The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study

Abstract

Background: While approximately one percent of the global population is formally diagnosed with psychosis or schizophrenia, the actual number is expected to be significantly higher. These patients often consume more healthcare resources and have poorer somatic health. In this study, we analyze potential differences in health, resources, and care process between stroke patients with and without a previous diagnosis of psychosis or schizophrenia.Methods: Ischemic stroke patients from seven regions in Sweden were identified via ICD-10 codes (I63.0-9) in regional administrative systems and the Swedish Stroke Register, and approximately 70% of all ischemic stroke cases in Sweden during 2008–2011 were included (n = 46,350). Relevant patient-level data from national registries were linked to enable multivariate regression analysis, including data on socioeconomics, mortality, municipality services, and filled prescriptions. History of psychosis or schizophrenia was defined via ICD-10 codes F20-29 (n = 389).Results: Patient-reported functional outcomes at 3 months and 1 year were significantly lower in the psychosis subgroup, and stroke recurrence was higher. Patients with pre-stroke psychosis did not receive the same levels of reperfusion treatment as the non-psychosis group. Time at the stroke unit was the same, as were first-year levels of somatic care, but dispensation of antihypertensives was less common.Conclusion: Our findings emphasize the importance of taking mental comorbidity into account during stroke treatment as well as when evaluating indicators for health, resources, and the care process, since mental comorbidity such as psychosis or schizophrenia may have a significant impact the year preceding and the year succeeding the stroke event.

Association between stroke and psychosis across four nationally representative psychiatric epidemiological studies

“…As psychosis, and treatment for psychosis, is a risk factor for later stroke (Li et al, 2014; Marto et al, 2021), stroke in patients with a preceding history of psychosis is also likely to be an important contributory factor to co-prevalence. We also note here that initial studies report that patients with psychosis who later experience stroke have worse outcomes and are less likely to receive equitable care (Kisely et al, 2009; Willers et al, 2018) including timely invasive interventions (Nielsen et al, 2021). Taken together, this evidence suggests that stroke and psychosis may be highly disabling, but is under-recognised and likely under-served by existing services.…”

Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study

“…se). [12][13][14][15] The research database consisted of data from patients with acute stroke 2007-2012, identified in patient administrative systems (PAS) from seven Swedish regions (Jämtland-Härjedalen, Östergötland, Dalarna, Uppsala, Skåne, Stockholm and Västra Götaland), covering approximately 60% of all registered strokes annually in Sweden. PAS contain information on diagnosis and procedure codes related to all healthcare activities registered within the region.…”

Stroke care and case fatality in people with and without schizophrenia: a retrospective cohort study

“…The association between schizophrenia and stroke case fatality is less well understood, with some studies suggesting an increase 3 10 11 and others no difference 12 or a decrease 13 in poststroke mortality in those with schizophrenia. Prestroke antipsychotic use has been associated with an increased risk of severe stroke, which in turn could contribute to poststroke mortality in those with schizophrenia.…”

“… 14 Following myocardial infarction, the excess mortality observed in people with schizophrenia is in part explained by lower use of guideline-recommended interventions and medications. 15–20 Previous research suggests that people with schizophrenia are also less likely to receive interventions for acute stroke care and secondary prevention, 12 but it is not known whether such differences in care explain variations in stroke case fatality.…”