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Kao SK, Chan CT. Increased risk of depression and associated symptoms in poststroke aphasia. Sci Rep 2024; 14:21352. [PMID: 39266657 PMCID: PMC11393353 DOI: 10.1038/s41598-024-72742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/10/2024] [Indexed: 09/14/2024] Open
Abstract
Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.
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Affiliation(s)
- Shih-Kai Kao
- Department of General Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Ta Chan
- Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shilin Dist., Taipei, 111, Taiwan.
- School of Medicine, College of Medicine, Fu Jen University, Taipei, Taiwan.
- Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
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Kumral E, Çetin FE, Özdemir HN, Çelikay H, Özkan S. Post-stroke aggressive behavior in patients wıth first-ever ischemic stroke: underlying clinical and imaging factors. Acta Neurol Belg 2024; 124:55-63. [PMID: 37442871 DOI: 10.1007/s13760-023-02319-6] [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: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Aggression is defined as a complex behavior consisting of a combination of sensory, emotional, cognitive and motor elements. We aimed to examine the relationships between post-stroke aggressive behavior (PSAB) and neuropsychological and neuroimaging findings. METHODS 380 patients in the stroke unit were classified as aggressive or non-aggressive based on symptoms elicited by the Neuropsychiatric Inventory (NPI) and aggression screening questionnaire. RESULTS Aggressive behavior was detected in 42 (11.1%) of 380 patients who had a first ischemic stroke. Patients with PSAB were older than those without (338 patients) (66.98 + 13.68 vs. 62.61 + 13.06, P = 0.043). Hamilton depression and anxiety scales showed significantly higher rates of depression and anxiety in the PSAB group compared to the non-PSAB group (47.6% vs. 16.3% and 57.1% vs. 15.4%, respectively; P = 0.001). Lesion mapping analysis showed that lesions in patients with PSAB mostly included the lower parietal lobe and lateral frontal gyrus. Multiple regression analysis showed that gender (OR, 2.81; CI%, 1.24-6.39), lateral prefrontal infarction (OR, 6.43; CI%, 1.51-27.44), parietal infarction (OR, 2.98; CI%, 1.15-7.76), occipital infarction (OR, 2.84; CI%, 1.00-8.06), multiple infarcts (OR, 5.62; CI%, 2.27-13.93), anxiety (OR, 2.06; CI%, 0.89-4.81) and verbal memory deficit (OR, 4.21; CI%, 1.37-12.93) were significant independent predictors of PSAB. CONCLUSION The presence of PSAB may be related to neuropsychiatric symptoms such as high anxiety and verbal memory impairment, and neuroanatomical location of the lesions.
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Affiliation(s)
- Emre Kumral
- Neurology Department, Ege University Medical School Hospital, İzmir, Turkey.
- Medical School, Department of Neurology, Stroke Unit, Ege University, Bornova, 35100, Izmir, Turkey.
