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Ignacio KHD, Muir RT, Diestro JDB, Singh N, Yu MHLL, Omari OE, Abdalrahman R, Barker-Collo SL, Hackett ML, Dukelow SP, Almekhlafi MA. Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107732. [PMID: 38657829 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107732] [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] [Received: 02/06/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Young adults with stroke have distinct professional and social roles making them vulnerable to symptoms of post-stroke depression (PSD) and post-stroke anxiety (PSA). Prior reviews have examined the prevalence of anxiety and depression in stroke populations. However, there are a lack of studies that have focused on these conditions in young adults. OBJECTIVE We performed a systematic review and meta-analysis of observational studies that reported on symptoms of PSD, PSA and comorbid PSD/PSA in young adults aged 18 to 55 years of age. METHODS MEDLINE, EMBASE, SCOPUS and PsycINFO were searched for studies reporting the prevalence of symptoms of PSD and/or PSA in young adults with stroke from inception until June 23, 2023. We included studies that evaluated depression and/or anxiety symptoms with screening tools or interviews following ischemic or hemorrhagic stroke. Validated methods were employed to evaluate risk of bias. RESULTS 4748 patients from twenty eligible studies were included. Among them, 2420 were also evaluated for symptoms of PSA while 847 participants were evaluated for both PSD and PSA symptoms. Sixteen studies were included in the random effects meta-analysis for PSD symptoms, with a pooled prevalence of 31 % (95 % CI 24-38 %). Pooled PSA symptom prevalence was 39 % (95 % CI 30-48 %) and comorbid PSD with PSA symptom prevalence was 25 % (95 % CI 12-39 %). Varying definitions of 'young adult', combinations of stroke subtypes, and methods to assess PSD and PSA contributed to high heterogeneity amongst studies. CONCLUSIONS We identified high heterogeneity in studies investigating the prevalence of symptoms of PSD and PSA in young adults, emphasizing the importance of standardized approaches in future research to gain insight into the outcomes and prognosis of PSD and PSA symptoms following stroke in young adults. Larger longitudinal epidemiological studies as well as studies on tailored interventions are required to address the mental health needs of this important population. FUNDING None.
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Affiliation(s)
- Katrina Hannah D Ignacio
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada.
| | - Ryan T Muir
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Jose Danilo B Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Nishita Singh
- Neurology division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Maree L Hackett
- University of New South Wales, Sydney, Australia; The School of Nursing and Midwifery, The University of Central Lancashire, Preston, United Kingdom
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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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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Gillam W, Godbole N, Sangam S, DeTommaso A, Foreman M, Lucke-Wold B. Neurologic Injury-Related Predisposing Factors of Post-Traumatic Stress Disorder: A Critical Examination. Biomedicines 2023; 11:2732. [PMID: 37893106 PMCID: PMC10604790 DOI: 10.3390/biomedicines11102732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
The present review aimed to identify the means through which neurologic injury can predispose individuals to Post-Traumatic Stress Disorder (PTSD). In recent years, comprehensive studies have helped to clarify which structures in the central nervous system can lead to distinct PTSD symptoms-namely, dissociative reactions or flashbacks-when damaged. Our review narrowed its focus to three common neurologic injuries, traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and stroke. We found that in each of the three cases, individuals may be at an increased risk of developing PTSD symptoms. Beyond discussing the potential mechanisms by which neurotrauma may lead to PTSD, we summarized our current understanding of the pathophysiology of the disorder and discussed predicted associations between the limbic system and PTSD. In particular, the effect of noradrenergic neuromodulatory signaling on the hypothalamic pituitary adrenal (HPA) axis as it pertains to fear memory recall needs to be further explored to better understand its effects on limbic structures in PTSD patients. At present, altered limbic activity can be found in both neurotrauma and PTSD patients, suggesting a potential causative link. Particularly, changes in the function of the limbic system may be associated with characteristic symptoms of PTSD such as intrusive memories and acute psychological distress. Despite evidence demonstrating the correlation between neurotrauma and PTSD, a lack of PTSD prognosis exists in TBI, SAH, and stroke patients who could benefit from early treatment. It should be noted that PTSD symptoms often compound with pre-existing issues, further deteriorating health outcomes for these patients. It is ultimately our goal to clarify the relationship between neurotrauma and PTSD so that earlier diagnoses and appropriate treatment are observed in clinic.
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Affiliation(s)
- Wiley Gillam
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Nikhil Godbole
- School of Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - Shourya Sangam
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Alyssa DeTommaso
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32827, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (W.G.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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Feely D, Slattery B, Walsh T, Galvin T, Donlon K, Hanlon M, Gormley D, Brown GM, Quinn S, Robinson S, Judge C, O’Donnell M, Sarma K, McGuire BE. Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study. PLoS One 2023; 18:e0286220. [PMID: 37792802 PMCID: PMC10550116 DOI: 10.1371/journal.pone.0286220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/10/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later. DESIGN Prospective within-groups study. METHODS Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points. RESULTS Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01). CONCLUSIONS The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.
