Managing Behavioral Disorders in Stroke Patients: Key Insights and Solutions

Q: Managing Behavioral Disorders in Stroke Patients: Key Insights and Solutions

Hello： Disordered behavior and hyperphagia (eating without satiety or being unaware of having eaten) together may indicate a lesion in the frontal lobe of the brain. <br>The patient has a history of brain tumor surgery combined with endocrine dysfunction, and it is unclear whethe

Can disorganized behavior after a stroke be controlled?

Hello Doctor, I have a few questions regarding stroke patients.

1.
Do stroke patients also experience various disordered behaviors psychologically and behaviorally (similar to hyperphagia where they never feel full, and may frequently yell due to food issues)? (They often stay awake at night and frequently yell, causing a lot of noise in the household.) (They cannot distinguish between morning, noon, and night.) My husband mentioned that his mother had a brain tumor when she was younger, underwent surgery, and subsequently developed endocrine disorders leading to diabetes, initially requiring insulin injections which later transitioned to medication management for her long-term diabetes.
A few years before her stroke, she also had heart surgery and had a stent placed in her heart, but less than three years later, she had a stroke.
When she was younger, her interactions with family members were poor, and she communicated with her husband and mother-in-law mostly through yelling.
Her husband, children, mother-in-law, and uncles do not pay attention to her.
Gradually, she began chanting Buddhist prayers, but her behavior became even more abnormal.
In addition to chronic illnesses, she has also become obese, although she exhibited hyperphagic behavior before her stroke.

I would like to ask the doctor the following questions:
1.
Does she need to see a psychologist for counseling? If so, which specialty should she consult?
2.
Besides using sleeping pills, are there other methods to manage her sleep?
3.
Can her eating habits be controlled? (If she continues to gain weight, she may struggle to support her upper body while walking, making caregiving more challenging.)

lili, 30~39 year old female. Ask Date: 2005/02/21

Dr. Cao Wenlong reply Neurology

Hello: Disordered behavior and hyperphagia (eating without satiety or being unaware of having eaten) together may indicate a lesion in the frontal lobe of the brain.
The patient has a history of brain tumor surgery combined with endocrine dysfunction, and it is unclear whether the tumor was located in the frontal lobe.
Additionally, we should consider whether a stroke has also affected the frontal lobe.

1.
It is recommended to consult a neurologist or psychiatrist, as there are medications that can improve disordered behavior, although they may have some side effects that depend on the severity of the condition and the dosage of the medication.

2.
If a sedative can control sleep, as long as the dosage does not increase, it can also be a method of treatment.

3.
If the first issue improves with medication, then the eating behavior may also improve.
Caring for an ill elder is a practice and a learning experience regarding life, aging, illness, and death.
Thank you! Dr.
Tsao Wen-Long

Reply Date: 2005/02/21

More Info

Managing behavioral disorders in stroke patients is a complex issue that requires a multifaceted approach. Stroke can lead to various cognitive and behavioral changes due to damage in specific areas of the brain. These changes can manifest as emotional instability, impulsivity, and disordered eating behaviors, among others. In your case, the patient’s history of brain surgery and chronic illnesses adds another layer of complexity to her condition.

1. Behavioral and Psychological Support: It is indeed common for stroke patients to exhibit behavioral disorders. These can include impulsivity, emotional lability, and even disordered eating behaviors, such as the inability to feel satiated. Given your description of the patient’s behavior, it would be beneficial for her to see a mental health professional. A psychiatrist or a neurologist specializing in behavioral neurology would be appropriate for assessing her condition. They can evaluate her mental state, provide a diagnosis, and recommend treatment options, which may include medication or therapy.

2. Sleep Management: Regarding her sleep issues, while sedative medications can help, they are not the only solution. Non-pharmacological approaches can also be effective. Establishing a consistent sleep routine, ensuring a comfortable sleep environment, and employing relaxation techniques such as mindfulness or cognitive behavioral therapy for insomnia (CBT-I) can be beneficial. Additionally, addressing any underlying issues, such as anxiety or depression, may also improve her sleep quality.

3. Nutritional Control: Managing her eating habits is crucial, especially considering her history of obesity and the potential for further health complications. A registered dietitian can help create a tailored meal plan that meets her nutritional needs while promoting weight management. Encouraging smaller, more frequent meals may help her feel satisfied without overeating. Additionally, involving her in meal planning and preparation can provide a sense of control and engagement, which may help mitigate some of the impulsive eating behaviors.

4. Family Support and Education: It’s essential for family members to be educated about the changes the patient is experiencing. Understanding that these behaviors are often a result of brain injury can foster empathy and patience. Family therapy or support groups can also provide a platform for family members to express their feelings and learn coping strategies.

5. Monitoring and Follow-Up: Regular follow-ups with healthcare providers are vital to monitor her progress and make necessary adjustments to her treatment plan. Behavioral changes can evolve, and ongoing assessment will help ensure that her care remains appropriate and effective.

In summary, managing behavioral disorders in stroke patients involves a comprehensive approach that includes psychological support, sleep management strategies, nutritional control, family education, and regular monitoring. Collaboration among healthcare providers, family members, and the patient herself is crucial to achieving the best possible outcomes.

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