Abstract 2388: Is Fatigue Associated With Symptoms Of Post Traumatic Stress Disorder In Subjects Following Stroke?

Abstract

Introduction: Significant fatigue affecting quality of life is reported by up to 60% of stroke patients in the 6 months post event. We have previously reported an association between post fatigue and anxiety measured by Hospital Anxiety and Depression Score in stroke survivors. Stroke presents frequently as an unexpected potentially life threatening event with features similar to traumatic episodes such as accidents etc. Traumatic events may in turn be associated with development of the anxiety disorder Post Traumatic Stress Disorder (PTSD). We hypothesised that post-stroke fatigue may be related to a PTSD like phenomenon. Method: Independent patients (modified Rankin score <3) who were cognitively intact (AMTS >6) with a history of stroke attending a secondary prevention clinic were approached to participate in the study. All underwent a detailed 1-2 hour interview including assessment of fatigue using 2 tools, the Fatigue Assessment Scale (FAS) and the Fatigue Severity Score (FSS). PTSD severity was assessed using the Clinician Administered PTSD Scale (CAPS). The CAPS is a 30-item structured interview that corresponds to the DSM-IV criteria for PTSD. The CAPS is a standard criterion for the assessment and diagnosis of PTSD. Results: The study was terminated early after 18 patients completed assessments (15 male, median 70 years) due to unexpected distress experienced by some patients in completing the CAPS requiring referral to psychological support services. CAPS correlated strongly with FAS (r=0.72 (95%CI 0.39-0.89) p=0.0007). Seven subjects had a FAS score>20, of these 3 had symptoms of moderate to severe PTSD. No subjects with a FAS <21 had such symptoms (p=0.04, Fishers Exact test). The FSS also correlated with the CAPS but less strongly (r=0.50, p=0.03) Conclusion: Symptoms of PTSD are found in a proportion of patients following stroke. Although subject numbers are small there appears to be a strong correlation between fatigue severity and symptoms of PTSD in patients with stroke.