Delusions and the Right Hemisphere: A Review of the Case for the Right Hemisphere as a Mediator of Reality-Based Belief

Gurin, Lindsey J.; Blum, Sonja

doi:10.1176/appi.neuropsych.16060118

Cited by 47 publications

(20 citation statements)

References 171 publications

(172 reference statements)

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“…The majority of patients were found to have right hemisphere lesions, in line with a large body of evidence that suggests right hemisphere pathology is associated with a range of perceptual anomalies and pathologies of belief. 29 The regions that were most affected included the right frontal, temporal and parietal regions, as well as the right caudate nucleus, supporting findings of previous case series on poststroke psychosis 10–12 and mirroring findings in psychosis after TBI. 21 However, it is worth bearing in mind that left hemisphere strokes are more likely to result in language and communication problems, which may impede the assessment of psychosis, and therefore these patients may be under-represented in the literature.…”

Section: Discussionsupporting

confidence: 82%

Poststroke psychosis: a systematic review

Stangeland¹,

Orgeta

Bell

2018

J Neurol Neurosurg Psychiatry

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A preregistered systematic review of poststroke psychosis examining clinical characteristics, prevalence, diagnostic procedures, lesion location, treatments, risk factors and outcome. Neuropsychiatric outcomes following stroke are common and severely impact quality of life. No previous reviews have focused on poststroke psychosis despite clear clinical need. CINAHL, MEDLINE and PsychINFO were searched for studies on poststroke psychosis published between 1975 and 2016. Reviewers independently selected studies for inclusion, extracted data and rated study quality. Out of 2442 references, 76 met inclusion criteria. Average age for poststroke psychosis was 66.6 years with slightly more males than females affected. Delayed onset was common. Neurological presentation was typical for stroke, but a significant minority had otherwise ‘silent strokes’. The most common psychosis was delusional disorder, followed by schizophrenia-like psychosis and mood disorder with psychotic features. Estimated delusion prevalence was 4.67% (95% CI 2.30% to 7.79%) and hallucinations 5.05% (95% CI 1.84% to 9.65%). Twelve-year incidence was 6.7%. No systematic treatment studies were found. Case studies frequently report symptom remission after antipsychotics, but serious concerns about under-representation of poor outcome remain. Lesions were typically right hemisphere, particularly frontal, temporal and parietal regions, and the right caudate nucleus. In general, poststroke psychosis was associated with poor functional outcomes and high mortality. Poor methodological quality of studies was a significant limitation. Psychosis considerably adds to illness burden of stroke. Delayed onset suggests a window for early intervention. Studies on the safety and efficacy of antipsychotics in this population are urgently needed.

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Section: Discussionsupporting

confidence: 82%

Poststroke psychosis: a systematic review

Stangeland¹,

Orgeta

Bell

2018

J Neurol Neurosurg Psychiatry

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“…The majority of patients were found to have right hemisphere lesions, in line with a large body of evidence that suggests right-hemisphere pathology is associated with a range of perceptual anomalies and pathologies of belief [29]. The regions that were most affected included the right frontal, temporal and parietal regions, as well as the right caudate nucleus, supporting findings of previous case series on post-stroke psychosis [10][11][12] and mirroring findings in psychosis after TBI [21].…”

Section: Clinical Presentationsupporting

confidence: 80%

Published paper

Stangeland¹,

Orgeta²,

Bell³

2017

Preprint

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Aims and objectives: A pre-registered systematic review of post-stroke psychosis examining clinical characteristics, prevalence, diagnostic procedures, lesion location, treatments, risk factors, and long-term outcomes.Background: Neuropsychiatric outcomes following stroke are common and severely impact quality of life. Previous reviews have focused on anxiety, depression and cognitive impairment in stroke but no systematic review has yet focused on post-stroke psychosis despite clear clinical need.Methods: CINAHL, MEDLINE and PsychINFO were searched for studies on post-stroke psychosis published between 1975 and 2016. Reviewers independently selected studies for inclusion, extracted data, and rated study quality.Results: Out of 2442 references, 75 met the inclusion criteria. Average age for post-stroke psychosis was 60.8 years with slightly more males than females affected. Average psychosis onset was 7.1 months after stroke. Neurological presentation was typical for stroke but a significant minority had ‘silent strokes’. The most common psychosis was delusional disorder, followed by schizophrenia-like psychosis and mood disorder with psychotic features. Mean prevalence was 4.1% (range 0.2% – 9.9%). 12 year incidence was 6.7%. Antipsychotic medication was commonly prescribed and the most frequent outcome was complete remission. Lesions were typically right hemisphere, particularly frontal, temporal and parietal regions, as well as the right caudate nucleus. Post-stroke psychosis was associated with poor functional outcomes and high mortality. Methodological quality of the studies was poor.Conclusion: Psychosis considerably adds to illness burden of stroke. Delayed onset suggests a window for early detection and intervention. Studies on the safety and efficacy of antipsychotics in this population are urgently needed.

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“…A retrospective study consecutively included 1,108 stroke survivors in Western Australia from 1990 to 2002, and reported the cumulative incidence of psychosis after stroke to be 6.7%, which is a significantly positive correlation with a 10-year mortality[ 86 ]. Structural lesions that were related to delusions were centered on the right frontal, temporal, and parietal lobes, as well as white matter lesions with connectivity to the above areas, in addition to the right caudate nucleus[ 87 , 88 ].…”

Section: Psychosis and Psychotic Disorders After Strokementioning

confidence: 99%

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

Zhang¹,

Xu²,

Liu³

et al. 2020

WJP

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A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.

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Delusions and the Right Hemisphere: A Review of the Case for the Right Hemisphere as a Mediator of Reality-Based Belief

Cited by 47 publications

References 171 publications

Poststroke psychosis: a systematic review

Poststroke psychosis: a systematic review

Published paper

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

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