Subjective experience and behavior in acute stroke - The Lausanne emotion in acute stroke study

Objective: To assess subjective experience in acute stroke and to correlate it with stroke features, acute emotional behavior, and impact on seeking o f medical care. Methods: The authors studied patients with acute first-ever stroke prospectively. During the first 4 days they rated subjective experi ence (happiness, sadness, irascibility, and fear); behavioral reactions, us ing a specifically designed scale; and mood (Hamilton anxiety and depressio n). 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 over t sadness, 20 presented indifference, 12 presented aggressiveness, 20 prese nted disinhibition, and 16 presented denial. Eight patients were anosognosi c and 12 were anosodiaphoric. Twenty-four patients expressed happiness, 20 expressed sadness, 7 expressed anger, and 11 expressed fear. Ten patients w ith aphasia could be interviewed, but four required delayed questioning. De nial reactions and anosognosia were independent. Acute denial reactions wer e not dependent on the side of stroke, but were more frequent after deep le sions (p < 0.010). Patients with a denial reaction had a tendency to presen t less subjective experience of fear (p < 0.078) and a higher occurrence of delayed depression (p < 0.02). Intergroup comparison of all measures showe d 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 beh avioral denial had a decreased occurrence of subjective experience of fear and a more frequent occurrence of delayed depression. These denial reaction s were independent of anosognosia. A subjective experience of fear was rela ted 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' subjecti ve experience.