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Griffin TT, Bhave V, McNulty J, Christophe BR, Garton AL, Sander Connolly E. Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder. Neurologist 2023; 28:362-366. [PMID: 37083500 PMCID: PMC10627542 DOI: 10.1097/nrl.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. METHODS Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. RESULTS Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. CONCLUSIONS Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.
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Affiliation(s)
- Tian T. Griffin
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons
| | | | - Jack McNulty
- Columbia Vagelos College of Physicians and Surgeons
| | | | - Andrew L.A. Garton
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
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Holman EA, Cramer SC. Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study. Stroke 2023; 54:2794-2803. [PMID: 37767737 PMCID: PMC10615770 DOI: 10.1161/strokeaha.123.043356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status. METHODS Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported. RESULTS Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (β=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (β=-0.21, P<0.001) and 12 months (β=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (β=0.23, P<0.001) and 12 months (β=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (β=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale. CONCLUSIONS Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.
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Affiliation(s)
- E. Alison Holman
- Sue & Bill Gross School of Nursing, Room 4517, Nursing & Health Sciences Hall, University of California, Irvine, CA 92697
- Department of Psychological Science, 4201 Social & Behavioral Sciences Gateway, University of California, Irvine, CA 92697
| | - Steven C. Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute
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Jiang C, Li Z, Wang J, Liu L, Luo G, Zheng X. Effectiveness of repetitive transcranial magnetic stimulation combined with a brief exposure procedure for post-stroke posttraumatic stress disorder. J Affect Disord 2023; 326:89-95. [PMID: 36717030 DOI: 10.1016/j.jad.2023.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
The incidence of posttraumatic stress disorder (PTSD) following stroke ranges from 6.5 % to 25 %. Presently few studies have focused on its treatment. Repetitive transcranial magnetic stimulation (rTMS) is often applied as a rehabilitation method after stroke, and it also represents a novel approach to PTSD. The aim of this study was to explore the effect of rTMS (or combined with a brief stroke re-exposure) on treating post-stroke PTSD. Sixty participants with post-stroke PTSD were randomly assigned into three groups (rTMS + brief exposure group, TMS + BE; rTMS alone group, TMS; sham treatment group, ST) and received 10 sessions of treatment accordingly over two weeks. Changes in PTSD symptoms (Impact of Event Scale-Revised, IES-R) were evaluated at pre-treatment (T1), the end of the first (T2), and the end of the second treatment week (T3). At the three-month follow-up (T4), a PTSD interview and IES-R assessment were given. Results showed that from T1 to T3, IES-R (and its intrusion subscale) scores of TMS + BE group and TMS group were significantly lower than the ST group, and the effect remained at three-month follow-up. The treatment effect was comparable between TMS + BE group and TMS group at T3, however, it was better for TMS + BE group than TMS group at T2, indicating a brief exposure promotes the effect of rTMS. At follow-up, the rates of PTSD were lower in TMS + BE group and TMS group than ST group. In conclusion, rTMS can effectively treat post-stroke PTSD and the effects may be accelerated by combining a brief exposure procedure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100043444.
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Affiliation(s)
- Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China.
| | - Zhensheng Li
- Department of Neurology, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Jiajia Wang
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Leiyuan Liu
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Gaoquan Luo
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou 510631, Guangdong, China.