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Affiliation(s)
- David Feely
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian Slattery
- School of Psychology, University of Galway, Galway, Ireland
| | - Thomas Walsh
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Trish Galvin
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Kate Donlon
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | | | - Darina Gormley
- School of Psychology, University of Galway, Galway, Ireland
| | | | - Sarah Quinn
- School of Psychology, University of Galway, Galway, Ireland
| | - Stephanie Robinson
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Conor Judge
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Martin O’Donnell
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
| | - Kiran Sarma
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, University of Galway, Galway, Ireland
- Department of Stroke and Geriatric Medicine, University Hospital, Galway, Ireland
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Meinhausen C, Sanchez GJ, Robles TF, Edmondson D, Kronish IM, Hinrichs R, Jovanovic T, Sumner JA. Correlates of Skin Conductance Reactivity to Stroke-Related Trauma Reminders During Hospitalization for Stroke. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231156571. [PMID: 36814781 PMCID: PMC9940223 DOI: 10.1177/24705470231156571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Objective Although several risk factors for stroke-induced posttraumatic stress disorder (PTSD) have been identified, objective risk measures that can be detected in the acute aftermath of these events are needed. This study is the first to collect an objective measure of psychophysiological arousal-skin conductance (SC) reactivity to a trauma interview-in patients after stroke or transient ischemic attack (TIA) and investigate correlates of SC reactivity. Methods Mobile SC measurement during a resting baseline and standardized trauma interview was performed in-hospital in 98 individuals following stroke/TIA. We examined associations between several stroke-induced PTSD risk factors (sociodemographic, psychosocial, and medical characteristics) and SC reactivity to a trauma interview involving a free-response recalling of the stroke/TIA event. Results Of the sociodemographic, psychosocial, medical characteristics examined as correlates to SC reactivity to recalling the stroke/TIA event, 2 factors reflecting aspects of prior and in-hospital experience were significantly associated with this indicator of sympathetic nervous system activation. A greater cumulative trauma burden was significantly associated with greater SC reactivity (r = .23, P = .04). Additionally, individuals administered benzodiazepines in-hospital had significantly greater SC reactivity to recalling the stroke/TIA event (M = 1.51, SD = 1.52) than those who were not (M = 0.76, SD = 1.16; P = .01). Greater cumulative trauma burden remained significantly associated with greater SC reactivity when adjusting for age and in-hospital benzodiazepine administration (β=0.22, P = .04). Conclusion This study demonstrated that SC reactivity was related to both behavioral and psychological risk factors for PTSD after a stroke/TIA event. Additionally, we demonstrated the feasibility of a low-cost, mobile measurement of SC that can be conducted in-hospital in a novel patient population: individuals with a medical trauma. With this measure, we were able to identify those individuals with the greatest trauma-related sympathetic nervous system reactivity in the days following a medical trauma. Future research is needed to determine whether SC reactivity may be leveraged in the development of brief, noninvasive screening measures for enhancing PTSD risk prediction.
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Affiliation(s)
- Corinne Meinhausen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA,Corinne Meinhausen, Department of Psychology, University of California, Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Gabriel J. Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA,Department of Psychology, St. John's University, Queens, NY, USA
| | - Theodore F. Robles
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State, University, Detroit, MI, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Coping Strategies and Posttraumatic Growth Following Transient Ischemic Attack: A Qualitative Study. J Clin Med 2023; 12:jcm12020575. [PMID: 36675504 PMCID: PMC9863589 DOI: 10.3390/jcm12020575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
A transient ischemic attack (TIA) is defined as a temporary neurological dysfunction due to focal brain ischemia. We aimed to identify common coping strategies and the possible occurrence of posttraumatic growth in TIA patients. Semistructured interviews were conducted with TIA patients three months after TIA. We asked the participants about possible changes in the aftermath of their TIA and their way of coping with said changes. All interviews were tape-recorded and subsequently transcribed verbatim. Thematic content analysis was performed to identify main categories and themes. Seventeen patients with a median age of 66 years completed the semistructured interviews. Qualitative content analysis revealed 332 single codes, from which the three main categories "impairments as a consequence of TIA", "coping strategies" and "posttraumatic growth" were generated. The main categories were further subdivided into seven categories and thirty-six themes. TIA patients may suffer from various physical impairments, which also involve medication side effects. Activating resources on the one hand, and avoiding negative thoughts and feelings on the other hand, were identified to be the relevant coping strategies in TIA patients. Posttraumatic growth seems to be a common phenomenon after TIA, which may have important implications for treatment and rehabilitation.
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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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Guan T, Guo Y, Li C, Zhou T, Yu Q, Yang C, Zhang G, Kong J. Cerebral Ischemic Preconditioning Aggravates Death of Oligodendrocytes. Biomolecules 2022; 12:biom12121872. [PMID: 36551300 PMCID: PMC9776065 DOI: 10.3390/biom12121872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Neurodegeneration can benefit from ischemic preconditioning, a natural adaptive reaction to sublethal noxious stimuli. Although there is growing interest in advancing preconditioning to preserve brain function, preconditioning is not yet considered readily achievable in clinical settings. One of the most challenging issues is that there is no fine line between preconditioning stimuli and lethal stimuli. Here, we show deleterious effect of preconditioning on oligodendrocyte precursor cells (OPCs). We identified Bcl-2/adenovirus E1B 19-kDa interacting protein 3 (BNIP3), a mitochondrial BH3-only protein specifically involved in OPCs loss after preconditioning. Repeated ischemia stabilized BNIP3 and increased the vulnerability of OPCs to subsequent ischemic events. BNIP3 became mitochondrial-bound and was concurrent with the dysfunction of monocarboxylate transporter 1 (MCT1). Inhibition of BNIP3 by RNAi or necrostatin-1 (Nec-1) and knocking out of BNIP3 almost completely prevented OPCs loss and preserved white matter integrity. Together, our results suggest that the unfavorable effect of BNIP3 on OPCs should be noted for safe development of ischemic tolerance. BNIP3 inhibition appears to be a complementary approach to improve the efficacy of preconditioning for ischemic stroke.
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Affiliation(s)
- Teng Guan
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Ying Guo
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Forensic Medicine, Hebei North University, Zhangjiakou 075000, China
| | - Chengren Li
- Department of Obstetrics and Gynecology, Guiqian International General Hospital, Guiyang 550024, China
| | - Ting Zhou
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Qiang Yu
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Chaoxian Yang
- Department of Anatomy and Histoembryology, School of Basic Medical Science, Southwest Medical University, Luzhou 646099, China
| | - Guohui Zhang
- Department of Forensic Medicine, Hebei North University, Zhangjiakou 075000, China
| | - Jiming Kong
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Correspondence: ; Tel.: +1-(204)977-5601
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The longitudinal course of anxiety, depression and apathy through two years after stroke. J Psychosom Res 2022; 162:111016. [PMID: 36063628 DOI: 10.1016/j.jpsychores.2022.111016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Estimate the prevalence of anxiety disorders, depressive disorders and apathy two years after stroke, examine their longitudinal course, describe the course of psychological distress through two years after stroke, and evaluate Hospital Anxiety and Depression Scale HADS-A and HADS-D cut-off scores of ≥4 and ≥ 8 for detection of anxiety and depressive disorders two years after stroke. METHODS In a longitudinal cohort study of 150 consecutive stroke patients in a stroke unit, 103 were assessed four months and 75 two years after stroke. Anxiety and depression disorders and symptoms were assessed by the Structured Clinical Interview for DSM-IV and HADS, apathy by the Apathy Evaluation Scale. RESULTS Prevalence of at least one anxiety disorder or one depressive disorder decreased from four months to two years (23% vs 9%, P = 0.026, 19% vs 10%, P = 0.17). Apathy remained stable at 48% vs 50%. After two years, 80%, 79% and 19% of those with anxiety, depression or apathy at four months had recovered. Recovery-rates among patients with anxiety were 83% for panic disorder, 60% for generalized anxiety disorder (GAD), and 50% for social phobia. CONCLUSIONS In contrast to apathy, recovery from anxiety and depression was high. About half of the patients with GAD, social phobia or agoraphobia did not recover. Co-morbid depression and apathy at four months implied a high risk for not recovering at two years. HADS-A and HADS-D cut-off scores of ≥8 were feasible for detection of anxiety and depression disorders two years after stroke.
