Spalletta G, Pasini A, Costa A, De Angelis D, Ramundo N, Paolucci S, Caltagirone C
IRCCS Fondazione Santa Lucia, Rome, Italy.
Psychosom Med. 2001 Nov-Dec;63(6):944-50. doi: 10.1097/00006842-200111000-00013.
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.
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.
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.
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.
中风患者行为障碍发生率较高，病变的偏侧性可能影响情绪障碍的表现。本研究检验了如下假设：右半球有病变的中风患者出现述情障碍特征的风险较高。
对48名患者进行了《精神疾病诊断与统计手册》第四版结构化临床访谈（患者版）、简易精神状态检查表、状态-特质焦虑量表（状态版）、贝克抑郁量表以及多伦多述情障碍量表（20项版本）的评估。通过协方差分析计算右半球有病变的中风患者与左半球有病变的中风患者之间的述情障碍差异，将简易精神状态检查表、贝克抑郁量表（心理分量表）和状态-特质焦虑量表的得分作为协变量，将多伦多述情障碍量表的得分作为因变量。使用多变量协方差分析以及一系列包含相同协变量的后续协方差分析来区分多伦多述情障碍量表各子量表的差异。还进行了探索性协方差分析以确定性别对两组中风患者述情障碍特征的影响。
21名右半球有病变的中风患者比27名左半球有病变的患者述情障碍更严重。分类分析强化了这一证据：48%的右半球病变患者患有述情障碍，而左半球病变患者的这一比例为22%。单变量协方差分析显示，两组在识别情感困难和描述情感困难方面存在显著差异，但在外部导向思维方面无显著差异。最后的探索性协方差分析表明，性别可能影响述情障碍特征。
本研究提供了直接证据，表明述情障碍，尤其是识别情感困难和描述情感困难，在右半球有病变的中风患者中比在左半球有病变的中风患者中更常见。它还提供了初步证据，表明性别可能影响述情障碍的表现。
