This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Spalletta, G. Articles by Caltagirone, C. Search for Related Content PubMed PubMed Citation Articles by Spalletta, G. Articles by Caltagirone, C. Related Collections Neurology Personality

Alexithymic Features in Stroke: Effects of Laterality and Gender

From IRCCS Fondazione Santa Lucia (G.S., A.C., D.D., N.R., S.P., C.C.), Rome; and the Departments of Psychiatry (A.P.) and Neuroscience (G.S., C.C.), University of Tor Vergata, Rome, Italy.

Address reprint requests to: Gianfranco Spalletta, IRCCS Santa Lucia, Laboratorio di Neuropsicologia Clinica e Comportamentale, Via Ardeatina, 306, 00179 Roma, Italy. Email: g.spalletta{at}hsantalucia.it

OBJECTIVE: Stroke patients suffer from a high rate of behavioral disorders, and the laterality of the lesion may affect the expression of emotional disturbances. This study tested the hypothesis that stroke patients with a lesion in the right hemisphere are at high risk of developing alexithymic features.

METHODS: Forty-eight patients were interviewed with the Structured Clinical Interview for DSM-IV (patient edition), the Mini-Mental State Examination, the State-Trait Anxiety Inventory (state form), the Beck Depression Inventory, and the Toronto Alexithymia Scale (20-item version). Alexithymic differences between stroke patients with a lesion in the right hemisphere and those with a lesion in the left hemisphere were computed by analysis of covariance, using scores on the Mini-Mental State Examination, Beck Depression Inventory (psychic subscore), and State-Trait Anxiety Inventory as covariates and the score on the Toronto Alexithymia Scale as the dependent variable. A multivariate analysis of covariance and a series of follow-up analyses of covariance with the same covariates were used to discriminate differences in subscores on the Toronto Alexithymia Scale. An exploratory analysis of covariance was also performed to determine the effect of gender on alexithymic features in both groups of stroke patients.

RESULTS: The 21 stroke patients with a lesion in the right hemisphere were more alexithymic than the 27 patients with a lesion in the left hemisphere. This evidence was strengthened by the categorical analysis: 48% of the patients with a right-hemisphere lesion had alexithymia, compared with 22% of patients with a left-hemisphere lesion. Univariate analyses of covariance showed significant differences between the two groups in difficulty identifying feelings and difficulty describing feelings, but not in externally oriented thinking. The last exploratory analysis of covariance suggested that gender may influence alexithymic features.

CONCLUSIONS: This study provides direct evidence that alexithymia, and more specifically difficulty identifying feelings and difficulty describing feelings, is more common in stroke patients with a right-hemisphere lesion than in those with a left-hemisphere lesion. It also provides preliminary evidence that gender may affect alexithymic expression.

Key Words: alexithymia, • laterality, • gender, • stroke.

Abbreviations: ACA = anterior cerebral artery;; ANCOVA = analysis of covariance;; BDI = Beck Depression Inventory;; BDI-PSY = psychic subscore of the BDI;; BI = Barthel Index;; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition;; LBD = brain damage in left hemisphere;; LSA = lenticulostriate artery;; MANCOVA = multivariate analysis of covariance;; MCA = middle cerebral artery;; MMSE = Mini-Mental State Examination;; MRI = magnetic resonance imaging;; PCA = posterior cerebral artery;; RBD = brain damage in right hemisphere;; SCID-P = Structured Clinical Interview for DSM-IV–patient edition;; SD = standard deviation;; STAI-S = State-Trait Anxiety Inventory–state form;; TAS-20 = 20-item Toronto Alexithymia Scale.

This article has been cited by other articles:

				S. Paradiso, J. Vaidya, D. Tranel, T. Kosier, and R. G. Robinson Nondysphoric Depression Following Stroke J Neuropsychiatry Clin Neurosci, February 1, 2008; 20(1): 52 - 61. [Abstract] [Full Text] [PDF]

				E. Townend, M. Brady, and K. McLaughlan A Systematic Evaluation of the Adaptation of Depression Diagnostic Methods for Stroke Survivors Who Have Aphasia Stroke, November 1, 2007; 38(11): 3076 - 3083. [Abstract] [Full Text] [PDF]

				G. Spalletta, A. Ripa, P. Bria, C. Caltagirone, and R. G. Robinson Response of Emotional Unawareness After Stroke to Antidepressant Treatment Am J Geriatr Psychiatry, March 1, 2006; 14(3): 220 - 227. [Abstract] [Full Text] [PDF]

				S. Koponen, T. Taiminen, K. Honkalampi, M. Joukamaa, H. Viinamaki, T. Kurki, R. Portin, L. Himanen, H. Isoniemi, S. Hinkka, et al. Alexithymia After Traumatic Brain Injury: Its Relation to Magnetic Resonance Imaging Findings and Psychiatric Disorders Psychosom Med, September 1, 2005; 67(5): 807 - 812. [Abstract] [Full Text] [PDF]

				H. Gundel, A. Lopez-Sala, A. O. Ceballos-Baumann, J. Deus, N. Cardoner, B. Marten-Mittag, C. Soriano-Mas, and J. Pujol Alexithymia Correlates With the Size of the Right Anterior Cingulate Psychosom Med, January 1, 2004; 66(1): 132 - 140. [Abstract] [Full Text] [PDF]