[Abstract] Objective To understand the psycho-affective disorders that may be triggered by social role changes after stroke. Methods Inspired by the literature, we summarized the observations through clinical practice in the past six months. Results and Conclusion The observation and study of psycho-emotional disorders in stroke patients due to social role changes, in order to help them to face the disease more quickly with an optimistic attitude and cooperate with the medical staff training, so that they can play their somatic functions in a real sense and return to their families and society as early as possible and improve their quality of life. Zhang Peijing, Rehabilitation Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
[Keywords] Stroke; role change; psycho-affective disorder
When a patient suffers a sudden blow with physical injury or illness, he or she is bound to have psychological distress or disorder, or emotional, cognitive and behavioral problems. In addition to the psychological changes of general patients, stroke patients also have more serious psycho-emotional disorders caused by brain function damage, which will directly affect the whole recovery process of patients. An in-depth understanding and correct handling of such disorders can help rehabilitation treatment, enable patients to recover faster, return to their families and society as early as possible, and return to work as early as possible.
According to the social role theory, when an individual’s social environment, job title, or condition changes, his or her psychology and behavior change accordingly, and he or she develops psychological and behavioral responses consistent with the new social role. [1]
1 The generation of mental activity is based on the function of the intact nervous system
1.1 Mental activity is generated by reflex arcs, which transmit external stimuli to higher centers through various neural pathways, undergo complex integration, refinement, and adjustment in different parts of the cerebral cortex, and are expressed in their unique manifestations.
1.2 The manifestation of mental activity varies from person to person, it is influenced by different social and historical stages, by family and education, and also by individual psychological quality. Stroke patients will have a series of abnormal mental activity and emotional abnormalities of different degrees due to the destruction of the integrity of the nervous system.
2 Changes in social roles faced after stroke
2.1 Physical condition Stroke patients have their original healthy body become disabled, and their activities and life will be restricted or even completely unable to take care of themselves.
2.2 Living environment After becoming disabled, they have to receive treatment and rehabilitation training in the hospital for a considerable period of time. The original unit and family become the current hospital and treatment room, and the objects of interaction change from colleagues, friends and relatives in the past to doctors, nurses, therapists and patients in the present.
2.3 Social relationships and roles After stroke, they cannot continue to work for a long period of time, and some of them cannot even return to their original jobs. At the same time, their social scope is narrowed, their social activities are reduced, their activities are limited, and the role they play changes from the original manager, mayor, teacher, etc. to a disabled person.
2.4 Family relationships After stroke, the patient’s family status, role in the family, and ability to assume obligations all change significantly. For example, the relationship between husband and wife: before the stroke, both husband and wife ran the family together, took care of their parents, raised their children, and shared family obligations, whereas after one partner had a stroke, the other partner was completely responsible and had to take care of the one who had a stroke.
2.5 Economic status Most stroke patients will be partially or completely incapacitated for social work, and their economic income will be significantly reduced, while they have to pay for various treatment and training costs, and many factors will lead to changes in the economic status of stroke patients.
3 Psycho-emotional disorders that may be triggered by role changes after stroke
3.1 Denial Stroke patients show a lack of understanding and denial of the disease in the initial period after the disease. In the case of unilateral neglect disorder, the individual patient feels that he/she can move all four limbs and completely denies having hemiparesis, and this denial lasts for some time; the former is a general psychological response, while the latter is a psychological disorder specific to cortical damage during stroke.
3.2 Anger Most patients quickly move from an attitude of denial to an angry “why am I paralyzed” mentality, which is characterized by depression, unresponsiveness, depression, anxiety, and in some cases, temper tantrums and irritability. [2]
3.3 Expectations Patients recover quickly in the early stages, with partial recovery of limb and speech functions. As a result, patients train excessively aggressively and are anxious to change the fact of hemiplegia immediately.
3.4 Depression In order to change the fact of hemiplegia as soon as possible, they believe in drugs, surgery, religion, and seek medical help everywhere, but except for TIA and RIND, it is impossible to recover quickly from a complete stroke, so most patients have different degrees of depression, and they are anxious, pessimistic, or alternately hopeful and disappointed about whether they can recover or not, and in severe cases, they may even think of suicide. Since recovery of motor function from a complete stroke may take a year or more, and a significant proportion of patients will have sequelae (especially in the upper limbs). Depression is the most common psychological problem.
3.5 Bearing In the end, the stroke patient acknowledges the reality, accepts the hemiplegia, and goes from being a normal person to a disabled person. This series of role changes puts the stroke patient’s psyche through a violent shock, and the psycho-emotional disorders at these different stages can seriously affect the recovery of his or her motor function.
Therefore, as a rehabilitation clinical worker, we must carefully analyze the psycho-emotional disorders of stroke patients, adopt different psychotherapy methods at different times, and through correct guidance, comfort and encouragement, use our love, patience, care and responsibility to complete the change of their social roles and promote the normal transformation of their psychological state, so that they can face the disease with a good state of mind and cooperate with the rehabilitation clinical The workers will conduct the training, give full play to the maximum potential of the body in the real sense, return to the family and society, and finally improve the quality of life.
[References]
[1] Mi Zhongxiang The significance and application of role reversal in the psychological rehabilitation of people with disabilities [J] China Rehabilitation Theory and Practice, 2001 7(1): 34-35
[2] Editorial Department, Encyclopedia of China Publishing House. Encyclopedia of China: Psychology [M]. Beijing: Encyclopedia of China Publishing House, 1991