Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study.
Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study.
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DOI：
10.1176/ajp.150.2.286
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发表时间：
1993-02
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影响因子：
--
通讯作者：
R. Robinson;R. Parikh;J. Lipsey;S. Starkstein;T. Price
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文献类型：
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作者：
R. Robinson;R. Parikh;J. Lipsey;S. Starkstein;T. Price
目的本研究旨在检验病理性哭笑量表的信度和效度以及去甲替林治疗脑卒中后情绪不稳定的疗效。方法82例缺血性脑损伤患者-54例因急性中风住院，28例因病理性大笑和哭泣而要求治疗-进行标准化精神和神经评估，然后进行病理性大笑和哭泣量表。对54例急性脑卒中患者进行病理性哭笑量表评定，对28例有病理性情绪表现的患者随机分为去甲替林组和安慰剂组，进行为期6周的双盲试验，以评价三环类抗抑郁药治疗脑卒中的疗效。结果15例患者病理性哭笑量表的评定者间信度为0.93，重测信度良好。经过4周和6周的治疗后，14名接受去甲替林治疗的患者的病理性大笑和哭泣量表评分比14名接受安慰剂治疗的患者有显著改善。虽然这些患者中几乎有一半也患有重度抑郁症，但情绪不稳定的改善与抑郁状态无关。此外，对治疗的反应不受病变位置或卒中后时间的显著影响。结论病理性笑哭量表能可靠地量化病理性情绪表现的症状严重程度，去甲替林治疗能有效改善这种情绪障碍。
OBJECTIVE This study was undertaken to test the reliability and validity of the Pathological Laughter and Crying Scale and the effectiveness of nortriptyline treatment for patients with emotional lability following stroke. METHOD Eighty-two patients with ischemic brain injury-54 who had been hospitalized with acute stroke and 28 others who requested treatment for pathological laughing and crying--were given standardized psychiatric and neurological assessments and then administered the Pathological Laughter and Crying Scale. The 54 acute stroke patients were used to evaluate the Pathological Laughter and Crying Scale, and the 28 patients with pathological emotional display were randomly assigned to nortriptyline treatment or placebo in a 6-week double-blind trial to assess the efficacy of a tricyclic antidepressant in treatment of this disorder. RESULTS The interrater reliability on the Pathological Laughter and Crying Scale for a subgroup of 15 patients was 0.93, and the test-retest reliability of the scale was excellent. After 4 and 6 weeks of treatment, scores on the Pathological Laughter and Crying Scale showed significantly greater improvement in the 14 patients given nortriptyline than in the 14 given placebo. Although almost one-half of these patients also had major depression, the improvement in emotional lability was independent of depression status. In addition, response to treatment was not significantly affected by lesion location or time since stroke. CONCLUSIONS The severity of symptoms in pathological emotional display can be reliably quantified with the Pathological Laughter and Crying Scale, and treatment with nortriptyline can effectively ameliorate this emotional disorder.