Abstract
Disturbances in the voluntary control of emotional expression after a stroke were first reported in the nineteenth century and extensively reviewed by Wilson in 1924. A variety of terms have since been used such as pathological laughing and crying, pseudobulbar affect, emotionalism, emotional lability, involuntary emotional expression disorder, and post-stroke emotional incontinence (PSEI). The prevalence of PSEI ranges 6–34 % (mostly 10–20 %) of stroke patients. It seems that PSEI is more often observed in the subacute stage than in the acute or chronic stage. However, there are patients who show abnormal emotional display before the onset of other major neurologic dysfunction (fou rire prodromique).
Recent advances in brain imaging technologies have shown that lesions affecting frontal-internal capsular-pontine base circuitry most often produce PSEI. Cerebellar, basal ganglionic, and thalamic lesions are also occasionally associated with PSEI. Wilson proposed that pathological crying and laughing is caused by disinhibition of a brainstem fasciorespiratory control center for emotional expression secondary to lesions of descending corticobulbar pathways from higher cortical brain centers. This disinhibition theory has been modified, and it is currently believed that deficits in any areas of brain network related to emotional expression (cortico-limbic subcortical-thalamic-ponto-cerebellar system) can lead to PSEI.
Lesion location studies, positron emission tomography studies, and clinical trial results have shown that serotonin dysfunction plays an important role in producing PSEI. Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line agents for the treatment of PSEI as they are promptly effective and tolerable and may also improve patients’ quality of life. When SSRIs are ineffective or poorly tolerated, tricyclic antidepressants, selective adrenergic receptor inhibitors, or dopaminergic agents can be considered.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wilson SA. Original papers: some problems in neurology. J Neurol Psychopathol. 1924;4(16):299–333.
Cummings JL, Arciniegas DB, Brooks BR, Herndon RM, Lauterbach EC, Pioro EP, et al. Defining and diagnosing involuntary emotional expression disorder. CNS Spectr. 2006;11(6):1–7.
Kim JS. Pathologic laughter after unilateral stroke. J Neurol Sci. 1997;148(1):121–5.
Magnus A. Fall von Aufhebung des Willenseinflusses auf einige Hirnnerven. In: Müller J, editors. Mullers Archiv fur Anatomie, Physiologies und Wissenschaftliche Medicin. Leipzig: Veit et Comp; 1837. p. 258–66.
Darwin C. The expression of the emotions in man and animals. New York/London: D Appleton and Company; 1872.
Oppenheim H, Siemerling E. Mittheilungen uber Psueobulbarparalyse und acute Bulbarparalyse. Ber Klin Wochenschr. 1886;23:791–4.
Brissaud E. Lecons sur les Maladies Nerveuses. Paris: Masson; 1895.
Nothnagel H. Zur Diagnose der Schugelerkrakungen. Z Kin Med. 1889;16:424–30.
Fere MC. Le fou rire prodromique. Rev Neurol (Paris). 1903;7:353–8.
Weisenberg T. Report of three cases with necropsy and of three cases without necropsy. Univ Penn Med Bull. 1905;18:1–39.
Davison C, Kelman H. Pathologic laughing and crying. Arch Neurol Psychiat. 1939;42:595–643.
Asfora WT, DeSalles AA, Abe M, Kjellberg RN. Is the syndrome of pathological laughing and crying a manifestation of pseudobulbar palsy? J Neurol Neurosurg Psychiatry. 1989;52(4):523–5.
Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence: correlation with lesion location. Neurology. 2000;54(9):1805–10.
Mega MS, Cummings JL, Salloway S, Malloy P. The limbic system: an anatomic, phylogenetic, and clinical perspective. In: Salloway S, Malloy P, Cummings JL, editors. The neuropsychiatry of limbic and subcortical disorders. Washington DC: American Psychiatric Press; 1997. p. 3–18.
Rosen HJ, Cummings J. A real reason for patients with pseudobulbar affect to smile. Ann Neurol. 2007;61(2):92–6.
