Psychosocial Problems

In the acute phase following stroke, 25-30% of patients develop clinical signs of depression, 30% are anxious, and a similar proportion report loss of confidence as a major psychological problem. Depression may result from an interaction of several factors including left frontal lobe damage, reactions to physical loss, and impaired performance of activities of daily living. Comparatively little is known of interactions between depression, anorexia, and nutritional status in the early stages of recovery following stroke in individuals with and without physical eating problems. However, patterns of behavioral disturbance characterized by verbal expressions of depressed mood, anorexia, and insomnia have been identified and associated with weight loss. Anxiety-evoking experiences relating to being fed, or choking in the presence of dysphagia, may also result in avoidance or withdrawal from eating. General approaches to the treatment of poststroke depression can involve the use of antidepressant drugs and behavioral and psychotherapeutic techniques. Specifically, the exercise of therapeutic skills in communication, assisting eating, and providing emotional support are vital in alleviating mealtime anxiety and increasing interest in food.

The enjoyment of eating as a social activity can be affected adversely by poststroke depression and impairments of speech, language, lip closure and, manual dexterity. Severely disabled individuals who are relearning swallowing techniques initially require a quiet environment with privacy. As swallowing and other difficulties abate, social integration at mealtimes can he achieved in conjunction with sensitive assistance.

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