Subarachnoid hemorrhage as a psychological trauma

Abstract

E vEn months to years after subarachnoid hemorrhage (SAH), increased irritability, personality changes, loss of interest and initiative, social problems, and emotional disturbances frequently persist. 6,15,16,23,25,28,29,31,34,35,38 These psychological changes and subjective complaints are also present even when the degree of neurological and/or cognitive impairment is relatively mild. 15,16,23,25,[28][29][30][31]35,38 Ropper and Zervas 35 and Ljunggren et al. 23 found that approximately 25% of their SAH patients with a good neurological result (Glasgow Outcome Scale [GOS] score of 1) exhibited substantial emotional maladjustment. The etiology of this psychosocial impairment has not been resolved conclusively. It can be speculated that these personality and emotional changes result directly of brain damage or can be regarded as an expression of chronic functional impairment. On the other hand, several authors have noted that the frequency and severity of emotional disturbances and personality changes after SAH are out of proportion to the typically rather moderate cognitive and neurological impairments of these patients. 15,16,23,25,[28][29][30][31]35,38 This discrepancy cannot be explained by a psychological reaction to persisting functional deficits or the social stigma associated with having had "trouble with the head." Therefore, the question about additional causes beyond brain damage for the psychological abnormalities occurring after SAH arises. Several authors have found that chronic posttraumatic stress disorder (PTSD) is far from being uncommon in patients who have experienced SAH, with rates ranging from 19% to 37% in the published literature. Object. Despite the progress made in the management of subarachnoid hemorrhage (SAH), many patients complain of persistent psychosocial and cognitive problems. The present study was performed to explore the significance of psychological traumatization by the bleeding with respect to psychosocial results after SAH.Methods. A series of 45 patients were examined in a cross-sectional study an average of 49.4 months after SAH by means of a quality-of-life questionnaire, the Beck Depression Inventory, the German version of the Impact of Event Scale (IES), and a clinical interview (Structured Clinical Interview for DSM Disorders) to make the diagnosis of chronic posttraumatic stress disorder (PTSD). Twenty-nine patients underwent surgery for treatment of a ruptured aneurysm; the remaining 16 patients had SAH of unknown origin.Results. Twelve patients (27%) exhibited PTSD, and almost two-thirds of the 45 patients in the study reported substantial fear of recurrent hemorrhage. Not only the presence of PTSD but the severity of psychological traumatization as assessed by the IES explained up to 40% of the variance of the self-and proxy-rated impairments. Multivariate analyses revealed psychological traumatization (IES) and neurological state on admission (Hunt and Hess grade) as substantial predictors of the self-and proxy-rated quality of life, explaining 31% and 42% of t...

Poststroke Post-Traumatic Stress Disorder

“…Yet, medical disorders are known to cause psychological trauma 18 (e.g. congenital heart disease 19 , subarachnoid hemorrhage 20 ). This is especially more common if the patient requires ICU care 21 .…”

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

“…Therefore, it is crucial to investigate the emergence and course of those symptoms. Studies on the development of PTSD in medical settings have been mostly restricted to life-threatening conditions, such as myocardial infarction and intracranial bleeding due to an aneurysm rupture (Hutter & Kreitschmann-Andermahr, 2014; Visser-Meily et al, 2013; Wasson, Shaffer, Alcantara, Schwartz, & Edmondson, 2014). Because these conditions represent medical emergencies, it was impossible to conduct a baseline (pretrauma) psychological evaluation of these patients.…”

Patient-reported outcome measures for patients with cerebral aneurysms acquired via social media: data from a large nationwide sample

“…The psychological trauma that results from a ruptured aneurysm has been demonstrated to contribute to chronic post-traumatic stress disorder (PTSD). Our results provide further evidence that neurosurgeons and neurointerventionalists should be sensitized to the symptoms of PTSD and refer patients to specialists so that PTSD may be diagnosed and treated as early as possible after subarachnoid hemorrhage 11. Patients who have experienced a ruptured aneurysm may benefit from survivorship care plans similar to those used for long-term cancer survivors.…”