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Psychother Psychosom Med Psychol 2002; 52(11): 469-478
DOI: 10.1055/s-2002-35276
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Differente Muster regionaler Hirnaktivität nach emotionaler Stimulation bei alexithymen Patienten im Vergleich zu Normalpersonen

Eine positronenemissionstomographische (PET-)Studie mit 15O-H2O und emotionaler Stimulierung durch autobiografische ErinnerungDifferent Patterns of Regional Brain Activation During Emotional Stimulation in Alexithymics in Comparison with Normal ControlsA Positron Emission Tomography (PET) Study with 15O-H2O and Emotional Stimulation by Way of Autobiographic RecallMichael  Huber1 , Karl  Herholz2 , Birgit  Habedank1 , Alexander  Thiel2 , Markus  Müller-Küppers3 , Hermann  Ebel3 , Claudia  Subič-Wrana1 , Karl  Köhle1 , Wolf-Dieter  Heiss2
  • 1Institut und Poliklinik für Psychosomatik und Psychotherapie der Universität zu Köln
  • 2Max-Planck-Institut für Neurologische Forschung, Köln
  • 3Psychiatrische Universitätsklinik der RWTH Aachen
Further Information

Publication History

Eingegangen: 25. April 2002

Angenommen: 20. August 2002

Publication Date:
05 November 2002 (online)

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Zusammenfassung

Unter Verwendung von 15O-H2O-Positronenemissionstomographie und einem autobiografischen emotionalen Stimulationsparadigma wurden 9 Patienten mit somatoformen Störungen ohne sonstige Achse-I- oder Achse-II-Störung nach dem DSM-IV und hohen TAS-20-Werten (Toronto-Alexithymie-Skala) mit 10 Normalpersonen verglichen. Unter Stimulationsbedingungen (Trauer, Freude) zeigten Normalpersonen stärkere Aktivierungen als Alexithyme in zingulären Arealen, dem Corpus callosum sowie rechtsseitigen Frontalregionen. Alexithyme aktivierten stärker Kuneus und Präkuneus, Thalamus (Pulvinar), linksseitig mediale frontale und rechtsseitige frontale Regionen, die rechtsseitige Präzentralregion sowie das Zerebellum. Das Merkmal der Alexithymie ist in dieser Untersuchung unter emotionaler Stimulation verbunden mit einer Aktivierung sprachassoziierter Regionen, während limbische und paralimbische Strukturen signifikant weniger in Anspruch genommen werden als dies bei Normalpersonen der Fall ist.

Abstract

Objective: This study was designed to determine patterns of regional brain activation during emotional stimulation in alexithymics as compared with normal controls. Method: We used 15O-water positron emission tomography and an emotional stimulation paradigm based upon autobiographic recall of either happy, sad or emotionally neutral situations. 10 normal subjects without medical or psychiatrical history were compared with 9 patients with somatoform disorder without any other DSM-IV diagnosis. TAS-20 was used as a measure for alexithymia, depression was measured using BDI. Results: Normal controls showed significantly greater activation than alexithymics in cingulate areas, corpus callosum, and right superior and inferior frontal gyrus. Alexithymics activated significantly more in cuneus and precuneus, thalamus (pulvinar), left medial frontal, right inferior temporal, left superior temporal regions, left precentral gyrus, and the cerebellum. Conclusions: During emotional autobiographic recall, alexithymia, either trait or state, is characterized by utilization of different brain regions when compared to normal controls. The areas activated by alexithymic persons largely comprise of language related regions, leaving out limbic and paralimbic areas.

