A brain stroke does not only bring health complications and physical changes, but also has an impact on the patient’s emotional and psychological health. In the aftermath, a stroke survivor may experience a lack of independence and may simply seem to be a different person. There may also be some noticeable behaviour changes. These changes are just the reflection of the injury caused to their brain while they suffered the stroke [1]. In this article, we shall see how the mental health of a stroke survivor is affected and what are the common psychological complications they face.
As stroke strikes, brains cells start dying and it physically damages the brain. This damage can also occur in the areas of the brain that control personality and emotions. In such cases, the patient is susceptible to changes in behaviour and emotional responses. In addition, the trauma caused by the sudden occurrence of a life-threatening event can also impact the patient’s mental health. However, with time and other tools like therapy, these undesired changes can be dealt with [2].
Depression
Depression is very commonly experienced among stroke survivors. The biochemical changes that occur in the brain post-stroke are considered to be one of the reasons. Stroke causes injury to the brain and an injured brain may not be able to feel positive emotions. In other cases, it can stem from the losses caused by stroke. Not only is depression difficult to deal with, it also forms a hurdle in the long run of post-stroke rehabilitation, making progress challenging. Slow-paced progress then intensifies the depressive episodes and the cycle continues. However, with the right measures and support, stroke patients can deal with depression efficiently [3].
Some of the most common symptoms of depression include [3]:
Persistent sad or lonely feeling
Restlessness and irritability
Feeling hopeless, worthless or helpless
Loss of interest in hobbies and activities
Decreased energy and fatigue
Difficulty concentrating, remembering and making decisions
Insomnia or oversleeping
Appetite and weight changes
Thoughts of death or suicide
Anxiety
Anxiety is best described as a physical and psychological response to a frightening situation. Anxiety after a stroke occurs as fears and concerns associated with health, survival and other aspects of life [4]. Studies have shown that anxiety post-stroke is more common in women. Just like depression, anxiety occurs in a stroke survivor due to a combination of psychosocial factors and biological changes that occur in the body during stroke [5]. The common fears in stroke survivors that lead to anxiety include [4]:
Having another stroke
Being unable to communicate during an emergency
Feeling embarrassed in a social situation
Assuming family members are now at risk too
Assuming they will never recover
Common symptoms of anxiety include [6]:
Restless feeling
Perpetual fatigue
Having difficulty concentrating
Irritable feeling
Muscle tension
Difficulty controlling feelings of worry
Sleep problems
Pseudobulbar Affect
Pseudobulbar affect, the recently coined name for emotional lability, is an involuntary emotional expression disorder that leads to rapid changes in mood. It occurs when there is a disconnect between the frontal lobe and the cerebellum & brain stem that control emotions and reflexes respectively. The expression and emotion often occur without any trigger and are often involuntary and exaggerated [7].
In addition to these major emotional disorders, stroke survivors may also experience other emotional issues such as apathy, anger and impulsive behaviour among others. However, with counselling interventions, medications, therapy and support, these psychological barriers can be crossed and a stroke survivor can go back to feeling emotionally healthy with time.
