0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
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?
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.; Ubaldo Bonuccelli, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2012;24:E36-E37. doi:10.1176/appi.neuropsych.11110326
View Author and Article Information

Send correspondence to Prof. Ubaldo Bonuccelli, Dept. of Neuroscience, University of Pisa, Italy; e-mail: u.bonuccelli@med.unipi.it

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).

Anchor for Jump
TABLE 1.Demographic and Clinical Characteristics of Healthy Controls and Drug-Naïve Parkinson's Disease (PD) Patients
Table Footer Note

Values are mean (standard deviation).

Table Footer Note

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.

In 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.

Conflict of interest relative to the research covered in this manuscript: none.

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 313
[CrossRef] | [PubMed]
 
Poletti  M;  Frosini  D;  Pagni  C  et al:  Alexithymia is associated with depression in de novo Parkinson’s disease.  Psychother Psychosom 2011; 80:251–253
[CrossRef] | [PubMed]
 
Zimmermann  G;  Rossier  J;  de Stadelhofen  FM  et al:  Alexithymia assessment and relations with dimensions of personality.  Eur J Psychol Assess 2005; 21:32–33
[CrossRef]
 
Zuckerman  M;  Kuhlman  DM:  Personality and risk-taking: common biosocial factors.  J Pers 2000; 68:999–1029
[CrossRef] | [PubMed]
 
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; 67:589–595
[CrossRef] | [PubMed]
 
References Container
Anchor for Jump
TABLE 1.Demographic and Clinical Characteristics of Healthy Controls and Drug-Naïve Parkinson's Disease (PD) Patients
Table Footer Note

Values are mean (standard deviation).

Table Footer Note

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.

+

References

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 313
[CrossRef] | [PubMed]
 
Poletti  M;  Frosini  D;  Pagni  C  et al:  Alexithymia is associated with depression in de novo Parkinson’s disease.  Psychother Psychosom 2011; 80:251–253
[CrossRef] | [PubMed]
 
Zimmermann  G;  Rossier  J;  de Stadelhofen  FM  et al:  Alexithymia assessment and relations with dimensions of personality.  Eur J Psychol Assess 2005; 21:32–33
[CrossRef]
 
Zuckerman  M;  Kuhlman  DM:  Personality and risk-taking: common biosocial factors.  J Pers 2000; 68:999–1029
[CrossRef] | [PubMed]
 
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; 67:589–595
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 2

Related Content
Books
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 34.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 34.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 1.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
PubMed Articles