Anger, hostility and aggression in the first days of acute stroke

Abstract

In acute stroke patients, anger can disturb management and rehabilitation and creates a stressful situation for family, health-care providers and other patients. We aim to describe the presence of anger and its association with demographic, clinical, psychiatric, lesion variables and functional outcome in acute stroke patients. We screened anger prospectively in 202 consecutive acute stroke patients (< or =4 days) using eight items from three psychiatric scales (Catastrophic Reaction Scale, Mania Rating Scale and Comprehensive Psychopathological Rating Scale). Anger was present if the patient scored in at least one item. Anger was detected in 71 (35%) patients and 26 of these were severely angry (> or =4 points). There was no association between anger and the considered variables. Analysis of the items extracted two factors: (i) the emotional-cognitive and (ii) the behavioural components of anger. These components were independent of each other in 26 patients. In 38 patients we found a dissociation between clinical observation and patients' subjective expression. Anger was frequent in acute stroke patients. Anger was probably triggered by the brain lesion, which interfered with the emotional control. The lack of an association with clinical and imaging variables suggests a contribution of psychological/psychosocial dimensions.

Cognitive complaints in the early phase after stroke are not indicative of cognitive impairment

“…Little is yet known about specific and subjective psychological problems or what cognitive and emotional changes patients themselves experience after stroke. Most studies explored cognitive consequences after stroke by neuropsychological examination,3 4 and although some studies explored other emotional consequences such as anger,21 the focus was often on depression 22 – 25…”

Brain Correlates of Impulsivity in Police Officers: A Neurocognitive and Ethnological Exploration

“…Absorption of these codes is based on neuro-cognitive processes elicited from the perception of a reality directly internalized by the police officer and relative to their cultural context in the police organization (Aguiar, 2006;Cruz, 2007;Terrill, Paoline, & Manning, 2003). Nevertheless, one focal problem identified in police samples concerns aggressive behaviors, meaning a series of actions directed to harm others usually connected with strong sympathetic activation and emotional experiences of anger or rage which in humans implies the idea of impulsivity (Ramírez, 2003;Ramírez & Andreu, 2006;Santos, Caeiro, Ferro, Albuquerque, & Luisa Figueira, 2006;Vaughn, Howard, & Delisi, 2008) in both normal and psychopathological individuals (Alcazar-Corcoles, Verdejo-Garcia, Bouso-Saiz, & Bezos-Saldana, 2010; Arce & Santisteban, 2006;Gansler, et al, 2011).…”

The Evaluation of Anosognosia in Stroke Patients

“…The relationship between anosognosia deficits and attentional control and inhibition function [85] on the one hand, and set-shifting or cognitive flexibility [86] on the other hand, are to be investigated, given their relevance in other self-awareness disorders [33, 49,87,88,89,90]; (e) psychopathology; as it is necessary to ascertain the relationship between anosognosia and neuropsychiatric symptoms. For instance, in anosognosic patients depression and/or anxiety [8, 30, 91], apathy [92, 93], anger and hostility [94, 95] and alexithymia [26, 96] require further investigation, given their frequency in stroke patients and their controversial role in awareness of illness and patient outcome [24, 30, 46, 49, 64]. …”