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NDDs/Stroke > Emotional Changes > Flashcards

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
Q

“Sleep disturbances, changes in appetite, feelings of helplessness, worhtlessness or hopelessness”

These are all symptoms of..

A

Post-stroke depression

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26
Q

Carota, 2002

Diagnosis for PSD must rely on…

A

Clinical evaluations, scales + questionnaires

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27
Q

2 examples of scales used to assess Depression?

A

Becks Depression Inventory

CES-D

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28
Q

2 problems with Diagnosis methods for PSD?

A
  1. Symptoms may overlap with cog. deficits

2. Neuro/physical changes may compromise patient answers

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29
Q

How are Depression scales usually administered?

A

Self-administered

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30
Q

“Brief episodes of uncontrollable, exaggerated reaction”

What is this?

A

Pseudobulbar Affect

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31
Q

How can PBA be distinguished from PSD?

A

PSD is classified as ongoing sadness, whereby the emotional reactions matches their internal state

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32
Q

3 ways in which Apathy may be recognised?

A

Personality scales
Neuropsychiatric inventory
Family members

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33
Q

The BDI, and CES-D are scales that can be used to assess…

A

Post-stroke depression

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34
Q

Two pharmacological treatments used for PSD?

A

SSRI’s

Tricyclic antidepressants

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35
Q

Two examples of Psychological therapies to treat PSD?

A

Counselling

CBT

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36
Q

What is CBT?

A

Patients learn to alter maladaptive thoughts and restore their sense of control

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37
Q

Management tactics for PSD? (3)

A
  1. Communication
  2. Stroke support group
  3. Staying active
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38
Q

van Heuvel et al., (2000)

What was recommended for caregivers?

A

Interventions to increase understanding of PS-care, self-efficacy and coping strategies

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39
Q

Ferro et al., (2016)

Treatments and management predictors for a FAVOURABLE PSD outcome:

A
  1. Psychotherapy
  2. SSRI’s
  3. Good coping skills
  4. Strong network
40
Q

SSRI’s can be used to treat both PSD and PBA. However, it works quicker for PBA. What does this show?

A

The mechanism upon which the SSRI works must be very different

41
Q

2 treatment options for aggressive personality change?

A

Pharmacological treatments

Counselling

42
Q

2 TRAINING strategies that could be used for Apathy?

A
  1. Coping strategy training

2. Problem solving therapy

43
Q

Eslinger et al., (2002)

Found that early post-stroke behaviour reactions may be correalted with….

A

PSD - an early marker

44
Q

Frontal lobe strokes are associated with the following emotional changes…

A
  • Disturbance of social behaviour

- Emotion processing changes

45
Q

____ is considered a ‘high level skill’, encompassing ability to step outside of own perspective

A

Empathy

46
Q

56% of patients generated empathy scores <2 SD’s below the mean in _______ (Grattan & Eslinger, 1989)

A

Empathy

47
Q

Posterior cortical stroke is associated with reduced ____ and difficulty understanding ____

A

Empathy

ToM related skills

48
Q

The system regulating executive function is very resistant to damage effects. Why?

A

High degree of intra and inter connectivity and subcortical areas

49
Q

Who said that apathetic personality change may be caused by reduced faculty to direct attention to novelty?

A

Daffner, 2000

50
Q

Chriki et al., (2006)

A key concept of PBA is that the stimulus…

A

Is not inductive of a SUBJECTIVE feeling of emotion

51
Q

Noh et al., (2014)

PBA

A

Is associated within impairment of patient QOL, and increase of caregiver burden

52
Q

Ferro et al., (2016)

2 examples of negative traits patients might exhibit post-stroke?

A

Detachment

Antagonism

53
Q

Levy (2016)

Apathetic change may be caused by

A

Impaired emotional reactivity or motor planning deficits

54
Q

Carota et al., 2005

A

Demographic factors (e.g. young, female) may put someone more at risk of PSEI

55
Q

Reding et al., (1993)

A

E/B changes can be diagnosed observationally, allowing inclusion of patients with language/cog disorders

56
Q

Morris et al., (1993) found that PSD is associated with

A

A 3-fold increase in mortality rates for up to 10 years post-stroke

57
Q

Carota et al., (2002) found that depressive symptoms negatively…

A

Influence prognosis

58
Q

Noh et al., (2014)

PBA

A

Impairs domains of patient QOL and increases caregiver burden

59
Q

PBA is caused by a….

A

Disconnect between the cortex, cerebellum and brainstem

60
Q

Chriki et al., (2006)

The stimulus that induces a PBA episode….

A

Is not inductive of a SUBJECTIVE EXPERIENCE of emotion

61
Q

Kim (2016) patients with aggressive personality change may show behaviours inc….

