Recent studies have concluded that neuropsychiatric complications (i.e. emotional, behavioural, and cognitive disorders) may have a negative effect not only on the social functioning and overall quality of life of stroke survivors (King, 1996) but on the recovery of their motor functioning as well (Clark & Smith 1997). This chapter will discuss a number of these neuropsychiatric disorders (Table 82.1), including their effect on recovery and methods of treatment.
Poststroke depression (PSD)
Depression is among the most common neuropsychiatric disorders that occur after stroke. Despite its high frequency and negative influence on the overall recovery of stroke patients, a study by Schubert et al. (1992) reported that poststroke depression (PSD) was under-diagnosed by nonpsychiatric physicians in 50% to 80% of cases.
The frequency of PSD has been examined in numerous studies. The frequency depends upon whether patients are examined in hospital or in community surveys and whether they are studied during the acute poststroke period or many months following stroke (Table 82.2). In addition, the use of cutoff scores to define the existence of PSD, rather than structured interviews and diagnostic criteria have also contributed to reported differences in the prevalence rates of PSD.
The mean prevalence in hospitalized acute stroke patients was 22% for major depression and 17% for minor depression. In outpatient populations, the mean prevalences were 23% for major depression, and 35% for minor depression; while in community samples was 13% for major depression and 10% for minor depression. (Table 82.2).
The diagnosis of PSD may be difficult or impossible in some groups of patients with stroke. For instance, the presence of language comprehension disorders and/or significant cognitive impairment may prohibit the reliable assessment of symptoms of depression (Gustafson et al, 1991).
While the DSM-IV (American Psychiatric Association, 1994) criteria for ‘mood disorders due to a medical condition’ are applicable for the diagnosis of PSD (Starkstein & Robinson, 1989), some investigators have suggested that several symptoms used by DSM-IV for the diagnosis of major depression, such as loss of energy and appetite, and insomnia, are also found among euthymic stroke patients secondary to hospital environment, the use of medications, other associated medical conditions or the stroke itself (Harrington & Salloway, 1997).