A prospective study of predictors of poststroke depression

Abstract

In the stroke unit, crying and overt sadness are more reliable indicators of depressed mood than apathy. In patients with first-ever stroke, crying behaviors soon after stroke, a younger age, and severe disability are predictors of poststroke depression occurrence within the first year after stroke onset.

The Recognition and Management of Psychological Reactions to Stroke

“…Catastrophic reactions and pseudobulbar affect are hard to distinguish from one another, as they have similar symptoms 2,10 ; patients present with outbursts of emotion (e.g., sudden crying, anger or aggression, uncontrollable laughing, or sudden surges of anxiety). The differences are related more to their triggers than to the behaviors associated with them.…”

“…10 Catastrophic reactions, a term first coined by Goldstein,17 are defined as the intense emotional reactions that patients have when presented with a task that they are unable to perform due to neurologic deficits. 10 Research has found that catastrophic reactions are prevalent and related to lesion location; they occur in about 4% to 20% of stroke survivors. 11,18 Denial of physical impairment can also lead to catastrophic reactions: when denial fails, anger arises.…”

“…17,19 Inappropriate or uncontrollable laughing or crying (also referred to as pseudobulbar affect) can be triggered by a stimulus that is related, yet disproportionate, to the behavior it elicits. 10 The condition occurs in 20% to 30% of stroke survivors and can be associated with intrusive thoughts about the stroke and with feelings of helplessness and hopelessness 20,21 or in response to a stimulus that has little or no emotional value and that does not induce a subjective experience of emotion (e.g., a patient may cry but not feel sad). 10 Afflicted individuals are often disinhibited or unable to control their emotional expressivity, and there is a disconnection between external stimuli and the emotional responses.…”

“…10 The condition occurs in 20% to 30% of stroke survivors and can be associated with intrusive thoughts about the stroke and with feelings of helplessness and hopelessness 20,21 or in response to a stimulus that has little or no emotional value and that does not induce a subjective experience of emotion (e.g., a patient may cry but not feel sad). 10 Afflicted individuals are often disinhibited or unable to control their emotional expressivity, and there is a disconnection between external stimuli and the emotional responses. 10,22,23 These reactions (which cause distress, embarrassment, and avoidance of social situations and have been linked to depression) 6,10,18,20 often occur in the first weeks after the stroke and are acute, short-lived, and intense.…”

“…[2][3][4][5][6][7] Although not every patient develops intense emotional responses to stroke, those who do often have risk factors that make them more vulnerable to psychological consequences. 3,4,[8][9][10][11] Attention paid to those patients who may benefit from psychotherapeutic treatments as well as from psychotropic medications can facilitate effective treatment.The patient we present sustained a stroke and had severe psychological reactions to it. We will highlight symptom recognition, review the risk factors for distress and dysfunction, and discuss the treatment of psychological reactions to stroke.…”