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Alexithymia After Traumatic Brain Injury: Its Relation to Magnetic Resonance Imaging Findings and Psychiatric Disorders

From the Department of Psychiatry (S.K., T.T.), Department of Radiology (T.K.), Department of Neurology (R.P., H.I., L.H., O.T.), Turku University Hospital, Turku, Finland; and Department of Biostatistics (S.H.), Turku University, Turku, Finland; Department of Psychiatry, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland (K.H., H.V.); School of Public Health, University of Tampere, and Department of Psychiatry, Tampere University Hospital, Tampere, Finland (M.J.).

Address correspondence and reprint requests to Salla Koponen, Department of Psychiatry, Turku University Hospital, PL 52, FI-20521 Turku, Finland. E-mail salla.koponen{at}utu.fi

Objective: People with traumatic brain injury (TBI) were studied to assess the prevalence of alexithymia and its relationship to magnetic resonance imaging (MRI) findings and psychiatric disorders.

Methods: Fifty-four participants, 67% men, were evaluated after a median of 30 years since TBI. A control group was matched for age, gender, and severity of depression. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). In patients with TBI, axis I psychiatric disorders were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1), and axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). MRI examinations were carried out with a 1.5 T MRI scanner.

Results: Alexithymia was significantly more common in patients with TBI than in controls (31.5% versus 14.8%; odds ratio 2.64, 95% confidence interval 1.03–6.80). None of the variables representing TBI, ie, severity of TBI or the presence, laterality, or location of contusions on MRI, was associated with the TAS-20 total scores. Several current axis I and II psychiatric disorders, particularly organic personality syndrome, were connected to higher TAS-20 scores.

Conclusion: Alexithymia is common, along with psychiatric disorders, in patients with TBI. Both of them may reflect dysfunction of the injured brain. In clinical practice, alexithymic features should be taken into consideration in psychosocial rehabilitation after TBI.

Key Words: alexithymia • traumatic brain injury • magnetic resonance imaging • psychiatric disorders

Abbreviations: MRI = magnetic resonance imaging; TBI = traumatic brain injury; TAS-20 = 20-item Toronto Alexithymia Scale; OR = odds ratio; 95% CI = 95% confidence interval; BDI-13 = 13-item Beck Depression Inventory; DAI = diffuse axonal injury.

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