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Jiang C, Xue G, Yao S, Zhang X, Chen W, Cheng K, Zhang Y, Li Z, Zhao G, Zheng X, Bai H. Psychometric properties of the post-traumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese stroke patients. BMC Psychiatry 2023; 23:16. [PMID: 36624414 PMCID: PMC9830864 DOI: 10.1186/s12888-022-04493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Stroke is a devastating disease and can be sufficiently traumatic to induce post-traumatic stress disorder (PTSD). Post-stroke PTSD is attracting increasing attention, but there was no study assessing the psychometric properties of the PCL-5 in stroke populations. Our study was conducted to examine the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Chinese stroke patients. METHODS This was a cross-sectional observational study conducted at our hospital. Three hundred and forty-eight Chinese stroke patients came to our hospital for outpatient service were recruited. They were instructed to complete the PCL-5 scales and were interviewed for PTSD diagnosis with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The cutoff scores, reliability and validity of the PCL-5 were analyzed. RESULTS PCL-5 scores in our sample were positively skewed, suggesting low levels of PTSD symptoms. The reliability of PCL-5 was good. Exploratory and confirmatory factor analyses indicated acceptable construct validity, and confirmed the multi-dimensionality of the PCL-5. By CFA analysis, the seven-factor hybrid model demonstrated the best model fit. The PCL-5 also showed good convergent validity and discriminant validity. Receiver operating characteristic (ROC) analyses revealed a PCL-5 score of 37 achieved optimal sensitivity and specificity for detecting PTSD. CONCLUSIONS Our findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.
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Affiliation(s)
- Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Gaici Xue
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Shujing Yao
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Xiwu Zhang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Wei Chen
- grid.263785.d0000 0004 0368 7397School of Psychology, South China Normal University, Guangzhou, 510631 China
| | - Kuihong Cheng
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Yibo Zhang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Zhensheng Li
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, 510010 China
| | - Gang Zhao
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010 China
| | - Xifu Zheng
- grid.263785.d0000 0004 0368 7397School of Psychology, South China Normal University, Guangzhou, 510631 China
| | - Hongmin Bai
- Department of Neurosurgery, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, China.
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Jiang C, Li Z, Du C, Zhang X, Chen Z, Luo G, Wu X, Wang J, Cai Y, Zhao G, Bai H. Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage. Front Neurosci 2022; 16:1007571. [PMID: 36278005 PMCID: PMC9583431 DOI: 10.3389/fnins.2022.1007571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) can develop after stroke attacks, and its rate ranges from 4 to 37% in the stroke population. Suffering from PTSD not only decreases stroke patient’s quality of life, but also relates to their non-adherence of treatment. Since strokes often recur and progress, long-term medical management is especially important. However, previous studies generally focused on the epidemiological characteristics of post-stroke PTSD, while there are literally no studies on the psychological intervention. In our study, 170 patients with a first-ever stroke during the acute phase were recruited. They were randomized into Psycho-therapy group 1 and Control group 1, and were administered with preventive intervention for PTSD or routine health education, respectively. At 2-month follow-up, PTSD symptoms were evaluated. Participants who were diagnosed with post-stroke PTSD were further randomized into Psycho-therapy group 2 and Control group 2, and received supportive therapy or routine health counseling, respectively. At 6-month follow-up (1°month after the therapy was completed), PTSD symptoms were re-evaluated. Our results showed that at 2-month, the PTSD incidence in our series was 11.69%, and the severity of stroke was the only risk factor for PTSD development. The preventive intervention was not superior to routine health education for PTSD prevention. At 6-month, results indicated the supportive therapy did have a fine effect in ameliorating symptoms for diagnosed PTSD patients, superior to routine health counseling. Thus, our study was the first to provide evidence that the supportive therapy was effective in treating post-stroke PTSD early after its diagnosis. This clinical trial was preregistered on www.chictr.org.cn (ChiCTR2100048411).