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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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11
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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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12
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Ben Assayag E, Tene O, Korczyn AD, Solomon Z, Bornstein NM, Shenhar-Tsarfaty S, Seyman E, Niry D, Molad J, Hallevi H. Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style. Stroke 2022; 53:1924-1933. [PMID: 35264011 DOI: 10.1161/strokeaha.121.036635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke. METHODS Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients. RESULTS Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08-21.34]; P<0.01) compared with low-anxious and repressive coping styles, after adjusting for age, education, stroke severity, brain atrophy, and depression. CONCLUSIONS In our cohort, PTSD was a common sequela among stroke survivors. We suggest that risk factors for PTSD development include stroke severity, white matter damage, and premorbid coping styles. Early identification of at-risk patients is key to effective treatment.
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Affiliation(s)
- Einor Ben Assayag
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Oren Tene
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Amos D Korczyn
- Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Israel. (Z.S.)
| | - Natan M Bornstein
- Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.)
| | - Shani Shenhar-Tsarfaty
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Estelle Seyman
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.)
| | - Dana Niry
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
| | - Jeremy Molad
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.)
| | - Hen Hallevi
- Departments of Neurology, Psychiatry and Radiology, Tel Aviv Sourasky Medical Center, Israel (E.B.A., O.T., S.S.-T., E.S., D.N., J.M., H.H.).,Faculty of Medicine, Tel Aviv University, Israel. (E.B.A., O.T., A.D.K., S.S.-T., D.N., H.H.)
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13
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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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14
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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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15
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Prevalence and correlates of post-traumatic stress disorder after ischaemic stroke. Acta Neurol Belg 2021; 121:437-442. [PMID: 31452093 DOI: 10.1007/s13760-019-01200-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
Although most often considered a consequence of traumatic event, post-traumatic stress disorder (PTSD) also occurs after illness. The aim of this study was to establish prevalence of PTSD in patients with ischaemic stroke (IS) and its correlation to lesion location, degree of disability, age, gender and marital status. The study included 85 patients with IS. PTSD was diagnosed using a modified version of the PTSD Checklist Specific for a stressor (PCL-S). Depression and anxiety were assessed using Hospital Anxiety and Depression Scale (HADS). We defined stroke localisation as right cerebral hemisphere, left cerebral hemisphere, brainstem and cerebellum. Stroke severity was measured using the modified Rankin scale (mRS). Demographic information including age, gender and marital status was collected from medical history. Of the 85 patients with IS, 11 (12.9%) fulfilled PCL-S criteria for PTSD. We found a positive correlation between PTSD and higher degree of disability, P < 0.001. Patients with PTSD had lesions more frequently localised in the right cerebral hemisphere and the brainstem. We found no statistically significant correlation of PTSD with age, gender and marital status. Our results show that a significant number of IS patients develop PTSD after IS. Determining correlates of post-stroke PTSD can help to identify those at higher risk for its development. If proven by additional large sample studies, more patients can benefit from screening for the PTSD symptoms.
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16
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Abstract
Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
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Affiliation(s)
- Katlyn Nemani
- Departments of Neurology and Psychiatry, NYU Langone Health, New York, New York
| | - Lindsey Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York
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18
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Cruz SA, Qin Z, Ricke KM, Stewart AFR, Chen HH. Neuronal protein-tyrosine phosphatase 1B hinders sensory-motor functional recovery and causes affective disorders in two different focal ischemic stroke models. Neural Regen Res 2021; 16:129-136. [PMID: 32788467 PMCID: PMC7818877 DOI: 10.4103/1673-5374.286970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Ischemic brain injury causes neuronal death and inflammation. Inflammation activates protein-tyrosine phosphatase 1B (PTP1B). Here, we tested the significance of PTP1B activation in glutamatergic projection neurons on functional recovery in two models of stroke: by photothrombosis, focal ischemic lesions were induced in the sensorimotor cortex (SM stroke) or in the peri-prefrontal cortex (peri-PFC stroke). Elevated PTP1B expression was detected at 4 days and up to 6 weeks after stroke. While ablation of PTP1B in neurons of neuronal knockout (NKO) mice had no effect on the volume or resorption of ischemic lesions, markedly different effects on functional recovery were observed. SM stroke caused severe sensory and motor deficits (adhesive removal test) in wild type and NKO mice at 4 days, but NKO mice showed drastically improved sensory and motor functional recovery at 8 days. In addition, peri-PFC stroke caused anxiety-like behaviors (elevated plus maze and open field tests), and depression-like behaviors (forced swimming and tail suspension tests) in wild type mice 9 and 28 days after stroke, respectively, with minimal effect on sensory and motor function. Peri-PFC stroke-induced affective disorders were associated with fewer active (FosB+) neurons in the PFC and nucleus accumbens but more FosB+ neurons in the basolateral amygdala, compared to sham-operated mice. In contrast, mice with neuronal ablation of PTP1B were protected from anxiety-like and depression-like behaviors and showed no change in FosB+ neurons after peri-PFC stroke. Taken together, our study identifies neuronal PTP1B as a key component that hinders sensory and motor functional recovery and also contributes to the development of anxiety-like and depression-like behaviors after stroke. Thus, PTP1B may represent a novel therapeutic target to improve stroke recovery. All procedures for animal use were approved by the Animal Care and Use Committee of the University of Ottawa Animal Care and Veterinary Service (protocol 1806) on July 27, 2018.
