The Recognition and Management of Psychological Reactions to Stroke

Abstract

ROUNDS IN THE GENERAL HOSPITALPrimwho is likely to cope poorly with physical impairments? Have you wondered how you can distinguish psychological reactions from neuropsychiatric and neurologic reactions? If you have, then the following case vignette (of a man who developed poststroke depression) should provide the forum for answers to these and other questions related to the psychological sequelae of stroke and comorbid neuropsychiatric syndromes. Cerebrovascular accidents (CVAs) disable thousands of people each year and are a major cause of death in this country. 1 CVAs lead to physical limitations in daily living and to psychological disorders, expressed in alterations to an individual's behavior and emotion. 2 However, in the recovery process after stroke, many patients and their caregivers focus on the patient's physical disabilities and fail to appreciate that the psychological complications of stroke can hinder a patient's recovery. Psychological reactions to stroke are manifested in myriad ways in the days, months, and years after a stroke. [2][3][4][5][6][7] Although not every patient develops intense emotional responses to stroke, those who do often have risk factors that make them more vulnerable to psychological consequences. 3,4,[8][9][10][11] Attention paid to those patients who may benefit from psychotherapeutic treatments as well as from psychotropic medications can facilitate effective treatment.The patient we present sustained a stroke and had severe psychological reactions to it. We will highlight symptom recognition, review the risk factors for distress and dysfunction, and discuss the treatment of psychological reactions to stroke. Case VignetteMr. B, a previously healthy, right-handed, 60-year-old man, suffered a CVA in his sleep. A sudden noise awakened him; his head ached, and he realized that he could barely move his right arm. Despite this, he managed to call for an ambulance. On arrival at the emergency room, his vital signs revealed a heart rate of 120 beats per minute, a respiratory rate of 26 breaths per minute, and a blood pressure reading of 172/112 mm Hg. The physical examination revealed decreased muscle tone, 1/5 muscle strength, and hyperreflexia in the right arm. A noncontrast computed tomography scan of Mr. B's head confirmed the diagnosis of stroke. Results of the rest of his examination were within normal limits. After 4 days in the hospital, Mr. B was discharged to his home and began a course of physical therapy as arranged by his family practitioner. Mr. B struggled to carry out the basic activities of daily living (ADLs); he had difficulty dressing himself and preparing his own food, and he was unable to write.

Medication adherence in stroke patients in Brunei Darussalam Public Hospital: the cross‐sectional study associated with chronic diseases, life style and potential barriers

“…After an incidence of stroke, patients may be presented with neurological deficit where they are unable to perform tasks that they would normally be able to do. This can lead to intense emotional reactions as they are unable to cope with sudden changes in their environment and would have to rely on their caregivers . Premorbid factors, for example, sociodemographic characteristics such as financial strain, marital status and alcohol abuse may also increase the intensity of psychological reactions to stroke .…”

Depression and anxiety one month after stroke

“…These findings suggest that screenings for both depression and anxiety should be included in a routine checkup from an early stage in a hospital (i.e., at 1 month) to years after stroke in a community. This will provide better opportunities for early identification of patients at risk because depression and anxiety may manifest at any stage of recovery (Chriki et al, 2006;Gillham & Clark, 2011).…”

“…When physical recovery is the main focus of treatment, the occurrence of depression and anxiety can be overlooked in the early stage of stroke recovery and thereafter (Chriki et al, 2006;De Ryck et al, 2014). Consequently, depression and anxiety are often poorly diagnosed and inadequately treated (Burton & Tyson, 2015;De Ryck et al, 2014).…”

“…Depression and anxiety are the most common mood disorders among stroke survivors with a prevalence of 13.7-31.1% for depression (American Stroke Association, 2014;Ayerbe, Ayis, Wolfe, & Rudd, 2013;Broomfield, Quinn, Abdul-Rahim, Walters, & Evans, 2014;Chriki, Bullain, & Stern, 2006;Pedroso, de Souza, Brunont, & Teixeira, 2015;Schöttke & Giabbiconi, 2015) and 20.0-38.3% for anxiety (American Stroke Association, 2014;Ayerbe, Ayis, Crichton, Wolfe, & Rudd, 2014;Schöttke & Giabbiconi, 2015). Depression or anxiety after stroke not only leads to poor involvement in rehabilitation and delays functional recovery, but results in limited social activity, poor quality of life, and increased disability (De Ryck et al, 2014;Skolarus, Burke, Brown, & Freedman, 2014).…”

“…Mood disorders after stroke can occur at any stage of recovery (Ayerbe, Ayis, Rudd, Heuschmann, & Wolfe, 2011;Chriki et al, 2006;Cichon, Bijak, Miller, Niwald, & Saluk, 2015) and are often chronic and recurrent (Ayerbe et al, 2013;Choi-Kwon et al, 2012). The prevalence of poststroke depression (13.7-31.1%) is 4 times higher than the likelihood of having depression in the general population without comorbid physical disease: 3.2% in individuals across 60 countries (Moussavi et al, 2007) and 6.7% in U.S. adults (National Institute of Mental Health, 2016a).…”