| 其他摘要 | Alexithymia, also known as "inability to express emotions disorder", is a type of affective cognitive disorder in which patients have difficulty recognizing and describing feelings, distinguishing feelings between emotional arousal and body. Alexithymia has been regarded as one of the risk factors for physical and mental problems. The incidence of alexithymia is much higher in schizophrenia than in healthy individuals, which affects their clinical symptoms and quality of life. Interoception refers to the process by which the nervous system perceives, interprets and integrates signals within the body which is a real-time mapping of the internal state of the body at the conscious and unconscious levels. According to the three-dimensional model of interoception, interoception can be divided into interoceptive accuracy, interoceptive sensibility and interoceptive awareness. Studies have indicated that there exists unique relationship between interoception and alexithymia in schizophrenia, but no studies have systematically examined the effect of interoceptive on alexithymia in this population and the differences in the role of different dimensions of interoceptive. In addition, the
psychological mechanism of interoception influence on alexithymia has not been explored. Based on the current research status, this study aims to explore the influence of interoceptive perception on alexithymia in schizophrenia, a group with a high incidence of alexithymia, and the underlying psychological and neural mechanisms from the behavioral and brain mechanisms.
The study consists of three sub-studies. Study 1 aimed to explore the relationships between interoception and alexithymia. In this study, 201 schizophrenia patients were recruited, scores of alexithymia, three dimensions of interoception and clinical were measured by questionnaires and heartbeat task. Study 2 aimed to test the mediation role of emotion recognition between interoception and alexithymia, which used emotion recognition task based on heartbeat cycle in 21 schizophrenia patients. In Study 3, a total of 28 patients with schizophrenia were selected to investigate the brain activation differences between low alexithymia patients and high alexithymia patients during interoception task.
Results of Study 1 showed that the prevalence of alexithymia in schizophrenia was 34.17%. Compared with low alexithymia patients, high alexithymia patients showed significant decreases in interoceptive sensibility, interoceptive accuracy and interoceptive awareness. The three domains negatively predicted the occurrence of alexithymia. Results of Study 2 showed that, compared with low alexithymia patients, high alexithymia patients had lower sensibility to emotional faces, needed more intensity to recognize specific emotions, and the accuracy was decreased. At high morph level, systolic emotion recognition was better than diastolic emotion recognition, systolic emotion sensibility was stronger, and the accuracy was higher. Furthermore, there were interactions between alexithymia and heartbeat cycles in high morph levels.
Systolic emotion recognition was superior to diastolic emotion recognition in patients with low alexithymia patients, while there were no differences in high alexithymia patients. Due to the impaired interoception, the promoting effect of emotion recognition during systole is reduced, resulting in the defect of emotion recognition ability, the impaired emotion recognition ability further leaded to the occurrence of alexithymia. Results of Study 3 showed that the main brain regions activated in schizophrenia patients during the interoceptive task were bilateral middle temporal gyros, bilateral superior temporal gyros, bilateral insula and right middle frontal gyros. The activation in bilateral insula higher in low alexithymia patients than high alexithymia patients. Further, correlation analysis showed that activations in bilateral insula was negatively correlated with the total score of the alexithymia scale and subscale.
These results suggested that: (1) The prevalence of alexithymia in patients with schizophrenia was 34.17%. Interoceptive sensibility, interoceptive accuracy and interoceptive awareness negatively predicted the occurrence of interoception; (2) Interoceptive deficits decreased the promoting effect of cardiac systolic on emotion recognition in high alexithymia patients, which further leads to the occurrence of alexithymia. (3) The decreased activity of bilateral insular cortex in interoceptive task is the neural mechanism of alexithymia in patients with schizophrenia. This study explores the mental and neural mechanism underlying the relationships between interoception and alexithymia in schizophrenia. On the one hand, it is helpful to better understand the pathogenesis of alexithymia, and clarify the relationship between emotion recognition and the corresponding feelings and interoceptive feelings. On the other hand, it can also provide objective scientific enlightenment for clinical intervention in schizophrenia with alexithymia. |
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