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Emotion processing, neuropsychiatric symptoms
and quality of life after a stroke
SOUTHERN AFRICAN NEUROLOGICAL REHABILITATION ASSOCIATION
Neurorehabilitation 2009“Bridging the Divide”26 – 28 August 2009
By Jeanine Blumenau
• In South Africa, stroke is one of the leading causes of death among persons aged 50 & above
• Stroke affects:CognitionBehaviorEmotionMotor functions
• Emotion expression is in psychiatric illness
• Neuropsychiatric disturbances = major obstacle for rehab
Costs > R8 billion a year• Family & caregivers affected
Quality of life obstructed
Literature• Stroke: A
disruption of blood flow to brain resulting in brain injury
• Human brain has structure-function dynamic
03-28a
W. W. Norton
Emotion Processing
Awareness ofrelevant info
Production of an affective state
Regulation of affect relative to context
Neuropsychiatric symptoms• Robinson (2006) noted a variety of
disturbances including Schizophrenia Depression Anxiety Mania Mood instability
Quality of life• Stroke survivors = lower QOL*
QOL includes domains: Intimacy Health & Safety Productivity
Objective Importance Satisfaction
Research aims to explore the relationship between:
… after a stroke
Quality of life
Neuropsychiatric symptoms
Emotion processing
RationaleImproved understanding will help: Rehabilitation Return to indep living Personal & economic burden Physiology Neuropsychology Social sciences
MethodologyDesign• Pre experimental -
exploring relationships
Subjects (N =21)• Temporal criteria• Neuropsychological
criteria• Neurological criteria
MethodologyInstruments
• Emotion Processing Scale (EPS)• Minnesota Multiphasic Personality Inventory
(MMPI-2) • Comprehensive Quality of Life Inventory
(ComQOL)
Ethics• Wits Committee for Research on Human Subjects
(Medical)
Analysis• Pearson’s correlations
Results: EPS
0
1
2
3
4
5
6
7
1 2 3 4 5
Emotion Processing Score
Mea
n
Stroke
NormalPopulation(UK)
Results: Neuropsych symptoms
Hypochondriasis Hs Moderate (T=59.3)Depression D High (T=65.0)*Conversion hysteria Hy Moderate (T=58.7)Psychopathic deviate Pd Moderate (T=60.5)
Paranoia Pa Moderate (T=61.8)Psychasthenia Pt Moderate (T=63.1)Schizophrenia Sc High (T=71.1)*Hypomania Ma High (T=67.9)*Social introversion Si Modal (T=54.2)
Results: QOL
43.53
57.66
68.88
57.1
69.880
0102030405060708090
OQOL SQOL IQOLQuality of Life
%SM Stroke
Normal population
Results: Correlations• Quality of Life was found to be correlated
with Pd* (r= -0.51) and Sc** (r= -060) • Unprocessed emotion was found to be
correlated with D* (r= 0.52), Hy* (r= 0.48), Pd** (r=0.60), Pt* (r= 0.53), Sc** (r= 0.57)
• Unregulated emotion correlated with Pd* (r= 0.53) and Sc* (r= 0.51)
* signif at =0.05; ** signif at = 0.01
Discussion• All 3 stages of emotion processing affected
• Rlshp between Neuropsychiatric symptoms & unpro emo = +ve
• Results consistent with other studies - Depression most common neuropsychiatric
symptom• Rlshp between Quality of Life &
Neuropsychiatric symptoms = -ve– Diagnosis & treatment will improve patients’
QOL
Limitations & future research– Aphasia for eg. may compromise
responses even if memory & attention are not involved
– Self report data– Small, specific sample Explore more in-depth Consider other variables e.g. time,
location of lesion
Conclusions• Relationship between emo processing,
neuro symptoms and QOL after stroke were explored
• Significant relationships were found • Therapy needs to take into account
these dynamics in order to develop strategies to allow for & treat symptomsThank you!
References• Carod-Artal, J., Egido, J.A., Gonzalez, J.L., & de Seijas, V. (2000).
Quality of life among stroke survivors evaluated 1 year after stroke. Stroke, 31, 2999-3000.
• Damasio, A.R. & Van Hoeson, G.W. (1983). Emotional disturbances associated with focal lesions of the limbic frontal lobe. In K. Heilman & P. Satz (Eds.), Neuropsychology of human emotion. New York: Guilford Press.
• Gainotti, G. (1983). Emotional and psychosocial problems after brain injury. Neuropsychological Rehabilitation, 3, 259-277.
• Ghika-Schmid, F. & Bogousslavsky, J. (2001). Disorders of mood and behaviour. In J. Bougousslavsky & L. Caplan (Eds.), Stroke syndromes (2nd ed.). Cambridge, UK: Cambridge University Press.
• Phillips, M.L., Drevets, W.C., Rauch, S.L., & Lane, R. (2003a). Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biological Psychiatry, 54, 504-514.
• Phillips, M.L., Drevets, W.C., Rauch, S.L., & Lane, R. (2003b). Neurobiology of emotion perception II: implications for major psychiatric disorders. Biological Psychiatry, 54, 515-528.
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