1
|
Nwafor DC, Kirby BD, Ralston JD, Colantonio MA, Ibekwe E, Lucke-Wold B. Neurocognitive Sequelae and Rehabilitation after Subarachnoid Hemorrhage: Optimizing Outcomes. JOURNAL OF VASCULAR DISEASES 2023; 2:197-211. [PMID: 37082756 PMCID: PMC10111247 DOI: 10.3390/jvd2020014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Subarachnoid hemorrhage (SAH) is a medical emergency that requires immediate intervention. The etiology varies between cases; however, rupture of an intracranial aneurysm accounts for 80% of medical emergencies. Early intervention and treatment are essential to prevent long-term complications. Over the years, treatment of SAH has drastically improved, which is responsible for the rapid rise in SAH survivors. Post-SAH, a significant number of patients exhibit impairments in memory and executive function and report high rates of depression and anxiety that ultimately affect daily living, return to work, and quality of life. Given the rise in SAH survivors, rehabilitation post-SAH to optimize patient outcomes becomes crucial. The review addresses the current rehabilitative strategies to combat the neurocognitive and behavioral issues that may arise following SAH.
Collapse
Affiliation(s)
- Divine C. Nwafor
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Brandon D. Kirby
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Jacob D. Ralston
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
| | - Mark A. Colantonio
- Department of Neuroscience, West Virginia University Health Science Center, Morgantown, WV 26506, USA
| | - Elochukwu Ibekwe
- Department of Neurology and Neurocritical Care, The Ohio State University, Columbus, OH 43210, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
| |
Collapse
|
2
|
Risk and Protective Factors for PTSD in Caregivers of Adult Patients with Severe Medical Illnesses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165888. [PMID: 32823737 PMCID: PMC7459858 DOI: 10.3390/ijerph17165888] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Caregivers of severely ill individuals often struggle to adjust to new responsibilities and roles while experiencing negative psychological outcomes that include depression, anxiety and Post-Traumatic Stress Disorder (PTSD). This systematic review aims to outline potential risk and protective factors for the development of PTSD in caregivers of adult subjects affected by severe somatic, potentially life-threatening illnesses. Twenty-nine studies on caregivers of adult patients affected by severe, acute, or chronic somatic diseases have been included. Eligibility criteria included: full-text publications reporting primary, empirical data; PTSD in caregivers of adult subjects affected by severe physical illnesses; risk and/or protective factors related to PTSD; and English language. Specific sociodemographic and socioeconomic characteristics, besides the illness-related distress, familiar relationships, exposure characteristics, coping style, and support, were identified as relevant risk/protective factors for PTSD. The review limitations are the small number of studies; studies on different types of diseases; studies with same samples. It is crucial to consider factors affecting caregivers of severely ill adult patients in order to plan effective intervention strategies aimed at reducing the risk of an adverse mental health outcome and at enhancing the psychological endurance of this population.
Collapse
|
3
|
Aneurysmal subarachnoid hemorrhage: A pilot study for using longitudinal cognitive and neuropsychological testing for functional outcomes. Clin Neurol Neurosurg 2020; 194:105941. [PMID: 32480295 DOI: 10.1016/j.clineuro.2020.105941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patients with aneurysmal subarachnoid hemorrhage (aSAH) often sustain substantial cognitive and functional impairment. Traditional outcome measures have emphasized radiographic and gross clinical outcomes, but cognitive and functional outcomes are less frequently documented. This pilot study assessed the feasibility of administering longitudinal cognitive and neuropsychological testing and tracked patterns of functional improvement in aSAH patients. PATIENTS AND METHODS Standardized cognitive and neuropsychological testing were administered to a prospective cohort of aSAH patients admitted for treatment to our tertiary care center. Thirty consecutive aSAH patients (Hunt and Hess score 1-3) were enrolled over 23-months and baseline evaluations were completed within 24-h after admission. Patients were followed prospectively after treatment (coiling or clipping) at 1-, 3-, 6-, and 12-months. Functional outcome measures included the Montreal Cognitive Assessment, the Neuropsychiatric Inventory-Questionnaire, and the Functional Activities Questionnaire. RESULTS Of the 30 patients, 23 (77%) followed-up at 3-months, 21 (70%) at 6-months, and 19 (63%) at 12-months. Improvement from baseline to follow-up at 12-months was noted for general cognitive function (p = .004), memory (p = .025), and executive function (p = .039), with the greatest improvement occurring within 6-months. Daily function also improved mostly within 6-months (p = .022) while changes in neuropsychological disturbances were insignificant from baseline to follow-up at 12-months (p = .216). CONCLUSION Standardized cognitive and neuropsychological testing provides metrics for evaluating functional outcomes following treatment of aSAH. The addition of a brief battery of tests to routine clinical and radiographic evaluations is feasible. The main limitations are related to practice and referral patterns, and future studies are needed to evaluate the impact of treatment modalities on functional outcomes.