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Affiliation(s)
- Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Zhensheng Li
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Chenggang Du
- Department of Health Service, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Xiwu Zhang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Zhuang Chen
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Gaoquan Luo
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Xiaona Wu
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Jiajia Wang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yan Cai
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Gang Zhao
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
- Gang Zhao,
| | - Hongmin Bai
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
- *Correspondence: Hongmin Bai,
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Zhang S, Yuan Y, Zhuang W, Xiong T, Xu Y, Zhang J, Tao C, Liang J, Wang Y. Contributing Factors and Induced Outcomes of Psychological Stress Response in Stroke Survivors: A Systematic Review. Front Neurol 2022; 13:843055. [PMID: 35812095 PMCID: PMC9257184 DOI: 10.3389/fneur.2022.843055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemarkable evidence indicates that psychological stress is significantly associated with stroke. However, a uniform recommendation to identify and alleviate poststroke psychological stress responses and improve postmorbid outcomes is not currently available. Thus, this systematic review aimed to summarize the types of poststroke psychological stress, measurement tools, contributing factors, and outcomes.MethodsThis systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in PubMed, Web of Science, Embase, CNKI, WanFangData, and CQVIP from database inception to November 2021. Cross-sectional and longitudinal studies were included in this research. Quality assessment was performed based on the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsEighteen quantitative, peer-reviewed studies were included for analysis. Selected articles mainly investigated perceived stress and posttraumatic stress disorder after stroke. We classified the contributing factors into four categories: sociodemographic factors, clinical disease factors, psychological factors, and behavioral and lifestyle factors. The postmorbid outcomes were divided into three categories: clinical disease outcomes, psychological outcomes, and behavioral and quality of life outcomes.ConclusionsCompared to common patients, stroke survivors with the following characteristics suffered an increased psychological stress response: younger age, the presence of caregivers, depression, unsuitable coping strategies, etc. Meanwhile, lower quality of life, worse drug compliance, worse functional independence, and more severe mental disorders were significantly associated with increased psychological stress symptoms. Further studies are required to provide more trustworthy and meaningful references for mitigating the damage caused by psychological stress after stroke.
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Affiliation(s)
- Song Zhang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Wenwen Zhuang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Tianqing Xiong
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yijun Xu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Jingwen Zhang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Chunhua Tao
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- *Correspondence: Yingge Wang
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Tang W, Wang L, F Tsoi K, Rutovic S, Kim J. Post-Traumatic Stress Disorder after Stroke: A Systematic Review. Neurol India 2022; 70:1887-1895. [DOI: 10.4103/0028-3886.359285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Occurence of Post-Traumatic Stress Symptoms, Anxiety and Depression in the Acute Phase of Transient Ischemic Attack and Stroke. Psychiatr Q 2021; 92:905-915. [PMID: 33387257 PMCID: PMC8379102 DOI: 10.1007/s11126-020-09873-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 10/31/2022]
Abstract
Rates of post-traumatic stress symptoms, anxiety and depression are increased in patients having experienced a transient ischemic attack (TIA) or stroke several months ago. However, data of psychiatric symptoms in the acute phase within the first days after ictus are lacking. In 20 patients with stroke and 33 patients with TIA we assessed disease severity by means of the NIHSS, levels of depression and anxiety by HADS, PTSD-like symptoms by PC-PTSD, quality of life (HrQoL) by SF-12, and coping style by brief COPE Inventory within the first 5 days after ictus. NIHSS on admission was lower in patients with TIA (0 ± 1) than in patients with stroke (3 ± 2, p < 0.001). HADS depression score was significantly higher in patients with stroke (7.0 ± 4.5) than in patients with TIA (4.9 ± 4.0). HADS anxiety score, HrQoL and coping styles were similar between TIA and stroke patients (p > 0.05). 5 and 3 of 33 TIA patients as well as 4 and 3 of 20 stroke patients had at least 11 points in the HADS anxiety and depression score respectively (p = 0.001). 2 of 33 TIA patients and 2 of 20 stroke patients had more than 2 points in the PC-PTSD (p = 0.646). We did not find consistent correlations between the NIHSS and the psychometric parameters. Within the first five days after patients having experienced a TIA or stroke PTSD-like, anxious and depressive symptoms are more common than in the general population. As the acute psychological status after ictus is predictive for psychiatric comorbidity years later physicians should pay attention and adequately treat psychiatric symptoms already in the acute phase of stroke.Trial Registration: German Clinical Trials Register, DRKS00021730, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730 , registered 05/19/2020- Retrospectively registered.
