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Yuan Y, Qin J, Ma G, Pei J, Wei X, Yang Y, Feng J, Nan J, Yan B, Han L, Ma Y. The prevalence and characteristics of alexithymia in stroke patients: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107712. [PMID: 38599473 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Previous studies have indicated the potential occurrence of alexithymia among stroke patients, yet the prevalence of alexithymia in this population remains disparate across different investigations without a synthesized overview. AIM To systematically evaluate the prevalence and characteristics of alexithymia in stroke patients. METHODS A systematic review and meta-analysis was conducted following the PRISMA guidelines. PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database, and Weipu Database (VIP) were searched from inception to December 31,2022, two independent researchers extracted data and evaluated article quality. RESULTS Seventeen studies were included, reporting on the prevalence of alexithymia or Toronto Alexithymia Scale-20 (TAS-20) scores among stroke patients. The pooled prevalence was found to be 35.0% (95%CI= 23.0-47.0%; I2 =97.5%), and the total scores (TS) of TAS-20 was 59.90 (95% CI=56.34-63.47; I2 =100.0%). Subgroup analysis revealed significant variation in TAS-20 scores across different geographical regions. Specifically, the total TAS-20 score in Chinese stroke patients (62.95, 95%CI=58.75-67.14; I2=100%) was higher compared to non-Chinese stroke patients (52.58, 95%CI=49.12-56.04; I2 = 99.0%). CONCLUSIONS The prevalence of alexithymia is high among stroke patients, with TAS-20 scores surpassing those observed in patients with certain other medical conditions. This underscores the importance of addressing alexithymia in stroke patients promptly through assessment and intervention to mitigate negative emotional consequences and enhance overall quality of life. Future research could explore the influence of demographic factors such as age and sex on alexithymia in stroke patients, enabling a more comprehensive understanding of alexithymia.
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Affiliation(s)
- Yue Yuan
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Jiangxia Qin
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Guifen Ma
- The Health School of Gannan Tibetan Autonomous Prefecture, Gannan Prefecture, Gansu Province, China
| | - Juhong Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Yiyi Yang
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Juanjuan Feng
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Jinhan Nan
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Boling Yan
- The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China; The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
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Fynn DM, Gignac GE, Becerra R, Pestell CF, Weinborn M. The Prevalence and Characteristics of Alexithymia in Adults Following Brain Injury: A Meta-Analysis. Neuropsychol Rev 2021; 31:722-738. [PMID: 33624197 DOI: 10.1007/s11065-021-09484-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/07/2021] [Indexed: 01/06/2023]
Abstract
Alexithymia is the inability to identify and describe one's own emotions. Some research suggests that organic alexithymia may occur after acquired brain injury (ABI). However, the results in the literature are inconsistent, when comparisons are made against healthy controls. Furthermore, a precise estimate of alexithymia prevalence in the ABI population has not yet been reported. Consequently, this meta-analysis aimed to estimate the prevalence and characteristics of alexithymia in ABI, as measured by the Toronto Alexithymia Scale-20 (TAS-20). Based on 22 unique ABI samples, a series of random-effects meta-analyses estimated moderate to large positive effect sizes (i.e., greater alexithymia in ABI samples) for the TAS-20 total scale (Hedges' g = 1.00, 95% CI [0.75, 1.35]), as well as the subscales: difficulty identifying feelings (Hedges' g = 0.92, 95% CI [0.66, 1.17]), difficulty describing feelings (Hedges' g = 0.69, 95% CI [0.50, 0.87]) and externally oriented thinking (Hedges' g = 0.75, 95% CI [0.64, 0.85]). Furthermore, a meta-regression identified a larger effect size (TAS-20 total scale score) for traumatic brain injury (TBI) samples, in comparison to non-TBI samples. Finally, the prevalence of clinically significant levels of alexithymia (TAS-20 total scale ≥ 68.4; i.e., two SDs above the general population mean) in ABI patients was estimated at 15.2%. We interpreted the results to suggest that ABI may have a substantial negative impact on affective processing abilities and, thus, comprehensive assessment of emotional functioning deficits following ABI should be considered by practitioners.
