Journal of Neurology

, Volume 251, Issue 7, pp 865–869

Emotional incontinence in Chinese stroke patients

Diagnosis, frequency, and clinical and radiological correlates
  • Wai Kwong Tang
  • Sandra S. M. Chan
  • Helen F. K. Chiu
  • Gabor S. Ungvari
  • Ka Sing Wong
  • Timothy C. Y. Kwok
  • K. T. Wong, MD, Department of Diagnostic Radiology and Organ Imaging
  • Polly S. Richards,MBBS, Department of Diagnostic Radiology and Organ Imaging
  • A. T.Ahuja, MD, Department of Diagnostic Radiology and Organ Imaging


Of the few studies published on poststroke emotional incontinence (PSEI), none has investigated a consecutive stroke cohort in a Chinese patient population. The objective of this study was to examine the frequency and the clinical and radiological correlates of PSEI in Chinese stroke patients in Hong Kong.

Three months after their admission, a psychiatrist interviewed 127 stroke patients who were consecutively admitted to the medical wards of a university-affiliated regional hospital. The presence of PSEI was defined according to both Kim’s and House’s criteria.

The frequency of PSEI was 17.9% according to Kim’s criteria and 6.3% according to House’s criteria. The kappa between the two sets of criteria was 0.34. Univariate analysis found that PSEI was associated with a younger age, previous history of depression, a higher National Institute of Health Stroke Scale total score and cortical infarcts. Multivariate logistic regression suggested that past history of depression and cortical infarcts were independent predictors for PSEI.

In conclusion, PSEI is relatively common among Chinese stroke survivors. A previous history of depression or cortical lesions were independent predictors for PSEI. There is a need for a revision of the diagnostic criteria for PSEI.

Key words

stroke emotional incontinence emotionalism pathological laughter and crying Chinese 


