Practical guidance on use of TEARS-Q to diagnose post-stroke emotionalism

Abstract

Objective: To evaluate, using a classification tree methodology, the ability of the Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q) to determine the need for further assessment of post-stroke emotionalism and to identify those whose emotionalism is sufficiently clear that they need assessment for potential intervention. Setting: Acute stroke units of nine Scottish hospitals in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 228 stroke survivors recruited between October 1st 2015 and September 30th 2018, within two weeks of stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on recognised diagnostic features of post-stroke tearful emotionalism. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Results: Nine of 159 subjects scoring 0 or 1 on TEARS-Q were diagnosed with post-stroke emotionalism on the reference standard, compared to 11 of 21 subjects scoring 2 to 5 on TEARS-Q and 42 of 48 participants scoring 6 and above. Adding age, sex, deprivation, stroke type, stroke severity, mood, cognition, daily functioning and education did not improve the prediction accuracy sufficiently to change the classification tree. Conclusion: TEARS-Q reliably identifies those who need no further post-stroke emotionalism assessment, those who need further assessment to clarify diagnosis, and those who almost certainly have post-stroke emotionalism and may benefit from intervention.

TEARS: a longitudinal investigation of the prevalence, psychological associations and trajectory of poststroke emotionalism

“…Clinical implications of the prevalence data are obvious. Reliable, targeted screening is needed across acute and community stroke pathways although it will be important to show that emotionalism screening changes outcomes 16 17. High-quality clinical trials must be prioritised to determine how to treat PSE effectively and safely.…”

“…There are study limitations, highlighted elsewhere 16 17. In the absence of any standardised alternative we developed TEARS-IV based on expert consensus diagnostic criteria.…”

“…Participants gave written informed consent. Individuals who lacked capacity or with aphasia on Frenchay Aphasia Screening Test (score <25)15 were included in the wider Testing Emotionalism After Recent Stroke (TEARS) cohort but excluded from this prevalence study as TEARS-Diagnostic Interview (TEARS-IV)16 17 was not completed (figure 1).…”

“…PSE diagnosis was made at 2 weeks, 6 and 12 months using TEARS-IV by pretrained research nurses16 17 with TEARS- Questionnaire (TEARS-Q) as a supplementary PSE measure. Hospital Anxiety and Depression Scale (HADS)18 evaluated mood symptoms, with Impact of Events Scale-Revised (IES-R)19 and Social Ties Checklist (STC)20 included at 6 and 12 months.…”

Demographic, clinical and neuroimaging markers of post-stroke emotionalism: A preliminary investigation

“…TEARS-IV comprises four sections on post-stroke crying: screen questions, case characteristics, frequency and impact. It has been validated in this population and is based on consensus diagnostic criteria for PSE [18,19]. These comprise: (1) increased tearfulness, (2) crying coming on suddenly with no warning, (3) crying not under usual social control, and (4) crying episodes occurring at least weekly [18].…”