Anger or Aggression in Stroke

Anger or aggression is prevalent during the acute and subacute stages of stroke. Thus, along with depression, anger/aggression appears to be one of the main emotional symptoms observed in patients with stroke. Post-stroke anger (PSA) is associated with neurological deficits, depression, and emotional incontinence. Although the study results are heterogeneous, lesions involving the frontal-lenticular-brainstem pathway appear to be related to PSA. Considering this, PSA seems to be, at least in part, related to neurochemical (e.g., serotonin) changes secondary to brain damage. However, patients’ frustration associated with their functional deficits, hostile environments, and genetic predisposition may also play a role in PSA development. Antidepressants, particularly SSRIs, are considered the management of choice. The recognition of PSA is important because not only does it deteriorate patients’ quality of life and increase caregivers’ burden but it is also treatable. However, several limitations need to be addressed. First, a standardized method for diagnosing or measuring PSA severity has not yet been established. Second, in most PSA studies, patients with severe aphasia or cognitive impairment were excluded. Thus, PSA prevalence is probably underestimated. Third, data from different continents (e.g., Europe, North America, and Asia) may generate further confounders because of the possible differences in the healthcare system across countries. Finally, studies involving large populations, appropriate controls, and well-designed clinical trials are rare. Thus, further research is needed to improve the understanding and management of PSA.