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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