Key words

Alexithymia - emotion

Literatur

  • 1 Sifneos P E. Alexithymia: past and present.  American Journal of Psychiatry. 1996;  153 137-142
    PubMedGoogle Scholar
  • 2 Bernstein E M, Putnam F W. Development, reliability, and validity of a dissociation scale.  Journal of Nervous u Mental Disease. 1986;  174 727-735
    CrossrefPubMedGoogle Scholar
  • 3 Lane R D, Sechrest L, Riedel R. Sociodemographic correlates of alexithymia.  Comprehensive Psychiatry. 1998;  39 377-385
    CrossrefPubMedGoogle Scholar
  • 4 Krystal J H, Giller E LJ, Cicchetti D V. Assessment of alexithymia in posttraumatic stress disorder and somatic illness: introduction of a reliable measure.  Psychosomatic Medicine. 1986;  48 84-94
    PubMedGoogle Scholar
  • 5 Hoppe K D, Bogen J E. Alexithymia in twelve commissurotomized patients.  Psychotherapy & Psychosomatics. 1977;  28 148-155
    PubMedGoogle Scholar
  • 6 TenHouten W D, Hoppe K D, Bogen J E, Walter D O. Alexithymia: an experimental study of cerebral commissurotomy patients and normal control subjects.  American Journal of Psychiatry. 1986;  143 312-316
    PubMedGoogle Scholar
  • 7 Zeitlin S B, Lane R D, O'Leary D S, Schrift M J. Interhemispheric transfer deficit and alexithymia.  American Journal of Psychiatry. 1989;  146 1434-1439
    PubMedGoogle Scholar
  • 8 Weintraub S, Mesulam M M. Developmental learning disabilities of the right hemisphere. Emotional, interpersonal, and cognitive components.  Archives of Neurology. 1983;  40 463-468
    PubMedGoogle Scholar
  • 9 Parker J D, Taylor G J, Bagby R M. Alexithymia and the recognition of facial expressions of emotion.  Psychotherapy u Psychosomatics. 1993;  59 197-202
    PubMedGoogle Scholar
  • 10 Lane R D, Sechrest L, Reidel R, Weldon V, Kaszniak A, Schwartz G E. Impaired verbal and nonverbal emotion recognition in alexithymia Psychosomatic.  Medicine. 1996;  58 203-210
    PubMedGoogle Scholar
  • 11 Lane R D, Reiman E M, Axelrod B, Yun L S, Holmes A, Schwartz G E. Neural correlates of levels of emotional awareness. Evidence of an interaction between emotion and attention in the anterior cingulate cortex.  Journal of Cognitive Neuroscience. 1998;  10 525-535
    CrossrefPubMedGoogle Scholar
  • 12 Lane R D, Ahern G L, Schwartz G E, Kaszniak A W. Is alexithymia the emotional equivalent of blindsight?.  Biological Psychiatry. 1997;  42 834-844
    CrossrefPubMedGoogle Scholar
  • 13 Mann L S, Wise T N, Trinidad A, Kohanski R. Alexithymia, affect recognition, and five factors of personality in substance abusers.  Perceptual & Motor Skills. 1995;  81 35-40
    PubMedGoogle Scholar
  • 14 Bagby R M, Parker J D, Taylor G J. The twenty-item Toronto Alexithymia Scale - I. Item selection and cross-validation of the factor structure.  Journal of Psychosomatic Research. 1994;  38 23-32
    CrossrefPubMedGoogle Scholar
  • 15 Bagby R M, Taylor G J, Parker J D. Construct validity of the Toronto Alexithymia Scale.  Psychotherapy & Psychosomatics. 1988;  50 29-34
    PubMedGoogle Scholar
  • 16 Bagby R M, Taylor G J, Parker J D. The Twenty-item Toronto Alexithymia Scale - II. Convergent, discriminant, and concurrent validity.  Journal of Psychosomatic Research. 1994;  38 33-40
    CrossrefPubMedGoogle Scholar
  • 17 Parker J D, Taylor G J, Bagby R M, Thomas S. Problems with measuring alexithymia.  Psychosomatics. 1991;  32 196-202
    PubMedGoogle Scholar
  • 18 Taylor G J, Bagby R M, Parker J D. The Revised Toronto Alexithymia Scale: some reliability, validity, and normative data.  Psychotherapy & Psychosomatics. 1992;  57 34-41
    PubMedGoogle Scholar
  • 19 Taylor G J, Bagby R M, Ryan D P, Parker J D, Doody K F, Keefe P. Criterion validity of the Toronto Alexithymia Scale.  Psychosomatic Medicine. 1988;  50 500-509
    PubMedGoogle Scholar
  • 20 Bach M, Bach D, Serim M, Bohmer F. Validation of the German version of the 20-item Toronto Alexithymia Scale in normal persons and psychiatric patients.  Psychotherapie, Psychosomatik, medizinische Psychologie. 1996;  46 23-28
    PubMedGoogle Scholar
