Neuropsychiatric sequelae of stroke

Abstract

Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.

Affective Prosody and Depression After Stroke

“…13 Because women were over-represented in our study, we adjusted our analysis by sex, and our results were replicated when examining men only. Furthermore, although several studies have suggested the potential influence of left brain lesions on the risk of PSD, 14 recent reviews do not support this association, 1,4 and there were no significant differences between PSD and non-PSD groups concerning stroke lateralization in our study. We observed significantly higher levels of anxiety symptoms among PSD patients, thus raising concerns about the potential influence of anxiety on prosodic parameters.…”

“…Although the need to identify new biomarkers 3 associated with PSD is increasingly recognized, progress has been slow, despite considerable investment. 4 The diagnosis of PSD is often complex because of the strong overlap between somatic symptoms related to stroke and those reported by patients during a depressive state. It is, therefore, essential that symptoms specific to PSD be identified.…”

Poststroke Post-Traumatic Stress Disorder

“…Likewise, depressive symptoms experienced up to twelve months following hospitalization for subarachnoid hemorrhage (SAH) are tightly associated with QOL, more so than both demographic variables -and hemorrhage severity 14 . But PSD is not the only mental health outcome that may follow stroke; post-stroke PTSD has similarly been shown to impact mental health and QOL as well 15 . Beyond mood dysregulation, post-stroke PTSD has also been associated with an increased risk of non-adherence to medication 16 , which presents a great obstacle for long-term management of cerebrovascular and psychiatric disorders.…”

Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis

“…Although rates of stroke mortality have decreased worldwide in the last few decades, relevant epidemiological burden remains high 2. More recently, increasing attention has been paid to mental health consequences of stroke,3 which involves an overall higher risk of mortality,4 5 in particular by suicide 6 7. Suicide-related behaviours, comprising ideation, attempt, and completion, all are associated with a previous history of stroke 8–10.…”