A

Hitting/hurting others, kicking, biting, throwing etc

62
Q

Castillo, 1995

A

Early onset of PSD may precede development of GAD

63
Q

4 premorbid factors for post-stroke emotional impairment? (Chriki et al., 2006)

A
  1. Prior stressors
  2. Fam history
  3. Demographic factors
  4. Thought processes/personality
64
Q

How can Doctors ensure PSEI is promptly diagnosed/treated? (2)

A
  • Pay close attention to behaviours early after stroke

- Assess risk factors for inadequate coping

65
Q

Kim (2016)

Drawback of taking antidepressants for PSD? (2)

A

(1) Mixed evidence

(2) CNS/gastro side effects

66
Q

Eslinger (2002)

What can be done for caregivers in the management of PSD/other cases of emotional impairment?

A
  • Interventions to increase PS care, self-efficacy, coping strategies etc
67
Q

Hacket et al., (2010)

A

SSRI’s are effective in reducing the FREQUENCY and SEVERITY of PBA

68
Q

Coccaro et al., (1997) –> pharmacological treatment for aggressive personality change

A

SSRIs

69
Q

Coccaro et al., (1997)

A

SSRI’s are of benefit in the treatment of aggressive behaviour

70
Q

Eslinger et al., (2002)

Early post-stroke behavioural reactions may be….

A

Correlated with PSD (early marker)

71
Q

Grattan & Eslinger (1989)

How did empathy change in a sample of stroke patients?

A

56% generated empathy scores < 2 SD’s away from the mean

72
Q

Chriki et al., (2006)

Common post-stroke changes include…

A

Affective
Behavioural
Cognitive

73
Q

Eslinger et al., (2002)

Social and emotional processing changes have an effect on…(5)

A
  1. Treatment outcome
  2. Functional independence
  3. Utilisation of services
  4. Disability
  5. QoL
74
Q

Kim (2016)

There is a close relationship between…

A

PSD and deficits, suggesting PSD may be a psychological, reactive depressive symptom associated with sudden functional deficits

75
Q

Carod-Artal et al., (2000)

A

Longitudinal study
90 stroke survivors over 1 year
1/3rd showed depression at discharge, 2/3rds within a year

76
Q

Carod-Artal et al., (2000)

Correlates for PSD included…(2)

A

Housewife status

Inability to work

77
Q

Kotila et al., 1999

A

PSD negatively influences functional outcomes after stroke

78
Q

“Depression negatively influences prognosis/functional outcomes”

2 studies to back up this statement

A

Carota et al., 2002

Kotila et al., 1999

79
Q

Astrom 1996

Early GAD onset has been…

A

Associated with its persistence

Early treatment is advised

80
Q

2 studies for PBA symptoms/effects

A

Chriki et al., 2006

Noh et al., 2014

81
Q

Daffner et al., 2000

A

Apathy may be caused by reduced faculty to direct attention to novelty

82
Q

Social Impairment can be associated with….

A

Physical/emotional/cogntive inabilities, combined with family, community and return to work issues (Eslinger et al., 2002)

83
Q

Martin-Gonzalez et al., (2000)

A

Individuals had perceived deterioration in social support post-stroke

84
Q

Aside from BDI, Zung scale etc, what else might be used in PSD diagnosis?

A

DSM-5 (Kim, 2016) –> depressed mood or anhedonia for 2 weeks or longer, in addition to min. 4 symptoms

85
Q

Kim (2016)

Controversy surrounding DSM-5 use for PSD diagnosis?

A

Controversial as to whether these criteria can be used in stroke patients, especially in acute setting

86
Q

Sarkamo et al., (2008) (extra reading)

METHOD

A

60 patients with stroke
Self-directed music listening daily
2 month intervention period

87
Q

Sarkamo et al., (2008)

FINDINGS

A

1-2 hours per day of favourite-music listening, patients reported less depressed/confused mood

88
Q

A recent review by _____ confirmed that SSRI’s are effective in reducing the FREQUENCY and SEVERITY of PBA

A

Hacket et al., 2010

89
Q

Grattan & Eslinger, 1989

A

56% of patients generated empathy scores < 2 SD’s below the mean

90
Q

Burvill (1997)

Factors correlated with PSD

A
  1. Low social contacts

2. High dependence low functioning (ADL’s)

91
Q

Robinson (2003) linked PSD to damage in areas of the brain such as

A

Left side anterior lesions/basal gaglia lesions

92
Q

primary care physicians can pay close attention to the behaviors that occur early after stroke, e.g. ….

A

Overt sadness

93
Q

Chriki et al., (2006)

Negative of CBT to treat PSD?

A

May not be available to physicians - requires training

94
Q

van Heuvel et al., (2000)

A

Caregiver interventions compared to a control group were seen to improve post-stroke care, self-efficacy and coping strategies

95
Q

Individuals had perceived deterioration in social support post-stroke

A

Martin-Gonzalez et al., (2000)

96
Q

Caregiver interventions compared to a control group were seen to improve post-stroke care, self-efficacy and coping strategies

^ Who conducted this study

A

van Heuvel et al., (2000)

NDDs/Stroke (9 decks)

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