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.
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Abbreviations
- CADASIL:
-
Cerebral autosomal dominant arteriopathies with subcortical infarcts and leukoencephalopathy
- CR:
-
Catastrophic reaction
- MAO:
-
Monoamine oxidase
- NDED:
-
Non-depressive emotional disturbances
- PSA:
-
Post-stroke anger
- QOL:
-
Quality of life
- SSRI:
-
Selective serotonin reuptake inhibitor
- TPH2:
-
Tryptophan hydroxylase 2
References
Annoni J-M, Staub F, Bruggimann L, Gramigna S, Bogousslavsky J (2006) Emotional disturbances after stroke. Clin Exp Hypertens 28(3–4):243–249
Åsberg M, Montgomery S, Perris C, Schalling D, Sedvall G (1978) A comprehensive psychopathological rating scale. Acta Psychiatr Scand 57(S271):5–27
Carota A, Rossetti AO, Karapanayiotides T, Bogousslavsky J (2001) Catastrophic reaction in acute stroke: a reflex behavior in aphasic patients. Neurology 57(10):1902–1905
Chan K-L, Campayo A, Moser DJ, Arndt S, Robinson RG (2006) Aggressive behavior in patients with stroke: association with psychopathology and results of antidepressant treatment on aggression. Arch Phys Med Rehabil 87(6):793–798
Choi-Kwon S, Kim H-S, Kwon SU, Kim JS (2005) Factors affecting the burden on caregivers of stroke survivors in South Korea. Arch Phys Med Rehabil 86(5):1043–1048
Choi-Kwon S, Han SW, Kwon SU, Kang D-W, Choi JM, Kim JS (2006) Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: a double-blind, placebo-controlled study. Stroke 37(1):156–161
Choi-Kwon S, Choi J, Kwon S, Kang D, Kim J (2008) Fluoxetine improves the quality of life in patients with poststroke emotional disturbances. Cerebrovasc Dis 26(3):266–271
Choi-Kwon S, Han K, Cho KH, Choi S, Suh M, Nah HW et al (2013) Factors associated with post-stroke anger proneness in ischaemic stroke patients. Eur J Neurol 20(9):1305–1310
Coccaro EF, Kavoussi RJ (1997) Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 54(12):1081–1088
Eng PM, Fitzmaurice G, Kubzansky LD, Rimm EB, Kawachi I (2003) Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosom Med 65(1):100–110
Everson SA, Kaplan GA, Goldberg DE, Lakka TA, Sivenius J, Salonen JT (1999) Anger expression and incident stroke: prospective evidence from the Kuopio ischemic heart disease study. Stroke 30(3):523–528
Everson-Rose SA, Roetker NS, Lutsey PL, Kershaw KN, Longstreth W Jr, Sacco RL et al (2014) Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke 45(8):2318–2323
Ferro JM, Caeiro L, Figueira ML (2016) Neuropsychiatric sequelae of stroke. Nat Rev Neurol 12(5):269–280
Fleminger S, Greenwood RR, Oliver DL (2003) Pharmacological management for agitation and aggression in people with acquired brain injury. Cochrane Database Syst Rev 1
Gainotti G (1972) Emotional behavior and hemispheric side of the lesion. Cortex 8(1):41–55
Gillen R, Tennen H, McKee TE, Gernert-Dott P, Affleck G (2001) Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Arch Phys Med Rehabil 82(12):1645–1649
Glenn MB, Wroblewski B, Parziale J, Levine L, Whyte J, Rosenthal M (1989) Lithium carbonate for aggressive behavior or affective instability in ten brain-injured patients. Am J Phys Med Rehabil 68(5):221–226
Huang HC, Huang LK, Hu CJ, Chang CH, Lee HC, Chi NF et al (2014) The mediating effect of psychological distress on functional dependence in stroke patients. J Clin Nurs 23(23–24):3533–3543
Kim JS (2016) Post-stroke mood and emotional disturbances: pharmacological therapy based on mechanisms. J Stroke 18(3):244
Kim JS, Choi S, Kwon SU, Seo Y (2002) Inability to control anger or aggression after stroke. Neurology 58(7):1106–1108
Kim JS, Lee E-J, Chang D-I, Park J-H, Ahn SH, Cha J-K et al (2017) Efficacy of early administration of escitalopram on depressive and emotional symptoms and neurological dysfunction after stroke: a multicentre, double-blind, randomised, placebo-controlled study. Lancet Psychiatry 4(1):33–41
Ko M, Choi-Kwon S, Jun SE, Kim JH, Cho KH, Nah HW et al (2018) Poststroke emotional disturbances and a tryptophan hydroxylase 2 gene polymorphism. Brain Behav 8(2):e00892
Kotila M, Numminen H, Waltimo O, Kaste M (1999) Post-stroke depression and functional recovery in a population-based stroke register. The Finnstroke study. Eur J Neurol 6(3):309–312
Kowalska K, Droś J, Mazurek M, Pasińska P, Gorzkowska A, Klimkowicz-Mrowiec A (2020) Delirium post-stroke: short-and long-term effect on depression, anxiety, apathy and aggression (research study—part of PROPOLIS study). J Clin Med 9(7):2232
Kwon B, Lee E-J, Park S, Lee JS, Lee MH, Jeong D et al (2021) Long-term changes in post-stroke depression, emotional incontinence, and anger. J Stroke 23(2):263
Lau CG, Tang WK, Liu XX, Liang HJ, Liang Y, Wong A et al (2017) Poststroke agitation and aggression and social quality of life: a case control study. Top Stroke Rehabil 24(2):126–133
Manuck SB, Flory JD, Ferrell RE, Mann JJ, Muldoon MF (2000) A regulatory polymorphism of the monoamine oxidase-A gene may be associated with variability in aggression, impulsivity, and central nervous system serotonergic responsivity. Psychiatry Res 95(1):9–23
Montgomery SA, Åsberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134(4):382–389
Noh S-M, Chung SJ, Kim K-K, Kang D-W, Lim Y-M, Kwon SU et al (2014) Emotional disturbance in CADASIL: its impact on quality of life and caregiver burden. Cerebrovasc Dis 37(3):188–194
Paradiso S, Robinson RG, Arndt S (1996) Self-reported aggressive behavior in patients with stroke. J Nerv Ment Dis 184(12):746–753
Pollock BG, Mulsant BH, Rosen J, Mazumdar S, Blakesley RE, Houck PR et al (2007) A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatry 15(11):942–952
Santos C, Caeiro L, Ferro J, Albuquerque R, Luisa FM (2006) Anger, hostility and aggression in the first days of acute stroke. Eur J Neurol 13(4):351–358
Starkstein SE, Fedoroff JP, Price TR, Leiguarda R, Robinson R (1993) Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale. J Neuropsychiatry Clin Neurosci
Williams LS, Weinberger M, Harris LE, Clark DO, Biller J (1999) Development of a stroke-specific quality of life scale. Stroke 30(7):1362–1369
Williams JE, Nieto FJ, Sanford CP, Couper DJ, Tyroler HA (2002) The association between trait anger and incident stroke risk: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke 33(1):13–20
WSO R, De Haan R, Pijnenborg J, Limburg M, Van den Bos G (1998) Assessment of burden in partners of stroke patients with the sense of competence questionnaire. Stroke 29(2):373–379
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Kim, J.S. (2023). Anger in Post-illness: The Example of Stroke. In: Martin, C.R., Preedy, V.R., Patel, V.B. (eds) Handbook of Anger, Aggression, and Violence. Springer, Cham. https://doi.org/10.1007/978-3-031-31547-3_39
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