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.
stroke emotional incontinence emotionalism pathological laughter and crying Chinese
Andersen G, Vestergaard K, Lauritzen L (1994) Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke 25:1099–1104PubMedGoogle Scholar
Andersen G (1997) Post-stroke depression and pathological crying: Clinical aspects and new pharmacological approaches. Aphasiology 11:651–664Google Scholar
Brott T, Adams HP Jr, Olinger CP (1989) Measurement of acute cerebral infarctions: a clinical examination scale. Stroke 20:864–870PubMedGoogle Scholar
Brown KW, Sloan RL, Pentland B (1998) Fluoxetine as a treatment for post-stroke emotionalism. Acta Psychiatr Scand 98:455–458PubMedGoogle Scholar
Calvert T, Knapp P, House A (1998) Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry 65:928–929PubMedGoogle Scholar
Damasio H (1983) A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 40:138–142PubMedGoogle Scholar
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
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
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
House A, Dennis M, Molyneux A, Warlow C,Hawton K (1989) Emotionalism after stroke. BMJ 298:991–994PubMedGoogle Scholar
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
Kim JS, Choi-Kwon S (2000) Poststroke depression and emotional incontinence: correlation with lesion location. Neurology 54:1805–1810PubMedGoogle Scholar
Kim JS (2002) Post-stroke emotional incontinence after small lenticulocapsular stroke: Correlation with lesion location. J Neurol 49:805–810CrossRefGoogle Scholar
Lai WKD (2000) Measuring depression in Canada’s elderly Chinese population: use of a community screening instrument. Can J Psychiatry 49:279–284Google Scholar
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
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
Morris PLP, Robinson RG, Raphael B (1993) Emotional lability after stroke. Aust NZ J Psychiatry 27:601–605Google Scholar
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
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
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
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
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
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