The relationship between alexithymia and circulating cytokine levels in subjects undergoing upper endoscopy

Objective: Despite emerging evidence suggesting a link between alexithymia and immune function, previous studies yielded contrasting results. The proposed link between alexithymia and immune function remains controversial as does the role, in this relationship, of anxiety, depression and subjective stress. The aim of the study is to investigate the possible association between alexithymia and circulating levels of cytokines in subjects awaiting an upper endoscopy, a stressful procedure, controlling for anxiety levels, depression and subjective stress. Methods: Participants were recruited from among consecutive patients referred for routine diagnostic upper endoscopy. All participants completed the Toronto Alexithymia Scale (TAS-20), the Hospital Anxiety and Depression Scale, and the Stress-related Vulnerability Scale. Serum levels of IL-1β, IL-4, IL-6, IL-10, TNF-α and IFN-γ were measured by ELISA. Results: Of the 90 subjects initially approached, 68 completed the study. The TAS-20 identified 22 alexithymic and 36 non-alexithymic patients. ELISA detected significantly lower IL-4 and IL-6 concentrations in alexithymic than in non-alexithymic patients. According to multiple linear regression analysis, alexithymia predicted low IL-4 and IL-6 levels in the sample overall, independently of stress, anxiety, depression and other possible confounders. No between-group differences were found in serum levels of IFN-γ, IL-1β, and TNF-α. Conclusion: These findings argue against an isolated shift towards pro-inflammatory or anti-inflammatory mediators and suggest that circulating cytokine profiles differ in alexithymic and non-alexithymic subjects

Diagnostic accuracy of the primary care screener for affective disorder (pc-sad) in primary care

Background: Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a 'gold standard' diagnostic interview in primary care. Methods: A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PCSAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results: Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions: While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available. © Picardi et al.; Licensee Bentham Open

Clinician' emotional resonance as investigation tool: development and preliminary validation of a questionnaire

Aims. A robust psychopathological and psychotherapeutic tradition underscores the importance of the clinician's feelings in the assessment and therapeutic process. Our aim is to develop an instrument to evaluate psychiatrist' experience induced by each patient. This paper describes the development and preliminary validation of this instrument. Methods. Based on the relevant literature and our clinical experience, we developed a self-completed questionnaire consisting of 65 items covering various aspects of the clinician' emotional resonance. Ten psychiatrists completed our questionnaire immediately after first clinical interviews involving a total of 125 patients with various psychiatric diagnoses. Also, they completed the Profile of Mood State (POMS) immediately before and after these interviews. The factor structure and convergent validity of the questionnaire was examined. Results. We identified a six-factor structure. The factors showed acceptable internal consistency and were interpretable as different aspects of the clinician-patient interaction as experienced by the clinician. There was a consistent pattern of correlations between factor scores and changes in POMS scale scores during the clinical interviews. Discussion. The study results, though preliminary, suggest that clinicians' subjective reactions during their interactions with patients can be validly and reliably measured. Quantitative measurement of clinician's subjectivity is potentially useful in both clinical and research settings