Schiffer R, Pope LE. Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci. 2005;17(4):447–54.
Arciniegas DB, Lauterbach EC, Anderson KE, Chow TW, Flashman LA, Hurley RA, et al. The differential diagnosis of pseudobulbar affect (PBA). Distinguishing PBA among disorders of mood and affect. Proceedings of a roundtable meeting. CNS Spectr. 2005;10(5):1–14, quiz 5–6.
Parvizi J, Anderson SW, Martin CO, Damasio H, Damasio AR. Pathological laughter and crying: a link to the cerebellum. Brain. 2001;124(Pt 9):1708–19.
Bhatjiwale MG, Nadkarni TD, Desai KI, Goel A. Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases. Neurosurgery. 2000;47(2):469–71; discussion 71–2.
Tei H, Sakamoto Y. Pontine infarction due to basilar artery stenosis presenting as pathological laughter. Neuroradiology. 1997;39(3):190–1.
Parvizi J, Arciniegas DB, Bernardini GL, Hoffmann MW, Mohr JP, Rapoport MJ, et al. Diagnosis and management of pathological laughter and crying. Mayo Clin Proc. 2006;81(11):1482–6.
Dark FL, McGrath JJ, Ron MA. Pathological laughing and crying. Aust N Z J Psychiatry. 1996;30(4):472–9.
Wortzel HS, Oster TJ, Anderson CA, Arciniegas DB. Pathological laughing and crying: epidemiology, pathophysiology and treatment. CNS Drugs. 2008;22(7):531–45.
Arroyo S, Lesser RP, Gordon B, Uematsu S, Hart J, Schwerdt P, et al. Mirth, laughter and gelastic seizures. Brain. 1993;116(Pt 4):757–80.
Berkovic SH, Andermann F. Pathologic laughter. In: Joseph AB, Young RR, editors. Movement disorders in neurology and neuropsychiatry. Boston: Blackwell Sci; 1992. p. 382–8.
House A, Dennis M, Molyneux A, Warlow C, Hawton K. Emotionalism after stroke. BMJ. 1989;298(6679):991–4.
Morris PL, Robinson RG, Raphael B. Emotional lability after stroke. Aust N Z J Psychiatry. 1993;27(4):601–5.
Arciniegas DB, Topkoff J. The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Semin Clin Neuropsychiatry. 2000;5(4):290–306.
Tang WK, Chen YK, Lu JY, Mok VC, Xiang YT, Ungvari GS, et al. Microbleeds and post-stroke emotional lability. J Neurol Neurosurg Psychiatry. 2009;80(10):1082–6.
Moore SR, Gresham LS, Bromberg MB, Kasarkis EJ, Smith RA. A self report measure of affective lability. J Neurol Neurosurg Psychiatry. 1997;63(1):89–93.
Poeck K. Pathophysiology of emotional disorders associated with brain damage. In: Vinken PJ, Bruyn GW, editors. Handbook of clinical neurology. New York: Elsevier; 1969. p. 343–67.
Nahas Z, Arlinghaus KA, Kotrla KJ, Clearman RR, George MS. Rapid response of emotional incontinence to selective serotonin reuptake inhibitors. J Neuropsychiatry Clin Neurosci. 1998;10(4):453–5.
Tang WK, Chan SS, Chiu HF, Ungvari GS, Wong KS, Kwok TC. Emotional incontinence in Chinese stroke patients – diagnosis, frequency, and clinical and radiological correlates. J Neurol. 2004;251(7):865–9.
Sandyk R, Gillman MA. Nomifensine for emotional incontinence in the elderly. Clin Neuropharmacol. 1985;8(4):377–8.
Calvert T, Knapp P, House A. Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry. 1998;65(6):928–9.
Allman P, Hope RA, Fairburn CG. Emotionalism following brain damage: a complex phenomenon. Postgrad Med J. 1990;66(780):818–21.
