P.2.h.024 Sensory processing patterns and their relation with impulsivity, alexithymia, depression, and hopelessness in major affective disorders

Gianluca Serafini1*, Batya Engel-Yeger2, Xenia Gonda3, Sara Costi4, Maurizio Pompili5, Zoltan Rihmer3, Paolo Girardi5, Mario Amore1

1 Section of Psychiatry, University of Genoa, Dept. of Neuroscience DINOGMI, Genoa, Italy; e.mail: [email protected];

2 Faculty of Social Welfare and Health Sciences, University of Haifa, Occupational Therapy, Haifa, Israel; 3 Kutvolgyi Clinical Center, Semmelweis University, Clinical and Theoretical Mental Health, Budapest, Hungary;

4 Icahn School of Medicine at Mount Sinai, New York, Psychiatry, Mood and Anxiety Disorders Program, New York, USA;

5 Sant’Andrea Hospital, Sapienza University of Rome, Dept. of Neurosciences, Rome, Italy.

Background Table 2. Predicting depression, alexithymia, impulsivity, and hopelessness Several studies suggested the role of sensory perception in emotional deficits of by sensory processing abilities higher-order processes [1]. Sensory processing disorders (SPDs) encompass Model 1 Model 2 Model 3 difficulties in registering/modulating sensory information and organizing sensory Variable B SE B β B SE B β B SE B β input to carry out adaptive responses to situational demands and may lead to BDI total scores maladaptive behaviors and impaired functioning [2]. SPDs have been proposed Low registration .62 .07 .47*** .38 .09 .29*** .41 .09 .31*** Sensitivity .31 .08 .26 .32 .08 .28*** as factors able to characterize individuals with major affective disorders. Seeking -.19 .07 -.15** Furthermore, impulsivity may be considered as a stable behavioral trait in clinical R2 22 26 27 F for change in R2 78.37*** 13.78*** 7.44** populations and it is frequently associated with psychiatric conditions [3]. SPDs 1,276 BIS total scores and impulsivity may also be associated with other stable factors which may Low registration .51 .11 .38*** impair emotional functioning such as alexithymia linked to a heterogeneous R2 15 F for change in R2 21.06*** range of sensory modulation related to either hypo- or hypersensitivity. 1,123 TAS-20 total scores Low registration .48 .09 .36*** Given this background, the present study aimed to: (1) examine the correlations R2 36 2 between SPDs, impulsivity, alexithymia, depression and hopelessness; (2) F 1,211 for change in R 31.11*** explore whether SPDs might predict depression level, alexithymia, impulsivity, BHS Low registration .05 .02 .15** and hopelessness; (3) investigate the relative contribution of SPDs, depression, R2 3 alexithymia, and impulsivity in predicting hopelessness. F 1,269 for change in R2 8.16** Note: ** p≤.01; *** p≤.001 Methods First, a lower registration of sensory input (e.g., hyposensitivity) and Our sample included 281 currently euthymic affective disorder patients of which hypersensitivity (expressed by either sensory sensitivity and sensation 175 diagnosed with unipolar and 106 with bipolar disorder with an age ranging avoidance) correlated with greater depression. A low registration of sensory from 18 to 65 years (mean=47.4±12.1). Overall, 63.1% of subjects were input characterized by the impaired ability to detect stimuli that others may diagnosed with unipolar major depressive disorder (MDD), 16.2% with bipolar perceive/detect may contribute to the emergence of depressive symptoms disorder type I (BD-I), and 20.7% type II (BD-II). as we found in another of our recently published study [4]. The results of our multivariate analyses indicated the complex involvement of SPDs in the Participants completed the Adolescent/Adult Sensory Profile (AASP), The emergence of depression. Toronto Alexithymia Scale (TAS-20), the second version of the Beck Depression Another significant correlation was also found between lower registration of Inventory (BDI-II), Barratt Impulsiveness Scale (BIS), and Beck Hopelessness sensory input, higher sensory sensitivity/sensation avoidance, and greater Scale (BHS). All analyses were performed using SPSS version 20.0. attentional/motor impulsivity, as well as between elevated sensory seeking, higher motor impulsivity, and lower non-planning impulsivity. Impulsivity has Results been previously related to different behavioral patterns including lack of concentration, disinhibition, lack of future planning, sensation seeking, and Correlations between SPDs, depression, impulsivity, alexithymia, and risk-taking behaviors [5]. Unfortunately, there are no studies in humans that hopelessness directly investigated the nature of the relationship between sensory Lower registration of sensory input significantly and moderately correlated with processing patterns and the component factors of impulsiveness. elevated depression (r=.464, p≤.001), greater impulsivity (r=.382, p≤.001), both Finally, specific sensory processing patterns may be differently associated attentional (r=.430, p≤.001) and motor impulsivity (r=.415, p≤.001), and higher with alexithymia, in particular with difficulties to describe/identify feeling. alexithymia (r=.358, p≤.001), specifically the abilities to describe and identify This is the case of our findings in which we found that both reduced feeling (r=.446, p≤.0001). responsiveness and registration of input as well as sensory seeking Elevated sensory seeking significantly but weakly correlated with elevated behaviors correlated with difficulties to describe/identify feelings among motor impulsivity (r=.224, p≤.05), and lower impulsivity expressed in non- subjects with higher alexithymia. planning (r=-.313, p≤.001). Higher sensory sensitivity and sensation avoiding significantly correlated with greater depression (r=.454, p≤.001 and r=.362, p≤.001, respectively), greater Limitations and strengths impulsivity total scores (r=.282, p≤.001 and r=.213, p≤.01, respectively), The present study should be considered in the light of the following attentional impulsivity (r=.422, p≤.001 and r=.275, p≤.001, respectively), motor limitations/shortcomings. First, the study is limited by the relatively small impulsivity (r=.272, p≤.001 and r=.314, p≤.001, respectively), and higher sample size of participants as well as the cross-sectional nature of this study alexitymia, specifically abilities to describe and identify feeling (r=.289, p≤.001) that do not allow the generalization of the main findings. These results (r=.222, p≤.001) (see Table 1). should be considered preliminary given the exploratory nature of the analyses. Furthermore, our sample comprised a specific population of Table 1. SPDs, depression, impulsivity, alexithymia, and hopelessness correlations outpatients with major affective disorders and this may increase referral bias. In addition, we used only self-report measures that may be potentially Psychometric Low Sensation Sensory Sensation biased by social desirability. Finally, we did not analyze the possible questionnaires Registration Seeking Sensitivity Avoiding confounding effect of psychoactive medications which have been BDI-II .464*** NS .454*** .362*** administered to the outpatients of our sample. TAS-20 .358*** NS .289*** .222***

