Anger in Post-illness: The Example of Stroke

Abstract

Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Out of these, post-stroke depression is best known. Although post-stroke anger (PSA) has been relatively less studied, this is not less common than depression. Manifestations of PSA range from overt aggressive behaviors such as hitting or hurting others to becoming irritable, impulsive, hostile, and less tolerable to family members. The pathophysiological mechanism of PSA remains unclear, but the neurochemical dysfunction due to brain injury, frustration associated with neurological deficits or surrounding environment, or genetic predisposition have been considered. In general, PSA is distressing for both the patients and their caregivers, negatively influences the patient’s quality of life, and increases the burden of caregivers. Fortunately, PSA can be treated or prevented by various methods, including pharmacological therapy. To administer appropriate management, we have to properly diagnose PSA and understand its phenomenology, predicting factors and pathophysiology. Nevertheless, PSA has been understudied and under-recognized, and well-designed clinical trials are rare. This narrative review describes the phenomenology, prevalence, factors or predictors, relevant lesion locations, and pharmacological treatment for PSA.