UNDERSTANDING AND MANAGEMENT OF NEUROPSYCHIATRIC SEQUELAE OF STROKE: AN OVERVIEW

Authors

  • Dr. Rajesh Jain
  • Prof. K.H.H.V.S.S. Narasimha Murthy
  • Prof. J. S. Tripathi

Abstract

Psychological anxiety and neuropsychiatric issues frequently afflict stroke survivors. The most frequent neuropsychiatric aftereffects of stroke are sadness, anxiety, and apathy, which affect around one-third of stroke survivors. Neuropsychiatric consequences are incapacitating, and they can hinder recovery, lower quality of life, and exhaust the carer. Neuropsychiatric disorders linked to stroke are currently underdiagnosed and undertreated despite the availability of screening tools and efficient treatments. The presence and severity of the psychiatric sequelae of stroke are influenced by the severity of the stroke, stroke-related disability, cerebral small artery disease, prior psychiatric illness, inadequate coping mechanisms, and adverse psychosocial context.

Keywords: Cerebrovascular accident, Ayurveda, Anxiety, Antidepressants, Chittaavasada.

References

Jones, S., K, B., A, C., R, G., C, H., EJ, H., ML, H. (2022, Feb;17). Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke, 132-140.

Bejot, Y., Daubail, B. & Giroud, M. Epidemiology of stroke and transient ischemic attacks: current knowledge and perspectives. Rev. Neurol. (Paris) 172,59–68 (2016)

Ferro, José & Caeiro, Lara & Figueira, Maria Luisa. (2016). Neuropsychiatric sequelae of stroke. Nature reviews. Neurology. 12. 10.1038/ nrneurol.2016.46.

Psychiatric, A. A. (2015). Diagnostic and statistical manual of mental disorders: DSM-V Washington, DC: American Psychiatric Association.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edition(American Psychiatric Association, 2013).

Robinson, R. G. & Jorge, R. E. Post-stroke depression: a review. Am. J. Psychiatry 173, 221–231 (2016).

Sheehan, D. V. et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry59 (Suppl. 20), 22–33 (1998)

Robinson, R. G. & Spalletta, G. Poststroke depression: a review. Can. J. Psychiatry 55, 341–349 (2010)

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J.& Erbaugh, J. An inventory for measuring depression.Arch. Gen. Psychiatry 4, 561–571 (1961)

Zigmond, A. S. & Snaith, R. P. The hospital anxiety and depression scale. Acta Psychiatr. Scand. 67,361–370 (1983).

Hamilton, M. A rating scale for depression.J. Neurol. Neurosurg. Psychiatry 23, 56–62 (1960).

Montgomery, S. A. & Asberg, M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry 134, 382–389 (1979).

De Ryck, A., Brouns, R., Geurden, M., Elseviers, M., De Deyn, P., & Engelborghs, S. (2014). Risk factors for poststroke depression: identification of inconsistencies based on a systematic review. J Geriatr Psychiatry Neurol., 27(3):147-58.

Jain, R., Girhepunje, K., Narsimha, K., & Tripathi, J. (2017). CONCEPT OF POST-STROKE DEPRESSION IN AYURVEDA: A SCIENTIFIC REVIEW. World Journal of Pharmaceutical Research, 6:236-245.

Ayerbe, L., Ayis, S., Wolfe, C. D. & Rudd, A. G. Natural history, predictors and outcomes of depression after stroke: a systematic review and meta-analysis. Br. J. Psychiatry 202, 14–21 (2013)

Kutlubaev, M. A. & Hackett, M. L. Part II: predictors ofdepression after stroke and impact of depression onstroke outcome: an updated systematic review ofobservational studies. Int. J. Stroke 9, 1026–1036(2014).

Ayerbe, L., Ayis, S., Crichton, S., Wolfe, C. D.& Rudd, A. G. The natural history of depression up to 15 years after stroke: the South London StrokeRegister. Stroke 44, 1105–1110 (2013)

Glodzik-Sobanska, L. et al. Single voxel protonmagnetic resonance spectroscopy in post-strokedepression. Psychiatry Res. 148, 111–120 (2006).

Wang, X. et al. Glutamate level detection by magneticresonance spectroscopy in patients with post-strokedepression. Eur. Arch. Psychiatry Clin. Neurosci. 262,33–38 (2012).

Brookes, R. L., Herbert, V., Lawrence, A. J.,Morris, R. G. & Markus, H. S. Depression in small-vessel disease relates to white matter ultrastructuraldamage, not disability. Neurology 83, 1417–1423(2014).

Yasuno, F. et al. Microstructural abnormality in whitematter, regulatory T lymphocytes, and depressivesymptoms after stroke. Psychogeriatrics 14, 213–221(2014)

Pascoe, M. C. et al. Homocysteine as a potentialbiochemical marker for depression in elderly strokesurvivors. Food Nutr. Res. http://dx.doi.org/10.3402/fnr.v56i0.14973 (2012).

