Lecture 9 Emotional and Behavioural Changes Following Stroke Flashcards
Which triad interacts with each other?
Thoughts, feelings and behaviour all interact with each other and affect how an individual interacts with the world
Which factors may influence the development of PSD?
A loss of independence, feeling of hopelessness, changes to self-perception, lack of emotional support
What is the prevalence of PSD?
Very common, seen in about a third of individuals but is often blinded by physical symptoms and under-diagnosed
What are some proposed causal factors?
Damage to key cortical and subcortical regions which are responsible for emotional processing e.g. regions that are rich in monoamine circuitry and serotonin activity
Could also be a reactive psychological condition resulting from the impact of the stroke
How do PSD and cognitive deficits interact?
If individuals are feeling depressed, less likely to engage in the therapies, support plans and management –> makes overcoming cognitive challenges difficult
Should be a primary focus, so they can engage with treatment properly
Unsolved Q whether depression negatively influences the cognitive impairment outcome or whether cognitive impairment leads to depression - probably bi-directional
What are some examples of PSD assessment?
Beck’s Depression Inventory
CES-D
Zung Scale
Emotional and Behavioural Index
But individuals may have communication issues, making it difficult to assess but is often recognised by a family member
What are some PSD treatments?
Pharmacological: anti-depressants (SSRIs)
Psychological: counselling, CBT
Other therapies: tackling cognitive deficits
What are some methods of PSD management?
Communicate how they are feeling, Improve nutrition Stroke support groups Practice stress/anxiety management Stay active and keep motivated
What is Pseudo-bulbar Affect (PBA)?
Sudden uncontrollable episodes of laughing or crying, not within the context of how the individual is feeling - some mismatch
Often inappropriate to the situation
Massively under-diagnosed, clear underlying neurological problem
Sometimes mistaken for depression
What is the cortical mechanism behind PBA?
PBA is a disconnect between the cortex, cerebellum and brainstem, which are associated with emotional processing
The lack of inhibitory control is the primary mechanism
What treatment is there for PBA?
Pharmacological treatment: SSRIs and TCA (tri-cyclic anti-depressants)
Mechanisms that make SSRIs work are not fully understood but thought to be different to depression
Need lower doses for PBA compared to depression
What can be used in management of PBA?
Telling people about it & raising awareness
Distracting yourself - cognitive shift
Focusing on breathing - can reduce episode length
Change in body position - potentially due to involvement of cerebellum
What is the relationship between stroke and personality changes?
Stroke is associated with a decrease in personality traits in the positive pole e.g. extraversion, agreeableness, emotional stability
And an increase in the negative pole e.g. antagonism, detachment, psychoticism
There is a relationship between stroke severity and degree of personality change
What is apathetic personality change?
Due to damage in the frontal lobe, a disorder of motivation, characterised by a decrease in physical & mental activity and an emotional indifference
Lack of interest in hobbies
Preference for passive activities
How is apathetic personality change assessed?
Personality Scales
Neuropsychiatric inventory
How is apathetic personality change treated/managed?
Coping Strategy Training
Problem Solving Therapy - based on CBT, goal oriented
What is aggressive personality change?
Due to frontal lobe damage, behaving aggressively without feeling angry, a reaction to other deficits and loss of empathy
How is aggressive personality change assessed?
Personality Scales
Neuropsychiatric inventory
How is aggressive personality change treated/managed?
Pharmacological treatment (SSRIs) Counselling
Important for the family to be involved so they know how to manage these outbursts of aggression
How is family support involved?
In a study, the levels of emotional support from their family was significantly correlated with the patient’s functional status, psychological status and social status during the first 6 months post stroke
What are the most common sites which affect emotion-related processing?
In cerebrovascular disease, the right hemisphere and frontal lobe affect emotion-related processing
What are the critical sites of damage for empathetic changes?
The prefrontal cortex and right posterior cortices have been identified as critical sites of damage leading to significant empathetic changes
Leads to impairments in theory of mind tasks and understanding sarcasm
What are the emotions like in aphasia?
Patients with Broca’s aphasia show intense emotional behaviours, often with a depressive content. Aphasia increases the risk of developing depression
In Wernicke’s aphasia, patients attribute their aggressiveness to the assumption that the examiner was deliberately speaking in an incomprehensible way
What is affective dysprosody?
Refers to the impairment of both the production and comprehension of language components that allow the translation of internal states in speech
