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Emotional Changes Flashcards

1
Q

Thoughts, feelings and behaviour are very much ______

A

Interlinked

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2
Q

Each concept can have a knock-on effect on the other. What is this referring to?

A

Thoughts, feelings + behaviours

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3
Q

Chriki, Bullain & Stern (2006)

Post-stroke, changes commonly affect a patients (1), (2) and (3) processes

A
  1. Affective
  2. Behavioural
  3. Cognitive
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4
Q

Chriki et al., (2006)

Post-stroke depression occurs in…

A

20-40% of stroke patients

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5
Q

There are 2 pathways to PSD…

A
  1. Damage to key cortical regions

2. Reactive

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6
Q

PSD has a bi-directional relationship with…

A

Cognitive deficits

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7
Q

PSD has a bi-directional relationship with cognitive deficits. Why?

A
  1. Can result in PSD

2. Can lead to lack of engagement with therapies, worsening cog. deficits

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8
Q

Cognitive deficits may lead to PSD, particularly if….

A

Progress is slow, reducing hope

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9
Q

Carota et al., (2002)

There is a correlation between depression (PS) and…(3)

A

Physical impairment
Reduced functional autonomy
Self-esteem

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10
Q

What is Pseudobulbar Affect?

A

Sudden, uncontrollable episodes of laughing/crying that may be inconsistent with their internal emotional state

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11
Q

Why has Pseudobulbar Affect been linked to depression? (Chriki et al., 2006)

A

Cause embarassment, distress & avoidance of social situations

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12
Q

Personality Changes are correlated with the…

A

Severity of the stroke

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13
Q

Ferro, Caerro & Figueira (2016)

A patient who has suffered a stroke may display traits such as (3)

A

Negative affectivity
Detachment
Antagonism

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14
Q

Personality Change

Stroke patients tend to undergo a shift from…

A

The ‘positive pole’ to the ‘negative pole’

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15
Q

What is Apathy?

A

Expressing no interest, enthusiasm or concern

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16
Q

What are 3 signs someone might have experienced Apathetic personality change?

A
  1. Lack of interest in previous hobbies
  2. Preference for passive activities
  3. Little spontaneous speech or actions
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17
Q

Daffner et al., (2000)

Apathetic personality change may be induced by…

A

Reduced faculty to direct attention to novelty

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18
Q

“Lack of control with aggressive or emotional responses”

What is this referring to?

A

Aggressive change

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19
Q

“Lack of interest in hobbies, emotionally indifferent, preference for passive activities”

What is this referring to?

A

Apathetic change

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20
Q

Burvill, 1997

What are 2 major risk factors for post-stroke emotional impairment?

A
  1. Limited social contacts

2. Low functioning - high dependence

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21
Q

Castillo, 1995

Early onset of PSD may precede…

A

Development of GAD

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22
Q

Prior stressors (divorce, alcohol intake), family history and demographic factors are all….

A

Premorbid factors for post-stroke emotional impairment

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23
Q

Which gender/age group may be more at-risk of post-stroke emotional impairment? (Carota et al., 2005)

A

Young

Females

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24
Q

Folkman + Lazarus, 1988

Identified individuals who….as more likely to suffer from post-stroke emotional impairment

