The doctor explains emotional lability to Trevor in some detail. It is agreed that Nurse Jones will discuss this further with Trevor and his family.
Emotional lability:
About one quarter of patients have difficulty controlling the expression of emotion in the year following stroke.
Emotional lability has been described using a variety of terms including emotionalism, pathological emotionalism, emotional incontinence, pathological crying/laughing, and pseudobulbar affect.
The patient abruptly starts to weep, or less commonly to laugh uncontrollably, sometimes with no obvious precipitant.
More often, episodes are triggered by a kind word (e.g. how are you feeling?) or a thought with emotional overtones (e.g. thinking of grandchildren) but the emotional response is out of proportion to the degree of ‘internal sadness’ (or mirth).
Usually, the episodes are short lived but may occur frequently enough to disrupt a conversation, therapy session or social event.
Such outbursts cause considerable distress to the patient and their carer and may be a major obstacle to rehabilitation and social integration.
(Paragraph taken from: Warlow C, Van Gijn J, Dennis M, Warlow J, Bamford J, Hankey G, Sandercock P, Langhorne P, Sudlow C, Rothwell P (2008) Stroke: Practical Management 3rd ed, Blackwell Publishing)
Click here to read more about experiencing emotional lability: Healthtalkonline (scroll down the page until you get to ‘Emotional lability’ section)
The doctor speaks with Trevor on the ward round. She tells Trevor that the team are aware that his crying is affecting his rehabilitation. She asks Trevor what he thinks about this. Trevor tells the doctor that the worst part of it is not being able to control his crying. He finds ‘the slightest thing’ sets him off, even when he doesn’t feel that upset. He says he feels embarrassed in front of everyone on the ward.
Nursing staff have carried out a mood screening questionnaire and the doctor discusses the results of this with Trevor. (See link below.)
Trevor’s score on the PHQ-9 falls in the range for mild depression (5-9). However, mood screening tools are not in themselves diagnostic and when asked for more information about the questions he rated as “on several days or more” they were clearly linked specifically to his crying and the effect this is having on his progress.
For more information on mood screening view the Topic loop which can be found below. See Additional Information box below for more information on the PHQ-9.
The following day at the weekly MDT meeting the physiotherapy and occupational therapy staff report that Trevor is making good progress. However, at times this has been hampered with tearful outbursts that bring therapy sessions to a halt. The nursing staff report that Trevor is eating and sleeping well but he is quite quiet on the ward and clearly upset by his crying. The nurse adds that Barbara is also very concerned about this and would like to know why this is happening.
Trevor has been in the ward a few days when his wife Barbara approaches nursing staff, anxious that her husband is still weeping. Tom (their son) is now refusing to visit finding it difficult to cope with this unusual behaviour in his father. Barbara questions whether this is happening at other times or just when she and the family visit. Why might Trevor be behaving like this?
Trevor has been in the acute unit for one month following a right hemisphere Total Anterior Circulatory Stroke (TACS). For more information on TACS click on the ‘Additional Information’ button below. Patients with more severe strokes, such as a TACS are likely to be more physically impaired.
CT scan showing large right Middle Cerebral Artery (MCA) territory infarct
Trevor presented with a dense left sided hemiplegia. He requires hoisting for transfers, has urinary incontinence, left homonymous hemianopia and mild cognitive impairment.
Trevor is making good functional progress with his rehabilitation and is about to be transferred to the Stroke Rehabilitation ward. His detailed transfer letter notes that Trevor is prone to unpredictable tearful episodes.
Trevor is 49 years old and is married with two teenage children – Molly who is 17 years old and Tom who is 14 years old. He is self-employed with a small engineering firm. Trevor is normally a very level-headed, quiet man who does not like to be the centre of attention.
He has close a relationship with his family and likes spending quality time with them. His hobbies include:
The patient is a 59-year old woman who is experiencing vision and memory problems. She is unable to drive and she is not coping well.
Specialist discusses a referral of a stroke patient with stroke psychologist.
(This video is dedicated to Sister Joanna MacFarlane, Stobhill Hospital.)
There are many mood disturbances that may follow stroke. This module aims to encompass depression, emotional lability and anxiety. On completion of this module you should have a critical understanding of these specific issues and how they may impact on a person. You will also be aware of strategies that may help.
Learning outcomes
On completion of this module you will:
Have improved your knowledge and understanding related to identifying the signs of depression, emotional lability and anxiety.
Have enhanced your skills related to dealing effectively with depression, emotional lability and anxiety.
Be aware of the support that may be available for people who present with depression, emotional lability or anxiety following stroke and be able to direct them to organisations or individuals that may help them.
Have improved understanding of the spiritual needs of your patient/clients.
Be aware of the various resources available to assist with spiritual needs assessment and provision.
Patient Scenario 2: Mary
Patient Scenario 3: Jennifer
Patient Scenario 4: Lisa
