Self-report of indifference and anxiety among persons with right hemisphere stroke

Lack of visual avoidance in patients with unilateral brain damage: New perspectives from old, unexpected, neglected data

The present commentary revisits some old data, concerning the same kind of visual avoidance behaviors described by Otero and Levenson's (2019) in their target paper and proposes a new perspective on the neural underpinnings of such behaviors. A lack of visual avoidance in response to a shocking film clip had been unexpectedly observed during a study of emotional expression in patients with unilateral brain damage (Mammucari et al., 1988). This lack of visual avoidance in subjects with right hemisphere brain lesions was attributed to the emotional indifference of these patients. These results could be complementary to those obtained by Otero and Levenson (2019) for two main reasons: (1) they concerned the inter-hemispheric, rather than the intra-hemispheric organization of emotional functions; (2) they could be replicated in FTD patients. Atrophy is, in fact, often asymmetrical in these subjects and several investigations have recently shown that emotional disorders can be on the foreground when atrophy prevails in the right frontal or temporal lobes. The present commentary suggests that a fruitful integration is possible between these two previously independent lines of neuropsychological research.

The effect of brain tumour laterality on anxiety levels among neurosurgical patients

OBJECTIVES

The aim of this study was to investigate the level of anxiety in patients with a primary brain tumour and to analyse the effect of tumour laterality and histology on the level of anxiety. Recurrent measurements were assessed preoperatively, three months, and one year after operation.

METHODS

The study population consisted of 101 patients with a primary brain tumour from unselected and homogeneous population in northern Finland. The patients were studied preoperatively with CT or MRI to determine the location of the tumour. The histology of the tumour was defined according to WHO classification. The level of anxiety was obtained by Crown-Crisp Experiential Index (CCEI) scale.

RESULTS

The patients with a tumour in the right hemisphere had statistically significantly higher mean anxiety scores compared to the patients with a tumour in the left hemisphere before surgery of the tumour. By three months and by one year after surgical resection of the tumour, the level of anxiety declined in patients with a tumour in the right hemisphere. A corresponding decline was not found in patients with a tumour in the left hemisphere. According to laterality by tumour histology, the level of anxiety decreased significantly in male and female patients with a glioma in the right hemisphere, but a corresponding decline was not significant in the female patients with a meningioma in the right hemisphere. Decreased level of anxiety was not found in patients with gliomas or meningiomas in the left hemisphere by follow up measurements.

CONCLUSIONS

Primary brain tumour in right hemisphere is associated with anxiety symptoms. The laterality of anxiety seems to reflect the differentiation of the two hemispheres. The level of anxiety declined after operation of right tumour, approaching that of the general population. The effect of right hemisphere gliomas on anxiety symptoms deserves special attention in future research.

Consequences of right cerebrovascular accident on emotional functioning: diagnostic and treatment implications

The relationship between lesion location and neuropsychiatric sequelae in stroke patients has been extensively studied. Emotional disorders associated with right hemisphere stroke include depression, anxiety, anger, and/or mania. Pharmacotherapy, electroconvulsive therapy, and/or psychotherapy are common treatments for these disorders. This article reviews the clinical presentations of seven right hemisphere stroke patients. The treatment rationale and course of treatment are described for two of these patients. The aims of this paper are to explore the appropriateness of various assessment tools and treatment modalities for stroke patients as well as to demonstrate the techniques of psychotherapy as applied to the two cases featured in this article. Specific factors that may significantly influence treatment outcome, such as lesion location and degree of cognitive impairment, are considered.

Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions

Neuroimaging is playing an increasing role in research of affective disorders, with investigators examining both volumetric changes of specific brain structures and vascular changes within white and gray matter. Recent studies have attempted to make clinical correlations between neuroimaging changes in unipolar and bipolar mood disorders. In this review, we focus particularly on those changes that are clinically meaningful. We conclude that there is enough evidence to begin to evaluate inclusion of neuroimaging findings in our mood disorder classification system. To this end, we propose two new mood disorder subtypes, vascular depression and vascular mania. Directions for future research in neuroimaging are then discussed.

Negative symptoms in stroke patients and length of hospital stay

The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.

Poststroke anxiety and its relationship to coping and stage of recovery

Anxiety disorders are reported to be common but poorly understood poststroke phenomena. The relationships between symptoms of anxiety, coping activity, and stage of recovery were investigated in 44 subjects who had suffered strokes (mean age 68.6 years). Consistent with general models of anxiety disorders, anxiety was associated with more frequent use of avoidant coping strategies. No significant relationship was found between time poststroke and self-reported distress.

Caregivers of persons with stroke: their physical and emotional wellbeing

This descriptive study was undertaken as a pilot test for several questionnaires designed to examine the well-being of caregivers of persons with stroke. This predominantly female sample was found to have moderately few physical symptoms, but to be in considerable emotional distress. Nearly half the sample had anxiety and depression scores above the level identified as suspicious for clinically relevant distress as indexed by the Symptom Questionnaire. Anger was also a salient finding: 40% of those questioned scored above the cutoff level for hostility and several caregivers expressed anger verbally during data collection. The degree of psychological distress in these individuals is of importance to all health care professionals and deserves increased attention, both from the perspective of the researcher and from the perspective of the clinician.