A
  • Are more likely to appraise situations as overly stressful
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25
"Sleep disturbances, changes in appetite, feelings of helplessness, worhtlessness or hopelessness" These are all symptoms of..
Post-stroke depression
26
Carota, 2002 Diagnosis for PSD must rely on...
Clinical evaluations, scales + questionnaires
27
2 examples of scales used to assess Depression?
Becks Depression Inventory | CES-D
28
2 problems with Diagnosis methods for PSD?
1. Symptoms may overlap with cog. deficits | 2. Neuro/physical changes may compromise patient answers
29
How are Depression scales usually administered?
Self-administered
30
"Brief episodes of uncontrollable, exaggerated reaction" What is this?
Pseudobulbar Affect
31
How can PBA be distinguished from PSD?
PSD is classified as ongoing sadness, whereby the emotional reactions matches their internal state
32
3 ways in which Apathy may be recognised?
Personality scales Neuropsychiatric inventory Family members
33
The BDI, and CES-D are scales that can be used to assess...
Post-stroke depression
34
Two pharmacological treatments used for PSD?
SSRI's | Tricyclic antidepressants
35
Two examples of Psychological therapies to treat PSD?
Counselling | CBT
36
What is CBT?
Patients learn to alter maladaptive thoughts and restore their sense of control
37
Management tactics for PSD? (3)
1. Communication 2. Stroke support group 3. Staying active
38
van Heuvel et al., (2000) | What was recommended for caregivers?
Interventions to increase understanding of PS-care, self-efficacy and coping strategies
39
Ferro et al., (2016) Treatments and management predictors for a FAVOURABLE PSD outcome:
1. Psychotherapy 2. SSRI's 3. Good coping skills 4. Strong network
40
SSRI's can be used to treat both PSD and PBA. However, it works quicker for PBA. What does this show?
The mechanism upon which the SSRI works must be very different
41
2 treatment options for aggressive personality change?
Pharmacological treatments | Counselling
42
2 TRAINING strategies that could be used for Apathy?
1. Coping strategy training | 2. Problem solving therapy
43
Eslinger et al., (2002) Found that early post-stroke behaviour reactions may be correalted with....
PSD - an early marker
44
Frontal lobe strokes are associated with the following emotional changes...
- Disturbance of social behaviour | - Emotion processing changes
45
____ is considered a 'high level skill', encompassing ability to step outside of own perspective
Empathy
46
56% of patients generated empathy scores <2 SD's below the mean in _______ (Grattan & Eslinger, 1989)
Empathy
47
Posterior cortical stroke is associated with reduced ____ and difficulty understanding ____
Empathy ToM related skills
48
The system regulating executive function is very resistant to damage effects. Why?
High degree of intra and inter connectivity and subcortical areas
49
Who said that apathetic personality change may be caused by reduced faculty to direct attention to novelty?
Daffner, 2000
50
Chriki et al., (2006) A key concept of PBA is that the stimulus...
Is not inductive of a SUBJECTIVE feeling of emotion
51
Noh et al., (2014) PBA
Is associated within impairment of patient QOL, and increase of caregiver burden
52
Ferro et al., (2016) 2 examples of negative traits patients might exhibit post-stroke?
Detachment | Antagonism
53
Levy (2016) Apathetic change may be caused by
Impaired emotional reactivity or motor planning deficits
54
Carota et al., 2005
Demographic factors (e.g. young, female) may put someone more at risk of PSEI
55
Reding et al., (1993)
E/B changes can be diagnosed observationally, allowing inclusion of patients with language/cog disorders
56
Morris et al., (1993) found that PSD is associated with
A 3-fold increase in mortality rates for up to 10 years post-stroke
57
Carota et al., (2002) found that depressive symptoms negatively...
Influence prognosis
58
Noh et al., (2014) PBA
Impairs domains of patient QOL and increases caregiver burden
59
PBA is caused by a....
Disconnect between the cortex, cerebellum and brainstem
60
Chriki et al., (2006) The stimulus that induces a PBA episode....
Is not inductive of a SUBJECTIVE EXPERIENCE of emotion
61
Kim (2016) patients with aggressive personality change may show behaviours inc....
Hitting/hurting others, kicking, biting, throwing etc
62
Castillo, 1995
Early onset of PSD may precede development of GAD
63
