Alexithymia Is Associated With Impulsivity in Newly-Diagnosed, Drug-Naïve Patients With Parkinson’s Disease: An Affective Risk Factor for the Development of Impulse-Control Disorders?
2012; American Psychiatric Association Publishing; Volume: 24; Issue: 4 Linguagem: Inglês
10.1176/appi.neuropsych.11110326
ISSN1545-7222
AutoresMichele Poletti, Daniela Frosini, Cristina Pagni, Claudio Lucetti, Del Dotto Paolo, Roberto Ceravolo, Ubaldo Bonuccelli,
Tópico(s)Mental Health Research Topics
ResumoBack to table of contents Previous article Next article LettersFull AccessAlexithymia Is Associated With Impulsivity in Newly-Diagnosed, Drug-Naïve Patients With Parkinson's Disease: An Affective Risk Factor for the Development of Impulse-Control Disorders?Michele Poletti, Psy.D., Daniela Frosini, M.D., Cristina Pagni, M.D., Lucetti Claudio, M.D., Del Dotto Paolo, M.D., Ceravolo Roberto, M.D., and Ubaldo Bonuccelli, M.D.Michele Poletti, Psy.D., Daniela Frosini, M.D., Cristina Pagni, M.D., Lucetti Claudio, M.D., Del Dotto Paolo, M.D., Ceravolo Roberto, M.D., and Ubaldo Bonuccelli, M.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11110326AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Depression has a high prevalence in patients with Parkinson's disease1 (PD) and has been associated with alexithymia,2 a clinical phenomenon related to an alteration in affect-regulation.We investigated the relationships between symptoms of negative affect (depression and alexithymia) and other neuropsychiatric symptoms in newly-diagnosed, drug-naïve (de novo) PD patients. We enrolled 42 de novo patients who fulfilled research diagnostic criteria for idiopathic PD and 30 age-matched healthy controls (HC). Both groups underwent a neuropsychiatric assessment including the Toronto Alexithymia Scale 20-item (TAS-20), the Geriatric Depression Scale Short Form (GDS-15), the Barratt Impulsiveness Scale (BIS-11), the Maudsley Obsessive-Compulsive Questionnaire (MOCQ-R), and the Hamilton Rating Scale for Anxiety (Ham-A). Informed consent was obtained in compliance with research standards for human research for all participating institutions and in accordance with the Helsinki Declaration.PD and HC groups did not differ in age, education, alexithymia, depression, impulsivity or anxiety (Table 1), whereas PD patients reported higher scores, as compared with HC, on the MOCQ-R Total score (p=0.038). In both groups, alexithymia correlated significantly with depression (PD: ρ=0.412; p=0.007; HC: ρ=0.819; p <0.001), and impulsivity (PD: ρ=0.316; p=0.041; HC: ρ=0.452; p=0.027). In each group, stepwise regression analyses showed that alexithymia predicted depression (PD: F=14.696; p <0.001; HC: F=44.926; p <0.001), and impulsivity (PD: F=5.063; p=0.029; HC: F=5.642; p=0.027). Considering TAS-20 factors (F-1: Difficulty Identifying Feelings; F-2: Difficulty Describing Feelings; F-3: Difficulty Focusing on Inner Affective Experience), depression was predicted by F-1 in PD (F=18.718; p <0.01) and by F-2 in HC (F=38.47; p <0.01), and impulsivity was predicted only by F-1 in both groups (PD: F=4.812; p <0.05; HC: F=13.450; p=0.01).TABLE 1. Demographic and Clinical Characteristics of Healthy Controls and Drug-Naïve Parkinson's Disease (PD) PatientsHealthy Controls (N=30)De Novo PD Patients (N=42)Age, years66.08 (7.62)64.97 (7.87)Sex: M/F18/1228/14Education, years8.58 (3.76)9.33 (4.31)UPDRS–II—8.19 (4.77)UPDRS–III—18.24 (12.60)MMSE28.93 (1.17)28.01 (1.52)TAS–2049.33 (11.06)50.54 (12.47)GDS–154.15 (4.15)4.54 (3.52)BIS–1164.67 (9.65)64.83 (9.24)MOCQ–R3.00 (2.53)4.71 (3.47)*Ham–A5.21 (2.17)5.80 (3.80)Values are mean (standard deviation).BIS–11: Barratt Impulsiveness Scale; GDS–15: Geriatric Depression Scale, 15 Items; Ham–A: Hamilton Rating Scale for Anxiety; MMSE: Mini-Mental State Exam; MOCQ–R: Maudsley Obsessive-Compulsive Questionnaire, Reduced Form; TAS–20: Toronto Alexithymia Scale.