DiscoverCounselor Toolbox PodcastPost Stroke Psychosocial Issues
Post Stroke Psychosocial Issues

Post Stroke Psychosocial Issues

Update: 2019-12-11
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Description

448 – Post Stroke Psychosocial Issues

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director: AllCEUs

Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review


Objectives

• Examine the prevalence of and risk factors for stroke

• Identify Post-Stroke Psychosocial Issues

Intro

• Many of our clients are at high risk of stroke

• People with anxiety disorders have a 33% higher risk of stroke partly due to HBP and lifestyle factors such as smoking

• Mood stabilizers were collectively associated with a significantly increased risk for stroke in participants with bipolar disorder

• Benzodiazepine use is associated with a 20% higher risk of stroke

• Almost 40% received 1 or a combination of drugs hypothesized to impair recovery during the first 30 days after stroke.(e.g. clonidine which reduces NE levels, atypical antipsychotics, benzodiazepines)

Risk for Stroke

• Smokers are 2-4x as likely to have a stroke

• Make blood sticky and more likely to clot, which can block blood flow to the heart and brain

• Damage cells that line the blood vessels

• Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels

• Cause thickening and narrowing of blood vessels

• Alcohol increases stroke risk by 38%

• Causing A-Fib

• Development of atherosclerosis, or the hardening and narrowing of arteries

• Liver damage impairing blood clotting

• HBP during detoxification

Risk for Stroke

• Stimulant abuse increasing blood pressure

• High blood pressure

• Sleep apnea

• Non-sleep-apnea sleep disorders

• Age

• Diabetes doubles the risk of stroke

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack

Mini-Strokes

• The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of:

• Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body

• Slurred or garbled speech or difficulty understanding others

• Blindness in one or both eyes or double vision

• Dizziness or loss of balance or coordination

• Sudden, severe headache with no known cause

• 70% reported that their TIA had long-term effects including memory loss, poor mobility, problems with speech and difficulty in understanding. 60% of people stated that their TIA had affected them emotionally


Assessments

• When

• Just before discharge

• One month after stroke

• Three months after stroke

• Six months after discharge

• What to look for

• Cognitive functioning

• Depression

• Anxiety

• Social withdrawal

• Changes in physical presentation

Impacts of Stroke

• General Physical Issues

• Reduced mobility / independence

• Vision problems

• Difficulty with ADLs

• Difficulty swallowing

• Sleep problems (36%)

• Chronic headaches

• Pneumonia

• Pain


Impacts of Stroke

• Difficulty understanding or expressing emotions

• Post-stroke depression (PSD) (67%)

• Post-stroke depression may remit as the person regains function

• Correlated with hospitalization, functional loss and particular areas of the brain being damaged

• Post-stroke anxiety (25%)

• Post-stroke emotional incontinence (PSEI) uncontrollable outbursts of involuntary laughing or crying for no apparent reason (34%)

• Functional status, serotonin polymorphisms, and low social support were related to PSEI at three months post-stroke

• SSRIs are often effective


Impact

• Post-stroke anger proneness (PSAP)

• serotonergic dysfunction seems to play a role in the development of PSAP

• Post-stroke fatigue (PSF) (50%-86%)

• Depression

• Neurological deficits

• Antidepressants

• Sleep disturbances

• Post-stroke pain

• Changes to thinking, memory and perception after stroke can impact how the person sees, hears and feels the world. This can affect how they feel about themselves and others


Impact

• Cognitive skills can be affected by emotional state or tiredness, but brain damage caused by stroke can also cause difficulties with

• Ability to learn new skills

• Ability to plan

• Ability to problem solve

• Attention – being able to concentrate and focus

• Orientation – knowing the day and time

• Short-term memory – knowing what happened recently

• Changes in working memory

• Intellectual fulfillment


Attention and Memory Intervention

• Minimum of 1 hour a day of actively listening to music showed recovery in both verbal memory and focused attention, as early as 3 months after a stroke

Impact

• Personality changes

• Repetitive behavior

• Disinhibition – tendency to say and do things that are socially inappropriate

• Impulsivity including sudden and socially inappropriate actions.


Impact

• Perception is the term that describes how you see, hear and feel the world. After a stroke, your perception can include changes to:

• Feeling contact, pain, heat or cold on the side of your body affected by stroke

• Judging distance

• Performing certain movements even without physical disability (apraxia)

• Recognising shapes and objects, or even your own body

• Seeing or feeling things only on one side – which can cause you to bump into things

• Watching TV or reading – can become difficult

• Vision – some people lose half their vision in each eye (hemianopia).


Impact

• Communication after stroke

• Difficulty in finding the right words or understanding what others are saying (aphasia or dysphasia)

• Weakness in the muscles that help speech (dysarthria)

• Dysfunction of the nerve connection between your brain and mouth, making speaking difficult (dyspraxia)

• Reading and writing problems caused by a weak writing hand or problems thinking or seeing.


Impact

• Physical changes after stroke

• Difficulty with gripping or holding things

• Fatigue or tiredness

• Incontinence – many types of incontinence can occur, but it can be caused by medication, muscle weakness, changes in sensations, thinking and memory

• Pain – can be caused by actual or potential damage to tissues (nociceptive pain) or by damage to nerves that then send incorrect messages to the brain (neuropathic pain)

• Restricted ability to perform physical activities or exercise

• Swallowing issues

• Vision problems

• Weakness or paralysis of limbs on one side of the body.


Impact

• Aphasia

• Affects about one third of the stroke population and 40% continues to have significant language impairment at 18 months post-stroke

• Persons with aphasia (PWA) are especially prone to psychosocial problems, such as

• Anxiety and depression

• Threatened identity

• Changes in interpersonal relationships

• Reduced social networks

• Unemployment

• Abandonment of leisure activities

Post Stroke Grief

• Losses

• Independence

• Function/hobbies/employment

• Home (if moved to an ALC)

• Self-Esteem

• Appearance

Post-Stroke Guilt

• Not being able to do things with kids/family/friends that they used to

• Needing assistance from caregivers/feeling like a burden


Post-Stroke Interpersonal Issues

• Social life

• Personality changes, anger, depression, fatigue may inhibit relationships

• Emotional Incontinence may cause social withdrawal

• Financial challenges

• Loss of employment

• Need for an ALC

• Need for PT/OT

Post-Stroke Caregiver Needs

• Caregivers should be assessed for their ability to provide care

• Regularly assess caregiver wellbeing

• Caregiver Strain Index

• Caregiver Burden Scale

• Support caregivers in balancing personal needs and caregiving responsibilities by providing community programs, respite care, and educational opportunities

Summary

• Stroke impacts people physically, affectively, cognitively, and interpersonally.

• It is important to explore the causes of mood or cognitive issues to identify the best interventions

• Brain damage

• Sleep dysfunction

• Cognitive issues

• Life changes

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Post Stroke Psychosocial Issues

Post Stroke Psychosocial Issues

Charles Snipes