Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study

Few data exist about post-stroke symptoms of post-traumatic stress disorder (sPTSD) and none on DSM-IV formally diagnosed PTSD (fdPTSD). We investigated the frequency and predictors of sPTSD and fdPTSD 1-6 months after a nondisabling ischemic stroke (IS) or transient ischemic attack (TIA).

Consecutive patients were assessed for sPTSD (Impact of Events Scale-Revised, IES-R, significant if >30) and fdPTSD (PTSD-Interview). We recorded sociodemographic factors, stroke features (including severity of the initial deficit, persistent disability, localization), associated mood changes, peritraumatic reactions during the stroke (Peritraumatic Distress Inventory (PDI) for fear and distress, Peritraumatic Dissociative Experience Questionnaire for cognitive appraisal), and psychiatric history. Patients with sPTSD and fdPTSD were compared to patients with IES-R<30.

Among the 40 patients (65% male, mean age 52 years) studied post-IS (n=30; mean initial NIHSS 4) or TIA, 25% had sPTSD, including 10% with fdPTSD. sPTSD was more frequent in women (p=0.02), patients with intense peritraumatic reactions especially on PDI (p=0.001) or identified prior depression and anxiety (p=0.007). No other demographic factors or stroke characteristics were associated with sPTSD. Forty percent of sPTSD patients were depressed versus none of the controls (p<0.002). All fdPTSD patients had ≥ 3 prior psychiatric co-morbidities.

After nondisabling IS or TIA, sPTSD is frequent, with fdPTSD for 10%. Patients with intense peritraumatic reactions, women, and those with prior psychiatric morbidity, require particular attention to detect sPTSD.