title: Salivary cortisol response after a medical interview: the impact of physician communication behaviour, depressed affect and alexithymia.
abstract: OBJECTIVE
  To explore if - and possibly how - a medical interview may affect adrenocortical activity in musculo-skeletal pain patients with and without alexithymia.
  
  
  METHODS
  Female patients (N = 54) recruited from a patient organization for fibromyalgia completed the Toronto Alexithymia Scale (TAS-20) and subgroups with, respectively, low and high scores were selected for participation. Seven physicians conducted consultations attempting to vary their communication in accordance with given guidelines. All consultations were videotaped and analysed by The Roter Interaction Analysis System (RIAS) to evaluate the actual content of the consultations.
  
  
  RESULTS
  An increase in depressed affect from pre- to post-interview was associated with relatively high cortisol levels 24 h after the consultation, but only in patients with alexithymia. Psychosocial questions from the physician were associated with increased depressed affect immediately following the interview, but not with cortisol responses at any time.
  
  
  CONCLUSIONS
  In patients with deficient affect regulation, increase in depressed affect after a medical interview may be associated with delayed effects in adrenocortical activity, possibly mediated by rumination.
  
  
  CONCLUSIONS
  Providers should be sensitive to potential deficits of affect regulation in their patients.
authors.affiliation: Department of Behavioural Sciences, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Arnstein
authors.initials: A
authors.lastname: Finset
authors.forename: Peter Kjaer
authors.initials: PK
authors.lastname: Graugaard
authors.forename: Kjersti
authors.initials: K
authors.lastname: Holgersen
mesh_terms: D000342:Affective Symptoms / Q000523:psychology*; D000704:Analysis of Variance; D003142:Communication; D003863:Depression / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008875:Middle Aged; D009664:Norway; D010817:Physician-Patient Relations; D012463:Saliva
chemical_list: D006854:Hydrocortisone