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Affiliation(s)
- Shelly A Cruz
- Ottawa Hospital Research Institute, Neuroscience Program; Brain and Mind Institute, University of Ottawa, Ottawa, ON, Canada
| | - Zhaohong Qin
- Ottawa Hospital Research Institute, Neuroscience Program; Brain and Mind Institute, University of Ottawa, Ottawa, ON, Canada
| | - Konrad M Ricke
- Brain and Mind Institute; Department of Biochemistry, Microbiology and Immunology, University of Ottawa; University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexandre F R Stewart
- Department of Biochemistry, Microbiology and Immunology; Centre for Infection, Immunity and Inflammation, University of Ottawa; University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Hsiao-Huei Chen
- Ottawa Hospital Research Institute, Neuroscience Program; Brain and Mind Institute; Cellular and Molecular Medicine; Department of Medicine; Centre for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
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19
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Pedowitz E, Derby L, Cruz GJ, Trainor A, Edmondson D, Cornelius T. Relationship between NIH stroke symptoms and post-traumatic stress disorder in patients evaluated for transient ischemic attack/stroke. Gen Hosp Psychiatry 2021; 70:98-102. [PMID: 33774490 PMCID: PMC8127400 DOI: 10.1016/j.genhosppsych.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) can develop after a life-threatening medical event. According to the enduring somatic treat (EST) model, internal somatic cues (e.g., rapid heart rate) may contribute to symptoms of stroke/TIA-induced PTSD. To address this possibility, the present study tested the association of stroke-induced disability with PTSD symptoms in patients treated for stroke or transient ischemic attack (TIA). METHOD Participants (n = 300) were drawn from an observational cohort study examining PTSD symptoms in patients admitted to the NewYork Presbyterian Hospital between 2015 and 2017 for a stroke/TIA. Patients self-reported acute stress symptoms in-person approximately 3 days post-stroke/TIA and PTSD symptoms via telephone one month later. Severity of stroke symptoms (i.e., stroke disability) was evaluated using the NIH Stroke Scale prior to hospital discharge. RESULTS Stroke disability had a significant, positive association with acute stress symptoms early post-stroke/TIA, B = 0.46, se = 0.15, p = .002, and with PTSD symptoms one month later, B = 0.56, se = 0.19, p = .003. CONCLUSIONS Stroke disability is positively associated with both acute distress and PTSD symptoms one month later following a stroke/TIA, supporting the hypothesis that internal somatic symptoms contribute to the development stroke/TIA-induced PTSD symptoms.
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Affiliation(s)
- Emily Pedowitz
- NYU Grossman School of Medicine, Department of Psychiatry, 1 Park Avenue, 8th Avenue, 10016, United States.
| | - Lilly Derby
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Gaspar J. Cruz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Alison Trainor
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W 168 St, PH9, New York, NY 10032
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Broken Heartstrings—Post-Traumatic Stress Disorder and Psychological Burden after Acute Mitral Regurgitation Due to Chordae Tendineae Rupture. J Clin Med 2020; 9:jcm9124048. [PMID: 33333785 PMCID: PMC7765219 DOI: 10.3390/jcm9124048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
Chordae tendineae rupture (CTR) is a potentially life-threatening cardiac event often resulting in Acute mitral regurgitation (AMR). We assessed Post-traumatic stress disorder (PTSD), depression, and anxiety symptoms in n=21 CTR patients with AMR (age 82.3 ± 4.2 years; 66.7% men) and compared them to n=23 CTR patients with Chronic mitral regurgitation (CMR) and n=35 Myocardial infraction (MI) patients. Regression analyses revealed that PTSD scores were significantly higher in CTR patients with AMR than in CTR patients with CMR or MI patients. CTR patients with CMR had the lowest levels of PTSD-symptoms. Depression and anxiety scores were elevated across all three groups. Our results suggest that psychosocial factors need to be considered in CTR patients’ care.
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21
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Liyanage-Don N, Birk J, Cornelius T, Sanchez G, Moise N, Edmondson D, Kronish I. Medications as Traumatic Reminders in Patients With Stroke/Transient Ischemic Attack-Induced Posttraumatic Stress Disorder. Stroke 2020; 52:321-324. [PMID: 33272128 DOI: 10.1161/strokeaha.120.031109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) symptoms are common after stroke/transient ischemic attack (TIA) and have been associated with medication nonadherence, potentially because medications serve as traumatic reminders of the prior stroke/TIA. This study examined associations between stroke/TIA-induced PTSD and aversive cognitions toward preventive medications. METHODS We enrolled a cohort of patients presenting to the emergency department with suspected stroke/TIA. One month posthospitalization, we assessed PTSD symptoms specific to the index stroke/TIA using the PTSD checklist specific and asked patients how often (1) did thinking about your stroke medication make you feel nervous or anxious?; (2) did thinking about your stroke medication make you think about your risk for future strokes?; and (3) did you skip or avoid taking your stroke medication so you would not have to think about your stroke? Logistic regression models tested the association between PTSD symptoms and each aversive cognition, adjusting for age, sex, ethnicity, and depression. RESULTS Among 408 included patients, 11.0% had elevated PTSD symptoms. These patients were more likely to report that thinking about their stroke medication made them feel nervous or anxious (37.8% versus 9.9%, P<0.001) that thinking about their stroke medication made them think about their risk for future stroke/TIA (60.0% versus 24.0%, P<0.001), and that they skipped or avoided their stroke medication to not think about their prior stroke/TIA (11.1% versus 2.2%, P=0.009). In adjusted analyses, higher PTSD checklist specific scores were associated with increased nervousness/anxiety (odds ratio, 1.33 [95% CI, 1.18-1.50], P<0.001) and thoughts of future stroke (odds ratio, 1.27 [95% CI, 1.14-1.41], P<0.001), with a trend toward significance for skipping medications to avoid reminders of stroke (odds ratio, 1.20 [95% CI, 0.99-1.44], P=0.06). CONCLUSIONS Medications may serve as traumatic reminders after stroke/TIA-induced PTSD, potentially leading to medication nonadherence.
