Psychiatric Hospitalization Increases Short-Term Risk of Stroke

Zuflacht, Jonah P.; Shao, Yuefan; Kronish, Ian M.; Edmondson, Donald; Elkind, Mitchell S.V.; Kamel, Hooman; Boehme, Amelia K; Willey, Joshua Z.

doi:10.1161/strokeaha.116.016371

Cited by 14 publications

(11 citation statements)

References 34 publications

(34 reference statements)

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“…Psychiatric conditions are frequently under-recognized, misdiagnosed, or undertreated, and nonpsychiatrists’ accuracy in recognizing psychiatric disorders does not improve over time without specific training 64. We furthermore did not distinguish between active versus remote history of psychiatric disorder, and we did not have information regarding the duration of and compliance to current psychopharmacotherapy as well as comprehensive data pertaining to past hospitalizations for psychiatric disorder, which would have been interesting in the context of Zuflacht et al’s28 research showing an association between time of last psychiatric hospitalization and timing of stroke . It would also have been desirable to have standardized follow-up evaluations after seven and 90 days to investigate the longer-term outcome.…”

Section: Discussionmentioning

confidence: 96%

“…Specific psychiatric disorders such as affective disor ders, schizophrenia, and dementia have mainly been studied with a focus on the evaluation of risk for stroke or their role in recovery or longer-term outcome in the wake of a stroke 19,24–26. Rarely, however, has a general perspective on psychiatric premorbidity and stroke risk27,28 or its impact on stroke severity on admission been taken. We aim to elaborate on this issue through a retrospective analysis of stroke patients’ documented pre-existing psychiatric diagnoses and severity and short-term functional outcome of stroke.…”

Section: Introductionmentioning

confidence: 99%

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

Hoyer

Schmidt

Kranaster

et al. 2019

NDT

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

Hoyer

Schmidt

Kranaster

et al. 2019

NDT

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“…The Epi info software (Centers for Disease Control and Prevention (CDC), Epi Info™) was used to calculate the minimum sample size required for our investigation, with a margin of error of 5%, a power of 80%, and an allocation ratio of 1:4. The number of controls exposed to mental health problems was estimated to be 17% [ 43 ], and the OR of stroke within 30 days of a hospital visit for a mental health concern was reported to be 3.11 [ 44 ] (the OR is a bit high, resulting in a small calculated sample size, so, OR = 2). According to the findings, a minimum of 564 participants were needed.…”

Section: Methodsmentioning

confidence: 99%

Eating Behaviors, Lifestyle, and Ischemic Stroke: A Lebanese Case-Control Study

Maalouf

Hallit

Salameh

et al. 2023

IJERPH

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Background: Stroke is the second leading cause of death and the third leading cause of disability on a global scale. Most clinicians tend to underestimate the importance of diet and inadequate or dysfunctional eating attitudes in patients with a complicated relationship with food. Concerned about the potential of an independent Lebanese approach, and also because prior international research has revealed a link between eating intake or choice and ischemic stroke risk, it was considered vital to broaden the scope of the literature and evaluate further the association of disordered eating attitudes and focus on the distinct relationship with food in the case of orthorexia nervosa (ON) in the Lebanese community. Consequently, the purpose of the present study is to investigate the potential association between pre-existing disordered eating attitudes, specifically ON, and ischemic stroke risk, with an emphasis on the evidence supporting a Mediterranean-style diet. Methods: This research is a case-control survey study involving 113 Lebanese individuals with ischemic stroke and 451 age-(within 5 years) and sex-matched controls recruited from several hospitals in Lebanon (April 2020–April 2021). Results: According to the findings of our first regression model, living 100 m from a crowded road (adjusted odds ratio [aOR]: 3.421, 95% confidence interval [CI]: 1.585–7.387), living 100 m from an electricity generator (aOR: 3.686, 95% CI: 1.681–8.085), higher waterpipe dependence (aOR: 1.204, 95% CI: 1.117–1.297), higher exposure to passive smoking (aOR: 2.651, 95% CI: 2.051–3.426), being married (aOR: 3.545, 95% CI: 1.297–9.689), having a low educational attainment (aOR: 0.239, 95% CI: 0.084–0.679), vigorous physical activity (aOR: 1.003, 95% CI: 1.001–1.006), and having more inappropriate eating (aOR: 1.040, 95% CI: 1.006–1.074) were all associated with higher odds of having ischemic stroke. Furthermore, atrial fibrillation (aOR: 2.945, 95% CI: 1.010–8.585), diabetes (aOR: 2.550, 95% CI: 1.169–5.561), heart diseases (aOR: 6.193, 95% CI: 2.196–17.463), and hypertension (aOR: 2.744, 95% CI: 1.049–7.180) were also linked to an increased risk of stroke. Moreover, having more orthorexia nervosa tendencies (aOR: 1.123, 95% CI: 1.021–1.235) was related to a higher odds of having an ischemic stroke, whereas better adherence to the MeD was significantly linked (aOR: 0.691, 95% CI: 0.583–0.819) to lower odds of ischemic stroke. Conclusions: Ischemic stroke patients were more likely to have disordered eating attitudes and orthorexic behaviors. Furthermore, the MeD has been found to be beneficial in reducing ischemic stroke risk. Despite the study’s focus, outdoor pollution, waterpipe dependence, and passive smoking were linked to ischemic stroke. In summary, this review suggests that improving one’s nutritional status and making a few lifestyle changes are key stroke prevention and treatment methods.

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“…Another important point regarding stroke among patients with psychiatric illness is that an increased risk of stroke has been noted in the year following psychiatric hospitalizations. 100 Among patients with a prior ED visit or inpatient stay for psychiatric disease, the highest odds of stroke occurs within 15 days of that initial psychiatric visit. 100 While the cause of this increased stroke risk is uncertain, it suggests psychosocial stress may serve as a stroke trigger and may point to potential diagnostic error at index visit wherein a cerebrovascular event is misdiagnosed as psychiatric in nature.…”

Section: Psychiatric Diseasementioning

confidence: 99%

“… 100 Among patients with a prior ED visit or inpatient stay for psychiatric disease, the highest odds of stroke occurs within 15 days of that initial psychiatric visit. 100 While the cause of this increased stroke risk is uncertain, it suggests psychosocial stress may serve as a stroke trigger and may point to potential diagnostic error at index visit wherein a cerebrovascular event is misdiagnosed as psychiatric in nature. 100 , 101 Having an increased level of suspicion for stroke in clinic patients with neurological symptoms or signs who have had a recent ED visit or inpatient stay due to psychiatric illness may be warranted.…”

Section: Psychiatric Diseasementioning

confidence: 99%

Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Wallace

Liberman

2021

NDT

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Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone to missed or delayed diagnosis. We therefore detail common stroke chameleon symptoms as well as atypical stroke presentations, broadly review new developments in the study of diagnostic error in the outpatient setting, suggest practical clinical strategies for diagnostic error reduction, and emphasize the need for rapid consultation of stroke specialists when appropriate. We also address the role of psychiatric disease and vascular risk factors in the diagnostic evaluation and treatment of suspected stroke/TIA patients. We advocate incorporating diagnostic timeouts into clinical practice to assure that the diagnosis of TIA or stroke is considered in all relevant patient encounters after a detailed history and examination are conducted in the outpatient setting.

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Psychiatric Hospitalization Increases Short-Term Risk of Stroke

Cited by 14 publications

References 34 publications

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

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

Eating Behaviors, Lifestyle, and Ischemic Stroke: A Lebanese Case-Control Study

Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

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