| | | | | | - Hande Çelikay
- Neurology Department, Ege University Medical School Hospital, Neuropsychology Unit, İzmir, Turkey
| | - Sevinç Özkan
- Neurology Department, Ege University Medical School Hospital, Neuropsychology Unit, İzmir, Turkey
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Iverson GL, Kissinger-Knox A, Huebschmann NA, Castellani RJ, Gardner AJ. A narrative review of psychiatric features of traumatic encephalopathy syndrome as conceptualized in the 20th century. Front Neurol 2023; 14:1214814. [PMID: 37545715 PMCID: PMC10401603 DOI: 10.3389/fneur.2023.1214814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Some ultra-high exposure boxers from the 20th century suffered from neurological problems characterized by slurred speech, personality changes (e.g., childishness or aggressiveness), and frank gait and coordination problems, with some noted to have progressive Parkinsonian-like signs. Varying degrees of cognitive impairment were also described, with some experiencing moderate to severe dementia. The onset of the neurological problems often began while they were young men and still actively fighting. More recently, traumatic encephalopathy syndrome (TES) has been proposed to be present in athletes who have a history of contact (e.g., soccer) and collision sport participation (e.g., American-style football). The characterization of TES has incorporated a much broader description than the neurological problems described in boxers from the 20th century. Some have considered TES to include depression, suicidality, anxiety, and substance abuse. Purpose We carefully re-examined the published clinical literature of boxing cases from the 20th century to determine whether there is evidence to support conceptualizing psychiatric problems as being diagnostic clinical features of TES. Methods We reviewed clinical descriptions from 155 current and former boxers described in 21 articles published between 1928 and 1999. Results More than one third of cases (34.8%) had a psychiatric, neuropsychiatric, or neurobehavioral problem described in their case histories. However, only 6.5% of the cases were described as primarily psychiatric or neuropsychiatric in nature. The percentages documented as having specific psychiatric problems were as follows: depression = 11.0%, suicidality = 0.6%, anxiety = 3.9%, anger control problems = 20.0%, paranoia/suspiciousness = 11.6%, and personality change = 25.2%. Discussion We conclude that depression, suicidality (i.e., suicidal ideation, intent, or planning), and anxiety were not considered to be clinical features of TES during the 20th century. The present review supports the decision of the consensus group to remove mood and anxiety disorders, and suicidality, from the new 2021 consensus core diagnostic criteria for TES. More research is needed to determine if anger dyscontrol is a core feature of TES with a clear clinicopathological association. The present findings, combined with a recently published large clinicopathological association study, suggest that mood and anxiety disorders are not characteristic of TES and they are not associated with chronic traumatic encephalopathy neuropathologic change.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | | | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Kutlubaev MA, Akhmetova AI, Ozerova AI. [Emotional disorders after stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:30-35. [PMID: 38148695 DOI: 10.17116/jnevro202312312230] [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] [Indexed: 12/28/2023]
Abstract
Emotional disorders are common among patients after stroke. They include anger, fear, emotional expression control (uncontrollable crying, laughing), emotional indifference (apathy), disorders of emotion recognition and emotional empathy. They might develop independently or as a presentation of depression, anxiety, catastrophic reaction, posttraumatic stress disorder etc. Treatment of post-stroke emotional disorders include pharmacotherapy, psychotherapy, neuromodulation.
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Affiliation(s)
| | | | - A I Ozerova
- Bashkir State Medical University, Ufa, Russia
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Jaillard A, Zeffiro TA. Phylogeny of Neurological Disorders/Anatomy and Disorders of Basic Emotion in Stroke: In Clinical Neuroanatomy, Brain Structure and Function. ENCYCLOPEDIA OF BEHAVIORAL NEUROSCIENCE, 2ND EDITION 2022:251-259. [DOI: 10.1016/b978-0-12-819641-0.00070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Stolwyk RJ, Low T, Gooden JR, Lawson DW, O’Connell EL, Thrift AG, New PW. A longitudinal examination of the frequency and correlates of self-reported neurobehavioural disability following stroke. Disabil Rehabil 2020; 44:2823-2831. [DOI: 10.1080/09638288.2020.1840637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Renerus J. Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Tiffany Low
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - James R. Gooden
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - David W. Lawson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Cheltenham, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Clayton, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
