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From the Department of Neurology (Drs. Ghika-Schmid and Bogousslavsky) and the Division of Psychosocial Medicine (Dr. Guex), Centre Hospitalier Universitaire Vaudois; and the University Institute of Social and Preventive Medicine (Dr. van Melle), Lausanne, Switzerland.
Address correspondence and reprint requests to Dr. Florence Ghika-Schmid, Department of Neurology, Centre Hospitalier Universitaire Vaudois-BH 13, 1011 Lausanne, Switzerland.
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.
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