Crystell Harty
A stroke can cause a wide range of emotional and behavioural changes, including agitation. Agitation can manifest as excessive motor activity, verbal outbursts, and physical aggression. Agitation after stroke is associated with damage to the frontal lobe, lenticulocapsular, and pontine base areas of the brain, which are involved in emotional regulation and impulse control. Agitation is also associated with neurochemical dysfunction, particularly in the brain's serotonin system. Agitation after stroke is common, with a prevalence of 15-35% in stroke survivors. It can occur as early as a few days after a stroke and may persist long-term. Treatment options include medication, such as selective serotonin reuptake inhibitors (SSRIs), and psychotherapy.
| Characteristics | Values |
|---|---|
| Prevalence of post-stroke agitation | 15% to 35% of all stroke survivors |
| Timeframe of post-stroke agitation | 4 days to 12 months after stroke |
| Factors contributing to post-stroke agitation | Young age, female sex, previous stroke, diabetes mellitus, severe stroke, cognitive impairment, depressive symptoms, impaired physical functioning, and damage to the frontal lobe, lenticulocapsular, and pontine base areas of the brain |
| Treatment for post-stroke agitation | Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine |
What You'll Learn
Post-stroke emotional disturbances
- Post-stroke depression (PSD)
- Post-stroke anxiety
- Post-stroke emotional incontinence (PSEI)
- Post-stroke anger proneness (PSAP)
- Post-stroke fatigue (PSF)
These emotional disturbances can be distressing for both patients and their caregivers and negatively impact the patient's quality of life. However, they are often under-recognised by clinicians.
PSD is associated with complex pathophysiological mechanisms involving both psychological/psychiatric problems associated with functional deficits and neurochemical changes secondary to brain damage. SSRIs are often used to treat PSD, but their benefits are not robust.
PSEI is more closely associated with lesion location and consequent alterations in neurotransmitters, particularly serotonin. SSRIs are the first-choice treatment for PSEI and tend to be more effective than for PSD.
PSAP is a complex phenomenon that may be related to reactive behavioural changes associated with functional deficits, repeated strokes, serotonergic dysfunction due to brain damage, or genetic factors. SSRIs can be effective in treating PSAP.
PSF is a common and disabling symptom that is closely associated with PSD. It is also causally related to multiple factors, including functional impairment, co-morbid diseases, and neurotransmitter changes. The benefits of pharmacological therapy for PSF are unproven, and treatment may need to be individualised.
White Matter Disease: Mini Strokes, Major Impact?
You may want to see also
Aggressive behaviour after stroke
Aggressive behaviour after a stroke is a common secondary effect, especially in the acute stages of recovery. This type of behaviour often resolves as the brain transitions out of the acute phase of recovery but may persist depending on the severity and area of the brain involved. Aggressive behaviour can be verbal or physical and can include screaming, refusal of treatment, muttering of unkind or hostile words, hitting, kicking, biting, and throwing objects.
Aggressive behaviour after a stroke is more likely to be a symptom of brain injury rather than reactive behaviour. When a stroke affects the frontal lobe, lenticulocapsular, or pontine base areas, emotional incontinence (inability to control emotion) is more likely to be a side effect. The frontal lobe plays a role in reasoning, problem-solving, and controlling basic impulses like anger. When the frontal lobe is damaged, it can affect emotional regulation and lead to aggressive or combative behaviour.
Additionally, damage to the brain after a stroke may inhibit the brain's serotonin system, increasing the prevalence of angry or aggressive behaviour. Furthermore, noxious (negative) stimulation from the environment can contribute to combative and aggressive behaviour after a stroke.
Aggressive behaviour after a stroke can be treated with medication such as selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of serotonin in the brain. Fluoxetine (Prozac) has been shown to improve "post-stroke anger proneness".
Coping strategies for aggressive behaviour after a stroke include understanding triggers, such as overstimulation, confusion, disruption of routine, and lack of control over the environment or physical functions. Therapy can also help to identify and manage aggressive behaviours.
Regaining Finger Movement Post-Stroke: Effective Strategies for Rehabilitation
You may want to see also
Post-stroke anger proneness
PSAP is often accompanied by emotional incontinence (PSEI), which involves sudden and uncontrollable emotional outbursts. Both PSAP and PSEI are associated with serotonergic dysfunction. PSAP is also associated with severe neurological dysfunction, depression, and a history of stroke.
SSRIs such as fluoxetine and citalopram have been found to be effective in treating aggressive behaviour in patients with personality disorders or dementia. They have also been shown to reduce anger scores in patients with subacute stroke and prevent anger-proneness when administered during the acute stage.
Heat Stroke: Impact on Blood Coagulation and Health
You may want to see also
Post-stroke depression
PSD is associated with poorer functional recovery, increased risk of dependence, poorer cognitive function, and a reduction in social participation. PSD has also been linked to an increased risk of mortality.
The diagnostic criteria for PSD are similar to those for depression triggered by other causes, but there are some differences. People with PSD experience more sleep disturbances, vegetative symptoms, and social withdrawal.
Vascular depression is a newer concept that incorporates a broader range of depressive disorders related to small-vessel ischemia. People with vascular depression may have white matter disease visible on brain imaging and tend to have a later age of onset, greater cognitive impairment, less family and personal history of depression, and greater physical impairment.
The choice of optimal treatment for PSD is not clear, and there is relatively little comparative information available. Selective serotonin reuptake inhibitors (SSRIs) are generally recommended due to their favourable tolerability profile, but there is no consensus on which SSRI is most effective.
Non-pharmacological approaches to treating PSD include different forms of psychotherapy, physical activity, non-invasive brain stimulation, and acupuncture. While psychotherapy has not been shown to be effective when used in isolation, it may be beneficial when used in combination with pharmacotherapy.
There is some evidence that pharmacological prophylaxis can help prevent PSD, but its impact on function is less clear. Routine use of prophylactic antidepressants for all stroke patients is not currently recommended due to an uncertain risk-benefit ratio.
Recognizing Heat Stroke: Houston's Summer Health Hazard
You may want to see also
Post-stroke anxiety
Symptoms and Diagnosis
Causes
Treatment
There are several ways to treat post-stroke anxiety. The first step is to seek information and support from friends, family, and medical professionals. Mindfulness techniques such as focusing on the present moment and progressive muscle relaxation can help to reduce anxiety. Cognitive-behavioural therapy (CBT) is also a common treatment, as it helps survivors to identify and address unhealthy thinking patterns. Lifestyle changes, such as diet and exercise, can also help to reduce anxiety. Finally, medication such as antidepressants, benzodiazepines, and antihistamines can be used to treat severe cases of anxiety.
Heat Stroke and Eye Twitching: Is There a Link?
You may want to see also
Frequently asked questions
A stroke can impact one's mood and outlook, and the area of the brain injured and chemical changes may have significant effects on the brain. Survivors often experience a range of emotional and behavioral changes, such as irritability, forgetfulness, carelessness, inattention or confusion, and feelings of fear, frustration, anger, grief, sadness, anxiety and depression.
A stroke can cause combative or aggressive behavior, especially in the acute stage of recovery. This can include physical behaviors such as hitting, kicking, biting, and throwing objects, as well as verbal behaviors such as screaming, refusal of treatment, and muttering of unkind or hostile words.
Aggressive behavior after a stroke often resolves as the survivor transitions out of the acute phase. However, in some cases, it can be long-lasting, depending on the area of the brain affected.