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Affiliation(s)
- Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Gabriel Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
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Grosse-Holz VM, Nikendei C, Andermann M, Ringleb PA, Friederich HC, Rizos T. Predictors of posttraumatic stress following transient ischemic attack: An observational cohort study. J Psychosom Res 2020; 137:110205. [PMID: 32768689 DOI: 10.1016/j.jpsychores.2020.110205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/15/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Transient ischemic attack (TIA) has been reported to be frequently followed by symptoms of post-TIA posttraumatic stress disorder (post-TIA PTSD). Risk factors for post-TIA PTSD remain largely unknown. We aimed to identify predictors of post-TIA PTSD development to enable post-TIA PTSD risk assessment and inform future development of treatment and prevention interventions. METHOD TIA patients were examined twice for this observational cohort study. Symptoms of post-TIA PTSD, depression and anxiety were assessed shortly after TIA during in-hospital stay (T1) and three months after TIA (T2). The impact of known general PTSD risk factors (psychiatric history, peritraumatic dissociation, social support), psychological resilience factors (sense of coherence, mindfulness, attachment style) and TIA characteristics (affected circulatory territory, symptom type and duration) at T1 on post-TIA PTSD symptom severity at T2 was tested using hierarchical multiple linear regression. RESULTS Sixty-one patients (83.6%) completed the study at T2. Fifteen patients (24.6%) were classified as post-TIA PTSD⊕ at T2. In multiple linear regression analysis, age, sex, psychiatric history, peritraumatic dissociation and social support together explained 39.9% of variance of post-TIA posttraumatic stress symptom severity. Sense of coherence and mindfulness explained further 17.8% of variance. Clinical TIA characteristics were not associated with post-TIA PTSD. CONCLUSIONS Post-TIA PTSD is a common phenomenon. General PTSD risk factors can be applied for post-TIA PTSD risk assessment. Sense of coherence and mindfulness are promising target variables for post-TIA PTSD treatment and prevention interventions.
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Affiliation(s)
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany.
| | | | | | | | - Timolaos Rizos
- Department of Neurology, University of Heidelberg, Germany
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Zhang S, Xu M, Liu ZJ, Feng J, Ma Y. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World J Psychiatry 2020; 10:125-138. [PMID: 32742946 PMCID: PMC7360525 DOI: 10.5498/wjp.v10.i6.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/13/2020] [Accepted: 04/25/2020] [Indexed: 02/05/2023] Open
Abstract
A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Michael Xu
- Department of Clinical Medicine, International Education School, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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25
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Musey PI, Schultebraucks K, Chang BP. Stressing Out About the Heart: A Narrative Review of the Role of Psychological Stress in Acute Cardiovascular Events. Acad Emerg Med 2020; 27:71-79. [PMID: 31675448 DOI: 10.1111/acem.13882] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Survivors of acute cardiovascular disease (CVD) events, such as acute coronary syndrome (ACS) and stroke, may experience significant psychological distress during and following the acute event. Long-term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD), increased overall all-cause mortality, and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long-term health and to provide a theoretical framework for future work. METHODS A panel of two board-certified emergency physicians, one with a doctorate in experimental psychology, along with one PhD clinical psychologist with expertise in psychoneuroendocrinology were co-authors involved in the paper. Each author used various search strategies (e.g., PubMed, Psycinfo, Cochrane, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors RESULTS: A meta-analysis of 24 studies (N > 2,300) found the prevalence of ACS-induced PTSD at nearly 12%, while a meta-analysis of nine studies (N = 1,138) found that 25% of survivors of transient ischemic attack and stroke report PTSD symptoms. The presence of PTSD doubles 3-year risk of CVD/mortality risk in ACS survivors. Cardiac patients treated during periods of ED overcrowding, hallway care, and perceived poor clinician-patient communication appear at greater risk for subsequent PTSD. CONCLUSIONS Psychological stress is often present in patients undergoing evaluation for acute CVD events. Understanding such associations provides a foundation to appreciate the potential contribution of psychological variables on acute and long-term cardiovascular recovery, while also stimulating future areas of research and discovery.
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Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Bernard P. Chang
- Department of Emergency Medicine Columbia University Medical Center New York NY
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26
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Garton ALA, Gupta VP, Pucci JU, Couch CK, Connolly ES. Incidence and predictors of post-traumatic stress symptoms in a cohort of patients with intracerebral hemorrhage. Clin Neurol Neurosurg 2019; 190:105657. [PMID: 31901614 DOI: 10.1016/j.clineuro.2019.105657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Examine the incidence and predictors of PTSD symptoms in a cohort of patients with ICH. PATIENTS AND METHODS This study uses a prospective cohort of 108 patients with complete follow-up data including a questionnaire regarding stress symptoms (PCL-S: PTSD checklist specific for a stressor) at 3, 6, and 12 months. RESULTS The incidence of novel stress symptoms following ICH was approximately 6.5%. Age was negatively associated with PTSD symptoms with only trend-level significance (3 months: OR = 0.83, p = 0.087; 6 months: OR = 0.70, p = 0.015; 12 months: OR = 0.88, p = 0.087). Gender did not affect PTSD symptom development, (t = 1.34, p = 0.18). Pre-morbid functioning, initial stroke prognosis, total number of complications, and length of hospital/ICU stay were not associated with PTSD symptoms; however, each was significantly correlated with poorer functional outcomes. Yet, poorer functional outcomes were observed in those with higher reports of PTSD symptoms (r = 0.24, p = 0.01). CONCLUSION Functional outcomes in ICH are correlated with PTSD symptoms, however the mechanism and relationship are difficult to elucidate. Further research is needed to determine possible mechanisms by which a stroke patient may develop PTSD.
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Affiliation(s)
- Andrew LA Garton
- Department of Neurosurgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York City, NY, USA.
| | - Vivek P Gupta
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MS, USA
| | - Josephine U Pucci
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York City, NY, USA
| | - Caroline K Couch
- Department of Neurology, Columbia University, College of Physicians and Surgeons, New York City, NY, USA
| | - E Sander Connolly
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York City, NY, USA
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Strege RJ, Kiefer R, Herrmann M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. BMC Neurol 2019; 19:312. [PMID: 31801464 PMCID: PMC6894297 DOI: 10.1186/s12883-019-1541-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. METHODS In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 0-2). Predictors for QOL at follow-up were analyzed by regression model. RESULTS 88.2% of patients with VAD suffered from acute cerebral ischemia. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite of good functional outcome (mRS score 0-2). Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p = 0.002) in this subgroup. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. CONCLUSION VAD leads to impaired QOL at 6 months follow-up due to multiple factors. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Clinical monitoring should address this topic to make timely treatment possible.