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  1. 1.
    Allman P, Hope T, Fairburn CG (1992) Crying following stroke: a report on 30 cases. Gen Hosp Psychiatry 14:315–321CrossRefPubMedGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Washington, D. C.Google Scholar
  3. 3.
    Andersen G, Vestergaard K, Riis JO (1993) Citalopram for post-stroke pathological crying. Lancet 342:837–839CrossRefPubMedGoogle Scholar
  4. 4.
    Andersen G, Vestergaard K, Lauritzen L (1994) Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke 25:1099–1104PubMedGoogle Scholar
  5. 5.
    Andersen G (1997) Post-stroke depression and pathological crying: Clinical aspects and new pharmacological approaches. Aphasiology 11:651–664Google Scholar
  6. 6.
    Brott T, Adams HP Jr, Olinger CP (1989) Measurement of acute cerebral infarctions: a clinical examination scale. Stroke 20:864–870PubMedGoogle Scholar
  7. 7.
    Brown KW, Sloan RL, Pentland B (1998) Fluoxetine as a treatment for post-stroke emotionalism. Acta Psychiatr Scand 98:455–458PubMedGoogle Scholar
  8. 8.
    Calvert T, Knapp P, House A (1998) Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry 65:928–929PubMedGoogle Scholar
  9. 9.
    Damasio H (1983) A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 40:138–142PubMedGoogle Scholar
  10. 10.
    Eccles S, House A, Knapp P (1999) Psychological adjustment and self reported coping in stroke survivors with and without emotionalism. J Neurol Neurosurg Psychiatry 67:125–126PubMedGoogle Scholar
  11. 11.
    Fuh JL, Teng EL, Lin KN (1995) The informant questionnaire on cognitive decline in the elderly (IQCODE) as a screening tool for dementia for a predominantly illiterate Chinese population. Neurology 45:92–96PubMedGoogle Scholar
  12. 12.
    Henon H, Godefroy O, Luca CH, Pruvo JP, Leys D (1996) Risk factors and leukoaraiosis in stroke patients. Acta Neurol Scand 94:137–144PubMedGoogle Scholar
  13. 13.
    House A, Dennis M, Molyneux A, Warlow C,Hawton K (1989) Emotionalism after stroke. BMJ 298:991–994PubMedGoogle Scholar
  14. 14.
    Kam IWK (2000) Development of the bilingual (Chinese/English) SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorder): a Study of its Reliability and Validity in an In-patient Population. Dissertation for Part III Examination of Fellowship of Hong Kong College of Psychiatrist, Hong KongGoogle Scholar
  15. 15.
    Kim JS, Choi-Kwon S (2000) Poststroke depression and emotional incontinence: correlation with lesion location. Neurology 54:1805–1810PubMedGoogle Scholar
  16. 16.
    Kim JS (2002) Post-stroke emotional incontinence after small lenticulocapsular stroke: Correlation with lesion location. J Neurol 49:805–810CrossRefGoogle Scholar
  17. 17.
    Lai WKD (2000) Measuring depression in Canada’s elderly Chinese population: use of a community screening instrument. Can J Psychiatry 49:279–284Google Scholar
  18. 18.
    Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, Dick F, Taylor GS,Murray G (2000) Medical complications after stroke: a multicenter study. Stroke 31:1223–1229PubMedGoogle Scholar
  19. 19.
    MacHale SM, O’Rourke SJ, Wardlaw JM, Dennis MS (1998) Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry 64:371–374PubMedGoogle Scholar
  20. 20.
    Morris PLP, Robinson RG, Raphael B (1993) Emotional lability after stroke. Aust NZ J Psychiatry 27:601–605Google Scholar
  21. 21.
    Palacios JM, Waeber C, Bruinvels AT, Hoyer D (1992) Direct visualization of serotonin(1D) receptors in the human brain using a new iodinated radioligand. Mol Brain Res 13:175–179CrossRefPubMedGoogle Scholar
  22. 22.
    Parvizi J, Anderson SW, Martin CO, Damasio H, Damasio AR (2001) Pathological laughter and crying: a link to the cerebellum. Brain 124:1708–1719CrossRefPubMedGoogle Scholar
  23. 23.
    Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR (1993) Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 150:286–293PubMedGoogle Scholar
  24. 24.
    Robinson RG (1997) Neuropsychiatric consequences of stroke. Ann Rev Med 48:217–229CrossRefPubMedGoogle Scholar
  25. 25.
    Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM (2002) Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 33:21–25CrossRefPubMedGoogle Scholar
  26. 26.
    Walters RJ, Fox NC, Schott JM, Crum WR, Stevens JM, Rossor MN, Thomas DJ (2003) Transient ischaemic attacks are associated with increased rates of global cerebral atrophy. J Neurol Neurosurg Psychiatry 74:213–216CrossRefPubMedGoogle Scholar
  27. 27.
    Wong KS, Huang YN, Gao S, Lam WW, Chan YL (2001) Cerebrovascular disease among Chinese populations—recent epidemiological and neuroimaging studies. HK Med J 7:50–57Google Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • Wai Kwong Tang
    • 1
    • 4
  • Sandra S. M. Chan
    • 1
    • 4
  • Helen F. K. Chiu
    • 1
    • 3
    • 4
  • Gabor S. Ungvari
    • 1
    • 4
  • Ka Sing Wong
    • 2
  • Timothy C. Y. Kwok
    • 2
  • K. T. Wong, MD, Department of Diagnostic Radiology and Organ Imaging
  • Polly S. Richards,MBBS, Department of Diagnostic Radiology and Organ Imaging
  • A. T.Ahuja, MD, Department of Diagnostic Radiology and Organ Imaging
  1. 1.Department of PsychiatryChinese University of Hong KongHong Kong
  2. 2.Department of Medicine and GeriatricsChinese University of Hong KongHong Kong
  3. 3.Jockey Club Center for Positive Ageing Hong Kong, SARChina
  4. 4.Department of PsychiatryShatin HospitalShatin, N. T. Hong Kong SARChina

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