Collapse
|
4
|
Haug Nordenmark T, Karic T, Røe C, Sorteberg W, Sorteberg A. The post-aSAH syndrome: a self-reported cluster of symptoms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2019; 132:1556-1565. [PMID: 31003212 DOI: 10.3171/2019.1.jns183168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although many patients recover to a good functional outcome after aneurysmal subarachnoid hemorrhage (aSAH), residual symptoms are very common and may have a large impact on the patient's daily life. The particular cluster of residual symptoms after aSAH has not previously been described in detail and there is no validated questionnaire that covers the typical problems reported after aSAH. Many of the symptoms are similar to post-concussion syndrome, which often is evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In the present study, the authors therefore performed an exploratory use of the RPQ as a template to describe post-aSAH syndrome. METHODS The RPQ was administered to 128 patients in the chronic phase after aSAH along with a battery of quality-of-life questionnaires. The patients also underwent a medical examination besides cognitive and physical testing. Based on their RPQ scores, patients were dichotomized into a "syndrome" group or "recovery" group. RESULTS A post-aSAH syndrome was seen in 33% of the patients and their symptom burden on all RPQ subscales was significantly higher than that of patients who had recovered on all RPQ subscales. The symptom cluster consisted mainly of fatigue, cognitive problems, and emotional problems. Physical problems were less frequently reported. Patients with post-aSAH syndrome scored significantly worse on mobility and pain scores, as well as on quality-of-life questionnaires. They also had significantly poorer scores on neuropsychological tests of verbal learning, verbal short- and long-term memory, psychomotor speed, and executive functions. Whereas 36% of the patients in the recovery group were able to return to their premorbid occupational status, this was true for only 1 patient in the syndrome group. CONCLUSIONS Approximately one-third of aSAH patients develop a post-aSAH syndrome. These patients struggle with fatigue and cognitive and emotional problems. Patients with post-aSAH syndrome report more pain and reduced quality of life compared to patients without this cluster of residual symptoms and have larger cognitive deficits. In this sample, patients with post-aSAH syndrome were almost invariably excluded from return to work. The RPQ is a simple questionnaire covering the specter of residual symptoms after aSAH. Being able to acknowledge these patients' complaints as a defined syndrome using the RPQ should help patients to accept and cope, thereby alleviating possible secondary distress produced.
Collapse
Affiliation(s)
| | - Tanja Karic
- Departments of1Physical Medicine and Rehabilitation and
| | - Cecilie Røe
- Departments of1Physical Medicine and Rehabilitation and.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Angelika Sorteberg
- 2Neurosurgery, Oslo University Hospital; and.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
5
|
Blixen C, Nakibuuka J, Kaddumukasa M, Nalubwama H, Amollo M, Katabira E, Sajatovic M. Community Perceptions of Barriers to Stroke Recovery and Prevention in Greater Kampala, Uganda: Implications for Policy and Practice. INTERNATIONAL JOURNAL OF HEALTHCARE 2017; 3:8-19. [PMID: 31080882 PMCID: PMC6510505 DOI: 10.5430/ijh.v3n2p8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Stroke risk and stroke burden are increasing in Sub Saharan Africa. Qualitative analysis was used to assess perceived barriers to stroke recovery and prevention in an urban/suburban Ugandan population in order to refine and implement a promising nurse and peer-led self-management intervention previously conducted in the United States. METHODS In depth interviews and focus groups were conducted with 48 participants (stroke survivors, caretakers, and those at risk for stroke. All interviews and focus groups were audiotaped, transcribed verbatim, and analyzed using content analysis, with an emphasis on dominant themes. RESULTS Three major domains of perceived barriers to stroke recovery and prevention emerged from the data: (1) Individual barriers (PTSD, stress, resistance to seeking care, medication non-adherence, unhealthy lifestyles, functional impairment, and a paucity of stroke knowledge); (2) Family/community barriers (lack of family and community support and caretaker burden); and (3) Provider and healthcare system barriers (lack of access and inadequate follow-up). Importantly, participants in this study identified a pressing need for increasing stroke awareness in the community as part of recovery and prevention efforts. CONCLUSIONS Stroke risk reduction efforts implemented at the patient, community, and healthcare system levels are needed. These efforts could, perhaps, be modeled along the lines of a previous very successful public health initiative to reduce HIV burden in Uganda.
