Is alexithymia a culture-bound construct? Validity and reliability of the Japanese versions of the 20-item Toronto Alexithymia Scale and modified Beth Israel Hospital Psychosomatic Questionnaire

The possibility remains that alexithymia is a culture-bound construct. The authors examined the validity and reliability of the Japanese versions of the 20-item Toronto Alexithymia Scale and the modified Beth Israel Hospital Psychosomatic Questionnaire, testing two samples of 473 college students and 149 psychiatric outpatients. The face validity and internal consistencies were suggested by factor analysis, adequate internal consistency, relatively high test-retest correlations, and high specificity and sensitivity. The Japanese versions of these two alexithymia scales therefore seem suitable for use among college students and psychiatric outpatients. However, there were several problematic points which may be associated with cultural differences.

Secondary alexithymia as a state reaction in panic disorder and social phobia

In a 6-month follow-up study, a change in alexithymia was examined in two samples of 26 patients with panic disorder and 24 patients with social phobia. Before psychiatric treatment, the prevalence rate of alexithymia, measured by the 20-Item Toronto Alexithymia Scale (TAS-20), was higher for both panic disorder (54%) and social phobia (58%) groups than for healthy persons (15%). After treatment, scores on the alexithymia constructs of difficulty identifying feelings and difficulty describing feelings significantly decreased in panic disorder and social phobia patients. The overall decrease in measures of alexithymia in both groups was significantly related to reduction in anxiety, but not depression. The results suggest that secondary alexithymia related to anxiety exists as a state reaction in patients with panic disorder and social phobia.

Changes in scores on alexithymia over a period of psychiatric treatment

We examined changes in alexithymia over a period of psychiatric treatment. Scores on a measure of alexithymia construct (affect awareness but not externally oriented thinking) decreased significantly after psychiatric treatment, suggesting that alexithymia or affect awareness for patients with psychiatric disorders or psychosocial problems is a state reaction rather than a personality trait. As for an association of reactions to stress with alexithymia, a group on high extrapunitiveness demonstrated significant decrease in scores on affect awareness compared to a group on low extrapunitiveness both before and after psychiatric treatment.

An investigation of the psychometric properties of the 26 item Toronto Alexithymia Scale in a Japanese culture

We investigated the psychometric properties of the Japanese version of the 26 item Toronto Alexithymia Scale in a Japanese culture, testing a sample of 1,008. The validity and reliability of this Japanese version were suggested by significant correlations with the Beth Israel Hospital Psychosomatic Questionnaire and estimates to test-retest and internal consistency. These results suggest that this version may be suitable for Japanese populations. Although alexithymia scores were correlated negatively with increasing age, the result, based on the large sample, seems to be of minimal significance.

[A case of hypopharyngeal stenosis caused by late radiation injuries--reconstruction of the hypopharynx with myomucosal tongue flap]

The authors reported a 47-year-old man with hypopharyngeal stenosis caused by late radiation injuries. At the age of ten he underwent irradiation (3000rads) to the neck because of the cervical lymphadenopathy. He had keroid skin change at the age of 19, hypothyroidism since 26, right cervical and brachial plexus neuropathy since 33, and paralysis and papilloma of right vocal cord at 34. And at the age of 41 he underwent tracheostomy owing to laryngeal stenosis. In November 1984 (at age 43) he felt abnormal sensation on the throat but had no dysphagia nor misdiglutition. On November 1987 he had difficulties of swallowing, and could not take anything but fluid. At that time he was diagnosed as hypopharyngeal stenosis. With steroids and antibiotics his difficulties of swallowing were reduced. He experienced the same difficulties on April 1988. Since December 1988 his dysphagia got worse and was not recovered with medication. On May 17 1989, laryngopharyngectomy was performed. At the level of cricoid cartilage hypopharynx was resected. As for the posterior wall, pharynx and cervical esophagus were fixed to prevertebral fascia and anastomosed with end-to-end. And antero-lateral defects were reconstructed with myomucosal tongue flap. Postoperatively he could eat orally. On the basis of the experience of this case and the review of the literature the authors conclude that myomucosal tongue flap is one of alternatives for hypopharyngeal reconstruction.

[The role of high-resolution CT in evaluating disease of the posterior tympanum]

The posterior tympanum consists of several irregular eminences, ridges, and sinuses. These sinuses do not communicate with the mastoid air cell system, and cholesteatoma and/or granulation tissue prefer to fill them. This area cannot be visualized with ease by the usual surgical approach, and is thus quite important for surgeons. Recent developments in high-resolution computed tomography (HRCT) allow more than ever precise identification of subtle changes in the posterior tympanum. Axial HRCT sections provide essential information for the preoperative evaluation of the posterior tympanum. The performance of surgeons has been promoted both in evaluation and treatment planning of patient with suspected posterior tympanic lesions. HRCT findings were compared with the operative findings in 52 patients (54 ears) who had the operation for chronic otitis media. Important findings by HRCT diagnosis of posterior tympanum are as follows: (1) Bone destruction in the posterosuperior part of the tympanic anulus and in the lateral wall of the facial sinus are the important findings for the diagnosis of invasion of cholesteatoma in the posterior tympanum. (2) Similarly important finding is the bone destruction of the pyramidal eminence. This was found in 6 of 9 cases with cholesteatomas extending into the sinus tympani. (3) The soft tissue density in the posterior tympanum does not necessarily indicate pathological processes. Effusion in the posterior tympanum is imaged as soft tissue density, and can not be differentiated from cholesteatoma or granulation by present HRCT.