first and 729 in the second study) to test this model and to propose a shortened version. A non-optimal fit was found with respect to the CFI value (Study 1). By splitting the student group into two random subsamples, EFA and then CFA were used to propose a 15-item, 4-factor model with good fit indices. A CFA on the second student group (Study 2) replicated this model. Results are discussed considering the influence of social desirability response bias, an absence of strong invariance across sex and the usefulness of self-report scales to measure empathy.

DETERMINATION OF THE CUTOFF THRESHOLD ON THE BERMOND-VORST ALEXITHYMIA QUESTIONNAIRE-20 FORM B: A STUDY OF 560 YOUNG ADULTS.

The aim of the study was to calculate the cutoff scores on the Bermond-Vorst Alexithymia Questionnaire-20 Form B. 560 students completed the Bermond-Vorst Alexithymia Questionnaire-20 Form B and the 20-item Toronto Alexithymia Scale. Using cutoff scores of the French or the original version of the 20-item Toronto Alexithymia Scale as the standard, the participants were divided into alexithymic and non-alexithymic groups. The Bermond-Vorst Alexithymia Questionnaire-20 Form B cutoff scores selection was based on the sensitivity, specificity, receiver operating characteristic curve analysis, and the analyses of the clinical data. The most appropriate cutoff scores for determining the absence and presence of alexithymia ranged from 43 to 45 and from 50 to 53, respectively.

[Individual differences in sleep macrostructure: effects of anxiety, depression, aging and gender]. / Egyéni különbségek az alvási makrostruktúrában: a szorongás, a depresszió, az öregedés és a nem hatása.

OBJECTIVE: Anxiety is one of the most common psychiatric symptoms frequently associated with sleep disorders. Despite the intensive research, the role of sleep in the patomechanism of anxiety has remained unclear. The aim of the study was to investigate the anxiety-related changes in the sleep macrostructure and the impact of ageing, gender and the presence of depression. METHODS: 1083 patients with sleep symptoms were enrolled in the study. All patients have all night polysomnographies. The effect of anxiety, depression, aging and gender on the sleep initiation, maintenance and sleep stages respectively; were analysed in 4 different statistical approaches. RESULTS: Anxiety increased the latency of sleep and REM sleep; and decreased the length of REM sleep and slow-wave sleep; while depressive symptoms were associated with reduced REM latency, slow-wave sleep and increased REM duration. The length of slow-wave sleep, REM phase decreased with ageing and the sleep was fragmented. Women had more slow-wave sleep and less REM sleep than men. CONCLUSION: Normal order of sleep stages is essential in the cognitive processing of the brain. Changes in sleep macrostructure may have an impact in the impairment of cognitive functions of patients suffering from anxiety or depression.

Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the chronic fatigue syndrome.

OBJECTIVES: To investigate associated dimensions of fatigue regarding cognitive impairment, psychomotor performances, muscular effort power and circulating cytokine levels and their relations to symptom intensity in a sample of pure chronic fatigue syndrome (CFS) patients without overlapping objective sleepiness or sleep disorders. METHODS: 16 CFS patients were compared to 14 matched controls. We assessed structured symptom-scales, polysomnography, multiple sleep latency tests, attention (Zazzo-Cancellation ZCT, digit-symbol-substitution DSST), psychomotor vigilance and speed (PVT, finger tapping test, FTT), dynamometer handgrip force (tonic and phasic trials) and circulating cytokines (IFN-γ, IL-1b, IL-6, IL-8, IL-10, TNF-α). RESULTS: In addition to fatigue, CFS patients presented with higher affective symptom intensity and worse perceived sleep quality. Polysomnography showed more slow-wave sleep and microarousals in CFS but similar sleep time, efficiency and light-sleep durations than controls. Patients presented with impaired attention (DSST, ZCT), slower reaction times (PVT) but not with lower hit rates (FTT). Notwithstanding lower grip strength during tonic and phasic trials, CFS also presented with higher fatigability during phasic trials. Cytokine levels were increased for IL-1b, IL-8, IL-10 and TNF-α and fatigue intensity was correlated to grip strength and IL-8. CONCLUSIONS: In contrast to sleepiness, chronic fatigue is a more complex phenomenon that cannot be reduced to one single measured dimension (i.e., sleep propensity). Showing its relations to different measurements, our study reflects this multidimensionality, in a psychosomatic disorder such as CFS. To obtain objective information, routine assessments of fatigue should rule out sleepiness, combine aspects of mental and physical fatigue and focus on fatigability.