Collapse
Affiliation(s)
- Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jane Nakibuuka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Haddy Nalubwama
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Mathew Amollo
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
6
|
Kutlubaev MA, Akhmadeeva LR. [Depression and depression-related disorders after a subarachnoid hemorrhage]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:20-26. [PMID: 28980577 DOI: 10.17116/jnevro20171178220-26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Psychiatric disorders often develop after subarachnoid hemorrhage (SAH); the most frequent of them are depression and depression-related disorders (anxiety, apathy, pathological fatigue, posttraumatic stress disorder, etc.). Both biological and psychological mechanisms may underlie the development of these disorders. Depression and depression-related disorders decrease patients' quality of life and prevent the full recovery after SAH. Identification and correction of these disorders should take a prominent place in the rehabilitation of post-SAH patients. More research is needed in this area.
Collapse
|
7
|
Alotaibi NM, Samuel N, Wang J, Ahuja CS, Guha D, Ibrahim GM, Schweizer TA, Saposnik G, Macdonald RL. The Use of Social Media Communications in Brain Aneurysms and Subarachnoid Hemorrhage: A Mixed-Method Analysis. World Neurosurg 2017; 98:456-462. [DOI: 10.1016/j.wneu.2016.11.085] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
|
8
|
Rueckriegel SM, Baron M, Domschke K, Neuderth S, Kunze E, Kessler AF, Nickl R, Westermaier T, Ernestus RI. Trauma- and distress-associated mental illness symptoms in close relatives of patients with severe traumatic brain injury and high-grade subarachnoid hemorrhage. Acta Neurochir (Wien) 2015; 157:1329-36; discussion 1336. [PMID: 26105760 DOI: 10.1007/s00701-015-2470-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/03/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Close relatives (CR) of patients with severe traumatic brain injury (TBI) and high-grade subarachnoid hemorrhage (SAH) suffer extraordinary distress during the treatment: Distress may lead to persisting mental illness symptoms within the spectrum of post-traumatic stress disorder (PTSD), anxiety disorders, and depression. The primary goal of this study was to determine the prevalence and severity of these symptoms in CR. The secondary goal was identification of associated factors. METHOD Standardized interviews were conducted with 53 CR (mean age of 57.7 ± 11.4 years) of patients with TBI °III (n = 27) and high-grade SAH H&H °III-V (n = 26) between 5 and 15 months after the event. The interviews contained a battery of surveys to quantify symptoms of PTSD, anxiety disorders, and depression, i.e., Impact of Event Scale (IES-R), 36-item Short-Form General Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Fixed and modifiable possibly influencing factors were correlated. RESULTS Twenty-eight CR (53 %) showed IES-R scores indicating a probable diagnosis of PTSD. Twenty-five CR (47 %) showed an increased anxiety score and 18 (34 %) an increased depression score using HADS. Mean physical component summary of SF-36 was not abnormal (49.1 ± 9.1), whereas mean mental component summary was under average (41.0 ± 13.2), indicating a decreased quality of life caused by mental effects. Perception of the interaction quality with the medical staff and involvement into medical decisions correlated negatively with severity of mental illness symptoms. Evasive coping strategies were highly significantly associated with symptoms. CONCLUSIONS This study quantifies an extraordinarily high prevalence of mental illness symptoms in CR of patients with critical acquired brain injury due to SAH and TBI. Modifiable factors were associated with severity of mental illness symptoms. Prospective studies testing efficiency of early psychotherapeutic interventions are needed.