  • 21 Beck A T, Guth D, Steer R A, Ball R. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care.  Behaviour Research & Therapy. 1997;  35 785-791
    PubMedGoogle Scholar
  • 22 Watson D, Clark L A, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales.  Journal of Personality & Social Psychology. 1988;  54 1063-1070
    CrossrefPubMedGoogle Scholar
  • 23 Schneider F, Gur R C, Gur R E, Muenz L R. Standardized mood induction with happy and sad facial expressions.  Psychiatry Research. 1994;  51 19-31
    CrossrefPubMedGoogle Scholar
  • 24 Wienhard K, Dahlbom M, Eriksson L, Michel C, Bruckbauer T, Pietrzyk U, Heiss W D. The ECAT EXACT HR: performance of a new high resolution positron scanner.  Journal of Computer Assisted Tomography. 1994;  18 110-118
    PubMedGoogle Scholar
  • 25 Wienhard K, Eriksson L, Grootoonk S, Casey M, Pietrzyk U, Heiss W D. Performance evaluation of the positron scanner ECAT EXACT.  Journal of Computer Assisted Tomography. 1992;  16 804-813
    PubMedGoogle Scholar
  • 26 Quarles R P, Mintun M A, Larson K B, Markham J, MacLeod A M, Raichle M E. Measurement of regional cerebral blood flow with positron emission tomography: a comparison of [15O]water to [11C]butanol with distributed-parameter and compartmental models.   Journal of Cerebral Blood Flow & Metabolism. 1993;  13 733-747
    PubMedGoogle Scholar
  • 27 Friston K J, Ashburner J, Poline J B, Frith C D, Heather J D, Frackowiak R SJ. Spatial Registration and Normalization of Images.  Human Brain Mapping. 2000;  2 165-189
    PubMedGoogle Scholar
  • 28 Friston K J, Holmes A P, Worsley K J, Poline J P, Frith C D, Frackowiak R SJ. Statistical Parametric Maps in Functional Imaging: A General Linear Approach.  Human Brain Mapping. 2000;  2 189-210
    PubMedGoogle Scholar
  • 29 Talairach J, Tournoux P. Co-Planar Sterotaxic Atlas of the Human Brain. New York; Thieme Medical Publishers 1988
    Google Scholar
  • 30 Frackowiak R S, Lenzi G L, Jones T, Heather J D. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values.  Journal of Computer Assisted Tomography. 1980;  4 727-736
    PubMedGoogle Scholar
  • 31 Lane R D, Fink G R, Chau P M, Dolan R J. Neural activation during selective attention to subjective emotional responses.  Neuroreport. 1997;  8 3969-3972
    PubMedGoogle Scholar
  • 32 Reiman E M, Lane R D, Ahern G L, Schwartz G E, Davidson R J, Friston K J, Yun L S, Chen K. Neuroanatomical correlates of externally and internally generated human emotion.  American Journal of Psychiatry. 1997;  154 918-925
    PubMedGoogle Scholar
  • 33 Mesulam M M. From sensation to cognition.  Brain. 1998;  121 1013-1052
    CrossrefPubMedGoogle Scholar
  • 34 Maddock R J. The retrosplenial cortex and emotion: new insights from functional neuroimaging of the human brain.  Trends in Neurosciences. 1999;  22 310-316
    CrossrefPubMedGoogle Scholar
  • 35 Goldman-Rakic P S, Selemon L D, Schwartz M L. Dual pathways connecting the dorsolateral prefrontal cortex with the hippocampal formation and parahippocampal cortex in the rhesus monkey.  Neuroscience. 1984;  12 719-743
    CrossrefPubMedGoogle Scholar
  • 36 Smith C A. Dimensions of appraisal and physiological response in emotion.   Journal of Personality & Social Psychology. 1989;  56 339-353
    PubMedGoogle Scholar
  • 37 Devinsky O, Morrell M J, Vogt B A. Contributions of anterior cingulate cortex to behaviour.  Brain. 1995;  118 279-306
    CrossrefPubMedGoogle Scholar
  • 38 Lane R D, Reiman E M, Bradley M M, Lang P J, Ahern G L, Davidson R J, Schwartz G E. Neuroanatomical correlates of pleasant and unpleasant emotion.  Neuropsychologia. 1997;  35 1437-1444
    CrossrefPubMedGoogle Scholar
  • 39 Warburton E, Wise R J, Price C J, Weiller C, Hadar U, Ramsay S, Frackowiak R S. Noun and verb retrieval by normal subjects. Studies with PET.  Brain. 1996;  119 159-179
    CrossrefPubMedGoogle Scholar
  • 40 Goel V, Gold B, Kapur S, Houle S. The seats of reason? An imaging study of deductive and inductive reasoning.  Neuroreport. 1997;  8 1305-1310