Psychological and socio-demographic data contributing to the resilience of holocaust survivors.

The authors provide a within-group study of 65 Former Hidden Children (FHC; i.e., Jewish youths who spent World War II in various hideaway shelters across Nazi-occupied Europe) evaluated by the Hopkins Symptom Check List (HSCL), the Sense of Coherence Scale (SOCS), the Resilience Scale for Adults (RSA), and a socio-demographic questionnaire. The aim of the present article is to address the sensitization model of resilience (consisting in a reduction of resistance to additional stress due to previous exposure to trauma) and to identify the family, psychological, and socio-demographic characteristics that predict resilience among a group of FHC. The RSA score is negatively correlated with the number of post-war traumas and positively correlated with the SOCS score. FHC who have children present a higher RSA score than FHC who have no children. RSA global score negatively and significantly predicts HSCL score. In a global multivariate model, and in accordance with the sensitization model, the number of post-war traumas negatively predicts the RSA score. Moreover, the SOCS score and the number of children positively predict it. Therapeutic implications are discussed, limitations are considered, and further investigations are proposed.

Long-term CPAP treatment partially improves the link between cardiac vagal influence and delta sleep.

BACKGROUND: Continuous positive airway pressure (CPAP) treatment improves the risk of cardiovascular events in patients suffering from severe sleep apnea-hypopnea syndrome (SAHS) but its effect on the link between delta power band that is related to deep sleep and the relative cardiac vagal component of heart rate variability, HF(nu) of HRV, is unknown. Therefore, we tested the hypothesis that CPAP restores the link between cardiac autonomic activity and delta sleep across the night. METHODS: Eight patients suffering from severe SAHS before and after 4 ± 3 years of nasal CPAP treatment were matched with fourteen healthy controls. Sleep EEG and ECG were analysed to obtain spectral sleep and HRV components. Coherence analysis was applied between HF(nu) and delta power bands across the first three sleep cycles. RESULTS: Sleep characteristics and spectral HRV components were similar between untreated patients, treated patients and controls, with the exception of decreased Rapid Eye Movement duration in untreated patients. Coherence and gain values between HF(nu) and delta EEG variability were decreased in untreated patients while gain values normalized in treated patients. In patients before and during long-term CPAP treatment, phase shift and delay between modifications in HF(nu) and delta EEG variability did not differ from controls but were not different from zero. In healthy men, changes in cardiac vagal activity appeared 9 ± 7 minutes before modifications in delta sleep. CONCLUSIONS: Long-term nasal CPAP restored, in severe SAHS, the information between cardiovascular and sleep brainstem structures by increasing gain, but did not improve its tightness or time shift.

Attachment and socio-emotional skills: a comparison of depressed inpatients, institutionalized delinquents and control adolescents.

UNLABELLED: This study compared 50 depressed inpatients, 51 institutionalized delinquents and 51 control adolescents (total n = 152) regarding attachment and associated socio-emotional skills. All of the participants took an individual interview (i.e., anamnesis, diagnostic interview and intelligence test) and completed the attachment measure and self-report measures of socio-emotional skills (i.e., emotional intelligence, empathy and resilience). Results showed that controls scored higher on secure attachment, whereas both of the other groups scored higher on preoccupied attachment. Depressed adolescents had lower scores on emotional intelligence than did controls. Finally, depressed adolescents had lower scores than the other two groups on resilience. The anxious or preoccupied attachment in both clinical groups, the overall frailty of depressive adolescents and the apparent resilience of delinquent adolescents despite their cognitive limitations should inform the respective treatment plans for these groups of adolescents. Suggestions for future research into differences between depressed and delinquent adolescents are outlined. KEY PRACTITIONER MESSAGE: Both depressed and delinquent adolescents show more anxious attachment. Depressed adolescents are less resilient than delinquent adolescents. Delinquent adolescents are less intelligent than the other two groups but well-adjusted overall. These differences should inform treatment plans for these two clinical groups.

Attachment, parenting, and separation--individuation in adolescence: a comparison of hospitalized adolescents, institutionalized delinquents, and controls.