Collapse
Affiliation(s)
- Stefan Mark Rueckriegel
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Stansfeld S, Smuk M, Onwumere J, Clark C, Pike C, McManus S, Harris J, Bebbington P. Stressors and common mental disorder in informal carers--an analysis of the English Adult Psychiatric Morbidity Survey 2007. Soc Sci Med 2014; 120:190-8. [PMID: 25259657 PMCID: PMC4224501 DOI: 10.1016/j.socscimed.2014.09.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/18/2014] [Accepted: 09/14/2014] [Indexed: 11/19/2022]
Abstract
This study investigates potential explanations of the association between caring and common mental disorder, using the English Adult Psychiatric Morbidity Survey 2007. We examined whether carers are more exposed to other stressors additional to caring--such as domestic violence and debt--and if so whether this explains their elevated rates of mental disorder. We analysed differences between carers and non-carers in common mental disorders (CMD), suicidal thoughts, suicidal attempts, recent stressors, social support, and social participation. We used multivariate models to investigate whether differences between carers and non-carers in identifiable stressors and supports explained the association between caring and CMD, as measured by the revised Clinical Interview Schedule. The prevalence of CMD (OR=1.64 95% CI 1.37-1.97), suicidal thoughts in the last week (OR=2.71 95% CI 1.31-5.62) and fatigue (OR=1.33 95% CI 1.14-1.54) was increased in carers. However, caring remained independently associated with CMD (OR=1.58 1.30-1.91) after adjustment for other stressors and social support. Thus caring itself is associated with increased risk of CMD that is not explained by other identified social stressors. Carers should be recognized as being at increased risk of CMD independent of the other life stressors they have to deal with. Interventions aimed at a direct reduction of the stressfulness of caring are indicated. However, carers also reported higher rates of debt problems and domestic violence and perceived social support was slightly lower in carers than in non-carers. So carers are also more likely to experience stressors other than caring and it is likely that they will need support not only aimed at their caring role, but also at other aspects of their lives.
Collapse
Affiliation(s)
- Stephen Stansfeld
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK.
| | - Melanie Smuk
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AZ UK
| | - Charlotte Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Cleo Pike
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Sally McManus
- NatCen Social Research, 35 Northampton Square, London EC1V 0AX UK
| | - Jenny Harris
- Florence Nightingale School of Nursing and Midwifery, Kings College, London, UK
| | - Paul Bebbington
- UCL Mental Health Sciences Unit, 2nd Floor, Charles Bell House 67-73, Riding House Street, London W1W 7EJ, UK
| |
Collapse
|
10
|
Kiphuth IC, Utz KS, Noble AJ, Köhrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Stroke 2014; 45:3360-6. [PMID: 25278556 DOI: 10.1161/strokeaha.113.004459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE A transient ischemic attack (TIA) involves temporary neurological symptoms but leaves a patient symptom-free. Patients are faced with an increased risk for future stroke, and the manifestation of the TIA itself might be experienced as traumatizing. We aimed to investigate the prevalence of posttraumatic stress disorder (PTSD) after TIA and its relation to patients' psychosocial outcome. METHODS Patients with TIA were prospectively studied, and 3 months after the diagnosis, PTSD, anxiety, depression, quality of life, coping strategies, and medical knowledge were assessed via self-rating instruments. RESULTS Of 211 patients with TIA, data of 108 patients were complete and only those are reported. Thirty-two (29.6%) patients were classified as having PTSD. This rate is 10× as high as in the general German population. Patients with TIA with PTSD were more likely to show signs of anxiety and depression. PTSD was associated with the use of maladaptive coping strategies, subjectively rated high stroke risk, as well as with younger age. Finally, PTSD and anxiety were associated with decreased mental quality of life. CONCLUSIONS The experience of TIA increases the risk for PTSD and associated anxiety, depression, and reduced mental quality of life. Because a maladaptive coping style and a subjectively overestimated stroke risk seem to play a crucial role in this adverse progression, the training of adaptive coping strategies and cautious briefing about the realistic stroke risk associated with TIA might be a promising approach. Despite the great loss of patients to follow-up, the results indicate that PTSD after TIA requires increased attention.
Collapse
Affiliation(s)
- Ines C Kiphuth
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Kathrin S Utz
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.).
| | - Adam J Noble
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Martin Köhrmann
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Thomas Schenk
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| |
Collapse
|
11
|
Pielmaier L, Milek A, Nussbeck FW, Walder B, Maercker A. Trajectories of Posttraumatic Stress Symptoms in Significant Others of Patients With Severe Traumatic Brain Injury. JOURNAL OF LOSS & TRAUMA 2013. [DOI: 10.1080/15325024.2012.719342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
12
|
|
13
|
Covey J, Noble AJ, Schenk T. Family and friends' fears of recurrence: impact on the patient's recovery after subarachnoid hemorrhage. J Neurosurg 2013; 119:948-54. [DOI: 10.3171/2013.5.jns121688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with subarachnoid hemorrhage (SAH) and their close friends and family may be excessively fearful that the patient will have a recurrence, and such fears could play a critical role in the poor recovery shown by many patients The authors examined whether these fears could account for significant variance in psychosocial outcomes.