    PubMedGoogle Scholar
  • 41 Kapur S, Craik F I, Jones C, Brown G M, Houle S, Tulving E. Functional role of the prefrontal cortex in retrieval of memories: a PET study.  Neuroreport. 1995;  6 1880-1884
    PubMedGoogle Scholar
  • 42 Kapur S, Rose R, Liddle P F, Zipursky R B, Brown G M, Stuss D, Houle S, Tulving E. The role of the left prefrontal cortex in verbal processing: semantic processing or willed action?.  Neuroreport. 1994;  5 2193-2196
    PubMedGoogle Scholar
  • 43 Cohen R. The neuropsychology of attention. New York; Plenum Press 1993
    Google Scholar
  • 44 Sierra M, Berrios G E. Depersonalization: neurobiological perspectives.  Biological Psychiatry. 1998;  44 898-908
    CrossrefPubMedGoogle Scholar
  • 45 Hauser M D. Perseveration, inhibition and the prefrontal cortex: a new look.  Current Opinion in Neurobiology. 1999;  9 214-222
    CrossrefPubMedGoogle Scholar
  • 46 Maguire E A, Frith C D, Burgess N, Donnett J G, O'Keefe J. Knowing where things are parahippocampal involvement in encoding object locations in virtual large-scale space.  Journal of Cognitive Neuroscience. 1998;  10 61-76
    CrossrefPubMedGoogle Scholar
  • 47 Milner B, Johnsrude I, Crane J. Right medial temporal-lobe contribution to object-location memory. Philosophical Transactions of the Royal Society of London - Series B.  Biological Sciences. 1997;  352 1469-1474
    PubMedGoogle Scholar
  • 48 Kapur N, Friston K J, Young A, Frith C D, Frackowiak R S. Activation of human hippocampal formation during memory for faces: a PET study.  Cortex. 1995;  31 99-108
    PubMedGoogle Scholar
  • 49 Sergent J, Ohta S, MacDonald B. Functional neuroanatomy of face and object processing. A positron emission tomography study.  Brain. 1992;  115 Pt 1 15-36
    PubMedGoogle Scholar
  • 50 Hemispheric .Communication - Mechanisms and Models Hillsdale. New Jersey; Lawrence Erlbaum Ass 1995
    Google Scholar
  • 51 Banich M T. The missing link: the role of interhemispheric interaction in attentional processing.  Brain & Cognition. 1998;  36 128-157
    PubMedGoogle Scholar
  • 52 Berlucchi G, Aglioti S, Marzi C A, Tassinari G. Corpus callosum and simple visuomotor integration.  Neuropsychologia. 1995;  33 923-936
    CrossrefPubMedGoogle Scholar
  • 53 Schuz A, Preissl H. Basic connectivity of the cerebral cortex and some considerations on the corpus callosum.  Neuroscience & Biobehavioral Reviews. 1996;  20 567-570
    CrossrefPubMedGoogle Scholar
  • 54 Robinson D L, Petersen S E. The pulvinar and visual salience.  Trends in Neurosciences. 1992;  15 127-132
    CrossrefPubMedGoogle Scholar
  • 55 Nathaniel-James D A, Fletcher P, Frith C D. The functional anatomy of verbal initiation and suppression using the Hayling Test.  Neuropsychologia. 1997;  35 559-566
    CrossrefPubMedGoogle Scholar
  • 56 Hagoort P, Indefrey P, Brown C, Herzog H, Steinmetz H, Seitz R J. The neural circuity involved in the reading of German words and pseudowords: A PET study.  Journal of Cognitive Neuroscience. 1999;  11 383-398
    CrossrefPubMedGoogle Scholar
  • 57 Gabrieli J D, Poldrack R A, Desmond J E. The role of left prefrontal cortex in language and memory.  Proceedings of the National Academy of Sciences of the United States of America. 1998;  95 906-913
    CrossrefPubMedGoogle Scholar
  • 58 Poldrack R A, Wagner A D, Prull M W, Desmond J E, Glover G H, Gabrieli J D. Functional specialization for semantic and phonological processing in the left inferior prefrontal cortex.  Neuroimage. 1999;  10 15-35
    CrossrefPubMedGoogle Scholar
  • 59 Howard D, Patterson K, Wise R, Brown W D, Friston K, Weiller C, Frackowiak R. The cortical localization of the lexicons. Positron emission tomography evidence.  Brain. 1992;  115 1769-1782
    PubMedGoogle Scholar
  • 60 Grabowski T J, Damasio H, Damasio A R. Premotor and prefrontal correlates of category-related lexical retrieval.  Neuroimage. 1998;  7 232-243
    CrossrefPubMedGoogle Scholar