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Affiliation(s)
- Rainer J Strege
- Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany. .,Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany.
| | - Reinhard Kiefer
- Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany
| | - Manfred Herrmann
- Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany
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Foertsch S, Lackner I, Weber B, Füchsl AM, Langgartner D, Wirkert E, Peters S, Fois G, Pressmar J, Fegert JM, Frick M, Gündel H, Kalbitz M, Reber SO. Sensory contact to the stressor prevents recovery from structural and functional heart damage following psychosocial trauma. Brain Behav Immun 2019; 80:667-677. [PMID: 31085218 DOI: 10.1016/j.bbi.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disorders (CVD) and posttraumatic stress disorder (PTSD) are highly comorbid, but the underlying mechanisms are not fully understood. Chronic psychosocial stress was induced in male mice by chronic subordinate colony housing (CSC), a pre-clinically validated mouse model for PTSD. Cardiac structure and function were assessed on day 20 of the CSC paradigm. Following CSC, mice were kept in different sensory contact modalities to the last aggressor for 30 days, and development of cardiac function and behavioral aspects were determined. Here we show that psychosocial trauma affects heart structure by disturbing cell-to-cell integrity of cardiomyocytes, causes tachycardia, disturbance of diurnal heart rate rhythmicity and behavioral deficits in a mouse model for PTSD. Structural and functional alterations were also found in cardiomyocytes upon in vitro treatment with pro-inflammatory cytokines typically increased after psychosocial trauma. Interestingly, sensory contact to the aggressor subsequent to psychosocial trauma prohibits functional and structural heart recovery, while isolation was beneficial for cardiac but detrimental for mental health. These findings contribute to our understanding of potential mechanisms underlying the high comorbidity of CVD and PTSD.
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Affiliation(s)
- Sandra Foertsch
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Ina Lackner
- Department of Traumatology, Hand, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Birte Weber
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Andrea M Füchsl
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Dominik Langgartner
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Eva Wirkert
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Giorgio Fois
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - Jochen Pressmar
- Department of Traumatology, Hand, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Manfred Frick
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Stefan O Reber
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany.
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Posttraumatic stress disorder in patients after transient ischemic attack: A one-year follow-up. J Psychosom Res 2019; 122:36-38. [PMID: 31126409 DOI: 10.1016/j.jpsychores.2019.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to determine the prevalence of posttraumatic stress disorder (PTSD) 12 months after transient ischemic attack (TIA). METHOD TIA patients of our previous investigation (examined 3 months after the event) were again examined 12 months after the diagnosis. PTSD and associated variables were assessed via self-rating instruments. RESULTS Eighty-four patients were included in the analyses. Twelve months after TIA the prevalence of probable PTSD was reduced (8.3%) compared to that found 3 months after TIA (29.6%). Coping assessed 3 months after TIA predicted long-term PTSD severity. CONCLUSION Although the prevalence of probable PTSD decreased 12 months after experiencing a TIA compared to 3 months after TIA, prevalence of probable PTSD is still increased relative to that in the general population.
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30
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Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol 2019; 18:248-258. [PMID: 30784556 PMCID: PMC6390174 DOI: 10.1016/s1474-4422(18)30442-3] [Citation(s) in RCA: 293] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Risk of dementia after stroke is a major concern for patients and carers. Reliable data for risk of dementia, particularly after transient ischaemic attack or minor stroke, are scarce. We studied the risks of, and risk factors for, dementia before and after transient ischaemic attack and stroke. METHODS The Oxford Vascular Study is a prospective incidence study of all vascular events in a population of 92 728 people residing in Oxfordshire, UK. Patients with transient ischaemic attack or stroke occurring between April 1, 2002, and March 31, 2012, were ascertained with multiple methods, including assessment in a dedicated daily emergency clinic and daily review of all hospital admissions. Pre-event and post-event (incident) dementia were diagnosed at initial assessment and during 5-years' follow-up on the basis of cognitive testing supplemented by data obtained from hand searches of all hospital and primary care records. We assessed the association between post-event dementia and stroke severity (as measured with the US National Institutes of Health Stroke Scale [NIHSS] score), location (ie, dysphasia), previous events, markers of susceptibility or reserve (age, low education, pre-morbid dependency, leucoaraiosis), baseline cognition, and vascular risk factors with Cox regression models adjusted for age, sex, and education. We compared incidence and prevalence of dementia in our population with published UK population age-matched and sex-matched rates. FINDINGS Among 2305 patients (mean age 74·4 years [SD 13·0]), 688 (30%) had transient ischaemic attacks and 1617 (70%) had strokes. Pre-event dementia was diagnosed in 225 patients; prevalence was highest in severe stroke (ie, NIHSS >10) and lowest in transient ischaemic attack. Of 2080 patients without pre-event dementia, 1982 (95%) were followed up to the end of study or death. Post-event dementia occurred in 432 of 2080 patients during 5 years of follow-up. The incidence of post-event dementia at 1 year was 34·4% (95% CI 29·7-41·5) in patients with severe stroke (NIHSS score >10), 8·2% (6·2-10·2) in those with minor stroke (NIHSS score <3), and 5·2% (3·4-7·0) in those with transient ischaemic attack. Compared with the UK age-matched and sex-matched population, the 1-year standardised morbidity ratio for the incidence of dementia was 47·3 (95% CI 35·9-61·2), 5·8 (4·4-7·5), and 3·5 (2·5-4·8), respectively. Consequently, prevalence of dementia in 1-year survivors was brought forward by approximately 25 years in those who had severe strokes, 4 years in those who had minor strokes, and 2 years in those who had transient ischaemic attacks. 5-year risk of dementia was associated with age, event severity, previous stroke, dysphasia, baseline cognition, low education, pre-morbid dependency, leucoaraiosis, and diabetes (p<0·0001 for all comparisons, except for previous stroke [p=0·006]). INTERPRETATION The incidence of dementia in patients who have had a transient ischaemic attack or stroke varies substantially depending on clinical characteristics including lesion burden and susceptibility factors. Incidence of dementia is nearly 50 times higher in the year after a major stroke compared with that in the general population, but excess risk is substantially lower after transient ischaemic attack and minor stroke. FUNDING Wellcome Trust, Wolfson Foundation, British Heart Foundation, National Institute for Health Research, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK.
