Somatization Symptoms or Interferon-Related Adverse Events? Alexithymia and Somatization in Somatic Symptom Reporting of Patients with Chronic Hepatitis C

Porcelli, Piero; Cozzolongo, Raffaele; Lanzilotta, Elsa; Giannuzzi, Vito; Leandro, Gioacchino

doi:10.1159/000360821

Cited by 8 publications

(11 citation statements)

References 10 publications

(11 reference statements)

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“…Differently from previous studies on FGID and IBD, 8 of the 10 included studies evaluating alexithymia in hepatology had a follow-up study design (Fukunishi et al, 2002 , 2003 ; Nardelli et al, 2013 ; Palmieri et al, 2013 ; Porcelli et al, 2014a , 2015 ; Cozzolongo et al, 2015 ; Murri et al, 2017 ). Research investigations focused more on the role that alexithymia might play in the course of disease and medical treatment rather that its prevalence.…”

Section: Resultsmentioning

confidence: 99%

“…However, they are generally neglected by both physicians (because considered as expected side effects of therapy) and clinical psychologists (because considered as biological-driven symptoms), thereby perpetuating the organic-functional dualism (Sirri et al, 2013 ; Carrozzino et al, 2017 ; Fava et al, 2017 ). Evidence however showed that psychological constructs such as proneness to somatization and higher depressive symptoms may explain not only poorer psychosocial functioning, but also higher perception and the reporting of somatic side effects (Porcelli et al, 2014a ; Cozzolongo et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Alexithymia in Gastroenterology and Hepatology: A Systematic Review

Carrozzino

Porcelli

2018

Front. Psychol.

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Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation.Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies.Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10–15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings.Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Alexithymia in Gastroenterology and Hepatology: A Systematic Review

Carrozzino

Porcelli

2018

Front. Psychol.

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“…There is evidence that 5-HT-related genetic factors are involved in IFN-induced depression in HCV patients [7] and interact with depression to explain alexithymia [8]. Furthermore, alexithymia contributes substantially to a greater rate of somatic IFN-related side effects in HCV patients [9]. This study aimed to replicate previous findings regarding the association between alexithymia and 5-HT-related gene polymorphisms [4,5] and, for the first time to our knowledge, to investigate longitudinally whether genetic factors (5-HTTLPR and HTR1A) and alexithymia may contribute to vulnerability to depression during IFN treatment in HCV patients.…”

Section: Introductionmentioning

confidence: 99%

Genetic Associations of Alexithymia in Predicting Interferon-Induced Depression in Chronic Hepatitis C

Porcelli

Cozzolongo

Cariola³

et al. 2015

Psychopathology

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Background: Previous studies have shown that alexithymia is associated with gene polymorphisms that regulate the availability of serotonin (5-HT) in the brain. Since the 5-HT network is involved in interferon (IFN)-induced depression, this paper aimed to investigate the role of alexithymia and the functional gene variants of the 5-HT1A receptor (HTR1A) and the 5-HT transporter (5-HTTLPR) in induction of depression during antiviral treatment. Methods: The depressive symptoms of 130 consecutive patients with chronic hepatitis C and no current psychopathology were measured during treatment with IFN and ribavirin (6-12 months) and at a 6-month follow-up. At baseline, alexithymia and 2 genotypes (5-HTTLPR and HTR1A) were also assessed. Results: Patients with homozygosity for HTR1A-G and 5-HTTLPR long alleles had significantly higher levels of alexithymia. After controlling for sociodemographic and disease-related factors, alexithymia and HTR1A-G polymorphism, both separately (20-22%) and jointly (14-16%), significantly and independently predicted the development of IFN-induced depression. Conclusions: Subjects carrying HTR1A-G and 5-HTTLRP double long alleles are more vulnerable to alexithymia. Also patients with a higher level of alexithymia and the HTR1A-G gene variant are more vulnerable to experiencing IFN-induced depressive symptoms. The clinical implications of targeting alexithymia and HTR1A receptors as a possible treatment option for mood disorders should be investigated in further studies.

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“…Thus, the main goal of interferon-α (IFN-α) therapy in patients with chronic HCV infection is viral eradication shown by a sustained virological response [1,2,3]. The two new useful Letters to the Editor from Mahajan et al [4] and Porcelli et al [5] are valuable contributions to the existing literature about IFN-α-induced psychiatric side effects. Mahajan et al [4] evaluated the high incidence of depression in patients receiving a combination therapy of pegylated IFN-α and ribavirin.…”

Section: Disclosure Statementmentioning

confidence: 99%

“…Mahajan et al [4] evaluated the high incidence of depression in patients receiving a combination therapy of pegylated IFN-α and ribavirin. Porcelli et al [5] highlighted for the first time the role of alexithymia and the tendency of somatization as relevant contributing factors for impaired mental health in patients with chronic HCV infection receiving IFN-α therapy. The authors succeeded in demonstrating that not only direct IFN-α-related biological pathways but also psychological variables provoke mental illness and impaired health-related quality of life in patients with chronic HCV infection.…”

Section: Disclosure Statementmentioning

confidence: 99%