Stroke's Emotional Impact: Brain Changes And Unseen Challenges

how a stroke can affect the emotional brain

A stroke is a significant medical event that disrupts blood flow to the brain, which is the seat of our emotions and behaviours. As a result, strokes can have a profound impact on the emotional brain, leading to various emotional and behavioural changes. These changes can be challenging for both the survivor and those closest to them. While some emotional shifts occur due to brain damage, others may arise from the stress of adjusting to a new normal. Recognising these changes and seeking help are crucial steps in managing the effects of a stroke.

Characteristics Values
Emotional changes Unpredictable changes in emotions, including laughing or crying for no reason, or extreme emotions in inappropriate situations (known as pseudobulbar affect or PBA)
Increased irritability, frustration, anger, fear, grief, sadness, anxiety, and depression
Lack of motivation, apathy, and fatigue
Difficulty controlling emotions (emotionalism)
Euphoria
Behavioral changes Aggression, including physical violence
Impulsivity and poor decision-making
Disinhibition, including saying or doing inappropriate things
Forgetfulness, inattention, carelessness, and confusion
Lack of interest in activities once enjoyed
Changes in appetite and sleeping patterns
Suicidal thoughts
Withdrawal from social situations

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Emotional lability

A stroke can affect the emotional brain in various ways, and emotional lability is one of the most common consequences. Emotional lability, also known as pseudobulbar affect, refers to when emotional responses don't seem to make much sense or are out of proportion. This can manifest as uncontrollable crying or laughing, or even rapid switching between the two. These outbursts may be inappropriate to the situation and can be extremely distressing for both the patient and their caregivers, negatively impacting the patient's quality of life.

While emotional lability is most common in the early stages of stroke recovery, affecting about one in five people, it can be upsetting and embarrassing, leading some to avoid social situations. However, it is important to know that these emotional responses are not a reflection of one's true character and that there are strategies to help manage them. Being aware of triggers such as fatigue, stress, anxiety, or crowded environments can help one prepare and respond to emotional episodes. Additionally, one can choose to ignore the emotional response and continue with their conversation or task, signalling to others to do the same. Taking a break, practising relaxation and breathing exercises, and seeking help from a psychologist for cognitive and behavioural strategies can also help.

While emotional lability can improve or disappear within the first six months, it is important to seek help if it is affecting one's life. Treatment options are available, and the first step is to get an accurate diagnosis and educate caregivers and family members. While antidepressants have been used in the past with moderate success, ongoing research is helping to increase our understanding of emotional lability and develop more effective treatments.

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Depression and anxiety

Depression

After a stroke, survivors often experience a range of emotional changes, and depression is one of the most common. About 30% of stroke survivors will develop depression, usually within the first year, but it can appear at any point, even months or years later. Depression after a stroke can manifest in various ways, including:

  • Feeling sad, empty, irritable, helpless, or hopeless
  • Changes in appetite and sleep patterns
  • Losing interest in activities and spending less time with loved ones
  • Fatigue and decreased concentration
  • Physical symptoms such as headaches or pains that don't respond to treatment
  • Suicidal thoughts or feelings of despair

It's important to note that people may not always recognize their depression, and family members or friends might notice the signs first. Therefore, it's crucial to pay attention to any changes in mood or behavior and seek help if needed.

Anxiety

Anxiety is also a common emotional change after a stroke, affecting about 20% of survivors. It can be exacerbated by new physical limitations and life changes resulting from the stroke. Symptoms of anxiety can include:

  • Excessive worry, nervousness, or unease
  • Irrational fears that disrupt daily life
  • Withdrawal from activities and social situations
  • Physical symptoms such as shortness of breath, heart palpitations, increased sweating, and a fast heartbeat

Treatment Options

The good news is that depression and anxiety after a stroke can be treated. One of the best treatments is counseling or therapy with a licensed mental health practitioner. Medications, such as antidepressants, can also be prescribed to improve anxiety or depression. Cognitive Behavioral Therapy (CBT) is often used to treat both conditions and can help individuals develop better problem-solving skills and change unhealthy thought patterns and behavior. Other therapeutic approaches, such as Solution-Focused Therapy, Problem-Solving Therapy, Acceptance and Commitment Therapy, and Interpersonal Therapy, can also be beneficial.

Additionally, social support is essential for managing depression and anxiety after a stroke. Joining a support group or seeking guidance from a trusted religious figure or counselor can provide valuable emotional support and help individuals feel less alone.

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Aggressive behaviour

The stroke survivor may also become more impulsive and act without thinking, which can lead to aggressive behaviour. This impulsiveness is often linked to a stroke that affects the right side or front lobe of the brain.