Nieuwenhuis-Mark RE, van Hoek A, Vingerhoets A. Understanding excessive crying in neurologic disorders: nature, pathophysiology, assessment, consequences, and treatment. Cogn Behav Neurol. 2008;21(2):111–23.
van Gijn J. Treating uncontrolled crying after stroke. Lancet. 1993;342(8875):816–7.
Grinblat N, Grinblat E, Grinblat J. Uncontrolled crying: characteristics and differences from normative crying. Gerontology. 2004;50(5):322–9.
Duda JE. History and prevalence of involuntary emotional expression disorder. CNS Spectr. 2007;12(4 Suppl 5):6–10.
Allman P, Hope T, Fairburn CG. Crying following stroke. A report on 30 cases. Gen Hosp Psychiatry. 1992;14(5):315–21.
Doorenbos DI, Haerer AF, Payment M, Clifton ER. Stimulus-specific pathologic laughter: a case report with discrete unilateral localization. Neurology. 1993;43(1):229–30.
Kim JS, Lee JH, Im JH, Lee MC. Syndromes of Pontine base infarction. A clinical-radiological correlation study. Stroke. 1995;26(6):950–5.
Choi-Kwon S, Han K, Choi S, Suh M, Kim YJ, Song H, et al. Poststroke depression and emotional incontinence: factors related to acute and subacute stages. Neurology. 2012;78(15):1130–7.
Coelho M, Ferro JM. Fou rire prodromique. Case report and systematic review of literature. Cerebrovasc Dis. 2003;16(1):101–4.
Mendez MF. Crying spells as symptoms of a transient ischaemic attack. J Neurol Neurosurg Psychiatry. 1999;67(2):255.
Chen YK, Wong KS, Mok V, Ungvari GS, Tang WK. Health-related quality of life in patients with poststroke emotional incontinence. Arch Phys Med Rehabil. 2011;92(10):1659–62.
Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry. 1993;150(2):286–93.
Smith RA, Berg JE, Pope LE, Callahan JD, Wynn D, Thisted RA. Validation of the CNS emotional lability scale for pseudobulbar affect (pathological laughing and crying) in multiple sclerosis patients. Mult Scler. 2004;10(6):679–85.
Ironside R. Disorders of laughter due to brain lesions. Brain. 1956;79(4):589–609.
Gallagher JP. Pathologic laughter and crying in ALS: a search for their origin. Acta Neurol Scand. 1989;80(2):114–7.
Kaschka WP, Meyer A, Schier KR, Froscher W. Treatment of pathological crying with citalopram. Pharmacopsychiatry. 2001;34(6):254–8.
Starkstein SE, Migliorelli R, Teson A, Petracca G, Chemerinsky E, Manes F, et al. Prevalence and clinical correlates of pathological affective display in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 1995;59(1):55–60.
Parvizi J, Joseph J, Press DZ, Schmahmann JD. Pathological laughter and crying in patients with multiple system atrophy-cerebellar type. Mov Disord. 2007;22(6):798–803.
Surridge D. An investigation into some psychiatric aspects of multiple sclerosis. Br J Psychiatry. 1969;115(524):749–64.
Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54(9):1116–21.
Zeilig G, Drubach DA, Katz-Zeilig M, Karatinos J. Pathological laughter and crying in patients with closed traumatic brain injury. Brain Inj. 1996;10(8):591–7.
McGrath J. A study of emotionalism in patients undergoing rehabilitation following severe acquired brain injury. Behav Neurol. 2000;12(4):201–7.
Tateno A, Jorge RE, Robinson RG. Pathological laughing and crying following traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2004;16(4):426–34.
MacHale SM, Cavanagh JT, Bennie J, Carroll S, Goodwin GM, Lawrie SM. Diurnal variation of adrenocortical activity in chronic fatigue syndrome. Neuropsychobiology. 1998;38(4):213–7.
Kim JS. Post-stroke emotional incontinence after small lenticulocapsular stroke: correlation with lesion location. J Neurol. 2002;249(7):805–10.
Kim JM, Stewart R, Kang HJ, Bae KY, Kim SW, Shin IS, et al. Associations of serotonergic genes with poststroke emotional incontinence. Int J Geriatr Psychiatry. 2012;27(8):799–806.