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Affiliation(s)
- Danielle M Fynn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gilles E Gignac
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Rodrigo Becerra
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Carmela F Pestell
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Michael Weinborn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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De Luca R, Sciarrone F, Manuli A, Torrisi M, Porcari B, Casella C, Bramanti A, Calabrò RS. Can emerging technologies be effective in improving alexithymia due to brain lesion?: Lessons from a case report. Medicine (Baltimore) 2020; 99:e22313. [PMID: 32957396 PMCID: PMC7505357 DOI: 10.1097/md.0000000000022313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION About 66% of stroke survivors present with cognitive or physical consequences, which are often complicated by emotional instability. Alexithymia is defined as "a difficulty in identifying and describing feelings", although there is no consensus on the exact diagnosis and treatment. PATIENT CONCERNS A 36-year-old right-handed man, affected by ischemic stroke (which occurred about 3 months before admission) involving the right hemisphere (ie, the fronto-parieto-temporal region) with left hemiparesis and behavioral abnormalities, came to our observation for intensive rehabilitation. He was treated unsuccessfully with a traditional and behavioral training. DIAGNOSIS Alexithymia due to ischemic stroke. INTERVENTIONS Then, a specific combined protocol using computerized emotional and virtual emotional training was applied in a semi-immersive virtual reality environment using the BTS-Nirvana device. OUTCOMES At the end of this novel rehabilitation approach, the patient showed a significant improvement in emotional skills, cognitive performances, and coping strategies. CONCLUSIONS Virtual reality, in addition to standard therapy, may be a valuable tool in improving emotional abnormalities due to brain lesions, such as alexithymia.
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Affiliation(s)
- Rosaria De Luca
- Robotic and Behavioral Laboratory - IRCCS Centro Neurolesi “Bonino-Pulejo”
| | | | - Alfredo Manuli
- Robotic and Behavioral Laboratory - IRCCS Centro Neurolesi “Bonino-Pulejo”
| | - Michele Torrisi
- Robotic and Behavioral Laboratory - IRCCS Centro Neurolesi “Bonino-Pulejo”
| | - Bruno Porcari
- Robotic and Behavioral Laboratory - IRCCS Centro Neurolesi “Bonino-Pulejo”
| | | | - Alessia Bramanti
- Robotic and Behavioral Laboratory - IRCCS Centro Neurolesi “Bonino-Pulejo”
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Hobson H, Chiu EG, Ravenscroft C, Partridge K, Bird G, Demeyere N. The association between communication impairments and acquired alexithymia in chronic stroke patients. J Clin Exp Neuropsychol 2020; 42:495-504. [PMID: 32576080 DOI: 10.1080/13803395.2020.1770703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Language dysfunction has recently been suggested to be one route to alexithymia, an impairment in recognizing and communicating one's own emotions. Neuropsychological evidence is needed to investigate the possibility that acquired language problems could underlie acquired alexithymia. METHOD This project examined data from a large group of chronic stroke patients (N = 118) to test whether self-reported or behavioral measures of language and communication problems were associated with alexithymia. We also examined the impact of hemisphere of damage on alexithymia. RESULTS We found no differences in alexithymia levels for patients with observed language impairments on brief tests of picture naming, comprehension, and reading vs unimpaired patients. However, self-reported communication difficulties were found to be associated with higher scores of alexithymia, even after controlling for depression and anxiety. Patients with left- versus right-hemisphere damage did not differ in their alexithymia scores. CONCLUSIONS We found partial support for the language hypothesis of alexithymia. We discuss potential reasons for the discrepant findings between the self-report and objective language measures and suggest that self-report measures may be more sensitive to milder, more pragmatic language impairments, as opposed to the severe structural language impairments measured by the cognitive screening tests.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, University of York , York, UK.,Department of Psychology Social Work & Counselling, University of Greenwich, Old Royal Naval College , London, United Kingdom
| | - Evangeline Grace Chiu
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Chloe Ravenscroft
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Kate Partridge
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Geoffrey Bird
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience , Denmark Hill, London, United Kingdom
| | - Nele Demeyere
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
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Hobson H, Brewer R, Catmur C, Bird G. The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. EMOTION REVIEW 2019. [DOI: 10.1177/1754073919838528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work & Counselling, University of Greenwich, UK
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway University of London, UK
| | - Caroline Catmur
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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