.382*** NS .282*** .213 Conclusions BIS total scores

BIS attentional .430*** NS .422*** .275** Individuals with major affective disorders may suffer from consistent difficulties in processing sensory input which may have been significantly BIS motor .415*** .224 .272** .314*** linked with higher depression, impulsivity, alexithymia, and hopelessness. BIS non-planning NS -.313*** NS NS Notable, these preliminary findings need to be further explored and replicated in order to develop targeted treatment interventions and improve BHS hopelessness NS NS NS NS subjective adaptive strategies together with functional behaviors. *** p≤.001; NS=not significant Predicting depression, alexithymia, impulsivity, hopelessness by SPDs References Lower ability to register sensory input accounted for 22% of the variance of the depression. Sensory sensitivity added 4% to this prediction while greater [1] Van Rheenen TE, Rossell SL. Auditory-prosodic processing in bipolar tendency to seek sensation predicted lower depression. Lower ability to disorder; from sensory perception to emotion. J Affect Disord. register sensory input accounted for 15% of the variance in greater impulsivity, 2013;151:1102-7. 36% of the variance in alexithymia, and 3% of the variance in hopelessness. [2] Miller LJ, Anzalone ME, Lane SJ, Cermak SA, Osten ET. Concept evolution in sensory integration: a proposed nosology for diagnosis. Am J Predicting hopelessness by sensory processing abilities, depression, Occup Ther. 2007;61:135-40. alexithymia and impulsivity [3] Moeller, F.G., Barratt, E.S., Dougherty, D.M., Schmitz, J.M., Swann, A.C., Lower ability to register sensory input accounted for 3% of the variance in 2001. Psychiatric aspects of impulsivity. The American Journal of Psychiatry hopelessness. Depression level accounted for 22% of the variance in BHS 158, 1783–1793. score of 9 or higher. [4] Engel-Yeger, B., Muzio, C., Rinosi, G., Solano, P., Geoffroy, P.A., Pompili, M., Amore, M., Serafini, G., 2016. Extreme sensory processing patterns and Discussion their relation with clinical conditions among individuals with major affective disorders. Psychiatry Research 236, 112-118. This is, to the best of our knowledge, the first study evaluating the association [5] Evenden, J.L., 1999. Varieties of impulsivity. Psychopharmacology 146, between SPDs, alexithymia, depression, and hopelessness. We identified a 348–361. characteristic pattern of association indicating the involvement of both hyper- and hyposensitivity that may shed new light on the etiological role and The authors declare no potential conflicts of interest mechanisms of these factors in the emergence of affective disorders. Poster presented at 29th ECNP Congress, Vienna, Austria, 17-20 September, 2016