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11 - Asomatognosia
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- By Sebastian Dieguez, Swiss Federal Institute of Technology, Lausanne, Switzerland, Fabienne Staub, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, Julien Bogousslavsky, Swiss Medical Network, Montreux, Switzerland
- Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
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- Book:
- The Behavioral and Cognitive Neurology of Stroke
- Published online:
- 10 October 2009
- Print publication:
- 18 January 2007, pp 215-253
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Summary
General presentation of the disorders of bodily awareness
The sense we have of our own bodies is of a very complex nature. French psychiatrist Henri Ey (1973) wrote: “In this sector of sensibility, neither the primary sensorial organ, neither the specific modality, neither especially the distinction of the subject and the object, are clear notions.” In fact, it is through its pathologies that our bodily sense came to be known as a useful theoretical construct.
In this chapter we will use the term asomatognosia as the general heading for the disorders of bodily awareness, where one's body may be perceived in an unusual manner, or not perceived as having changed in its functions. Following neurological damage, the body can be entirely or partly forgotten, ignored, denied, disowned, or misperceived. These disorders have proven notoriously difficult to organize and classify. What is more, the topic of asomatognosia is confounded with those of hemineglect, anosognosia, delusions, and more generally all disorders of the awareness of the self. A framework will be proposed in order to see things clearer in this multifaceted topic that draws its unity from phenomenological resemblance, organic overlap, and presumably common mechanisms ranging from sensorimotor functions to higher cognition. Hence, we will state that asomatognosia, roughly defined as the disturbances of the body schema, encompasses a wide array of clinical pictures under a unitary conceptual framework.
30 - Fatigue
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- By Fabienne Staub, CHUV, Lausanne, Switzerland
- Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
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- Book:
- The Behavioral and Cognitive Neurology of Stroke
- Published online:
- 10 October 2009
- Print publication:
- 18 January 2007, pp 571-585
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Summary
Introduction
Fatigue is a non-specific symptom associated with a wide range of states and diseases. The feeling of fatigue is a frequent complaint in various medical conditions, including psychiatric diseases (mainly depression, anxiety, and somatoform disorders), cancer, autoimmune, endocrinological, infectious, rheumatological and neurological affections, and sleep disorders. Fatigue may also develop without any antecedent condition other than a viral infection, leading to what is known as “chronic fatigue syndrome” (Holmes et al., 1988). Some medical and pharmacological treatments (cytokines, interferon, radiotherapy, chemotherapy), physical or mental exertions, or particular environmental or psychological conditions (extreme temperature, stress, inactivity) can also induce fatigue.
Fatigue is an extremely widespread, and often benign, symptom in the general population, headaches being the only somatic complaint occurring at a higher frequency. In general practice, fatigue is a significant symptom in 10–30% of outpatients, presenting as an isolated symptom in only 1–3% of these (Kroenke and Price, 1993; Fuhrer and Wessely, 1995). Because the phenomenon constitutes an evil of modern society, the distinction between normal benign fatigue and abnormal fatigue is very difficult to make. Severity, chronicity, and an association with other symptoms or functional disability all point to a pathological condition.
The origin of fatigue can be attributed to general non-specific factors characterizing most diseases, such as pain, sleep disorders, depression, anxiety, inactivity, or to specific variables related to disease pathophysiology or treatment. The pathophysiological mechanisms are usually divided into central and peripheral causes, the latter being better known and better understood.
21 - Depression and fatigue after stroke
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- By Fabienne Staub, Department of Neurology, University of Lausanne, Antonio Carota, Clinique de Rééducation, University Hospital Geneva
- Edited by Michael P. Barnes, University of Newcastle upon Tyne, Bruce H. Dobkin, University of California, Los Angeles, Julien Bogousslavsky, Université de Lausanne, Switzerland
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- Book:
- Recovery after Stroke
- Published online:
- 05 August 2016
- Print publication:
- 10 March 2005, pp 556-579
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Summary
Introduction
Post-stroke depression (PSD) is a significant factor affecting functional and social disability, even long after neurological and neuropsychological recovery. Fatigue is a commonly reported complaint in clinical practice. Fatigue after stroke (PSF), often disabling, is frequently reported and can in some cases be the only significant sequelae. It is often neglected or is considered as one aspect of PSD.
Post-stroke depression
The occurrence of PSD has been extensively investigated, with over 200 scientific papers published between 1985 and 1995 (Gordon and Hibbard, 1997). However, major methodological differences between the studies prevent straightforward conclusions being drawn and the following paragraphs are more descriptive than synthetic. For example, PSD has been reported in both less than 25% and in more than 75% of patients. The role of the side and site of stroke also remains controversial.
Diagnosis
The diagnostic accuracy of the standardized psychiatric assessment for patients with neurological impairment is questionable. Psychiatric criteria of mood disorders rely heavily on patients' reports of their own symptoms. This requires patients to be aware of their situation and to be capable of providing an accurate report of it, a task that can be difficult or impossible in patients with aphasia and other cognitive impairment caused by stroke. The presence of neurobehavioral sequelae such as aphasia, psychomotor slowing, anosognosia, and denial often compromises the validity of patients' answers. The presence of conditions interfering with the appreciation of the symptoms of depression should be carefully considered. (Table 21.1).
The diagnosis of mood disorders caused by medical conditions, including stroke, is actually based on the DSM-IV criteria (American Psychiatric Association, 1994). According to these criteria, the diagnosis of PSD requires the presence of persistent symptoms and cannot be made in the very acute phase of stroke. It is also uncertain if the DSM-IV diagnosis of PSD is valid for all depressive episodes occurring at any time after stroke. It is still a subject of controversy whether behavioral changes and subjective symptoms of PSD, and endogenous depression are equivalent (Robertson, 1998) or at least partially different (Lipsey et al., 1986), and whether the two conditions share the dysfunction of the same cerebral areas and neurotransmitters.