Emotional and psychological effects of stroke

1. Emotional and psychological effects of stroke Dr Ndidi Boakye, Principal Clinical Neuropsychologist

2. Prevalent rates for Stroke (State of the Nation, 2016) • Stroke is the single largest cause of adult disability • There are over 1.2 million stroke survivors in the UK. • 3 in 10 stroke survivors will go on to have a recurrent stroke or TIA. • 1 in 8 strokes are fatal within the first 30 days. • 1 in 4 strokes are fatal within a year.

3. But what does it all mean?

4. Impact of Stroke (1) • Physical • Sensory • Cognitive • Behavioural • Emotional

5. Impact of Stroke (2) These impairments may have functional consequences for all domains of daily living: • Personal (Cobley, 2016, Lincoln, 2012 ) • Family (Cobley, 2016, Lincoln, 2012) • Occupational (Vestling, Tufvesson & Iwarsson, 2003) • Social (Cobley, 2016)

6. Impact of Stroke (2) • https://www.stroke.org.uk/what-we-do/our-campaigns/emotional-impact-stroke Youtube clip of stroke survivors talking about emotional impact of stroke

7. Adjustment and Grief • Anxiety, anger, sadness = normal ‘healthy’ distress (grief reaction)

8. Adjustment • Promote adjustment by: • Acknowledging (negative) emotions • Self management, to increase control • Remain as active as possible • - Find positive meaning

10. Signs of not adjusting • Low mood / Depression. • Worrying about the future – “how will I cope”! • Sleep problems – not sleeping through the night, broken sleep. • Anxiety – what if it happens again. • Agitation.

11. Other barriers to adjusting well Preoccupation with lost skills or roles. Sex, breakdown in relationship, relationship changes Lost / changed sense of identity - Who am I? Worries that it will happen again Losing confidence –due to repeated failure Not being fully aware of impact of stroke Tyerman (2008)

12. Yale Question • Do you often feel sad or depressed? If they have Profound Cognitive Impairment and or Communication Problems? • Does the patient sometimes look sad, miserable or depressed? • Does the patient ever cry or seem weepy? • Does the patient seem restless or anxious? • Is the patient lethargic or reluctant to mobilise?

13. Assessment of Depression

14. Be careful! • Overlap of Stroke and Depressive Symptomatology Babin (2003)

15. Stroke Manifestations

16. Profound cognitive impairment and/or communication problems? Signs of Depression Scale (Hammond, O’Keefe & Barer, 2000) Does the patient sometimes look sad, miserable or depressed? Does the patient ever cry or seem weepy? Does the patient seem anxious, restless or anxious? Is the patient lethargic of reluctant to mobilise?

17. Cognitive Impact of Stroke

18. Left Hemisphere Strokes e.g Left middle cerebral artery, Lincoln, 2012) • Aphasias • Apraxia • Anterior cerebral artery-Executive function (EF) deficit • Posterior cerebral artery stroke-Cortical blindness, Visual agnosias • -Subcortical stroke-EF deficits, attentional deficits, speed of information processing

19. Right Hemisphere Strokes e.g Right middle cerebral artery, Lincoln, 2012) • Impairment of visuospatial abilities • Deficits in the following area -Attention -Executive abilities -Speed of information processing

20. Temporal Lobe Stroke (Lincoln, 2012) • Aphasia • Amnestic dysnomia: difficulty retrieving names for things and people • Hearing loss • Auditory agnosia • Memory, Emotion, and Behaviour

21. OtherStroke profiles (Lincoln, 2012) • Thalamic infarction-Memory deficits, Attentional deficits and Executive functioning problems • Vascular dementia-Executive functioning deficits, behavioural problems, attention, speed of processing • Multi-infarct dementia-Aphasias, Apraxias, Agnosias, Memory

22. Cognitive assessment - areas of cognition • Intellectual abilities • Attention • Memory • Language • Visual skills • Executive functions Most cognitive tests will look at more than one!

23. Approaches to Intervention Carry out neuropsychological assessment to establish the patient’s new level of ability (strengths and weaknesses). Use the strengths to support weaknesses. Provide explicit and clear feedback about the results. Provide feedback about their progress through using strategies (positive reinforcement).

24. Behavioural Impact of Stroke

25. Challenging Behaviour CPD / St George’s University Hospitals NHS Foundation Trust A Simple Theoretical Model BEHAVIOUR … is an interaction

26. Behaviour Management Disorders of behaviour are common after stroke and can interfere with individuals’ progress in rehabilitation, e.g. • Aggression • Disinhibition • Impulsivity • Distractibility • Techniques mostly involve behavioural modifications by means of (classical or operant) conditioning methods

27. Behaviour Management (2) The ABC approach • Antecedents (what occurs before the behaviour, acting as a potential trigger?) • Behaviour (what happens during the behaviour, what does it look like?) • Consequences (what are the immediate and delayed reactions of everyone involved?)

29. Clinical Neuropsychology Role (Cobley, 2016) Working with the patient: assessment and treatment of mood, behaviour and cognitive skills. Working with the family: helping with adjustment related difficulties and coping, facilitating decision making about care. Working with the MDT: contributing towards discussions and thinking on discharge planning and care packages for patients.

30. Any questions?

31. Dr Ndidi Boakye Clinical Neuropsychologist Drndidiboakye@gmail.com

32. References • Available upon request