Choi-Kwon S, Kim JS. Poststroke emotional incontinence and decreased sexual activity. Cerebrovasc Dis. 2002;13(1):31–7.
McCullagh S, Moore M, Gawel M, Feinstein A. Pathological laughing and crying in amyotrophic lateral sclerosis: an association with prefrontal cognitive dysfunction. J Neurol Sci. 1999;169(1–2):43–8.
Kim JS, Choi S, Kwon SU, Seo YS. Inability to control anger or aggression after stroke. Neurology. 2002;58(7):1106–8.
Choi-Kwon S, Han SW, Kwon SU, Kang DW, Choi JM, Kim JS. Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: a double-blind, placebo-controlled study. Stroke. 2006;37(1):156–61.
Choi-Kwon S, Han K, Cho K-H, Choi S, Suh M, Nah H-W, Kim JS. Factors associated with post-stroke anger proneness in ischemic stroke patients. Eur J Neurol, in press.
Gorzalka BB, Mendelson SD, Watson NV. Serotonin receptor subtypes and sexual behavior. Ann N Y Acad Sci. 1990;600:435–44; discussion 45–6.
Ceccaldi M, Milandre L. A transient fit of laughter as the inaugural symptom of capsular-thalamic infarction. Neurology. 1994;44(9):1762.
Lauterbach EC, Price ST, Spears TE, Jackson JG, Kirsh AD. Serotonin responsive and nonresponsive diurnal depressive mood disorders and pathological affect in thalamic infarct associated with myoclonus and blepharospasm. Biol Psychiatry. 1994;35(7):488–90.
Tasch E, Cendes F, Li LM, Dubeau F, Montes J, Rosenblatt B, et al. Hypothalamic hamartomas and gelastic epilepsy: a spectroscopic study. Neurology. 1998;51(4):1046–50.
Dericioglu N, Cataltepe O, Tezel GG, Saygi S. Gelastic seizures due to right temporal cortical dysplasia. Epileptic Disord. 2005;7(2):137–41.
Sackeim HA, Greenberg MS, Weiman AL, Gur RC, Hungerbuhler JP, Geschwind N. Hemispheric asymmetry in the expression of positive and negative emotions. Neurologic evidence. Arch Neurol. 1982;39(4):210–8.
Wali GM. “Fou rire prodromique” heralding a brainstem stroke. J Neurol Neurosurg Psychiatry. 1993;56(2):209–10.
Assal F, Valenza N, Landis T, Hornung JP. Clinicoanatomical correlates of a Fou rire prodromique in a Pontine infarction. J Neurol Neurosurg Psychiatry. 2000;69(5):697–8.
Ertekin C, Ekmekci O, Celebisoy N. Le fou rire prodromique. J Neurol. 1997;244(4):271–2.
Gondim FA, Parks BJ, Cruz-Flores S. “Fou rire prodromique” as the presentation of pontine ischaemia secondary to vertebrobasilar stenosis. J Neurol Neurosurg Psychiatry. 2001;71(6):802–4.
Uzunca I, Utku U, Asil T, Celik Y. “Fou rire prodromique” associated with simultaneous bilateral capsular genu infarction. J Clin Neurosci. 2005;12(2):174–5.
Carel C, Albucher JF, Manelfe C, Guiraud-Chaumeil B, Chollet F. Fou rire prodromique heralding a left internal carotid artery occlusion. Stroke. 1997;28(10):2081–3.
Osseby G, Manceau E, Huet F, Becker F, Chouchane W, Durand C, et al. ‘Fou Rire prodromique’ as the heralding symptom of lenticular infarction, caused by dissection of the internal carotid artery in a 12-year-old boy. Eur J Paediatr Neurol. 1999;3(3):133–6.
Garg RK, Misra S, Verma R. Pathological laughter as heralding manifestation of left middle cerebral artery territory infarct: case report and review of literature. Neurol India. 2000;48(4):388–90.
Phillips ML, Drevets WC, Rauch SL, Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14.
