PracticeUpdate Conference Series European Congress of Psychiatry 2019

Positive Emotions Following Stroke Predictive of Functional Recovery Primary care physicians should screen post-stroke patients for low emotional states and refer for psychological support, if needed.

S creening patients for positive emotions should be undertaken following a stroke, as this can have an impact on both functional independence and functional recovery, according to a poster presentation at EPA 2019. Importantly, the predictive value of patients’ emotional state was significant even in the absence of clinical depression. “Stroke is a major global health problem with tre- mendous disease burden,” lead author Jesjeet Singh Gill, MBBS, of the University of Malaya in Malaysia told Elsevier’s PracticeUpdate . “Post-stroke depression is well-[known] to be associated with post-stroke functional recovery. However, positive emotions, another domain of mood, [have not been] given much scientific atten- tion. Positive emotions are thought to be vital in promoting recovery process in medical illness.” Dr. Gill pointed out that while two previous studies (by Ostir et al and Seale et al) have examined the relationship between positive emotions and recov- ery of function following stroke, it has never been evaluated in a Malaysian population. Dr. Gill and his colleagues Dr. Low Jong Sern (Penang Hospital) and Dr. Amarpreet Kaur (University of Malaya) recruited 136 patients dur- ing the 6 to 12 weeks after they experienced a stroke. These patients’ positive emotional states were assessed using the Positive Emotion Rating Scale (PERS). They were also evaluated for the presence of depression using the Montgomery- Åsberg Depression Rating Scale-Self (MADRS-S) or the Malay version of the MADRS-S. In addition,

patients’ functional status was assessed using the Modified Barthel Index (MBI). Overall, 65.4% of patients had a good positive emotional state, with the remaining 34.6% having a poor positive emotional state. In addition, a total of 23.5% of the patients met the clinical criteria for depression. Patients who had a length of inpatient hospital stay <5 days were 7.3 times more likely to have a good positive emotional state and 12.3 times less likely to have depression. Similarly, patients with fewer than three medical comorbidities were 4.3 times less likely to have depression. Dr. Gill told Elsevier’s PracticeUpdate that longer hospital stays were likely a marker of more severe stroke. Total PERS and MADRS-S scores were significantly associated with both functional independence and functional recovery. Multiple regression analysis revealed, however, that only PERS was significantly independently associated with both functional independence and functional recovery. Other factors significantly associated with post- stroke function were length of hospital stay, MBI at discharge, presence of a spouse and age. “Positive emotions screening should be consid- ered in post-stroke patients upon discharge [from hospital] and during follow-up, in order to detect those [patients who] are at risk,” said Dr. Gill. “Early intervention, such as medications that promote positive emotions or positive psychotherapy, can be provided if poor positive emotions are detected early.”

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PRACTICEUPDATE CONFERENCE SERIES • EPA 2019