title: Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV.
abstract: The neuropathological changes resulting from Human Immunodeficiency Virus (HIV) infection may manifest in alexithymia (AL), a multidimensional trait characterized by impairments in the cognitive assimilation of feelings and emotions. A sample of 93 HIV survivors scoring high, i.e., ⩾74 on the 26-item Toronto Alexithymia Scale (TAS-26), were compared to 79 low AL (TAS-26⩽54) survivors on measures of neurocognitive, psychological, neuroendocrine and immune function. Neurocognitive function was evinced by a standardized test of psychomotor speed, cognitive flexibility and task switching ability, HIV Dementia and general cognitive status. Patients were also screened for levels of depression, anxiety and psychological stress. A 24-h urinary norepinephrine (NE) and cortisol (CORT) collection was taken; blood was drawn for T lymphocyte subset counts (CD4+CD3+) and HIV-1 viral load. Alexithymic patients exhibited higher levels of executive dysfunction, psychological distress, norepinephrine-to-cortisol (NE/CORT) ratio and viral load. Linear regression models accounting for sociodemographic and disease-related variables revealed two AL subscales, difficulties identifying and describing feelings, predicted and explained a significant proportion of variance in the outcome measures. Specifically, poorer executive task-switching/cognitive flexibility was associated with greater difficulty describing feelings; dysregulated autonomic response (high NE/CORT ratio) and depressive symptoms were predicted by difficulty identifying feelings; higher levels of anxiety and psychological stress were both predicted by greater difficulty describing and identifying feelings. Overall, the psychoneuroimmunological profile of alexithymia in HIV positive persons at mid-stage of infection suggests a greater vulnerability for disease progression.
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, USA. Electronic address: rmcintosh@psy.miami.edu.
authors.forename: Roger C
authors.initials: RC
authors.lastname: McIntosh
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Immunology and Psychology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000209:etiology / Q000276:immunology* / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology / Q000652:urine; D005260:Female; D015658:HIV Infections / Q000150:complications*; D020276:HIV Long-Term Survivors / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D009483:Neuropsychological Tests; D009638:Norepinephrine / Q000652:urine; D013315:Stress, Psychological / Q000276:immunology; D013601:T-Lymphocytes / Q000378:metabolism
chemical_list: D006854:Hydrocortisone; D009638:Norepinephrine
keywords: Alexithymia; Cortisol; Depression; Executive function; HIV/AIDS; Norepinephrine; Stress; Viral load