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Iverson GL, Gardner AJ. Risk for Misdiagnosing Chronic Traumatic Encephalopathy in Men With Anger Control Problems. Front Neurol 2020; 11:739. [PMID: 32849206 PMCID: PMC7399643 DOI: 10.3389/fneur.2020.00739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background: There are no validated or agreed upon criteria for diagnosing chronic traumatic encephalopathy (CTE) in a living person. In recent years, it has been proposed that anger dyscontrol represents a behavioral clinical phenotype of CTE. This is the first study to examine the specificity of the diagnostic research criteria for traumatic encephalopathy syndrome (TES, the clinical condition proposed to be CTE) in men from the US general population who have anger dyscontrol problems. It was hypothesized that a substantial percentage of these men would meet the research criteria for TES. Methods: Data from 4,139 men who participated in the National Comorbidity Survey Replication, an in-person survey that examined the prevalence and correlates of mental disorders in the United States, were included in this study. Men who were diagnosed with intermittent explosive disorder in the past year were the clinical sample of interest (n = 206; 5.0% of all men in the database), and the remaining men were used as a comparison sample. They were classified as meeting the research criteria for TES if they presented with the purported supportive clinical features of CTE (e.g., impulsivity/substance abuse, anxiety, apathy, suicidality, headache). Results: In this sample of men from the general population with intermittent explosive disorder, 27.3% met a conservative definition of the proposed research criteria for CTE (i.e., traumatic encephalopathy syndrome). If one assumes the delayed-onset criterion is present, meaning that the men in the sample are compared to former athletes or military veterans presenting with mental health problems years after retirement, then 65.0% of this sample would meet the research criteria for TES. Conclusions: These results have important implications. Using conservative criteria, at least one in four men from the general population, who have serious anger control problems, will meet the symptom criteria for TES. If one considers former athletes and military veterans with anger control problems who present many years after retirement and who experienced a documented decline in their mental health, nearly two-thirds will meet these research criteria. More research is needed to examine risks for misdiagnosing TES and to determine whether anger dyscontrol is a clinical phenotype of CTE.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, United States.,MassGeneral Hospital for Children™ Sport Concussion Program, Boston, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Andrew J Gardner
- Hunter New England Local Health District, Sports Concussion Program, Newcastle, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Santos AC, Ferro JM. Profile of Anger in Acute Stroke: A Multifactorial Model of Anger Determinants. J Neuropsychiatry Clin Neurosci 2019; 31:159-164. [PMID: 30458665 DOI: 10.1176/appi.neuropsych.18030037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Higher levels of anger can have a major impact on treatment and recovery among stroke patients. METHODS The authors identified the presence of anger in patients with acute stroke, as well as state and trait anger and anger expression and control, and analyzed its association with demographic, clinical, brain lesion, and psychosocial variables. The authors screened anger prospectively in 114 consecutive patients by using the State-Trait Anger Expression Inventory-2, which enabled them to distinguish between the experience, expression, and control of anger. RESULTS State anger was detected in 21 (18%) patients, whereas trait anger was present in 22 patients (20%). The best regression model revealed that age, hypertension, complaints about environment, anxiety symptoms, and disability were independent predictive factors for anger (R2=54%). CONCLUSIONS Anger appears to be explained by prestroke variables such as age, hypertension, and the profile of anger, stroke itself as a sudden and potentially disabling condition, the environment, and the psychological and functional consequences of stroke.
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Affiliation(s)
- A Catarina Santos
- From the Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (ACS, JMF); and the Hospital do Mar Cuidados Especializados Lisboa, Portugal. (ACS)
| | - José M Ferro
- From the Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (ACS, JMF); and the Hospital do Mar Cuidados Especializados Lisboa, Portugal. (ACS)
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Abstract
AIM In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. METHODS We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. SUMMARY OF REVIEW The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. CONCLUSION Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.
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Affiliation(s)
- José M Ferro
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria-,Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana C Santos
- Hospital do Mar - Cuidados Especializados Lisboa, Bobadela, Portugal
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Abstract
INTRODUCTION Mood and emotional disturbances are common in stroke patients. Out of diverse post-stroke emotional disturbances, depression, anxiety, emotional incontinence, anger proneness, and fatigue are frequent and important symptoms. These symptoms are distressing for both the patients and their caregivers, and negatively influence the patient's quality of life. The emotional symptoms are not apparent and are therefore often neglected by neurologists. Their phenomenology, predicting factors, and pathophysiology have been under-studied, and are under-recognized. In addition, well-designed clinical trials targeting on these symptoms are rare. Areas covered: This review will describe some of the most common or relevant post-stroke mood and emotional disturbances. The phenomenology, factors or predictors, and presumed etio-pathogenesis will be described. Current pharmacological and non-pharmacological management strategies of these diverse emotional disturbances will be discussed based on different pathophysiological mechanisms. Expert commentary: It is fortunate that these mood and emotional disturbances can be treated by various methods, including pharmacological and non-pharmacological therapy. To administer the appropriate therapy, we must understand the similarities and differences in the pathophysiological mechanisms associated with these emotional symptoms.
