<p>Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke</p>

Abstract

Background and purpose The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. Patients and methods We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. Results More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p <0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p <0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: −0.78, z=4.59, p <0.0001). Conclusion Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.

Did COVID-19 impact stroke services? A multicenter study

“…Another etiology for the increased stroke severity and worse outcome was attributed, by a systematic review, to increased stress and depression during the pandemic. Psychosocial stressors have been associated with more severe strokes and poor outcome [ 32 , 33 ].…”

Sex-Specific Differences in Pre-Stroke Characteristics Reveal Vulnerability of Elderly Women

“…Other types of comorbidity such as a co-existent psychiatric disorder, may also contribute to higher degrees of actual or perceived social isolation. Notably, there is a distinct female predominance in depression prevalence [ 18 ], and associations between pre-existing depressive disorder as well as other psychiatric comorbidities with short- and long-term post-stroke outcomes [ 19 , 20 ] have been noted earlier, thus identifying another important area in need for interdisciplinary preventative strategies. Finally, previous studies found an association between living alone, risk of stroke [ 21 ] as well as a delayed presentation with symptoms of stroke [ 22 ].…”

Stroke Patients’ Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study

“…These psychological disorders could be expected to impose more challenges in stroke care. Several studies have reported associations of psychological distress with more severe strokes and a higher prevalence of a poorer outcome [ 22 ]. Interestingly, our study suggested that stroke severity and stroke outcome were constant across the two periods despite the possibility that the stroke patients involved may have experienced some degree of psychological dysfunction.…”