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In a logistic regression analysis, irritability and ideas of reference were associated with emotionalism after adjustment for the presence of depression. These psychological associations with emotionalism may be incorporated into a psychological model of emotionalism as a disorder of emotional control, and they may help in the understanding of the socially disabling effects of this common condition.

Although traditionally thought of as being linked to bilateral brain damage—the condition has even been called pseudobulbar affect—it is common after single unilateral strokes, 1 and there is no specific link between lesion location and the emergence of emotionalism.

For that reason, and because drug treatment is ineffective in many cases, we have been interested in developing a psychological model of the disorder. We therefore undertook the present study to identify psychological symptoms, other than those that define emotionalism, which are associated with the condition. The Stroke Outcome Study is a randomised controlled trial to evaluate the effects of psychological treatment after stroke. The trial inclusion criteria are: stroke diagnosed on standardised criteria, leading to hospital admission; fit to interview within 1 month of stroke; living independently before stroke; lack of severe language or cognitive impairment, sufficient use of English to interview; Leeds or Bradford resident; no concurrent major illness; consent to participate.

Suitable subjects are randomised to receive treatment as usual, volunteer visits, or a brief psychological therapy aimed at improving problem solving skills. The present study reports findings from the initial interview, at 1 month after stroke, for the patients who were subsequently randomised in the trial. Measures at this interview included the Barthel activities of daily living ADL index 5 ; a standard series of questions to identify emotionalism 1 ; a self report questionnaire designed to identify symptoms of mood disturbance, the general health questionnaire 6 ; and a standardised psychiatric interview, the short form present state examination.

The subjects were aged 18—94 years median 71 years ; Prestroke scores on the Barthel ADL index were a maximum 20 in of Mean Barthel score after stroke was A total of Of these, 83 reported symptoms of crying only, 16 reported symptoms of laughter and crying, and two reported symptoms of laughter only. Patients with emotionalism were slightly younger mean age Only eight emotional subjects could not identify a provoking stimulus. Mean total scores on the GHQ were 8.

Edited by Paul Kennedy

Of those who could complete the GHQ, 64 of Thus 97 Patients with emotionalism scored significantly higher than patients without emotionalism on all four subscales of the GHQ. The present state examination can be analysed to yield a measure of severity, the index of definition, which is scored 1—7; an index of definition of 5 or greater is taken to indicate the presence of diagnosable psychiatric disorder, so called caseness. The present state examination can also be used to identify the presence of 14 psychiatric syndromes, which are derived by aggregating scores from the individual items in the interview for details, see Wing et al 7.

The prevalence of these syndromes, for survivors with and without emotionalism, is shown in the table. We used multivariate logistic regression to test the independent effects of relevant syndromes, when the effects of simple depression had been taken into account.

Irritability and ideas of reference were associated with emotionalism over and above the effect of simple depression. We have confirmed previous reports of high rates of mood disorder and emotionalism among survivors in hospital in the first month after stroke. Depressed mood was more likely among those with emotionalism, but most people with emotionalism were not depressed. Patients described most episodes of emotionalism as provoked by meaningful stimuli.

The association with ideas of reference might be explained by the embarrassing nature of emotionalism, but what about irritability? It may be that the association indicates that emotionalism is just one manifestation of a more general disorder of emotional control occurring after stroke, but we are interested in another hypothesis. Irritability is a common feature of post-traumatic stress disorder, a condition in which—as in emotionalism—the patient experiences recurring uncontrollable emotionally charged mental events. In post-traumatic stress disorder these are reliving experiences, whereas in emotionalism they are the thoughts and memories which the patient reports as precipitants.

We plan to explore the evidence for these two possibilities in further research, as a means of developing our psychological understanding of a disorder which has—up to now—largely been thought of as a psychologically meaningless accompaniment of brain injury. Present state examination: syndromes in stroke survivors with and without emotionalism.


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You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content. We use cookies to improve our service and to tailor our content and advertising to you. Psychologists are experts in human behaviour, having studied the brain, memory, learning, human development and the processes of how people think, feel, behave and react.

A psychologist can help you manage difficult or overwhelming emotions or moods. They provide treatment for depression and anxiety. They can also help you if you or your family is having trouble getting used to life after stroke.

Aftercare for stroke patients | Nursing in Practice

Your psychologist may use a variety of techniques, and will work to find an approach that works for you. A neuropsychologist may work with you if you are having trouble with memory, thinking or behavioural problems. They may team up with an occupational therapist to develop practical strategies.

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A neuropsychology assessment may be required after a stroke to establish a treatment plan or to provide rehabilitation recommendations. A neuropsychological assessment can help clarify whether or not you are able to return to work, study and driving and what support you might need. In more complex cases, a neuropsychological assessment can help determine if you have capacity to make decisions on lifestyle and finances, or if an alternative decision maker may be required.

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