Tang, W. K. et al. Association between highserum total bilirubin and post-stroke depression.Psychiatry Clin. Neurosci. 67, 259–264 (2013).

Zhan, Y. et al. Plasma-based proteomics reveals lipidmetabolic and immunoregulatory dysregulation inpost-stroke depression. Eur. Psychiatry 29, 307–315(2014).

Li, Y. T., Zhao, Y., Zhang, H. J. & Zhao, W. L. Theassociation between serum leptin and post strokedepression: results from a cohort study. PLoS ONE 9,e103137 (2014).

Cheng, S. Y. et al. Plasma levels of glutamate duringstroke is associated with development of post-strokedepression. Psychoneuroendocrinology 47,126–135 (2014).

Mak, K. K., Kong, W. Y., Mak, A., Sharma, V. K.& Ho, R. C. Polymorphisms of the serotonintransporter gene and post-stroke depression:a meta-analysis. J. Neurol. Neurosurg. Psychiatry 84,322–328 (2013).

Harmandayan, M., Romanowicz, M. & Sola, C.Successful use of ECT in post-stroke depression.Gen. Hosp. Psychiatry 34, 102.e5–102.e6 (2012).

Bueno, V. F., Brunoni, A. R., Boggio, P. S.,Bensenor, I. M. & Fregni, F. Mood and cognitiveeffects of transcranial direct current stimulation inpost-stroke depression. Neurocase 17, 318–322(2011).

Mead, G. E. et al. Selective serotonin reuptakeinhibitors (SSRIs) for stroke recovery.Cochrane Database Syst. Rev. 11, CD009286(2012)

` Almeida, O. P. et al. B-vitamins reduce the long-termrisk of depression after stroke: the VITATOPS-DEPtrial. Ann. Neurol. 503–510 (2010).68.

, Peng, L., Zhang, X., Kang, D. Y., Liu, X. T. & Hong, Q.Effectiveness and safety of Wuling capsule for poststroke depression: a systematic review. Complement.Ther. Med. 22, 549–566 (2014)

Zhang, G. C. et al. Meta analysis of the curativeeffect of acupuncture on post-stroke depression.J. Tradit. Chin. Med. 32, 6–11 (2012).

Man, S. C. et al. A pilot controlled trial of acombination of dense cranial electroacupuncturestimulation and body acupuncture for post-strokedepression. BMC Complement. Altern. Med. 14, 255(2014).

Kim, D. S. et al. Effects of music therapy on mood instroke patients. Yonsei Med. J. 52, 977–981 (2011)

Tubaki, B., Chandake, S., & Sarhyal, A. (2021). Ayurveda management of Major Depressive Disorder: A case study. J Ayurveda Integr Med., 12(2):378-383.

Kajaria, D. (2013). An introduction to Sattvavajaya: Psychotherapy in ayurveda. Unique J Ayuvedic Herb Med, 01:10–3.

Murthy, A., & Singh, R. (1987).The concept of psychotherapy in ayurveda with special reference to satvavajaya. Anc Sci Life, 6:255–61.

Luijendijk, H. J. et al. Transient ischemic attack andincident depression. Stroke 42, 1857–1861 (2011)

Herrmann, N. et al. Detection and treatment of poststroke depression: results from the registry of theCanadian stroke network. Int. J. Geriatr. Psychiatry 26,1195–1200 (2011)

Fuller-Thomson, E., Tulipano, M. J. & Song, M. Theassociation between depression, suicidal ideation, andstroke in a population-based sample. Int. J. Stroke 7,188–194 (2012).

Yamauchi, T. et al. Death by suicide and other externallycaused injuries after stroke in Japan (1990–2010): theJapan Public Health Center-based prospective study.Psychosom. Med. 76, 452–459 (2014).

Tang, W. K. et al. Is insomnia associated with suicidalityin stroke? Arch. Phys. Med. Rehabil. 92, 20252027(2011).

Tang, W. K. et al. Cerebral microbleeds and suicidalityin stroke. Psychosomatics 53, 439–445 (2012).

Tang, W. K., Liang, H., Mok, V., Ungvari, G. S.& Wong, K. S. Is pain associated with suicidality instroke? Arch. Phys. Med. Rehabil. 94, 863–866(2013).

Tang, W. K. et al. Apathy and suicide-related ideation3 months after stroke: a cross-sectional study.BMC Neurol. 15, 60 (2015)

Starkstein, S. E. & Robinson, R. G. Affective disordersand cerebral vascular disease. Br. J. Psychiatry 154,170–182 (1989).