These behavioural changes can be challenging for those closest to the survivor, and it is important to recognise that these changes are a result of the stroke. It can be helpful to identify triggers for aggressive behaviour and to develop strategies to manage it. This may include relaxation techniques, such as breathing exercises, or seeking professional help, such as cognitive behavioural therapy.

It is also crucial to remember that these emotional and behavioural changes may improve over time, and with the right support and treatment, recovery is possible.

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Communication problems

A stroke can affect the emotional brain and lead to communication problems. These problems can manifest in various ways, and it is important to recognise the signs and seek help if needed. Here are some key points to understand about communication issues following a stroke:

Impact on Emotional Expression

A stroke can cause emotional lability, also known as pseudobulbar affect (PBA), leading to unpredictable and uncontrollable emotional outbursts. This may result in crying or laughing that seems inappropriate for the situation. For example, a person might laugh at a funeral or cry in response to a joke. PBA can be distressing and challenging to cope with. It is characterised by a mismatch or exaggeration of feelings and expressions, and it affects a significant number of stroke survivors.

Social Interactions and Relationships

Impact on Self-Expression and Understanding

Strategies for Coping with Communication Problems

There are several strategies that can help manage communication problems after a stroke:

  • Therapy and Counselling: Seeking professional help from therapists, psychologists, or counsellors can provide individuals with tools to handle their emotions effectively. Cognitive Behavioural Therapy (CBT) is often recommended to address communication issues, as it focuses on examining the relationships between thoughts, feelings, and behaviour.
  • Support Groups: Joining support groups specifically for stroke survivors can be beneficial. Interacting with others who have had similar experiences provides a sense of community and understanding. Group therapy sessions can also be a safe space to practice communication skills and express emotions.
  • Medication: In some cases, medication may be prescribed to manage specific emotional changes, such as antidepressants for depression or anxiety, and other drugs to help with PBA.
  • Relaxation and Mindfulness: Techniques such as relaxation, meditation, and mindfulness can help individuals cope with communication problems. These practices can provide a sense of calm and improve emotional regulation, making it easier to manage unpredictable emotional outbursts.
  • Explaining PBA to Others: Informing people around the survivor about their PBA can be helpful. Explaining that their emotional reactions are beyond their control can foster understanding and support from loved ones.

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Grief and loss

A stroke is a major life event that can lead to sudden and shocking changes in one's life, including their home, work, and relationships. It is therefore understandable that a stroke survivor might experience grief and loss.

Emotional Changes

Stroke survivors often experience a range of emotional and behavioural changes. This is because a stroke impacts the brain, and the brain controls our behaviour and emotions. The area of the brain injury and chemical changes may have significant effects on the brain, which can be challenging for both the survivor and those closest to them.

Types of Emotional Changes

Emotional lability, also known as pseudobulbar affect (PBA), is common after a stroke. This is when a person's emotional responses seem out of proportion or do not seem to make much sense. For example, a person with PBA may cry or laugh uncontrollably, or their emotional responses may appear out of character or out of context.

Causes of Emotional Changes

Emotional changes can be caused by the physical effects of brain damage from the stroke, or they may be caused by the stress of coping with a "new normal". For example, survivors may worry about their health and an uncertain future, or they may feel depressed due to physical limitations caused by the stroke, such as weakness or coordination issues. Abnormalities in brain chemical levels can also lead to depression.

Dealing with Emotional Changes

It is important to recognise new symptoms, behaviours, or emotions and seek help from a doctor to manage them effectively. Rehabilitation and therapy are crucial aspects of managing emotional changes after a stroke. This includes physical and occupational therapy, cognitive behavioural therapy, speech therapy, and medication.

Support

It can be helpful for stroke survivors to connect with others who have been through a similar experience, whether through support groups, counselling, or therapy. Social connections have been shown to help with depression and anxiety after a stroke. Caregivers can also encourage their loved ones to get assessed for changes and seek appropriate treatment.

Frequently asked questions

A stroke is a significant medical event that disrupts blood flow to the brain, which is the seat of our emotions and behaviours. Emotional and behavioural changes are common after a stroke. Survivors often experience feelings of irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, anger, grief, sadness, anxiety, and depression.

PBA is a common emotional change after a stroke, characterised by a mismatch or exaggeration of feelings and expression. For example, a person with PBA may laugh at a funeral or cry at a joke. They may also experience fatigue, excessive noise or crowded, highly stimulating situations.

It is important to encourage your loved one to get assessed for emotional changes and seek treatment if needed. They might be willing to increase their social support by joining a support group or seeking guidance from a religious leader. As a caregiver, you can also help them develop coping strategies and routines, such as setting specific goals, using reminder apps, and breaking tasks into simple steps.

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