Pollack IF, Polinko P, Albright AL, Towbin R, Fitz C. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995;37(5):885–93.
Schmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain. 1998;121(Pt 4):561–79.
Levisohn L, Cronin-Golomb A, Schmahmann JD. Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain. 2000;123(Pt 5):1041–50.
Parvizi J, Schiffer R. Exaggerated crying and tremor with a cerebellar cyst. J Neuropsychiatry Clin Neurosci. 2007;19(2):187–90.
Sinha R, Lacadie C, Skudlarski P, Wexler BE. Neural circuits underlying emotional distress in humans. Ann N Y Acad Sci. 2004;1032:254–7.
Davidson RJ, Abercrombie H, Nitschke JB, Putnam K. Regional brain function, emotion and disorders of emotion. Curr Opin Neurobiol. 1999;9(2):228–34.
Schmahmann JD, Caplan D. Cognition, emotion and the cerebellum. Brain. 2006;129(Pt 2):290–2.
Rabins PV, Arciniegas DB. Pathophysiology of involuntary emotional expression disorder. CNS Spectr. 2007;12(4 Suppl 5):17–22.
Swash M. Released involuntary laughter after temporal lobe infarction. J Neurol Neurosurg Psychiatry. 1972;35(1):108–13.
Andersen G, Ingeman-Nielsen M, Vestergaard K, Riis JO. Pathoanatomic correlation between poststroke pathological crying and damage to brain areas involved in serotonergic neurotransmission. Stroke. 1994;25(5):1050–2.
Lavoie B, Parent A. Immunohistochemical study of the serotoninergic innervation of the basal ganglia in the squirrel monkey. J Comp Neurol. 1990;299(1):1–16.
Palacios JM, Waeber C, Bruinvels AT, Hoyer D. Direct visualization of serotonin1D receptors in the human brain using a new iodinated radioligand. Brain Res Mol Brain Res. 1992;13(1–2):175–8.
Andersen G, Vestergaard K, Riis JO. Citalopram for post-stroke pathological crying. Lancet. 1993;342(8875):837–9.
Murai T, Barthel H, Berrouschot J, Sorger D, von Cramon DY, Muller U. Neuroimaging of serotonin transporters in post-stroke pathological crying. Psychiatry Res. 2003;123(3):207–11.
Wolf JK, Santana HB, Thorpy M. Treatment of “emotional incontinence” with levodopa. Neurology. 1979;29(10):1435–6.
Udaka F, Yamao S, Nagata H, Nakamura S, Kameyama M. Pathologic laughing and crying treated with levodopa. Arch Neurol. 1984;41(10):1095–6.
O’Donnell P. Dopamine gating of forebrain neural ensembles. Eur J Neurosci. 2003;17(3):429–35.
Rogawski MA. Low affinity channel blocking (uncompetitive) NMDA receptor antagonists as therapeutic agents–toward an understanding of their favorable tolerability. Amino Acids. 2000;19(1):133–49.
Brooks BR, Thisted RA, Appel SH, Bradley WG, Olney RK, Berg JE, et al. Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology. 2004;63(8):1364–70.
Panitch HS, Thisted RA, Smith RA, Wynn DR, Wymer JP, Achiron A, et al. Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59(5):780–7.
Klein M, Musacchio JM. High affinity dextromethorphan binding sites in guinea pig brain. Effect of sigma ligands and other agents. J Pharmacol Exp Ther. 1989;251(1):207–15.
Bermack JE, Debonnel G. The role of sigma receptors in depression. J Pharmacol Sci. 2005;97(3):317–36.
Muller U, Murai T, Bauer-Wittmund T, von Cramon DY. Paroxetine versus citalopram treatment of pathological crying after brain injury. Brain Inj. 1999;13(10):805–11.
Benedek DM, Peterson KA. Sertraline for treatment of pathological crying. Am J Psychiatry. 1995;152(6):953–4.
Mukand J, Kaplan M, Senno RG, Bishop DS. Pathological crying and laughing: treatment with sertraline. Arch Phys Med Rehabil. 1996;77(12):1309–11.