Methods
The authors prospectively studied a sample of 69 patients with SAH alongside their spouse, other family member, and/or close friend identified as their significant other (SO). The patient/SO pairs were assessed at 13 months postictus for their fears of recurrence and for health-related quality of life on the 8 domains of the 36-Item Short Form Health Survey.
Results
The SOs were found to be significantly more fearful of SAH recurrence than the patients. The SO's fears also explained unique variance in the patient's recovery on 4 of the 36-Item Short Form Health Survey domains over and above the patient's own fears, demographic and/or neurological variables, and the patient's history of psychiatric or neurological problems. The domains affected reflected activity-based and functional aspects of the patient's quality of life as opposed to more general characteristics of their emotional well-being or physical health state.
Conclusions
The patient's recovery may be compromised if their spouse, close family, and/or friends are excessively fearful about their suffering a recurrence. Perhaps the SO's fears cause them to be overprotective of the patient and to restrict their day-to-day activities. Attention must therefore be given to the experience of having a loved one suffer from an SAH, and alleviating the caregiver's fears could help to promote a better outcome for the patient.
Collapse
Affiliation(s)
- Judith Covey
- 1Department of Psychology, Durham University, Stockton-on-Tees
| | - Adam J. Noble
- 2Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, United Kingdom; and
| | - Thomas Schenk
- 3Department of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
14
|
Pritchard C, Lindsay K, Cox M, Foulkes L. Re-evaluating the National Subarachnoid Haemorrhage study (2006) from a Patient-Related-Outcome-Measure perspective: comparing fiscal outcomes of Treatment-as-Usual with an enhanced service. Br J Neurosurg 2011; 25:376-83. [PMID: 21513445 DOI: 10.3109/02688697.2011.566379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) is neurological catastrophe, creating major disruption for patient and family, hence the importance of considering Patient-Related-Outcome-Measures (PROM). This study uses the National Study of SAH (2006) to explore any fiscal benefits to patients and NHS if they had an enhanced Neuro-Vascular-Specialist-Nurse (NVSN) service compared to Treatment-as-Usual (TAU). METHOD Ensuring total confidentiality, clinical data from the National Study (n=2397) were matched with regional clinical data of a TAU (n=137) and prospective NVSN service (n=184) patients. The TAU and NVSN fiscal outcomes were projected onto the National Study patients to provide estimates of the potential benefits that could accrue nationally from a NVSN service based upon length of stay and earlier return to work of patients and carers. RESULTS There were substantial benefits for NVSN cohort related to shorter time in hospital, reduced family disruption, earlier return to work and fiscal benefits to family and the NHS. NVSN patients and carers potential savings were estimated at £ 8.097 million and £ 2.492 million to the service, £ 10.497 million overall. PRACTICE IMPLICATIONS This PROM approach allows the 'patient's voice' to be heard, which facilitates speedier patient and family recovery, showing that an integrated treatment approach in 'high tech' neuro-surgery is cost-effective.
Collapse
Affiliation(s)
- Colin Pritchard
- School of Health & Social Care, Bournemouth University, Bournemouth, UK.
| | | | | | | |
Collapse
|
15
|
Rinkel GJE, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10:349-56. [DOI: 10.1016/s1474-4422(11)70017-5] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Pielmaier L, Walder B, Rebetez MML, Maercker A. Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury. Brain Inj 2011; 25:259-65. [DOI: 10.3109/02699052.2010.542429] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
|
18
|
Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke 2010; 41:e519-36. [DOI: 10.1161/strokeaha.110.581975] [Citation(s) in RCA: 455] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Timour Al-Khindi
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
| | - R. Loch Macdonald
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
| | - Tom A. Schweizer
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
| |
Collapse
|
19
|
Noble AJ, Schenk T. Psychosocial outcome following subarachnoid haemorrhage: An under-researched problem. ACTA ACUST UNITED AC 2009. [DOI: 10.12968/bjnn.2009.5.8.43598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adam J Noble
- Institute of Psychiatry, King's College London, PO 41, Denmark Hill Campus, London SE5 8AF
| | - Thomas Schenk
- Department of Psychology, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH
| |
Collapse
|