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. 2023 Dec 15:14:1252763.
doi: 10.3389/fpsyt.2023.1252763. eCollection 2023.

Alexithymia is associated with insomnia in Chinese patients with schizophrenia

Fangfang Cai #  1 , Huixia Jiang #  1 , Siyu Tong #  1 , Siyao Zhou  1 , Mengpu Wang  1 , Shiyu Sun  1 , Jie Liu  1 , Yao Xu  1 , Nankai Lin  1 , Jiajing Dai  1 , Xinyao Wang  2 , Wei Wang  1   3 , Ke Zhao  4   5 , Xixi Wu  6
Affiliations

Alexithymia is associated with insomnia in Chinese patients with schizophrenia

Fangfang Cai et al. Front Psychiatry. .

Abstract

Background: Sleep disorders are prevalent among patients with schizophrenia and are associated with several negative consequences. Although, researchers have recently suggested that sleep disorders have a close correlation with alexithymia, and schizophrenia also has a strong correlation with alexithymia, there have been few studies on the relationships between schizophrenia, sleep disorders and alexithymia. Therefore, this study aimed to explore the relationships between psychiatric symptoms, alexithymia and sleep problems in patients with schizophrenia so as to provide a reference for the clinical treatment of this comorbidity.

Methods: In total, 977 patients with schizophrenia were recruited for this study. The Insomnia Severity Index (ISI) was used to assess sleep disorders, and the Positive and Negative Syndrome Scale (PANSS), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Toronto Alexithymia Scale (TAS) were used to evaluate clinical symptoms, cognitive functions and the ability to express emotion, respectively.

Results: The results indicated that the PANSS subscales (G-subscore) and TAS group were risk factors for insomnia in schizophrenia patients (all p < 0.05). The mediation model showed the standardized path coefficients from schizophrenia to alexithymia (β = 0.104, p < 0.001) and from alexithymia to insomnia (β = 0.038, p < 0.001) were statistically significant.

Conclusion: The results of this study indicated that alexithymia is associated with sleep disturbance in patients with schizophrenia. These findings may provide a new avenue for the treatment of schizophrenia patients with sleep disorders.

Keywords: alexithymia; insomnia; negative symptom; recognition; schizophrenia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Sample flow chart.
Figure 2
Figure 2
Mediation effect of TAS-DIF on the link between schizophrenia and insomnia in Chinese Patients. PANSS, Positive and Negative Syndrome scale; TAS-DIF, Toronto Alexithymia Scale-Difficulties Identifying Feelings; ISI, Insomnia Severity Index. ***p < 0.001.
Figure 3
Figure 3
Mediation effect of TAS-DDF on the link between schizophrenia and insomnia in Chinese Patients. PANSS, Positive and Negative Syndrome scale; TAS-DDF, Toronto Alexithymia Scale-Difficulties Describing Feelings; ISI, Insomnia Severity Index. *p < 0.05, ***p < 0.001.
Figure 4
Figure 4
Correlation between subtypes of alexithymia [TAS-DIF (A), TAS-DDF (B), TAS-EOT (C) and TAS Total (D)] and PANSS negative symptoms in patients with schizophrenia. TAS-DIF, Toronto Alexithymia Scale-Difficulties Identifying Feelings, r = 0.167, p = 0.087; TAS-DDF, Toronto Alexithymia Scale-Difficulties Describing Feelings, r = 0.240, p < 0.05; TAS-EOT, Toronto Alexithymia Scale-External Oriented Thinking, r = 0.054, p = 0.577; TAS-TOTAL, Toronto Alexithymia Scale-total score, r = 0.212, p < 0.05.
Figure 5
Figure 5
Correlation between subtypes of alexithymia [TAS-DIF (A), TAS-DDF (B), TAS-EOT (C) and TAS Total (D)] and RBANS total score in patients with schizophrenia. RBANS, Repeatable Battery for the Assessment of Neuropsychological Status; TAS-DIF, Toronto Alexithymia Scale-Difficulties Identifying Feelings, r = −0.241, p < 0.05; TAS-DDF, Toronto Alexithymia Scale-Difficulties Describing Feelings, r = −0.249, p < 0.05; TAS-EOT, Toronto Alexithymia Scale-External Oriented Thinking, r = −0.045, p = 0.616; TAS-TOTAL, Toronto Alexithymia Scale-total score, r = −0.255, p < 0.01.
Figure 6
Figure 6
The association among ISI-Total scores and subtypes of alexithymia [TAS-DIF (A), TAS-DDF (B), TAS-EOT (C) and TAS Total (D)] in schizophrenia patients with insomnia. ISI, Insomnia Severity Index; TAS-DIF, Toronto Alexithymia Scale-Difficulties Identifying Feelings, r = 0.231, p < 0.05; TAS-DDF, Toronto Alexithymia Scale-Difficulties Describing Feelings, r = 0.205, p < 0.05; TAS-EOT, Toronto Alexithymia Scale-External Oriented Thinking, r = 0.102, p = 0.298; TAS-TOTAL, Toronto Alexithymia Scale-total score, r = 0.254, p < 0.01. *Bonferroni corrected p < 0.05/4 = 0.0125.
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