Alexithymia, Anxiety and Depression in Patients with Idiopathic Generalized Pruritus

Year 2019, , 648 - 657, 30.09.2019

Medine Gıynaş Ayhan , Zubeyde Tekin Kurku İbrahim Eren İbrahim Eren

https://doi.org/10.17098/amj.624491

Cited By: 1

Abstract

Objectives: Idiopathic
generalized pruritus (IGP) is a condition characterized by persistent and
generalized pruritus without clinical evidence of inflammation or skin diseases
in seemingly healthy skin. Our knowledge about IGP is insufficient as
relatively little research has been carried out on this disease. We aimed to
assess the prevalence of alexithymia and its association with anxiety and depression
in patients with IGP compared with control subjects.

Materials and Methods: The study
sample was formed by 35 patients with IGP and 40 control subjects. All the
participants were interviewed by using a semi-structured socio-demographic form
and all the modules of Structured Clinical Interview for DSM-IV (SCID-I).
Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI) and the
Beck Anxiety Inventory (BAI) were applied to the participants.

Results: Patients with IGP had
significantly higher TAS-20 score compared with controls. There was no
difference between two groups in terms of BDI and BAI scores. BDI score was
positive correlated with TAS-20 and DIF (difficulty in identifying feelings)
scores, while BAI score was positive correlated with TAS-20, DIF, DDF
(difficulty in describing feelings) and EOT (externally oriented thinking) as
well.

Conclusion: The alexithymia
prevalence was higher in patients with IGP than that in control subjects, while
it was positively correlated with anxiety and depression scores in IGP group.
Although larger studies are required, alexithymia and its relationship with
depression and anxiety should be taken into consideration while evaluating the
patients with IGP.

Keywords

Alexithymia, anxiety, depression, pruritis

İdiyopatik Jeneralize Pruritus Hastalarında Aleksitimi, Anksiyete ve Depresyon

Abstract

Amaç: İdiopatik
jeneralize pruritus (IGP), sağlıklı görünen ciltte klinik olarak inflamasyon
veya cilt hastalığı olmaksızın persistan ve jeneralize kaşıntı ile karakterize
bir durumdur. IGP hakkında nispeten az sayıda araştırma yapıldığından
hakkındaki bilgimiz yetersizdir. Bu çalışmada IGP tanılı hastalarda kontrol
grubu ile karşılaştırılarak aleksitiminin yaygınlığını ve anksiyete ve
depresyonla ilişkisini değerlendirmeyi amaçladık

Materyal ve Metot: Çalışmaya 35 IGP
tanılı hasta ile 40 sağlıklı kontrol dahil edildi. Tüm katılımcılar DSM-IV’e
göre yapılandırılmış klinik görüşme (SCID-I) ve yarı-yapılandırılmış
sosyodemografik form kullanılarak değerlendirildi. Katılımcıların Toronto
Aleksitimi Ölçeği (TAS-20), Beck Depresyon Ölçeği (BDI) ve Beck Anksiyete Ölçeği
(BAI) doldurmaları sağlandı.

Bulgular: IGP tanılı hastalarda
kontrol grubuna göre anlamlı olarak yüksek TAS-20 skoru olduğu bulundu. Gruplar
arasında BDI ve BAI skorları yönünden fark yoktu. BDI skoru ile TAS-20 ve DIF
(duyguları tanıma zorluğu) arasında pozitif korelasyon gözlendi. BAI skoru ile
TAS-20, DIF, DDF (duyguları ifade zorluğu) ve EOT (dışa-dönük düşünce) arasında
pozitif korelasyon saptandı.

Sonuç: IGP tanılı hastalarda
aleksitiminin prevalansı kontrol grubunda yüksektir ve anksiyete ve depresyonla
arasında pozitif korelasyon mevcuttur. Her ne kadar daha kapsamlı çalışmalara
ihtiyaç varsa da, IGP tanılı hastalar değerlendirilirken aleksitimi ve
aleksitiminin depresyon ve anksiyete ile ilişkisi göz önünde bulundurulmalıdır.

