Abstract

Introduction. Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH).Materials and methods. Eighty-three SAH patients without apparent cognitive dysfunction were assessed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) after their SAH. Diagnoses were assessed for three time periods, ‘lifetime before SAH’, ‘12 months before SAH’ and ‘7 months after SAH’.Results. Forty-five percentage of patients with SAH reported at least one lifetime psychiatric disorder. After SAH, symptoms of depression and/or post-traumatic stress disorder (PTSD) were seen in 41%, more often in those with a psychiatric history prior to SAH (p = 0.001). In logistic regressions, depression after SAH was associated with a lifetime history of major depression, or of anxiety or substance use disorder, as well as with lifetime psychiatric comorbidity. Subsyndromal or full PTSD was predicted by a lifetime history of major depression. After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder. Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p = 0.019 and p = 0.031, respectively). This was also true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH (p = 0.001 and p = 0.031, respectively).Conclusions. Depression and PTSD are present in a substantial proportion of patients 7 months after SAH. Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and also constitute a risk group for difficulties in returning to work.

Highlights

  • Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH)

  • A number of studies suggest that patients afflicted with subarachnoid haemorrhage (SAH) have a considerable burden of psychopathology in its aftermath, such as depression and post-traumatic stress disorder (PTSD)

  • Of the 325 patients with SAH who were admitted during the study period, 129 met criteria for inclusion (Fig. 1)

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Summary

Introduction

Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH). After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p 1⁄4 0.019 and p 1⁄4 0.031, respectively). This was true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH (p 1⁄4 0.001 and p 1⁄4 0.031, respectively). Depression and PTSD are present in a substantial proportion of patients 7 months after SAH Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and constitute a risk group for difficulties in returning to work. Prevalence figures for PTSD after SAH show even greater variation, with studies reporting from 6%,6 19%,11 32%,12 to 60%.8

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