4 premorbid factors for post-stroke emotional impairment? (Chriki et al., 2006)
1. Prior stressors 2. Fam history 3. Demographic factors 4. Thought processes/personality
64
How can Doctors ensure PSEI is promptly diagnosed/treated? (2)
- Pay close attention to behaviours early after stroke | - Assess risk factors for inadequate coping
65
Kim (2016) Drawback of taking antidepressants for PSD? (2)
(1) Mixed evidence | (2) CNS/gastro side effects
66
Eslinger (2002) What can be done for caregivers in the management of PSD/other cases of emotional impairment?
- Interventions to increase PS care, self-efficacy, coping strategies etc
67
Hacket et al., (2010)
SSRI's are effective in reducing the FREQUENCY and SEVERITY of PBA
68
Coccaro et al., (1997) --> pharmacological treatment for aggressive personality change
SSRIs
69
Coccaro et al., (1997)
SSRI's are of benefit in the treatment of aggressive behaviour
70
Eslinger et al., (2002) Early post-stroke behavioural reactions may be....
Correlated with PSD (early marker)
71
Grattan & Eslinger (1989) How did empathy change in a sample of stroke patients?
56% generated empathy scores < 2 SD's away from the mean
72
Chriki et al., (2006) Common post-stroke changes include...
Affective Behavioural Cognitive
73
Eslinger et al., (2002) Social and emotional processing changes have an effect on...(5)
1. Treatment outcome 2. Functional independence 3. Utilisation of services 4. Disability 5. QoL
74
Kim (2016) There is a close relationship between...
PSD and deficits, suggesting PSD may be a psychological, reactive depressive symptom associated with sudden functional deficits
75
Carod-Artal et al., (2000)
Longitudinal study 90 stroke survivors over 1 year 1/3rd showed depression at discharge, 2/3rds within a year
76
Carod-Artal et al., (2000) Correlates for PSD included...(2)
Housewife status | Inability to work
77
Kotila et al., 1999
PSD negatively influences functional outcomes after stroke
78
"Depression negatively influences prognosis/functional outcomes" 2 studies to back up this statement
Carota et al., 2002 Kotila et al., 1999
79
Astrom 1996 Early GAD onset has been...
Associated with its persistence | Early treatment is advised
80
2 studies for PBA symptoms/effects
Chriki et al., 2006 | Noh et al., 2014
81
Daffner et al., 2000
Apathy may be caused by reduced faculty to direct attention to novelty
82
Social Impairment can be associated with....
Physical/emotional/cogntive inabilities, combined with family, community and return to work issues (Eslinger et al., 2002)
83
Martin-Gonzalez et al., (2000)
Individuals had perceived deterioration in social support post-stroke
84
Aside from BDI, Zung scale etc, what else might be used in PSD diagnosis?
DSM-5 (Kim, 2016) --> depressed mood or anhedonia for 2 weeks or longer, in addition to min. 4 symptoms
85
Kim (2016) Controversy surrounding DSM-5 use for PSD diagnosis?
Controversial as to whether these criteria can be used in stroke patients, especially in acute setting
86
Sarkamo et al., (2008) (extra reading) METHOD
60 patients with stroke Self-directed music listening daily 2 month intervention period
87
Sarkamo et al., (2008) FINDINGS
1-2 hours per day of favourite-music listening, patients reported less depressed/confused mood
88
A recent review by _____ confirmed that SSRI's are effective in reducing the FREQUENCY and SEVERITY of PBA
Hacket et al., 2010
89
Grattan & Eslinger, 1989
56% of patients generated empathy scores < 2 SD's below the mean
90
Burvill (1997) Factors correlated with PSD
1. Low social contacts | 2. High dependence low functioning (ADL's)
91
Robinson (2003) linked PSD to damage in areas of the brain such as
Left side anterior lesions/basal gaglia lesions
92
primary care physicians can pay close attention to the behaviors that occur early after stroke, e.g. ....
Overt sadness
93
Chriki et al., (2006) Negative of CBT to treat PSD?
May not be available to physicians - requires training
94
van Heuvel et al., (2000)
Caregiver interventions compared to a control group were seen to improve post-stroke care, self-efficacy and coping strategies
95
Individuals had perceived deterioration in social support post-stroke
Martin-Gonzalez et al., (2000)
96
Caregiver interventions compared to a control group were seen to improve post-stroke care, self-efficacy and coping strategies ^ Who conducted this study
van Heuvel et al., (2000)

NDDs/Stroke (9 decks)

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