Aggressive behavior in patients with stroke: association with psychopathology and results of antidepressant treatment on aggression.
OBJECTIVE
To examine, in a post hoc analysis of an antidepressant treatment trial, correlates of irritability and aggression after stroke and changes in irritability scores associated with antidepressant treatment.


METHODS
Aggressive patients (n=23) were compared with nonaggressive patients (n=69) on numerous measures of psychopathology, poststroke impairment, and neuroimaging findings.


METHODS
All patients were hospitalized at the time of the initial evaluation for acute stroke or for rehabilitation therapy.


METHODS
Ninety-two patients from the Iowa City Stroke Study were classified as aggressive or nonaggressive, based on symptoms elicited by the Present State Examination (PSE) and from family or caretaker reports.


METHODS
All patients were randomized to receive nortriptyline, fluoxetine, or placebo using a double-blind methodology.


METHODS
The change in aggression score as elicited by the PSE at the beginning and the end of a 12-week treatment trial.


RESULTS
Twenty-five percent (23/92) of patients reported irritability or aggression. Irritable and aggressive patients had higher total PSE scores, Hamilton Depression Rating Scale scores, Hamilton Anxiety Rating Scale (HAMA) scores, and lower Mini-Mental State Examination scores. They also had lesions that were more proximal to the frontal pole. Stepwise regression analysis showed that HAMA scores and proximity of lesion to the frontal pole were significant independent predictors of irritability. Among irritable and aggressive patients with depression who responded to antidepressants, there was a significantly greater reduction in irritability after treatment, compared with patients whose depression did not lessen with treatment.


CONCLUSIONS
Several factors, such as severity of impairment, other psychopathology, and neurobiologic factors, appear to contribute to irritable and aggressive behavior in stroke patients. If depression accompanies aggression, the results of this small study suggest that successful treatment of depression may reduce aggressive behavior.
Chan
Keen-Loong
KL
Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore.
Campayo
Antonio
A
Moser
David J
DJ
Arndt
Stephan
S
Robinson
Robert G
RG
D000368:Aged; D000374:Aggression / Q000523:psychology*; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D009661:Nortriptyline