Santos, C., Caeiro, L., Ferro, J. & Figueira, M.Mania and stroke: a systematic review.Cerebrovasc. Dis. 32, 11–21 (2011).

Ferro, José & Caeiro, Lara & Santos, Catarina. (2009). Poststroke Emotional and Behavior Impairment: A Narrative Review. Cerebrovascular diseases (Basel, Switzerland). 27 Suppl 1. 197-203. 10.1159/000200460.

Beigel A, Murphy DL: Assessing clinical characteristics of the manic state. Am J Psy-chiatry 1971;128:688–694.

Petterson U, Fyrö B, Sedvall G: A new scale for the longitudinal rating of manic states.Acta Psychiatr Scand 1973;49:248–256.

Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity, and sensitivity. Br J Psychiatry 1978;133:429–435

Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity, and sensitivity. Br J Psychiatry 1978;133:429–435

Santos, C., Caeiro, L., Ferro, J. & Figueira, M.Mania and stroke: a systematic review.Cerebrovasc. Dis. 32, 11–21 (2011).

Podawiltz, A. A review of current bipolar disorder treatment guidelines. J. Clin. Psychiatry 73, e12 (2012).

Vataja, R. & Kaste, M. in Neuropsychiatric Symptomsof Cerebrovascular Disease NeuropsychiatricSymptoms of Neurological Disease (ed. Ferro, J. M.)81–108 (Springer, 2013).

Campbell Burton, C. A. et al. Frequency of anxiety afterstroke: a systematic review and meta-analysis ofobservational studies. Int. J. Stroke 8, 545–559(2013)

Ayerbe, L., Ayis, S. A., Crichton, S., Wolfe, C. D.& Rudd, A. G. Natural history, predictors andassociated outcomes of anxiety up to 10 years afterstroke: the South London Stroke Register. Age Ageing43, 542–547 (2014).

Morrison, V., Pollard, B., Johnston, M. & MacWalter, R.Anxiety and depression 3 years following stroke:demographic, clinical, and psychological predictors.J. Psychosom. Res. 59, 209–213 (2005).

Chi, S. et al. Tryptophan hydroxylase 2 genepolymorphisms and poststroke anxiety disorders.J. Affect. Disord. 144, 179–182 (2013).

Stein, M. B. & Sareen, J. Generalized anxiety disorder.N. Engl. J. Med. 373, 2059–2068 (2015)

Kiphuth, I. C., Utz, K. S., Noble, A. J., Kohrmann, M.& Schenk, T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemicattack. Stroke 45, 3360–3366 (2014)

Weiss, D. & Marmar, C. in Assessing PsychologicalTrauma and PTSD (eds Wilson, J. & Keane, T. M.)168–189 (The Guilford Press, 2004)

Favrole, P. et al. Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study.J. Neurol. Sci. 327, 35–40 (2013).

Goldfinger, J. Z. et al. Correlates of post-traumaticstress disorder in stroke survivors. J. StrokeCerebrovasc. Dis. 2

Kronish, I. M., Edmondson, D., Goldfinger, J. Z., Fei, K.& Horowitz, C. R. Posttraumatic stress disorder andadherence to medications in survivors of strokes andtransient ischemic attacks. Stroke 43, 2192–2197(2012) 3, 1099–1105 (2014).

Roy, M. J., Costanzo, M. E., Blair, J. R. & Rizzo, A. A.Compelling evidence that exposure therapy for PTSDnormalizes brain function. Stud. Health Technol. Inform.199, 61–65 (2014)

Wright, A. G. et al. Stability of the DSM-5 Section IIIpathological personality traits and their longitudinalassociations with psychosocial functioning in personalitydisordered individuals. J. Abnorm. Psychol. 124,199–207 (2015).

Afanasiev, S., Aharon-Peretz, J. & Granot, M.Personality type as a predictor for depressive symptomsand reduction in quality of life among stroke survivals.Am. J. Geriatr. Psychiatry 21, 832–839 (2013).

Marijnissen, R. M. et al. Depression in context of lowneuroticism is a risk factor for stroke: a 9-year cohortstudy. Neurology 83, 1692–1698 (2014).

Cummings, J. L. et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology indementia. Neurology 44, 2308–2314 (1994)

Starkstein, S. E. & Leentjens, A. F. The nosologicalposition of apathy in clinical practice. J. Neurol.Neurosurg. Psychiatry 79, 1088–1092 (2008).

Habib, M. in Behavior and Mood Disorders in FocalBrain Lesions (eds Bogousslavsky, J. & Cummings, J. L.)261–284 (Cambridge Univ. Press, 2000).

Caeiro, L., Ferro, J., e Melo, T., Canhao, P.& Figueira, M. Post-stroke apathy: an exploratorylongitudinal study. Cerebrovasc. Dis. 35, 507–513(2013).

