Post-stroke Depression, Anxiety, Emotional incontinence, Anger-proneness and Fatigue

Kim, Jong Sung

Abstract

Stroke patients often develop emotional disturbances including depression. The prevalence of this post-stroke depression (PSD) has been reported to range from 12 % to 64 %. The wide variation in the frequency of PSD may be related to methodological heterogeneity in items such as the criteria for depression, the timing of assessment, the sampled population and ethnicities. The relationship between the location of stroke and PSD remains also elusive. In addition to PSD, many of stroke patients reveal emotional incontinence, which is characterized by inappropriate or excessive laughing or crying. The incidence of and factors related to this post-stroke emotional incontinence (PSEI) also remain unclear. According to our study on out-patients with single, unilateral stroke, 18% had PSD and 34% had PSEI. Although both PSD and PSEI were related to motor dysfunction and location (anterior vs. posterior cortex) of the lesion, the latter was a stronger determinant for PSD. PSEI was more closely associated with subcortical strokes than was PSD. In addition, stroke patients may become easily irritated, impulsive, less generous, and prone to be angry or aggressive at others. This post stroke anger proneness (PSAP) was also common (32%) in our study. The PSAP was closely associated with the presence of PSEI. The lesion distribution was also similar. Both PSEI and PSAP respond well to serotonin reuptake inhibitors suggesting that these symptoms may be related to the alteration of an identical neurotransmitter (possibly serotonin) after a brain injury. Finally, post-stroke fatigue is common, occurring in 57% of the patients in our series. The post-stroke fatigue was related to the pre-stroke fatigue, physical disability and PSD. In summary, emotional disturbances such as depression, emotional incontinence, anger-proneness and fatigue are fairly common but under-recognized sequelae of stroke. These emotional disturbances decrease the quality of life of the patients and caregivers, and may affect the overall prognosis adversely. Therefore, these problems must be appropriately recognized and strategies to alleviate the symptoms should be developed based on the understanding of causative factors in individual patient.