Okun MS, Riestra AR, Nadeau SE. Treatment of ballism and pseudobulbar affect with sertraline. Arch Neurol. 2001;58(10):1682–4.
Hackett ML, Yang M, Anderson CS, Horrocks JA, House A. Pharmaceutical interventions for emotionalism after stroke. Cochrane Database Syst Rev. 2010;(2), CD003690.
Brown KW, Sloan RL, Pentland B. Fluoxetine as a treatment for post-stroke emotionalism. Acta Psychiatr Scand. 1998;98(6):455–8.
Burns A, Russell E, Stratton-Powell H, Tyrell P, O’Neill P, Baldwin R. Sertraline in stroke-associated lability of mood. Int J Geriatr Psychiatry. 1999;14(8):681–5.
Murray V, von Arbin M, Bartfai A, Berggren AL, Landtblom AM, Lundmark J, et al. Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression. J Clin Psychiatry. 2005;66(6):708–16.
Ohkawa S, Mori E, Yamadori A. Treatment of pathological laughing with amitriptyline. Rinsho Shinkeigaku. 1989;29(9):1183–5.
Choi-Kwon S, Choi J, Kwon SU, Kang DW, Kim JS. Fluoxetine improves the quality of life in patients with poststroke emotional disturbances. Cerebrovasc Dis. 2008;26(3):266–71.
Moller M, Andersen G. Inhibition of selective noradrenergic reuptake as treatment of pathological laughter. J Clin Psychopharmacol. 2007;27(1):108–10 [Case Reports Letter].
Smith AG, Montealegre-Orjuela M, Douglas JE, Jenkins EA. Venlafaxine for pathological crying after stroke. J Clin Psychiatry. 2003;64(6):731–2.
Kim SW, Shin IS, Kim JM, Lim SY, Yang SJ, Yoon JS. Mirtazapine treatment for pathological laughing and crying after stroke. Clin Neuropharmacol. 2005;28(5):249–51.
Ramasubbu R. Lamotrigine treatment for post-stroke pathological laughing and crying. Clin Neuropharmacol. 2003;26(5):233–5.
Peeters M, Maloteaux JM, Hermans E. Distinct effects of amantadine and memantine on dopaminergic transmission in the rat striatum. Neurosci Lett. 2003;343(3):205–9.
Peeters M, Romieu P, Maurice T, Su TP, Maloteaux JM, Hermans E. Involvement of the sigma 1 receptor in the modulation of dopaminergic transmission by amantadine. Eur J Neurosci. 2004;19(8):2212–20.
Pioro EP, Brooks BR, Cummings J, Schiffer R, Thisted RA, Wynn D, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Ann Neurol. 2010;68(5):693–702.
Scogin F, Welsh D, Hanson A, Stump J, Coates A. Evidence-based psychotherapies for depression in older adults. Clin Psychol Sci Pract. 2005;12(3):222–37.
Kemp BJ, Corgiat MD, Gill C. Effects of brief cognitive-behavioral group psychotherapy on older persons with and without disabling illness. Behav Health Aging. 1992;2:21–8.
Watkins CL, Auton MF, Deans CF, Dickinson HA, Jack CI, Lightbody CE, et al. Motivational interviewing early after acute stroke: a randomized, controlled trial. Stroke. 2007;38(3):1004–9.
Lincoln NB, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke. 2003;34(1):111–5.
Mitchell PH, Veith RC, Becker KJ, Buzaitis A, Cain KC, Fruin M, et al. Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke. 2009;40(9):3073–8.
Hackett ML, Anderson CS, House AO, Xia J. Interventions for treating depression after stroke. Stroke. 2009;40:e487–e488
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Kim, J.S., Choi-Kwon, S. (2013). Disturbances in the Voluntary Control of Emotional Expression After Stroke. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_7
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2428-3_7
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2427-6
Online ISBN: 978-1-4471-2428-3
eBook Packages: MedicineMedicine (R0)