Anxiety Disorders After Stroke: Results from the Perth Community Stroke Study

Abstract

BackgroundThe prevalence of anxiety disorders in 294 patients who survived to four months in the Perth Community Stroke Study (Perth, Australia), and a follow-up of these patients at 12 months, are presented.MethodDiagnoses are described both in the usual DSM hierarchic format and by a non-hierarchic approach. Adoption of the hierarchic approach alone greatly underestimates the prevalence of anxiety disorders.ResultsMost cases were of agoraphobia, and the remainder were generalised anxiety disorder. The prevalence of anxiety disorders alone was 5% in men and 19% in women; in community controls, it was 5% in men and 8% in women. Adopting a non-hierarchic approach to diagnosis gave a prevalence of 12% in men and 28% in women. When those who showed evidence of anxiety disorder before stroke were subtracted, the latter prevalence was 9% in men and 20% in women.ConclusionOne-third of the men and half of the women with post-stroke anxiety disorders showed evidence of either depression or an anxiety disorder at the time of the stroke. At 12 month follow-up of 49 patients with agoraphobia by a non-hierarchic approach, 51 % had recovered, and equal proportions of the remainder had died or still had agoraphobia. The only major difference in outcome between those with anxiety disorder alone and those with comorbid depression was the greater mortality in the latter.

Frequency of Depression After Stroke

“…There were no restrictions on the basis of language, sample size, or duration of follow-up, but we excluded studies of mixed populations (such as stroke and head injury) unless separate results for stroke patients were identified. Studies were also excluded if they had any of the following: (1) limited to specific patient characteristics such as sex or location of stroke lesion; (2) convenience sampling; (3) retrospective recruitment; or (4) there was only unstructured assessment of mood.…”

“…ome form of depression is considered to occur in at least one-quarter of patients in the first year after acute stroke, [1][2][3][4] with the period of greatest risk being the first few months after onset. 2,5,6 However, such estimates vary considerably across studies because of differences in definitions, study populations and the timing of assessments, as well as complexities in the recognition, assessment, and diagnosis of abnormal mood in the setting of stroke-related disability.…”

Music as Medicine: The Therapeutic Potential of Music for Acute Stroke Patients

“…49 Moreover, anxiety and depression are both prevalent in rehabilitative care and may limit recovery. [50][51][52][53][54] Anxiety manifests in 2 ways: emotional symptoms, such as fear and worry, and physical symptoms, such as dry mouth, dizziness, increased heart rate, sweating, rapid breathing, Music therapy may help to maintain a positive outlook in stroke patients who are undergoing rehabilitation therapy. and possibly fatigue.…”

Prise en charge des troubles anxieux dans le cadre d'atteintes neurologiques

“…On a également rapporté des troubles agoraphobiques après un accident vasculaire cérébral qui sont décrits comme une crainte démesurée de présenter une récidive cérébro-vasculaire dans une situation ou un endroit dont il pourrait être difficile de s'échapper [8]. Plus récemment, des réactions associées à un état de stress post-traumatique (ESPT) ont été observées 1 dans les suites d'un accident vasculaire cérébral avec un taux de prévalence variant de 6 à 20% selon les études [9,10].…”

“…Elle est plus fréquente en cas d'antécédents d'alcoolisme [6,11], chez les femmes [8,12] et chez les jeunes patients [12], mais elle ne serait pas nécessairement liée à la gravité des séquelles fonctionnelles [6,11,13]. Par ailleurs, l'anxiété comme la dépression, n'est pas incompatible avec une anosognosie du trouble neurologique, ce qui suggère que les symptômes anxieux ne traduisent pas simplement une réaction psychologique face à la maladie.…”