Emotional and Behavioural changes following Stroke Flashcards
Post Stroke Depression (PSD)
- occurs in 1/3 individuals
- could be due to damage in cortical or subcortical regions (responsible for emotional processing - frontal lobe, basal ganglia, RAF NUCLEI)
- could be reactive to psychological problems (impact on the individual)
cognitive deficits > influence how individual feels > PSD > engagement in therapy > cognitive deficits
RAF nuclei
serotonin rich nuclei in brainstem
- damage here can lead to impairment in neurotransmitters associated with depression
emotional and behavioural changes
collective combination of thoughts, feelings and behaviour
- emotion often gets ignored
PSD symptoms
- persistent sadness, anxiety or empty feelings
- sleep disturbances
- changes in appetite
- feelings of helplessness, worthlessness or hopelessness
- social withdrawal
- fatigue
- difficulty concentrating or remembering details
PSD management
communicate > improve nutrition > stroke support group > set realistic goals and prioritise > practice stress and anxiety management > be patient > stay active > get into the community
PSD treatments
- pharmacology (SSRI’s) - antidepressants, serotonin replacement, reduce dependancy and improve stability
- psychological therapies (CBT, counselling) - help with thoughts of and helplessness feelings
- other therapies (tackling cognitive deficit) - family and friends
PSD assessment
- Becks depression inventory
- Zung scale
- CES-D
- Emotional and behavioural index
> physical assessment may not always be available after stroke
problems with communication (aphasia)
depression usually recognised by a family member (could train for this)
Becks depression inventory
- used to rate mood
- 21 items
- self administered questionnaire
Zung scale
- affective, psychological and semantic depressive symptoms
- 20 items (10+, 10-)
- self administered telephone interview
CES-D
- depression screening
- 20 items assess current symptoms
- self administered interview
Emotional and Behavioural index
- rating emotional reaction to acute stroke
- item ratings
- examiner rated index
Pseudobulbar affect (PBA)
sudden uncontrollable episodes of laughing or crying, out of context of personal feelings
- often referred to as emotionalism
- affects individuals with other disorders like Parkinson’s and Alzheimer’s (NEUROLOGICAL)
- disconnect between cortex, brainstem and cerebellum
- lack of inhibition
- mood = internal
- affect = external (how we express whats going on between in and out)
Diagnosis (PBA)
- brief episodes (seconds > minutes)
- episodes are sudden /abrupt
- uncontrollable
- exaggerated reaction
- does not match internal mood
Treatment of PBA
- antidepressants (SSRI’s)
- TCA [tricyclic antidepressants] - 2 weeks to take an effect in depression, 2 days in PBA (mechanism must be different [lower dose for PBA too])
PBA management
- raising awareness - informing people about it so they aren’t surprised
- distracting yourself can work too (cognitive shift when an episode is coming) e.g. focus on breathing
