Emotional and Behavioural Changes Following a Stroke Flashcards
What can occur following a stroke?
Post-stroke depression
Pseudobulbar Affect (PBA)
Personality Changes (Apathy and Aggression)
Factors that may influence post-stroke depression
Family support
How severe the impairments are
Thinking style of the person
Feelings of hopelessness
Depression prior to the stroke
Small vessel disease
Anxiety
Social isolation
Poor coping skills
How many people does post stroke depression affect?
1/3 of stroke patients
What may cause post-stroke depression
Damage to cortical and subcortical regions responsible for emotional processing
Reactive psychological conditions resulting from the impact of the stroke
PSD and cognitive deficits
Might not be able to do the things they could do before
This can have an effect on how people feel about themselves
PSD can affect cognitive deficits as they may not want to engage in therapies that may help them to recover
What is Pseudobulbar Affect?
A condition which results in sudden, uncontrollable episodes of laughing or crying
Not within the context of how the person is feeling
Incongruence with how they feel and what they express
Often inappropriate to the situation
What is Pseudobulbar Affect also known as?
Emotional incontinence
What other diseases can show Pseudobulbar Affect?
Other neurological diseases
Parkinsons
Dementia
What does the fact that PBA affects other conditions tell us?
That there is an underlying neurological problem
What is thought to cause PBA?
A disconnect between the brainstem, cerebellum and the cortex
A lack of inhibitory control (the uncontrollable nature of the condition)
What part of the brain causes personality changes in stroke?
Frontal lobe
Apathy changes
Disorder of motivation
Characteristics of apathy changes in stroke
Lack of interest in hobbies
Emotionally indifferent
Preference for passive activities
Characteristics of aggression changes in stroke
Behaving aggressively without feeling angry
Reaction to other deficits of the stroke
Loss of empathy
PSD assessment
Beck’s Depression Inventory
Centre for Epidemiological Studies Depression Scale (CES-D)
Zung Scale
Emotional and Behavioural Index
Beck’s Depression Inventory
21 item scale
Used to rate mood
Self-administered questionnaire
CES-D
Depression screening
20 items assess current symptoms over the past week
Interview
Self-Administration
Zung Scale
Assesses affective, psychological and somatic depressive symptoms
20 items: 10 negative statements and 10 positive statements
Self-administration
Telephone interview
Emotional and Behavioural Index
Behaviour index form rating emotional reaction to acute stroke
Item ratings
Examiner-rated index
What symptoms of depression is it important to encourage family members to look out for?
Persistent sadness, anxious or empty feelings
Sleep disturbances
Changes in appetite
Feelings of helplessness, worthlessness or hopelessness
Social withdrawal
Fatigue
Difficulty concentrating or remembering details
Why is post-stroke depression hard to diagnose?
It is hard to distinguish which symptoms are depression and which are due to cognitive deficits
PBA Assessment
Look for symptoms
- Brief episodes (seconds to minutes)
- Episodes are sudden/abrupt
- Uncontrollable
- Exaggerated reaction
- Does not match internal state
Personality Change Assessment - Apathetic Personality Change
Personality scales
Neuropsychiatric inventory
PSD Therapies
Pharmacological treatments
- Anti-depressants
Psychological therapies
- Counselling
- CBT
Other therapies
- Tackling cognitive deficits
