Neuropsychiatric Aspects of a Common Problem: Stroke

Abstract

Stroke ranks second in the list of major causes of disability and death in the world. Stroke is the sudden onset of focal or generalized abnormalities of brain function caused solely by vascular causes that are associated with cerebral blood flow and last for more than 24 hours. Stroke can also be diagnosed if symptoms persist for more than 24 hours, but with a confirmation of neuroimaging studies, the ischemic area has been clearly located and documented, symptoms disappeared after thrombolytic therapy, or the patient died within 1 day of symptoms onset. Often, patients with stroke experience emotional and behavioral disorders. Their frequency varies depending on factors such as the patient's age, gender, socio-economic status, post-stroke disability, and cognitive changes that play a crucial role in patients’ well-being and can significantly affect the recovery process. This article describes common psychiatric presentations in patients in a post-stroke period. Some available evidence-based data on the treatment of these conditions and identified possible risk factors that influence their development are presented.

Recommendations For The Management Of Patients With Depression In General Clinical Practice

“…Comorbid psychiatric disorders and other medical conditions should also be identified and the patient's functional status assessed [5], [6], [7], [8]. When making a differential diagnosis, clinicians should keep in mind that many other mental disorders, somatic conditions, or even the use of certain medications can cause symptoms of depression [9], [10], [11], [12]. Therefore, when assessing the patient's condition, the primary care physician should clearly determine whether depression is the initial stage of this process or a symptom of other disease or disorder.…”

“…Zoryana Lebedyn to a specialist in case of risk of bipolar disorder development or onset, psychiatric comorbidity (use of psychoactive substances, anxiety, OCD, eating disorders), risk of suicide and / or murder, symptoms of psychosis, insufficient effectiveness of their drugs, significant or prolonged disability, inability to care for themselves and / or family and diagnostic uncertainty [1], [4], [5], [9], [10], [11], [14], [15]. The initial response to PHQ-9 therapy should be evaluated after 4-6 weeks of pharmacotherapy (monotherapy or combination therapy), or after 6-12 weeks of psychotherapeutic interventions in the form of monotherapy.…”

“…Consultation with a psychiatrist is recommended if there is: suspicion of bipolar disorder, comorbid psychiatric disorder (e.g. substance abuse, gambling, anxiety, obsessive compulsive disorder or eating disorder), risk of suicide and / or homicide, psychosis combined with depression signs of improvement when taking drugs prescribed by a primary care physician, despite changes in dosage and replacement of drug classes, significant or prolonged disability, inability to take care and / or family, diagnostic uncertainty [1], [4], [5], [9], [10], [11], [14], [15], [20], [21], [22].…”

Diagnostic Procedure and Therapeutic Approaches in Nonconvulsive Status Epilepticus (NCSE)

“…Even after excluding of all patients with a history of seizures, up to 8% of patients in a coma have NCSE [5]. According to some authors, NCSE has been described in 27% of patients with altered consciousness in 48% of patients after generalized status epilepticus, in 22% of patients with severe brain damage of traumatic origin, in 6% of patients with ischemic stroke and 28% of patients with intracerebral haemorrhage [6]- [10]. It is especially important to diagnose such patients as early as possible, as factors associated with seizure activity (changes in cerebral metabolic activity, mismatch of neuronal energy consumption and energy supply) can dramatically worsen the further prognosis for the patient in the intensive care unit.…”

Use of pramipexole in neuropsychiatry

“…One of the most prevailing and progressive neurodegeneration among the patients of elderly age (1-2% in population older than 65 years) is Parkinson's disease (PD), which represents special interest to modern pharmacotherapy, which is aimed at the uncovering of key pathobiochemical mechanisms of brain's lesion [1], [2]. The prevalence of PD in Zambia is unknown, but it is the third of the most often disease after epilepsy and stroke [3]. Except PD, which is connected mainly with neurodegeneration, the syndrome of parkinsonism is highlighted, which can become apparent with akinetic rigid disorders in other brain injuries (vascular, toxic, medication induced, posttraumatic and post-encephalitic parkinsonism) [1], [2], [4].…”