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The impact of anger in adherence to treatment and beliefs about disease 1 year after stroke

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Abstract

Anger is a frequent neuropsychiatric symptom after stroke, which can disrupt treatment and recovery, in particular by affecting adherence behaviour to treatment and health care education. This study aimed to follow-up a cohort of stroke patients 12 months after their stroke to describe the presence of anger, compare levels and profile of acute and post-acute anger and analyse its impact on the adherence to treatment and beliefs about stroke. We followed (13.3 months mean follow-up) 91 stroke patients with a standardized protocol, using State-Trait Anger Expression Inventory-2 (STAXI-2) to assess the frequency and profile of anger and its components and one questionnaire to measure adherence to treatment and health education (meaning on the treatment) (Adh-T). We used as explanatory variables socio-demographic, clinical, stroke type and location information collected during the acute phase. Anger-state was detected in 15 (17%) patients, while anger-trait was present in 7 (8%) patients. The best regression model revealed that trait-anger, stroke location (posterior infarcts), and impact of stroke sequels were independent predictive factors for anger (R 2 = 43%). Patients with higher levels of anger expression had lower adherence rates, independently of the adherence dimension. In the chronic phase after stroke anger was related with posterior lesions, the impact of stroke consequences and anger as a personality trait. The detection and monitoring of anger could eventually prevent the negative impact of anger in care, especially in adherence to rehabilitation and secondary prevention.

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Abbreviations

IS:

Ischemic stroke

ICH:

Intracerebral haemorrhage

STAXI-2:

State-Trait Anger Expression Inventory-2

S-Ang:

State-anger

S-Ang/F:

Feeling angry

S-Ang/V:

Feel like expressing anger verbally

S-Ang/P:

Feel like expressing anger physically

T-Ang:

Trait-anger

T-Ang/T:

Angry temperament

T-Ang/R:

Angry reaction

AX-O:

Anger expression-out

AX-I:

Anger expression-in

AC-O:

Anger control-out

AC-I:

Anger control-in

AX:

Anger expression

AC:

Anger control

AX-Index:

Anger expression index

MMSE:

Mini-Mental State Examination

HADS:

Hospital Anxiety Depression Scale

SASC-19:

Satisfaction with Stroke-Care Questionnaire

Adh-T:

Meaning on the treatment

Mean-D:

Meaning on the disease

TACI:

Total anterior circulation infarct

PACI:

Partial anterior circulation infarct

POCI:

Posterior circulation infarct

LACI:

Lacunar infarct

mRS:

Modified Rankin Scale

SPSS:

Statistical Package for Social Sciences

χ2 :

Chi-square

SD:

Standard deviation

Z :

Wilcoxon signed ranks test

OR:

Odds ratio

95% CI:

95% confidence interval

U :

Mann–Whitney test

ROC curve:

Receiver operating characteristic curve

SD:

Standard deviation

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Correspondence to A. Catarina Santos.

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Sources of funding

Funding for Fundação para a Ciência a Tecnologia (FCT) PhD Programmes between July 2009 and July 2013—SFRH/BD/44792/2008.

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the Ethical Committee of the University Hospital (Faculdade de Medicina, Hospital de Santa Maria).

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Patients gave their informed consent.

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Santos, A.C., Ferro, J.M. The impact of anger in adherence to treatment and beliefs about disease 1 year after stroke. J Neurol 264, 1929–1938 (2017). https://doi.org/10.1007/s00415-017-8577-x

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  • DOI: https://doi.org/10.1007/s00415-017-8577-x

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