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Stroke Smart Magazine

May/June 2008

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'What, Me Worry?!'
When Anxiety Follows a Stroke

By Jay Schneiders, PhD, ABPP

Most When it comes to understanding fear, anxiety and worry after stroke, we can look to the brain for answers.

Simple fear is wired into the brain. When we see a big, hairy spider, for example, a tiny organ at the center of the brain, called the amygdala, produces strong emotions and guides us to protect ourselves. Anxiety is a more complex emotion. About 70 percent of stroke survivors suffer from some sort of anxiety disorder right after the stroke. Yet anxiety conditions are often missed or minimized by medical teams.

Some anxiety after a stroke is normal. Survivors worry about their health and how to manage the changes in their lives. Normal worries can be lessened with time, education and recovery.

But the brain itself can become anxiety-prone in some stroke survivors. This is especially true for people whose strokes affected the non-dominant side of the brain. When anxiety persists and starts to interfere with the ability to relax, sleep or find happiness in life, it may be time to seek help. A neuropsychologist or a psychiatrist who has experience with stroke survivors can provide necessary care.

The absence of worry or anxiety also can cause problems.If you are not worried enough, you may not be motivated to take your medicine or maintain habits that could help prevent another stroke. This can be tricky, because for optimal healing and health, you must see yourself as a person and not just a patient. And yet, stroke recovery can be a lifelong journey.

With never-ending rehab, frequent doctor checkups and an array of medicines, stroke  survivors can feel like perpetual patients. The patient-to-person transition can be even harder for a person whose insight, planning, judgment, self-monitoring and control have been affected by stroke. Some patients aren’t worried enough because they have a condition called anosognosia and are unaware of their illness. Anosognosia typically goes away shortly after the stroke, but as many as 10 percent of stroke survivors continue to have problems of this type.

Anxiety after stroke is completely normal and even necessary and helpful under certain circumstances. But it can be dangerous under other conditions. The key is to understand anxiety in the specific, unique and personal terms of the human being experiencing it. Never be afraid to ask for help in sorting out your own worries and concerns, whether about  yourself or a loved one.

Things to Bring up with a Doctor:

1. Did the anxiety come on all of a sudden or gradually?

2. Does reasonable reassurance lessen the worry or make it worse?

3. Was the survivor an anxious person before the stroke, or is this a major change in personality?

4. Did the anxiety start around the time a medicine was added or stopped?

5. Is anxiety the only change in thinking abilities and emotional reactions after the stroke, or are there signs of depression, apathy, emotional hyper-reactivity or other changes in the person that accompany it?

6. Is the anxiety about specific things, or is it more “free-floating” and general?

7. Does the anxiety come on in episodes or bursts, or is it there all the time?

Dr. Jay Schneiders is a neuropsychologist at the Colorado Neurological Institute in Denver, Colo.


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