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

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
• 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
• 3 Lane R D, Sechrest L, Riedel R. Sociodemographic correlates of alexithymia.  Comprehensive Psychiatry. 1998;  39 377-385
• 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
• 5 Hoppe K D, Bogen J E. Alexithymia in twelve commissurotomized patients.  Psychotherapy & Psychosomatics. 1977;  28 148-155
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 15 Bagby R M, Taylor G J, Parker J D. Construct validity of the Toronto Alexithymia Scale.  Psychotherapy & Psychosomatics. 1988;  50 29-34
• 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
• 17 Parker J D, Taylor G J, Bagby R M, Thomas S. Problems with measuring alexithymia.  Psychosomatics. 1991;  32 196-202
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 29 Talairach J, Tournoux P. Co-Planar Sterotaxic Atlas of the Human Brain. New York; Thieme Medical Publishers 1988
• 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
• 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
• 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
• 33 Mesulam M M. From sensation to cognition.  Brain. 1998;  121 1013-1052
• 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
• 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
• 36 Smith C A. Dimensions of appraisal and physiological response in emotion.   Journal of Personality & Social Psychology. 1989;  56 339-353
• 37 Devinsky O, Morrell M J, Vogt B A. Contributions of anterior cingulate cortex to behaviour.  Brain. 1995;  118 279-306
• 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
• 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
• 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
• 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
• 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
• 43 Cohen R. The neuropsychology of attention. New York; Plenum Press 1993
• 44 Sierra M, Berrios G E. Depersonalization: neurobiological perspectives.  Biological Psychiatry. 1998;  44 898-908
• 45 Hauser M D. Perseveration, inhibition and the prefrontal cortex: a new look.  Current Opinion in Neurobiology. 1999;  9 214-222
• 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
• 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
• 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
• 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
• 50 Hemispheric .Communication - Mechanisms and Models Hillsdale. New Jersey; Lawrence Erlbaum Ass 1995
• 51 Banich M T. The missing link: the role of interhemispheric interaction in attentional processing.  Brain & Cognition. 1998;  36 128-157
• 52 Berlucchi G, Aglioti S, Marzi C A, Tassinari G. Corpus callosum and simple visuomotor integration.  Neuropsychologia. 1995;  33 923-936
• 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
• 54 Robinson D L, Petersen S E. The pulvinar and visual salience.  Trends in Neurosciences. 1992;  15 127-132
• 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
• 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
• 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
• 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
• 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
• 60 Grabowski T J, Damasio H, Damasio A R. Premotor and prefrontal correlates of category-related lexical retrieval.  Neuroimage. 1998;  7 232-243
• 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
• 62 Lumley M A, Sielky K. Alexithymia, gender, and hemispheric functioning.  Compr Psychiatry. 2000;  41 (5) 352-359
• 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
• 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
• 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
• 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
• 67 Dolan R J, Friston K J. Functional imaging and neuropsychiatry.  Psychological Medicine. 1997;  27 1241-1246
• 68 Parker J D, Bagby R M, Taylor G J. Alexithymia and depression: distinct or overlapping constructs?.  Comprehensive Psychiatry. 1991;  32 387-394
• 69 Wise T N, Mann L S, Randell P. The stability of alexithymia in depressed patients.  Psychopathology. 1995;  28 173-176
• 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
• 71 Hoppe K D. Hemispheric specialization and creativity.  Psychiatric Clinics of North America. 1988;  11 303-315
• 72 Hoppe K D. Current alexithymia research. Critical comments on the „instrumentalizing” critique.  Psyche. 1989;  43 1029-1043
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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