Keywords

Aleksitimi, anksiyete, depresyon, pruritus

References

• T-J Goon A, Yosipovitch G, Chan YH, Goh CL. Clinical characteristics of generalized idiopathic pruritus in patients from a tertiary referral center in Singapore. Int J Dermatol 2007;46:1023-6.
• Afifi Y, Aubin F, Puzenat E, et al. Pruritus sine materia: a prospective study of 95 patients. Rev Med Interne 2004;25:490-3.
• Zirwas MJ, Seraly MP. Pruritus of unknown origin: a retrospective study. J Am Acad Dermatol 2001;45:892-6.
• Sifneos PE. The prevalence of 'alexithymic' characteristics in psychosomatic patients. PsychotherPsychosom 1973;22:255-62.
• Picardi A, Porcelli P, Mazzotti E et al. Alexithymia and global psychosocial functioning: a study on patients with skin disease. J Psychosom Res. 2007;62:223-9.
• Willemsen R, Roseeuw D, Vanderlinden J. Alexithymia and dermatology: the state of art. Int J Dermatol 2008;47:903-10.
• Ghiggia A, Romeo A, Tesio V et al. Alexithymia and depression in patients with fibromyalgia: When the whole is greater than the sum of its parts. Psychiatr Res 2017;255:195-7.
• Shibata M, Ninomiya T, Jensen MP et al. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PloS one 2014;9:e90984.
• Poot F, Sampogna F, Onnis L. Basic knowledge in psychodermatology.J EurAcadDermatolVenereol 2007;21:227-34.
• Taylor GJ, Bagby RM, Parker JDA. Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge Univ. Press; 1997:67-137.
• Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol 2003;4:833-42.
• Picardi A, Abeni D. Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom 2001;70:118-36.
• Giovannelli L, Barbasio C, Burroni AG, Fassino M, Parodi A, Granieri A. Alexithymia, dissociation, and trauma in patients with chronic skin conditions. Giornaleitaliano di dermatologia e venereologia: organoufficiale, Societaitaliana di dermatologia e sifilografia 2016;151:347-52.
• Allegranti I, Gon T, Magaton-Rizzi G, et al. Prevalence of alexithymic characteristics in psoriatic patients. Acta Derm Venereol Suppl (Stockh) 1994;186:146-7.
• Sellami R, Masmoudi J, Ouali U et al. The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study. Indian J Dermatol 2014;59:421.
• DiTella M, Ghiggia A, Tesio V et al. Painexperience in FibromyalgiaSyndrome: The role of alexithymiaandpsychologicaldistress. JAffectDisord. 2017;208:87-93.
• Sheehan-Dare RA, Henderson MJ, Cotterill JA. Anxiety and depression in patients with chronic urticaria and generalized pruritus. Br J Dermatol 1990;123:769-74.
• Yosipovitch G, David M. The diagnostic and therapeutic approach to idiopathic generalized pruritus. Int J Dermatol 1999;38:881-7.
• Baron R, Schwarz K, Kleinert A, Schattschneider J, Wasner G. Histamine-induced itch converts into pain in neuropathic hyperalgesia. Neuroreport 2001;12:3475-8.
• Yosipovitch G, Carstens E, McGlone F. Chronic itch and chronic pain: analogous mechanisms. Pain 2007;131:4-7.
• Psouni EE. On psychological factors affecting reports on itch perception. In: Yosipovitch G, Greaves MW, Fleischer AB, McGlone F, editors. Itch basic mechanisms and therapy. New York: Marcel Dekker Inc.; 2004:351-66.
• Tesio V, Di Tella M, Ghiggia A et al. Alexithymia and Depression Affect Quality of Life in Patients with Chronic Pain: A Study on 205 Patients With Fibromyalgia. Front Psychol 2018;9:442.
• Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res. 2002;53:823-30.
• Kantor GR, Bernhard JD. Investigation of the pruritic patient in daily practice. SeminDermatol 1995;14:290-6.
• Bagby RM, arker JD, Taylor GJ.The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23-32.
• Güleç H, Köse S, Güleç MY et al. Reliability and Factorial Validity of the Turkish Version of the 20-Item Toronto Alexithymia Scale (TAS-20). Klinik Psikofarmakoloji Bülteni 2009;19:213-9.
• Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
• Hisli N. A study on the validity of Beck Depression Inventory. Turk J Psycho 1988;6:118-22. Beck AT, Epstein N, Brown G et al. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol 1988;56:893-7.
• Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cognitive Psychother 1998;12:163-72.
• Korkoliakou P, Christodoulou C, Kouris A et al. Alexithymia, anxiety and depression in patients with psoriasis: a case control study. Ann Gen Psychiatry 2014;13:38.
• Yosipovitch G, Samuel LS: Neuropathic and psychogenic itch. Dermatol Ther 2008;21:32-42.
• Laurent A, Boucharlat J, Bosson JL, Derry A, Imbert R. Psychological assessment of patients with idiopathic pruritus ani. Psychother Psychosom 1997;66:163-6.
• Heisig M, Reich A, Szepietowski JC. Alexithymia in Uraemic Pruritus. Acta Derm Venereol 2016;96:699-700.
• Salminken JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland.J Psychosom Res 1999;46:75-82.
• Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res 2000;48:99-104.
• Honkalampi K, Saarinen P, Hintikka J, Virtanen V, Viinamäki H. Factors associated with alexithymia in patients suffering from depression. Psychother Psychosom 1999;68:270-5.
• Fortune DG, Richards HL, Griffiths CE, Main CJ. Psychological stress, distress and disability in patients with psoriasis: consensus and variation in the contribution of illness perceptions, coping and alexithymia. Br J Clin Psychol 2002;41:157-74.
• Arnold LM, Auchenbach MB, McElroy SL. Psychogenic Excoriation. Clinical Features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 2001;15:351-9.