Personality change after stroke: some preliminary observations.

OBJECTIVES: To describe changes in personality after stroke and effects on carers. METHODS: A consecutive series of patients was recruited from hospital admissions with stroke. A novel questionnaire was administered to the patients' main carer at nine months after the stroke to determine their perception of the patients' pre-stroke and post-stroke personality. Personality change was identified by changes in these ratings, and associations between personality change and the following variables explored: emotional disorder in patients and carers (measured using the hospital anxiety and depression scale and a structured psychiatric interview), stroke classification (Oxford community stroke classification), residual disability (Barthel index and Nottingham extended activities of daily living scale), and lesion characteristics on computed tomography (CT). RESULTS: Carers of 35 patients with stroke took part. Reported changes in personality after stroke included: reduced patience and increased frustration (both p<0.0001, t test of difference), reduced confidence, more dissatisfaction, and a less easy going nature (all p<0.005). Occasionally, aspects of personality change were seen as positive by carers. There were relations between greater personality change and interviewer rated patient depression or anxiety (p<0.001) but not when this was self rated; and between personality change and both emotional disorder in carers (p<0.005) and greater disability (p<0.01) but not CT lesion characteristics. CONCLUSIONS: Carers commonly perceive personality change in stroke patients. This is associated with self rated emotional distress in the carer. More research is needed to understand what carers mean by "personality change" and what factors contribute to the perceived change.

A clinical study of child dental anxiety.

Dental fear in children was studied using Rachman's theory of fear acquisition. Sixty children from two age groups (7-10 years, 11-14 years) participated in the project. The children were new patients attending a paediatric consultation clinic for specialised dental treatment. Thirty-one were diagnosed as being clinically anxious regarding dentistry and 29 were found to be nonanxious. Information regarding children's past experiences and present level of anxiety was obtained from the examining dentist, the children and their parents. Mothers were also interviewed and observed to ascertain their own anxieties and behaviour. The results showed that of Rachman's three pathways to fear, conditioning appeared largely responsible for the children's development of dental fear. Children's fear was more strongly associated with subjective experience of pain and trauma than with objective dental pathology. Indirect learning processes were found to be of only minor importance in this study.