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Dollenberg A, Moeller S, Lücke C, Wang R, Lam AP, Philipsen A, Gschossmann JM, Hoffmann F, Müller HHO. Prevalence and influencing factors of chronic post-traumatic stress disorder in patients with myocardial infarction, transient ischemic attack (TIA) and stroke - an exploratory, descriptive study. BMC Psychiatry 2021; 21:295. [PMID: 34098930 PMCID: PMC8186229 DOI: 10.1186/s12888-021-03303-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cardio- and cerebrovascular events such as myocardial infarction (MI), stroke and transient ischemic attack (TIA) are leading causes of death and disability and have also been associated with poor mental outcomes. In addition, cardio- and cerebrovascular events may pose the risk of experiencing a sudden traumatic occurrence of symptoms during ictus and thus contribute to high rates of PTSD as well as high rates of subsequent depression and anxiety. Moreover, MI, TIA and stroke survivors with PTSD, depressive and anxiety symptoms may have poorer health-related quality of life (HRQoL) and poorer disease prognosis than patients who do not develop psychiatric symptoms after ictus. However, data on the prevalence of PTSD, anxiety and depression, as well as the HRQoL, coping strategies and potential risk factors for development of PTSD in these patients, are rare. METHODS In an exploratory, descriptive study we interviewed 112 patients (54 MI, 18 TIA, 40 stroke; mean age: 69.5 years, 55.4% males) from three general physician practices and used psychometric self-assessment tools to determine the occurrence of PTSD and psychosomatic comorbidity, anxiety and depression and to assess HRQoL and coping strategies. We evaluated disease severity and compared the patient groups to each other. Moreover, we assessed psychological outcome differences between patients with or without PTSD after ictus. RESULTS The prevalence of PTSD after MI, TIA and stroke was 23.2%. The patients who developed PTSD had higher rates of depression, anxiety and maladaptive coping as well as reduced HRQoL. Adaptive coping was positively related to better mental HRQoL and negatively related to anxiety and depression. Disease severity of MI, TIA and stroke was not related to PTSD, depression, anxiety or physical HRQoL. CONCLUSIONS Experiencing MI, TIA or stroke means confronting a life-threatening event for those affected and, therefore, these can be regarded as traumatic events. Cerebral and cardiovascular events increase the risk of developing chronic PTSD with subsequent increased depression and anxiety and reduced HRQoL. These findings emphasize the need for early screening and diagnosis of PTSD in somatically ill patients, which should be followed by specialized treatment, as PTSD hampers overall (somatic) disease prognosis. TRIAL REGISTRATION German Clinical Trials Register, DRKS00021730, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730 , registered 05/19/2020 - Retrospectively registered.
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Affiliation(s)
- Aurora Dollenberg
- School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany
- Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Sebastian Moeller
- Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Universitätsklinikum Bonn AöR, Klinik und Poliklinik für Psychiatrie, Bonn, Germany
| | - Caroline Lücke
- School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany
- Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Ruihao Wang
- Universitätsklinikum Erlangen, Klinik und Poliklinik für Neurologie, Erlangen, Germany
| | - Alexandra P. Lam
- Universitätsklinikum Bonn AöR, Klinik und Poliklinik für Psychiatrie, Bonn, Germany
| | - Alexandra Philipsen
- Universitätsklinikum Bonn AöR, Klinik und Poliklinik für Psychiatrie, Bonn, Germany
| | - Jürgen M. Gschossmann
- Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Klinikum Forchheim-Fränkische Schweiz gGmbH, Forchheim, Germany
| | - Falk Hoffmann
- School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany
| | - Helge H. O. Müller
- School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany
- Faculty of Health/School of Medicine, Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Universitätsklinikum Bonn AöR, Klinik und Poliklinik für Psychiatrie, Bonn, Germany
- Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Division of Medical Psychology, Universitätsklinikum Bonn, Bonn, Germany
- Abteilung für Psychiatrie und Psychotherapie, Lehrstuhl für integrative Psychiatrie und Psychotherapie Private Universität Witten/Herdecke Gemeinschaftskrankenhaus Herdecke gGmbH, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
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