A IRA NO ACIDENTE VASCULAR CEREBRAL. DETERMINANTES E IMPACTO NA ADESÃO AO TRATAMENTO E NO BEM-ESTAR DOS CUIDADORES

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A ira no acidente vascular cerebral : determinantes e impacto na adesão ao tratamento e no bem-estar dos cuidadores

Publication . Oliveira, Ana Catarina da Costa Oliveira Santos Ermida de, 1979-; Ferro, José Manuel Morão Cabral

Anger is one of the most frequent neuropsychiatric disorders after stroke and one that could have a stronger negative impact on stroke patients and their informal caregivers. In a previous study, we found that 35% of the patients (N = 202) with acute stroke presented anger, without it being associated with any demographic, clinical, imaging, psychiatric and functional variables studied. We found significant dissociations between the emotional-cognitive and behavioral components of anger and between anger expressed by the patients and the one that was clinically observed. This work encouraged us to formulate a multifactorial model of anger in stroke, including four triggering factors: (1) brain injury; (2) stroke as a non-normative life event that disturbs the patient and requires him to integrate the new demands arising from the disease and the expectations about the future; (3) anger as a pre-morbid personality trait in patients who frequently express anger in their interactions / relationships, (4) anger as a reaction to a hostile, real or perceived hospital environment and related to the degree of patient satisfaction about this environment and care. Thus, we proposed to carry out the present study, whose main objective was to determine the frequency of anger in stroke, to identify its determinants, testing the above model, and its impact on treatment adherence and on the well-being of the patient's informal caregivers. We assessed the presence of anger, its components (emotional, cognitive and behavioral, state-anger and trait-anger), forms of expression and control in 114 consecutive patients with stroke (ischemic or hemorrhagic) in the acute phase (up to 7 days after stroke) and 12 months after stroke. We used the State-Trait Anger Expression Inventory-2 (STAXI-2), a specific, widely used and recognized anger assessment scale. We also assessed the perception of the environment (acute phase), the presence of cognitive impairment, anxiety and depressive symptoms and satisfaction with the care (acute phase and at 12 months), adherence to treatment and beliefs about treatment and healthcare education (12 months). The first work concerns the results obtained in the acute stroke, with 18% of patients presenting state-anger and 20% trait-anger. The predictive variables of anger were age, hypertension, complaints about the environment, the presence of anxiety symptoms and functional disability at discharge. The second work refers to the results obtained 12 months after the stroke, with 17% of the patients presenting state-anger and 8% trait- anger. At this stage, having a posterior ischemic stroke, trait-anger and considering stroke sequels as relevant were predictive factors for anger. Patients with higher levels of anger had lower adherence rates. The anger profile was slightly different between the two phases, with more intense and frequent anger in the acute stroke, probably due to differences in anger control. In both moments, anger was essentially experienced as an intense internal feeling, avoiding its expression. The third work presents the results obtained by the informal caregivers of the patients, 12 months after stroke. The objective was to assess the impact that the presence of anger in patients had on the caregivers' well-being, specifically on burden, anxiety and depressive symptoms, quality of life and coping strategies. Anger was perceived by 37% of the caregivers, who presented higher levels of depressive symptoms, burden, worse quality of life and use dysfunctional coping strategies. The predictors of burden were the presence of anger and the use of dysfunctional coping strategies. Conclusion: Anger is a frequent and relevant neuropsychiatric symptom since the acute phase to a chronic phase after stroke. Over time the importance of stroke as a non-normative, acute and unexpected disease decreases as patients deal with it, remaining the more objective impact of brain injury, symptoms that interfere with daily life, and previous experiences of anger (trait-anger). For caregivers, the presence of anger in patients makes difficult the already complex process of caring, contributing to diminish their well-being and increase the burden. The results presented here have an important clinical implication, highlighting the importance of the early detection and anger management, in order to prevent its negative impact on care and recovery of the patients and on the well-being of their informal caregivers.

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Entidade financiadora

Fundação para a Ciência e a Tecnologia

Número da atribuição

SFRH/BD/44792/2008