Caeiro, L., Ferro, J. & Figueira, M. Apathy in acutestroke patients. Eur. J. Neurol. 19, 291–297 (2012).

Van Dalen, J. W., Moll van Charante, E. P.,Nederkoorn, P. J., van Gool, W. A. & Richard, E.Poststroke apathy. Stroke 44, 851–860 (2013).

Withall, A., Brodaty, H., Altendorf, A. & Sachdev, P. S. Alongitudinal study examining the independence ofapathy and depression after stroke: the Sydney StrokeStudy. Int. Psychogeriatr. 23, 264–273 (2011).

Caeiro, L., Ferro, J. & Costa, J. Apathy secondary tostroke: a systematic review and meta-analysis.Cerebrovasc. Dis. 35, 23–39 (2013

Marin, R. S., Biedrzycki, R. C. & Firinciogullari, S.Reliability and validity of the Apathy Evaluation Scale.Psychiatry Res. 38, 143–162 (1991).

Martin, R., Watson, D. & Wan, C. K. A three-factormodel of trait anger: dimensions of affect, behavior,and cognition. J. Pers 68, 869–897 (2000).

Ishikawa, S. & Raine, A. in Neuropsychiatry (edsSchiffer, R. B. et al.) 660–678 (Lippincott Williams& Wilkins, 2003).

Carota, A., Bogousslavsky, J. & Calabrese, P.in Neuropsychiatric Symptoms of CerebrovascularDiseases Neuropsychiatric Symptoms of NeurologicalDisease (ed. Ferro, J. M.) 161–188 (Springer, 2013).

Ramos-Perdigues, S., Mane-Santacana, A.& Pintor-Perez, L. Prevalence and associated factors ofanger post stroke: a systematic review. Rev. Neurol.60, 481–489 (in Spanish) (2015)

Caeiro, L., Ferro, J., e Melo, T., Canhao, P.& Figueira, M. Post-stroke apathy: an exploratorylongitudinal study. Cerebrovasc. Dis. 35, 507–513(2013).

Caeiro, L., Ferro, J. & Figueira, M. Apathy in acutestroke patients. Eur. J. Neurol. 19, 291–297 (2012).

Van Dalen, J. W., Moll van Charante, E. P.,Nederkoorn, P. J., van Gool, W. A. & Richard, E.Poststroke apathy. Stroke 44, 851–860 (2013).

Withall, A., Brodaty, H., Altendorf, A. & Sachdev, P. S. Alongitudinal study examining the independence ofapathy and depression after stroke: the Sydney StrokeStudy. Int. Psychogeriatr. 23, 264–273 (2011).

Caeiro, L., Ferro, J. & Costa, J. Apathy secondary tostroke: a systematic review and meta-analysis.Cerebrovasc. Dis. 35, 23–39 (2013).

Tang, W. K. et al. Location of infarcts and apathy inischemic stroke. Cerebrovasc. Dis. 35, 566–571(2013)

Yang, S. R., Shang, X. Y., Tao, J., Liu, J. Y. & Hua, P.Voxel-based analysis of fractional anisotropy in post-stroke apathy. PLoS ONE 10, e116168 (2015)

Skidmore, E. R. Training to optimize learning aftertraumatic brain injury. Curr. Phys. Med. Rehabil. Rep.3, 99–105 (2015)

Kohno, N. et al. Successful treatment of post-strokeapathy by the dopamine receptor agonist ropinirole.J. Clin. Neurosci. 17, 804–806 (2010)

Robinson, R. G., Jorge, R. E., Clarence-Smith, K.& Starkstein, S. Double-blind treatment of apathy inpatients with poststroke depression using nefiracetam.J. Neuropsychiatry Clin. Neurosci. 21, 144–151(2009).

Waldemar, G. et al. Effect of donepezil on emergenceof apathy in mild to moderate Alzheimer’s disease.Int. J. Geriatr. Psychiatry 26, 150–157 (2011).

Frakey, L. L., Salloway, S., Buelow, M. & Malloy, P. Arandomized, double-blind, placebo-controlled trial ofmodafinil for the treatment of apathy in individualswith mild-to-moderate Alzheimer’s disease. J. Clin.Psychiatry 73, 796–801 (2012).

Rosenberg, P. B. et al. Safety and efficacy ofmethylphenidate for apathy in Alzheimer’s disease:a randomized, placebo-controlled trial. J. Clin.Psychiatry 74, 810–816 (2013)

Choi-Kwon, S. et al. Fluoxetine treatment inpoststroke depression, emotional incontinence, andanger proneness: a double-blind, placebo-controlledstudy. Stroke 37, 156–161 (2006)

Downloads

Published

2023-04-28

Issue

Section

Review Article