Delusions and mood disorders in patients with chronic aphasia

Abstract

Sixty-one inpatients manifesting chronic aphasic syndromes were reviewed. Most aphasic patients with behavioral abnormalities sufficiently severe to require hospitalization had posterior hemispheric lesions and fluent disorders. Thirty-eight (62%) had fluent aphasia, eight (13%) had nonfluent aphasia, and 15 (25%) had anomic, global, or transcortical aphasic syndromes. Delusions were more common among patients with fluent aphasias (58%), whereas depression was the most common psychiatric disorder among patients with anterior lesions (63%). Elation occurred in 12 patients, 11 with posterior lesions and 1 with a nonlocalizing syndrome. Neuropsychiatric disturbances in patients with chronic aphasia syndromes correlate with the type of language disorder and with the location of the associated lesion.

Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

“…Hypomania/mania: Elevated mood, hypomania and mania are seldomly reported in PWA, except in aphasic patients with posterior left hemisphere strokes[ 140 ]. Mania is defined as an abnormally and persistently raised expansive or irritable mood, thought and speech acceleration, lack of insight, overactivity, and social disinhibition[ 141 ].…”

“…In the context of PWA, the DSM-5 classifies these conditions as bipolar and related disorders due to another medical condition[ 51 ]. In a study conducted by Signers et al [ 140 ], one-fifth of participants with chronic fluent aphasia and posterior left hemisphere lesions were elated (a state of extreme happiness or excitement[ 142 ]) and unaware of their language impairment[ 140 ]. By contrast, elation has not been described among patients with non-fluent aphasia[ 143 ], except in a case of mixed transcortical aphasia associated with hypermusia, musicophilia, and compulsive whistling[ 144 ].…”

“…Shehata et al [ 55 ] evaluated 30 PWA and 31 non-aphasic stroke patients with the Eysenck Personality Questionnaire and found that psychosis was more prominent in PWA. Another study found that 28 PWA out of 61 chronic participants developed delusions, being mostly of persecutory nature[ 140 ]. The symptoms were found to be more common with posterior left hemisphere lesions[ 140 ], particularly in patients with Wernicke´s aphasia[ 154 ], who are more paranoid and aggressive[ 19 , 155 , 156 ] than patients with anterior lesions who instead may become more frustrated and depressed[ 133 , 140 ].…”

“…Another study found that 28 PWA out of 61 chronic participants developed delusions, being mostly of persecutory nature[ 140 ]. The symptoms were found to be more common with posterior left hemisphere lesions[ 140 ], particularly in patients with Wernicke´s aphasia[ 154 ], who are more paranoid and aggressive[ 19 , 155 , 156 ] than patients with anterior lesions who instead may become more frustrated and depressed[ 133 , 140 ]. A detailed language evaluation of Wernicke’s aphasia is desirable because characterization of speech and language deficits can be misinterpreted as psychotic speech disorder[ 157 - 159 ].…”