The authors compared parent-related perceptions by hospitalized adolescents (i.e., who were admitted to a specialized psychiatric unit; n = 50) and delinquent adolescents (i.e., who were placed at a juvenile treatment institution; n = 51) with adolescents from the general population (n = 51). All adolescents completed a broad set of measures of attachment, perceived parenting, and separation-individuation. Contrary to initial expectations, hospitalized adolescents scored higher than controls on indices of excessive autonomy. Ambivalence regarding issues of interpersonal closeness and distance was found among delinquent adolescents. In addition, hospitalized and delinquent adolescents were found to be struggling, each in their specific way, with attachment-related experiences of trauma. Finally, delinquent adolescents also showed a stage-appropriate form of potentially adaptive narcissism. These findings add to the growing consensus in the literature that associations between adolescent psychopathology and parent-related perceptions are typically complex and somewhat counterintuitive.

Perceived parenting and separation-individuation in Belgian college students: associations with emotional adjustment.

The present study examined associations among perceived parenting, separation-individuation, and emotional adjustment in a convenience sample of college students in Belgium (N=350; 68% female; aged 18 to 26). In line with a conceptual model advanced in the literature, factor analysis supported the distinction between three dimensions of separation-individuation: overdependence and healthy separation (both of which had already been described in earlier research) and a new dimension, labeled excessive autonomy. Path analysis findings were consistent with a mediational model in which lower quality of perceived parenting predicted more excessive autonomy, which in turn predicted poorer emotional adjustment. In addition, healthy separation predicted superior emotional adjustment, whereas overdependence was not associated with this particular type of adjustment. Implications for current understanding of the process of separation-individuation in college students and of excessive autonomy, in particular, are discussed.

Bayesian Network Structure and Predictability of Autistic Traits.

The aim of this work is to explore the construct of autistic traits through the lens of network analysis with recently introduced Bayesian methods. A conditional dependence network structure was estimated from a data set composed of 649 university students that completed an autistic traits questionnaire. The connectedness of the network is also explored, as well as sex differences among female and male subjects in regard to network connectivity. The strongest connections in the network are found between items that measure similar autistic traits. Traits related to social skills are the most interconnected items in the network. Sex differences are found between female and male subjects. The Bayesian network analysis offers new insight on the connectivity of autistic traits as well as confirms several findings in the autism literature.

Using Bayesian Networks to Investigate Psychological Constructs: The Case of Empathy.

Network analysis is an emerging field for the study of psychopathology that considers constructs as arising from the interactions among their constituents. Pairwise effects among psychological components are often investigated by using this framework. Few studies have applied Bayesian networks, models that include directed interactions to perform causal inference on psychological constructs. Directed graphical models may be less straightforward to interpret in case the construct at hand does not contain symptoms but instead psychometric items from self-report measures. However, they may be useful in validating specific research questions that arise while using standard pairwise network models. In this study, we use Bayesian networks to investigate a well-known psychological construct, empathy from the Interpersonal Reactivity Index, in large two samples of 1973 university students from Belgium. Overall, our results support the hypotheses emphasizing empathic concern (i.e., sympathy) as causally important in the construct of empathy, and overall attribute the primacy of emotional components of empathy over their intellectual counterparts. Bayesian networks help researchers identify the plausible causal relationships in psychometric data, to gain new insight on the psychological construct under examination, help generate new hypotheses and provide evidence relevant to old ones.

Cognitive impairment in fatigue and sleepiness associated conditions.

Although relating to very different concepts, sleepiness and fatigue are often confounded. However, both fatigue-associated conditions such as the chronic fatigue syndrome (CFS) and sleepiness-associated conditions such as the sleep apnea-hypopnea syndrome (SAHS) are associated with cognitive impairment with impaired attention, concentration and memory performances. Fifteen pure CFS patients, without primary sleep disorders or clinically relevant sleepiness, were compared to 15 untreated SAHS patients, without clinically relevant fatigue, and to 16 healthy controls of similar age. The auditory verbal learning test (AVLT), digit span, digit symbol and finger tapping test (FTT) were used as cognitive and behavioural measures. In addition we assessed daytime EEG spectral power and P300 evoked potentials. With exception for the digit span, all tests showed lower performances in patient groups. Recall on the AVLT did not differ between the two patient groups, but the digit and symbol spans showed more severe impairment in SAHS patients. Psychomotor performance on the FTT presented with slower hit rates in SAHS than in CFS. EEG theta power was highest in CFS patients. P300 latencies and amplitudes did not differ between groups. Fatigue- and sleepiness-associated conditions can both present with significant and objective impairment of cognitive functioning and behavioural motor performance. In our sample cognitive impairment and psychomotor performance were worse when associated to sleepiness in SAHS than with fatigue in CFS.