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
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Edmondson D, Birk JL, Ho VT, Meli L, Abdalla M, Kronish IM. A challenge for psychocardiology: Addressing the causes and consequences of patients' perceptions of enduring somatic threat. AMERICAN PSYCHOLOGIST 2018; 73:1160-1171. [PMID: 30525797 PMCID: PMC6619434 DOI: 10.1037/amp0000418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The enduring somatic threat (EST) model of posttraumatic stress disorder (PTSD) due to life-threatening medical events suggests that PTSD-like symptoms represent patients' sensitization to cues of ongoing threat in the body. In this article, we review research on the prevalence and consequences of such reactions in cardiovascular disease patients, discuss early tests of the EST model, and then report a new test of the EST model in 143 patients enrolled during their first acute coronary syndrome (ACS; i.e., non-ST elevation myocardial infarction or unstable angina-colloquially, "heart attack"). Invasive coronary revascularization procedures are commonly used to reduce secondary ACS risk and may reduce patients' EST, as revascularized patients often report being "cured." We assessed ACS patients' initial threat perceptions during emergency department (ED) evaluation and followed them for 1 month for PTSD symptoms (specific for ACS, by telephone). We compared PTSD symptoms in participants who were revascularized (n = 65), catheterized but not revascularized (n = 35), and medically managed (n = 43). PTSD symptoms were lower for revascularized versus medically managed participants (B = -5.32, 95% confidence interval [-9.77, -0.87]), t(98.19) = -2.37, p = .020. In a multiple regression model adjusted for clinical and psychosocial covariates, the interaction of threat perception in the ED and ACS management group was significant (greater ED threat predicted greater 1-month PTSD symptoms only in medically managed participants). These findings offer further support for the EST model and suggest that psychological interventions to preempt patients' development of EST should be considered in the hospital. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Vivian T Ho
- Department of Medicine, College of Physicians & Surgeons, Columbia University
| | - Laura Meli
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Marwah Abdalla
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center
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Abstract
This manuscript summarizes the literature on mental health outcomes after cardiac arrest. Survivors of cardiac arrest show high rates of mental illness with more than 40% suffering from anxiety, 30% from depression, and 25% from posttraumatic stress disorder (PTSD). Mental health outcomes may differ depending on the setting in which the cardiac arrest occurred. A major problem is reduced neuropsychological functioning. Between 30% and 50% of survivors of cardiac arrest suffer from cognitive deficits. Deficits of attention, declarative memory, executive function, visual-spatial abilities, and verbal fluency have been observed. As a result of numerous psychopathological symptoms (depression in 14% to 45%, anxiety in 13% to 61%, and PTSD in 19% to 27%) and reduced cognitive functioning (about 20% to 60%), relevantly reduced quality of life is observed in about 20% of cardiac arrest survivors.
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Affiliation(s)
- Dieter Naber
- Department of Psychiatry, University of Hamburg, Germany
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33
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Stein LA, Goldmann E, Zamzam A, Luciano JM, Messé SR, Cucchiara BL, Kasner SE, Mullen MT. Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke. Front Neurol 2018; 9:890. [PMID: 30450075 PMCID: PMC6224432 DOI: 10.3389/fneur.2018.00890] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD). Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work. Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6-12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center. Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0-100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders. Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.
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Affiliation(s)
- Laura A. Stein
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Goldmann
- College of Global Public Health, New York University, New York, NY, United States
| | - Ahmad Zamzam
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jean M. Luciano
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven R. Messé
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael T. Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Grabowska-Fudala B, Jaracz K, Górna K, Miechowicz I, Wojtasz I, Jaracz J, Kaźmierski R. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. J Neurol 2018; 265:1891-1899. [PMID: 29916129 PMCID: PMC6060771 DOI: 10.1007/s00415-018-8938-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. METHODS Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale. RESULTS At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61). LIMITATIONS The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results. CONCLUSIONS (1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients' mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.
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Affiliation(s)
- Barbara Grabowska-Fudala
- Department of Neurological Nursing, Poznan University of Medical Sciences, Smoluchowski 11 Str., 61-170, Poznan, Poland.
| | - Krystyna Jaracz
- Department of Neurological Nursing, Poznan University of Medical Sciences, Smoluchowski 11 Str., 61-170, Poznan, Poland
| | - Krystyna Górna
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Izabela Miechowicz
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Izabela Wojtasz
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, L. Bierkowski Hospital, Poznan, Poland
| | - Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Radosław Kaźmierski
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, L. Bierkowski Hospital, Poznan, Poland
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Jiang C. Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:1-8. [PMID: 29617165 DOI: 10.1080/23279095.2018.1451334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Che Jiang
- Department of Neurology, Guangzhou Military General Hospital, Guangzhou, China
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Juth V, Chan MK, Cramer SC, Holman EA. Assessing acute psychological distress in the immediate aftermath of stroke. Eur J Cardiovasc Nurs 2017; 17:186-189. [PMID: 28699766 DOI: 10.1177/1474515117719809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE High acute stress may presage the development of subsequent cardiovascular ailments. Understanding how best to assess acute stress may inform early interventions seeking to prevent long-term morbidity/mortality following stroke. A mixed methods approach examined early post-stroke acute stress symptoms using the post-traumatic stress disorder checklist-5 (PCL-5) and the acute stress disorder scale (ASDS). METHODS A focus group of stroke survivors and/or their caregivers ( N=8) evaluated PCL-5/ASDS feasibility, and 20 patients hospitalized for acute stroke were interviewed 2-10 days post-stroke onset, using either the PCL-5 or the ASDS. RESULTS Acute stress symptoms were present and measurable during acute stroke recovery. Assessment of acute stress in hospitalized patients with stroke is feasible; a briefer modified ASDS has advantages over the PCL-5. CONCLUSIONS The ASDS is a viable and useful measure for assessing psychological distress during the acute post-stroke aftermath. Findings suggest that acute stress symptoms are present among patients with stroke, warranting greater attention to psychological responses in the early post-stroke period. Given that acute stress has serious potential long-term health consequences, additional research on stroke-related acute stress may prove useful for understanding post-stroke morbidity/mortality.