*p <0.05.TABLE 1. Demographic and Clinical Characteristics of Healthy Controls and Drug-Naïve Parkinson's Disease (PD) PatientsEnlarge tableIn de novo PD patients, as in HC, alexithymia was associated with depression and impulsivity, but these neuropsychiatric features were not associated. In addition to the known association between alexithymia and depression2 in both groups, impulsivity was predicted by alexithymia, and, considering TAS-20 factors, only by the TAS-20 F-1 factor. This finding is partially at variance with findings reported in a study with healthy subjects,3 in which impulsivity was not found to be associated with the TAS-20 total score, in contrast with our study, but only with the TAS-20 F-1 factor, as we found for PD and HC. Therefore, alexithymic difficulty in identifying one's own feelings could factor into situations where there is rapid respond to cues for potential reward without much planning or deliberation and without consideration of potential punishment or loss of reward, as defines impulsivity.4 Considering that dopamine agonists adopted to treat PD motor symptoms may increase impulsivity and the risk of developing impulse-control disorders,5 the clinical implication of this finding is that the presence of alexithymic features, especially the difficulty in identifying one's own feelings, could represent a risk factor for the development of impulse-control disorders when patients are treated with dopamine agonists. This hypothesis, which deserves further empirical investigation, highlights the importance of assessing multiple mental health domains, including alexithymia, in de novo PD patients, in order to prevent and/or better manage possible neuropsychiatric side effects of dopaminergic drugs.Dept. of Neuroscience, University of Pisa, ItalyNeurology Unit, USL of Viareggio, ItalyDept. of Neuroscience, University of Pisa, ItalyNeurology Unit, USL of Viareggio, ItalyDept. of Neuroscience, University of Pisa, ItalyDept. of Neuroscience, University of Pisa, ItalyNeurology Unit, USL of Viareggio, ItalySend correspondence to Prof. Ubaldo Bonuccelli, Dept. of Neuroscience, University of Pisa, Italy; e-mail: u.bonuccelli@med.unipi.itConflict of interest relative to the research covered in this manuscript: none.References1 Reijnders JS, Ehrt U, Weber WE, et al.: A systematic review of prevalence studies of depression in Parkinson's disease. Mov Disord 2008; 23:183–189, quiz 313Crossref, Medline, Google Scholar2 Poletti M, Frosini D, Pagni C, et al.: Alexithymia is associated with depression in de novo Parkinson's disease. Psychother Psychosom 2011; 80:251–253Crossref, Medline, Google Scholar3 Zimmermann G, Rossier J, de Stadelhofen FM, et al.: Alexithymia assessment and relations with dimensions of personality. Eur J Psychol Assess 2005; 21:32–33Crossref, Google Scholar4 Zuckerman M, Kuhlman DM: Personality and risk-taking: common biosocial factors. J Pers 2000; 68:999–1029Crossref, Medline, Google Scholar5 Weintraub D, Koester J, Potenza MN, et al.: Impulse control disorders in Parkinson disease: a cross-sectional study of 3,090 patients. Arch Neurol 2010; 67:589–595Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byImpulsivity Traits in Parkinson's Disease: A Systematic Review and Meta‐Analysis26 July 2023 | Movement Disorders Clinical Practice, Vol. 2015Impulse Control Disorders and the Dopamine Dysregulation SyndromeAugmentation in restless legs syndrome: an eye tracking study on emotion processing12 August 2020 | Annals of Clinical and Translational Neurology, Vol. 7, No. 9, Vol. 141Alexithymia in Parkinson's disease: a point of view on current evidenceNeurodegenerative Disease Management, Vol. 6, No. 3Psychiatric Conditions in Parkinson Disease16 September 2015 | Journal of Geriatric Psychiatry and Neurology, Vol. 29, No. 2Child Abuse & Neglect, Vol. 52Parkinsonism & Related Disorders, Vol. 28Failing as doorman and disc jockey at the same time: Amygdalar dysfunction in Parkinson's disease9 December 2015 | Movement Disorders, Vol. 31, No. 1Impulse control disorders in Parkinson's disease: don't set your mind at rest by self‐assessments18 January 2015 | European Journal of Neurology, Vol. 22, No. 4Impulsive and Compulsive Behaviors in Parkinson's DiseaseAnnual Review of Clinical Psychology, Vol. 10, No. 1Movement Disorders, Vol. 29, No. 2 Volume 24Issue 4 Fall 2012Pages E36-E37 Metrics Conflict of interest relative to the research covered in this manuscript: none.PDF download History Published online 1 October 2012 Published in print 1 October 2012
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