  • 61 McGuire P K, Silbersweig D A, Murray R M, David A S, Frackowiak R S, Frith C D. Functional anatomy of inner speech and auditory verbal imagery.  Psychological Medicine. 1996;  26 29-38
    PubMedGoogle Scholar
  • 62 Lumley M A, Sielky K. Alexithymia, gender, and hemispheric functioning.  Compr Psychiatry. 2000;  41 (5) 352-359
    CrossrefPubMedGoogle Scholar
  • 63 Baker S C, Frith C D, Dolan R J. The interaction between mood and cognitive function studied with PET.  Psychological Medicine. 1997;  27 565-578
    CrossrefPubMedGoogle Scholar
  • 64 Bench C J, Frackowiak R S, Dolan R J. Changes in regional cerebral blood flow on recovery from depression.  Psychological Medicine. 1995;  25 247-261
    PubMedGoogle Scholar
  • 65 Elliott R, Baker S C, Rogers R D, O'Leary D A, Paykel E S, Frith C D, Dolan R J, Sahakian B J. Prefrontal dysfunction in depressed patients performing a complex planning task: a study using positron emission tomography.  Psychological Medicine. 1997;  27 931-942
    CrossrefPubMedGoogle Scholar
  • 66 Bench C J, Friston K J, Brown R G, Frackowiak R S, Dolan R J. Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions.  Psychological Medicine. 1993;  23 579-590
    CrossrefPubMedGoogle Scholar
  • 67 Dolan R J, Friston K J. Functional imaging and neuropsychiatry.  Psychological Medicine. 1997;  27 1241-1246
    CrossrefPubMedGoogle Scholar
  • 68 Parker J D, Bagby R M, Taylor G J. Alexithymia and depression: distinct or overlapping constructs?.  Comprehensive Psychiatry. 1991;  32 387-394
    CrossrefPubMedGoogle Scholar
  • 69 Wise T N, Mann L S, Randell P. The stability of alexithymia in depressed patients.  Psychopathology. 1995;  28 173-176
    PubMedGoogle Scholar
  • 70 Haviland M G, Hendryx M S, Cummings M A, Shaw D G, MacMurray J P. Multidimensionality and state dependency of alexithymia in recently sober alcoholics.  Journal of Nervous & Mental Disease. 1991;  179 284-290
    PubMedGoogle Scholar
  • 71 Hoppe K D. Hemispheric specialization and creativity.  Psychiatric Clinics of North America. 1988;  11 303-315
    PubMedGoogle Scholar
  • 72 Hoppe K D. Current alexithymia research. Critical comments on the „instrumentalizing” critique.  Psyche. 1989;  43 1029-1043
    PubMedGoogle Scholar
  • 73 Lane R D, Ahern G L, Schwartz G E, Kaszniak A W. Is alexithymia the emotional equivalent of blindsight?.  Biological Psychiatry. 1997;  42 834-844
    CrossrefPubMedGoogle Scholar
  • 74 Papciak A S, Feuerstein M, Belar C D, Pistone L. Alexithymia and pain in an outpatient behavioral medicine clinic.  International Journal of Psychiatry in Medicine. 1986;  16 347-357
    PubMedGoogle Scholar
  • 75 Lane R D, Quinlan D M, Schwartz G E, Walker P A, Zeitlin S B. The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion.  Journal of Personality Assessment. 1990;  55 124-134
    PubMedGoogle Scholar
  • 76 Papciak A S, Feuerstein M, Spiegel J A. Stress reactivity in alexithymia: decoupling of physiological and cognitive responses.  Journal of Human Stress. 1985;  11 135-142
    PubMedGoogle Scholar
  • 77 Todarello O, Taylor G J, Parker J D, Fanelli M. Alexithymia in essential hypertensive and psychiatric outpatients: a comparative study.  Journal of Psychosomatic Research. 1995;  39 987-994
    CrossrefPubMedGoogle Scholar
  • 78 Kentridge R W, Heywood C A, Weiskrantz L. Attention without awareness in blindsight.  Proceedings of the Royal Society of London - Series B: Biological Sciences. 1999;  266 1805-1811
    PubMedGoogle Scholar
  • 79 Berthoz S, Artiges E, Van De Moortele P F, Poline J B, Rouquette S, Consoli S M, Martinot J L. Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia.  Am J Psychiatry. 2002;  159 (6) 961-967
    CrossrefPubMedGoogle Scholar
  • 80 Salminen J K, Saarijarvi S, Aarela E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland.  Journal of Psychosomatic Research. 1999;  46 75-82
    CrossrefPubMedGoogle Scholar

Priv.-Doz. Dr. med. Michael Huber

Institut und Poliklinik für Psychosomatik und Psychotherapie der Universität zu Köln

50924 Köln

Email: Michael.Huber@Uni-Koeln.de