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Affiliation(s)
- Jong S Kim
- a Department of Neurology , University of Ulsan, Asan Medical Center , Seoul , Republic of Korea
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12
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The impact of anger in adherence to treatment and beliefs about disease 1 year after stroke. J Neurol 2017; 264:1929-1938. [DOI: 10.1007/s00415-017-8577-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 01/24/2023]
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Abstract
OBJECTIVE To assess the relationship between states of anger and stroke. METHODS Systematic review of the literature. RESULTS In total, 21 papers were selected for the systematic review of data published on the subject of anger and stroke. A state of anger may be a risk factor for stroke, as well as a consequence of brain lesions affecting specific areas that are caused by a stroke. Scales to assess anger varied among authors. There was no consensus regarding the area of brain lesions that might lead to a state of anger. Although some authors agreed that lesions on the right side led to angrier behaviour, others found that lesions on the left side were more relevant to anger. Likewise, there was no consensus regarding the prevalence of anger pre or post-stroke. Some authors did not even find that these two conditions were related. CONCLUSION Although most authors have accepted that there is a relationship between anger and stroke, studies with uniform methodology need to be conducted if this association is to be properly evaluated and understood.
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Kim JS. Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms. J Stroke 2016; 18:244-255. [PMID: 27733031 PMCID: PMC5066431 DOI: 10.5853/jos.2016.01144] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/11/2022] Open
Abstract
Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Out of the many post-stroke disturbances, post-stroke depression, post-stroke anxiety, post-stroke emotional incontinence, post-stroke anger proneness, and post-stroke fatigue are frequent and important symptoms. These symptoms are distressing for both the patients and their caregivers, and negatively influence the patient's quality of life. Unfortunately, these emotional disturbances are not apparent and are therefore often unnoticed by busy clinicians. Their phenomenology, predicting factors, and pathophysiology have been under-studied, and are under-recognized. In addition, well-designed clinical trials regarding these symptoms are rare. Fortunately, these mood and emotional disturbances may be treated or prevented by various methods, including pharmacological therapy. To administer the appropriate therapy, we have to understand the phenomenology and the similarities and differences in the pathophysiological mechanisms associated with these emotional symptoms. This narrative review will describe some of the most common or relevant post-stroke mood and emotional disturbances. The phenomenology, factors or predictors, and relevant lesion locations will be described, and pharmacological treatment of these emotional disturbances will be discussed based on presumable pathophysiological mechanisms.
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Affiliation(s)
- Jong S. Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Dimitriadis DG, Mamplekou E, Dimitriadis PG, Komessidou V, Papakonstantinou A, Dimitriadis GD, Papageorgiou C. The Association Between Obesity and Hostility: The Mediating Role of Plasma Lipids. J Psychiatr Pract 2016; 22:166-74. [PMID: 27123796 DOI: 10.1097/pra.0000000000000147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Recent research indicates an association between obesity and psychopathology status, the nature of which remains unclear. We evaluated the mediating role of biochemical disturbances in this association among a treatment-seeking sample of obese individuals. METHOD The study enrolled 143 consecutive overweight and obese individuals (mean age 35±9 y) and 143 normal-weight controls (mean age 34±9 y), matched by age and sex. We measured psychopathology features using the Symptom Checklist 90-Revised (SCL-90-R), a standardized self-evaluation rating scale, and biochemical parameters (plasma cholesterol, triglyceride, and fasting glucose levels) of all participants. Nonlinear regression models were used to estimate the associations among obesity, psychopathology, and biochemical factors. RESULTS Obesity was associated positively and significantly (P<0.05) with all of the SCL-90-R subscales, with the exception of anxiety and phobic anxiety, as well as with levels of plasma glucose, cholesterol (P<0.01), and triglycerides (P<0.001). Tests for mediation showed that obesity was significantly associated, for the mediators of plasma cholesterol [parameter estimate=-0.033, P<0.05] and triglycerides (parameter estimate=-0.059, P<0.05), only with hostility (parameter estimate=-0.024, P<0.05 and parameter estimate=-0.041, P<0.05, respectively). CONCLUSIONS Our data suggest that biological substrates that are critically related to obesity, such as dyslipidemia, may mediate, at least in part, the association between obesity and hostility.
