Subjective experience and behavior in acute stroke - The Lausanne emotion in acute stroke study
Subjective experience and behavior in acute stroke - The Lausanne emotion in acute stroke study
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DOI：
10.1212/wnl.52.1.22
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发表时间：
1999-01-01
期刊：
影响因子：
9.9
通讯作者：
Bogousslavsky, J
中科院分区：
文献类型：
--
作者：
Ghika-Schmid, F;van Melle, G;Bogousslavsky, J
目的：评估急性卒中患者的主观体验，并探讨其与卒中特征、急性情绪行为及对就医的影响的相关性。方法：对急性首次卒中患者进行前瞻性研究。在最初的4天里，他们使用专门设计的量表对主观体验(快乐、悲伤、易怒和恐惧)、行为反应和情绪(汉密尔顿焦虑和抑郁)进行了评级。53名患者(30名男性，23名女性；年龄60+/-19岁)完成了3个月的随访。结果：17例患者未能自发就医。16例患者表现为明显悲伤的行为反应，20例表现为冷漠，12例表现为攻击性，20例表现为去抑制，16例表现为否认。8例感觉失认症，12例感觉失调症。24名患者表示高兴，20名患者表示悲伤，7名患者表示愤怒，11名患者表示恐惧。10名失语症患者可以接受采访，但有4名患者需要延迟询问。否认反应和病感缺失是独立的。急性否认反应不依赖于卒中侧，但在深部损伤后更频繁(p<；0.010)。有否认反应的患者倾向于表现出较少的主观恐惧体验(p<；0.078)和较高的迟发性抑郁发生率(p<；0.02)。所有指标的组间比较显示，缺乏寻求治疗与冷漠反应(p<；0.007)、较少主观的恐惧体验(p<；0.078)、对急性事件的回忆不佳(p<；0.001)、认知力下降(p<；0.001)以及右侧病变(p<；0.035)有关。结论：急性行为否认患者的主观恐惧体验减少，迟发性抑郁发生率增加。这些否认反应与病感失认症无关。恐惧的主观体验与适当的护理寻求有关。与病感失认症一样，主观恐惧的受损体验可能会导致咨询延迟的增加。所有其他情绪反应都与患者的主观体验无关。
Objective: To assess subjective experience in acute stroke and to correlate it with stroke features, acute emotional behavior, and impact on seeking of medical care. Methods: The authors studied patients with acute first-ever stroke prospectively. During the first 4 days they rated subjective experience (happiness, sadness, irascibility, and fear); behavioral reactions, using a specifically designed scale; and mood (Hamilton anxiety and depression). Fifty-three patients (30 men, 23 women; age, 60 +/- 19 years) completed the 3-month follow-up. Results: Seventeen patients failed to seek medical care spontaneously. Sixteen patients presented behavioral reactions of overt sadness, 20 presented indifference, 12 presented aggressiveness, 20 presented disinhibition, and 16 presented denial. Eight patients were anosognosic and 12 were anosodiaphoric. Twenty-four patients expressed happiness, 20 expressed sadness, 7 expressed anger, and 11 expressed fear. Ten patients with aphasia could be interviewed, but four required delayed questioning. Denial reactions and anosognosia were independent. Acute denial reactions were not dependent on the side of stroke, but were more frequent after deep lesions (p < 0.010). Patients with a denial reaction had a tendency to present less subjective experience of fear (p < 0.078) and a higher occurrence of delayed depression (p < 0.02). Intergroup comparison of all measures showed that lack of seeking care was related to reactions of indifference (p < 0.007), a tendency toward a less subjective experience of fear (p < 0.078), poor recall of the acute event (p < 0.001), decreased nosognosia (p < 0.001), and right-side lesions (p < 0.035). Conclusions: Patients with acute behavioral denial had a decreased occurrence of subjective experience of fear and a more frequent occurrence of delayed depression. These denial reactions were independent of anosognosia. A subjective experience of fear was related to appropriate care seeking. An impaired subjective experience of fear may contribute, as with anosognosia, to an increased delay in consultation. All other emotional reactions were dissociated from the patients' subjective experience.