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Affiliation(s)
- Vanessa Juth
- 1 Sue and Bill Gross School of Nursing, University of California, USA
| | - Michelle K Chan
- 1 Sue and Bill Gross School of Nursing, University of California, USA
| | - Steven C Cramer
- 2 Departments of Neurology, Anatomy and Neurobiology, and Physical Medicine and Rehabilitation, University of California, USA
| | - E Alison Holman
- 1 Sue and Bill Gross School of Nursing, University of California, USA
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Mindfulness and Coping Are Inversely Related to Psychiatric Symptoms in Patients and Informal Caregivers in the Neuroscience ICU: Implications for Clinical Care. Crit Care Med 2017; 44:2028-2036. [PMID: 27513536 DOI: 10.1097/ccm.0000000000001855] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the correlation of psychosocial resiliency factors (mindfulness and coping) with symptoms of posttraumatic stress, anxiety, and depression in patients recently admitted to the neuroscience ICU and their primary informal caregivers. DESIGN A descriptive, cross-sectional correlational study. SETTING Neuroscience ICU in a major medical center. PARTICIPANTS A total of 78 dyads of patients (total n = 81) and their primary caregivers (total n = 92) from June to December 2015. Study enrollment occurred within the first 2 weeks of patient admission to the neuroscience ICU. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Dyads completed self-report measures of mindfulness (Cognitive and Affective Mindfulness Scale-Revised), coping (Measure of Coping Status-A), posttraumatic stress (Posttraumatic Checklist-Specific Stressor), anxiety (Hospital Anxiety and Depression Scale-A), and depression (Hospital Anxiety and Depression Scale-D). Rates of clinically significant posttraumatic stress, anxiety, and depressive symptoms were high and comparable between patient and caregiver samples. Own psychological resilience factors and psychiatric symptoms were strongly correlated for both patients and caregivers. Depressive symptoms were interdependent between patients and their caregivers, and one's own mindfulness was independently related to one's partner's depressive symptoms. CONCLUSIONS Rates of clinically significant psychiatric symptoms were high, equally prevalent in patients and caregivers, and interdependent between patients and their caregivers. For both patients and caregivers, psychological resiliency factors were associated with both self and partner psychiatric symptoms. Findings suggest that attending to the psychiatric health of both patients and caregivers in the neuroscience ICU is a priority and that patients and their caregivers must be considered together in a system to fully address either individual's psychiatric symptoms.
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Edmondson D, von Känel R. Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry 2017; 4:320-329. [PMID: 28109646 PMCID: PMC5499153 DOI: 10.1016/s2215-0366(16)30377-7] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023]
Abstract
In this paper, a first in a Series of two, we look at the evidence for an association of post-traumatic stress disorder with incident cardiovascular disease risk and the mechanisms that might cause this association, as well as the prevalence of post-traumatic stress disorder due to cardiovascular disease events and its associated prognostic risk. We discuss research done after the publication of previous relevant systematic reviews, and survey currently funded research from the two most active funders in the field: the National Institutes of Health and the US Veterans Administration. We conclude that post-traumatic stress disorder is a risk factor for incident cardiovascular disease, and a common psychiatric consequence of cardiovascular disease events that might worsen the prognosis of the cardiovascular disease. There are many candidate mechanisms for the link between post-traumatic stress disorder and cardiovascular disease, and several ongoing studies could soon point to the most important behavioural and physiological mechanisms to target in early phase intervention development. Similarly, targets are emerging for individual and environmental interventions that might offset the risk of post-traumatic stress disorder after cardiovascular disease events.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York City, NY, USA.
| | - Roland von Känel
- Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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Abstract
Stroke is a life-changing experience. Current treatments focus on treating the condition, rather than the whole person. The goal of this report was to communicate the benefits of a holistic approach to the treatment and recovery of stroke. Our intent was to begin a conversation to transform our approach to stroke care to focus on the whole person, body, mind, and spirit. Wellness approaches are fiscally responsible ways of providing holistic care for patients and their family members to help them achieve optimal individualized recovery. Very few multidimensional programs for wellness exist for patients with stroke and brain injury. Given the changes in health care and the Call to Action set forth in the Institute of Medicine's 2010 report, it would behoove us to consider holistic approaches to stroke care and research programs. Nurses are uniquely positioned to implement multidisciplinary, innovative holistic approaches to address solutions for issues in stroke care. Wellness is a critically important area of stroke care and an opportunity for research. As advocates for patients, and nurses with personal experiences, we hope this commentary stimulates conversation around developing and testing multidimensional holistic programs of wellness for stroke prevention, treatment, and recovery.
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Garton ALA, Sisti JA, Gupta VP, Christophe BR, Connolly ES. Poststroke Post-Traumatic Stress Disorder: A Review. Stroke 2016; 48:507-512. [PMID: 27932604 DOI: 10.1161/strokeaha.116.015234] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/24/2016] [Accepted: 11/09/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew L A Garton
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.).
| | - Jonathan A Sisti
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Vivek P Gupta
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Brandon R Christophe
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - E Sander Connolly
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
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[Posttraumatic stress disorder : Trigger and consequence of vascular diseases]. DER NERVENARZT 2016; 88:234-246. [PMID: 27752723 DOI: 10.1007/s00115-016-0231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) was previously thought to be a psychological reaction precipitated by exposure to war, sexual and physical violence; however, PTSD is also prevalent after life-threatening medical events, such as stroke and myocardial infarction. After such events PTSD is often underdiagnosed despite the fact that it is clearly associated with adverse clinical outcomes including recurrence of cardiac events and increased mortality. Moreover, PTSD increases the risk of vascular events. This review summarizes the bidirectional relationship between PTSD and vascular diseases and outlines current knowledge regarding clinical features, prevalence and the putative underlying pathophysiological mechanisms.
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Turner GM, Calvert M, Feltham MG, Ryan R, Marshall T. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol 2016; 23:1642-1650. [DOI: 10.1111/ene.13088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G. M. Turner
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - M. Calvert
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - M. G. Feltham
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - R. Ryan
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - T. Marshall
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
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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.
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Vickrey BG, Williams LS. Posttraumatic stress disorder after cerebrovascular events: broadening the landscape of psychological assessment in stroke and transient ischemic attack. Stroke 2014; 45:3182-3. [PMID: 25278558 DOI: 10.1161/strokeaha.114.006865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barbara G Vickrey
- From the Department of Neurology, University of California, Los Angeles (B.G.V.); Department of Neurology, Greater Los Angeles Veteran's Administration HealthCare System, Los Angeles, CA (B.G.V.); Department of Neurology, Indiana University School of Medicine, Indianapolis (L.S.W.); Department of Neurology, Richard L. Roudebush Veteran's Administration Medical Center, Indianapolis, IN (L.S.W.); and Regenstrief Institute, Inc, Indianapolis, IN (L.S.W.)
| | - Linda S Williams
- From the Department of Neurology, University of California, Los Angeles (B.G.V.); Department of Neurology, Greater Los Angeles Veteran's Administration HealthCare System, Los Angeles, CA (B.G.V.); Department of Neurology, Indiana University School of Medicine, Indianapolis (L.S.W.); Department of Neurology, Richard L. Roudebush Veteran's Administration Medical Center, Indianapolis, IN (L.S.W.); and Regenstrief Institute, Inc, Indianapolis, IN (L.S.W.)
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