ACUTE Vs LATE POST-STROKE MOOD DISORDERS
Background and Methods: We studied emotional behaviors and mood disorders in 165 consecutive patients with acute first-ever hemispheral stroke. In all patients, a specifically designed observational scale for behavioral appraisal (Emotional Behaviour Index Form or EBIF) was assessed daily for four days, starting within 48 hours. The EBIF, which is independent of language abilities, includes 38 rated items, divided in the categories of overt sadness, passivity, aggressiveness, indifference, disinhibition, denial and adaptation. Prospective evaluation, including a standardized neuropsychological battery, Hamilton depression and anxiety rating scales, Rankin scale, Barthel index, and psychiatric interview with DSM-IV diagnosis , was also performed 3 and 12 months after stroke. RESULTS: In the acute phase, observed depressive behaviors and mood verbal scores were not significantly associated with lesion side. However, in patients with left hemispheral lesion, we found a significant relation between aphasia, overt sadness and passivity (p<0.04), while in patients with right lesion, anosognosia was associated with both indifference and depressive behaviors (p<0.04). Only aphasic patients showed catastrophic reactions, and only patients with anosognosia showed extreme indifference reactions. At 3 and 12 months, prevalence of depression was respectively 35% (22/62) and 30% (18/51), while prevalence of anxiety was 33% (16/48) and 27% (12/46). At 12 months, major depression (HDRS>18) was found in 2 patients (3%). Left hemispheral (p=0.05) and subcortical lesions (38% p=0.06) were associated with delayed, but not acute, mood disorders. Anxiety (p=0.05), but not depression (p=0.8), was related to poorer functional impairment (dependency). CONCLUSIONS: In acute stroke, observed emotional behaviors are related to specific cognitive impairment (i.e. aphasia and anosognosia), but not to lesion site and side. Acute mood changes are not a strong indicator of delayed post-stroke depression. Post-stroke depression, which is preferentially associated with left or subcortical involvement, may have a different origin from post-stroke anxiety.