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Mood disorders in the year after first stroke
A House1, M Dennis, L Mogridge
1Department of Liaison Psychiatry, Leeds General Infirmary.
Insights
Following a first stroke, psychiatric issues like mood disorders are common but typically resolve within 12 months. Major depression is less persistent than often suggested in stroke patient literature.
Area of Science:
- Neurology
- Psychiatry
- Epidemiology
Background:
- Stroke is a significant health event with potential long-term psychological consequences.
- Previous research has suggested a high incidence of persistent psychiatric disorders, particularly major depression, post-stroke.
Purpose of the Study:
- To investigate the incidence and persistence of psychiatric disorders in a community sample of first-time stroke patients over 12 months.
- To compare the psychiatric status of stroke patients with a general population control group.
- To evaluate the prevalence of specific psychiatric symptoms and disorders following stroke.
Main Methods:
- A prospective study of 128 unselected community patients following their first stroke.
- Comparison with a control sample from the general population.
- Assessment of psychiatric status using the Present State Examination (PSE) and Beck Depression Inventory (BDI).
Main Results:
- Symptoms of mood disorder were more frequent in stroke patients than controls initially.
- These differences in mood disorder symptoms diminished substantially by the 12-month follow-up.
- Observed psychiatric problems included agoraphobia, social withdrawal, apathy, self-neglect, irritability, and pathological emotionalism.
- A high cumulative incidence of psychiatric disorder was noted, but most were transient.
Conclusions:
- While psychiatric disturbances are common in the early period after stroke, they are generally not persistent.
- The study suggests that major depression is not a consistently enduring syndrome following stroke.
- The emphasis on major depression as a specific, long-term post-stroke syndrome may be overstated in current literature.
Abstract:
An unselected community sample of 128 patients were studied over the 12 months after their first stroke, and compared with a control sample of subjects from the general population. Psychiatric status was assessed using the PSE and BDI. Symptoms of mood disorder were commoner in the stroke patients than the controls, but the differences were not substantial and had largely disappeared by 12 months. Psychiatric problems encountered included agoraphobia, social withdrawal, apathy and self-neglect, irritability and pathological emotionalism. While there was a high cumulative incidence of psychiatric disorder, little of it persisted: only two cases of major depression were present for the whole 12 months. We believe undue emphasis has been placed in the recent literature on major depression as a specific syndrome following stroke.