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Aggressive Behavior After a Stroke

By Walt Kilcullen

 

When someone has a debilitating stroke, at some point the survivor may experience anger. It will vary as to the severity and the intensity, but anger of some degree usually happens.

 

But when anger is not controlled and when it becomes part of the survivor’s personality, aggressive behavior can result. By aggressive behavior, I mean uncontrollable irritability, anger pointed at someone such as the caregiver, sudden outbursts without any reason, or, in some cases, unprovoked violence.

 

Jordan Grafman, PhD has been researching the cause of this behavior in brain injured patients. He is presently on the staff of the Kessler Foundation Research Center. Dr. Grafman led a 2011 study published in the journal Neurology, where he and his team found that two main factors are the cause of aggressive behavior. The first is the location of the injury to the brain, and second, the behavior is influenced by genetics (pre-disposition). Dr. Grafman stated, “This indicates that brain imaging and genetic testing can add to what we learn from psychological assessment.”

 

Another study was led by Jong S. Kim, MD, Department of Neurology at Asan Medical Center in Seoul, South Korea. His findings agree with Dr. Grafman’s. His study showed that aggressive behavior after a stroke is usually related to brain damage rather than from distress over their condition. The study of 145 people who suffered a stroke, researchers found that those survivors that experienced anger or aggressive behavior (forty seven of the patients) had lesions on the parts of the brain responsible for producing serotonin, a brain chemical that moderates behavior. This study was also published in the journal Neurology.

 

Dr. Kim states, “To my mind, these anger symptoms are generally neurologic but not psychiatric, and doctors should explain this to patients and relatives who are disturbed by these behavioral changes.”

 

Managing this aggressive behavior is important for recovery, the patient’s relationships, and the patient’s ability to work. It is also important for the caregivers well-being. Dr. Grafman states, “Clinicians who see patients with lesions of the prefrontal cortex should inquire specifically about aggressive behavior.” He adds, “patients and their families may benefit from counseling or medication to manage this behavior. Short-term cognitive behavioral therapy can also be very helpful.”

 

Caregivers may benefit from these tips:

 

Remember that aggressive behavior is part of the effects of the stroke. Your loved one cannot always control their behavior.

Stay calm. Do not overreact to your loved one’s outbursts. Speak slowly and softly without raising your voice until your loved one calms down.

Avoid arguing with your loved one. Redirect their attention to something else.

After you find things that create anger in your loved one, avoid them as much as possible. For example, if you observe that being around a large amount of people sets them off, avoid that environment.

If you as a caregiver become angry or frustrated, back off and cool down.

Chances are they will calm down after you step back and remain calm.

Stay safe. If your loved one becomes violent, back away; keep a safe distance, and seek help from a family member, a friend, or a neighbor if needed.

 

Many marriages break up after one spouse has a stroke. It is important that you have help with care giving. Don’t wait for friends and family members to volunteer. Ask them to give you a break by caring for your loved one periodically.

 

 

Copyright ©September 2012

The Stroke Network, Inc.

P.O. Box 492 Abingdon, Maryland 21009

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