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Affiliation(s)
- Dimitrios G Dimitriadis
- D. G. DIMITRIADIS: Psychiatric Hospital of Attiki, Haidari, Greece MAMPLEKOU: Department of Mental Health, General Military Hospital of Athens, Athens, Greece P. G. DIMITRIADIS: Department of Water Resources and Environmental Engineering, School of Civil Engineering, National Technical University of Athens, Athens, Greece KOMESSIDOU and PAPAKONSTANTINOU: 1st Surgical Department, Evangelismos General Hospital, Athens, Greece G. D. DIMITRIADIS: 2nd Department of Internal Medicine and Research Institute, Athens University Medical School, Attikon University Hospital, Haidari, Greece PAPAGEORGIOU: 1st Department of Psychiatry, Athens University Medical School, Aiginition University Hospital, Athens, Greece
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Abstract
Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.
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Chang K, Zhang H, Xia Y, Chen C. Testing the Effectiveness of Knowledge and Behavior Therapy in Patients of Hemiplegic Stroke. Top Stroke Rehabil 2015; 18:525-35. [DOI: 10.1310/tsr1805-525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Toscano M, Viganò A, Puledda F, Verzina A, Rocco A, Lenzi GL, Di Piero V. Serotonergic Correlation with Anger and Aggressive Behavior in Acute Stroke Patients: An Intensity Dependence of Auditory Evoked Potentials (IDAP) Study. Eur Neurol 2014; 72:186-92. [DOI: 10.1159/000362268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
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Choi-Kwon S, Han K, Cho KH, Choi S, Suh M, Nah HW, Kim JS. Factors associated with post-stroke anger proneness in ischaemic stroke patients. Eur J Neurol 2013; 20:1305-10. [DOI: 10.1111/ene.12199] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/18/2013] [Indexed: 12/13/2022]
Affiliation(s)
- S. Choi-Kwon
- College of Nursing, Research Institute of Nursing Science, Seoul National University; Seoul Korea
| | - K. Han
- Red Cross College of Nursing, Chung-Ang University; Seoul Korea
| | - K.-H. Cho
- Department of Neurology; Korea University; Seoul Korea
| | - S. Choi
- College of Nursing, Research Institute of Nursing Science, Seoul National University; Seoul Korea
| | - M. Suh
- College of Nursing, Research Institute of Nursing Science, Seoul National University; Seoul Korea
| | - H.-W. Nah
- Dong-A University Hospital; Busan Korea
| | - J. S. Kim
- University of Ulsan, Asan Medical Center; Seoul Korea
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20
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I. Kneebone I, B. Lincoln N. Psychological Problems after Stroke and Their Management: State of Knowledge. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/nm.2012.31013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Cahana-Amitay D, Albert ML, Pyun SB, Westwood A, Jenkins T, Wolford S, Finley M. Language as a Stressor in Aphasia. APHASIOLOGY 2011; 25:593-614. [PMID: 22701271 PMCID: PMC3372975 DOI: 10.1080/02687038.2010.541469] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Healthcare System, 150 South Huntington Avenue Boston, MA 02130
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Caeiro L, Santos CO, Ferro JM, Figueira ML. Neuropsychiatric disturbances in acute subarachnoid haemorrhage. Eur J Neurol 2010; 18:857-64. [DOI: 10.1111/j.1468-1331.2010.03271.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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