Poststroke Post-Traumatic Stress Disorder Research Articles

Abstract TP122: Variables Associated With Post-Stroke PTSD; a Systematic Review and Narrative Synthesis

Background: Stroke is often a sudden, traumatic, and potentially catastrophic event for those who experience it, leading to many stroke survivors experiencing post-stroke post-traumatic stress disorder (sPTSD). The development of sPTSD may impede patients' rehabilitation and negatively affect their long-term physical and psychological outcomes. Aim: This review aims to identify and provide a narrative synthesis of the factors associated with sPTSD onset. Methods: Six databases (Web of Science, social sciences citation index, Embase, Pubmed, PsychInfo, Cinahl and PTSDPubs) were searched for studies that included samples of people who were 18 years of age or over, had had a stroke that was clinically recorded and who had a clinical diagnosis of PTSD post-stroke. Results: A total of 21 studies were included in the review, with prevalence rates of stroke varying between 6.5% - 31%, and the PDS and PCL being the most frequent method of assessing PTSD. The most common factors found to be associated with the onset of PTSD were depression, younger age, symptoms of anxiety and lifetime history of psychiatric comorbidity. Conclusion: Following a stroke, patients are at an increased risk for developing sPTSD. Preliminary analyses would suggest certain factors such as gender, age, and marital status impact the development of sPTSD. However, an agreed-upon, standardised practice in measuring and reporting SPTSD is necessary to ensure findings can be readily contextualised against previous research in a sensible and meaningful way.

Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder.

Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.

Abstract WP61: Impact Of Post-stroke Post Traumatic Stress Disorder On Quality Of Life

Introduction: After an ischemic stroke or transient ischemic attack (TIA), patients may have post-event anxiety and re-experience transient neurological symptoms. However, some stroke patients develop persistent and disabling symptoms of post-traumatic stress disorder (PTSD). Data on post-stroke post-traumatic stress disorder (PS-PTSD) is sparse. Methods: We conducted a single-center observational pilot study of 20 adult patients diagnosed with stroke or TIA in the previous 31 days to 1 year. Patients completed the PTSD Check List-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), stroke specific Quality of Life Scale-12 (SS-QOL-12), modified Rankin Scale of disability, and the National Institutes of Health Stroke Scale. The PCL-5 is a 20 item self-report score assessing symptoms of re-experiencing (Criterion B), avoidance (Criterion C), negative alterations in cognition or mood (Criterion D), and hyperarousal (Criterion E). Subjects were classified as having PS-PTSD with PCL-5 score ≥33 or endorsement of moderate symptoms in at least one B item, one C item, two D items, and two E items. Results: Twenty patients completed the PCL-5 and 19 completed the follow up scales. Seven patients (35%) were found to have PS-PTSD. Higher PCL-5 scores were significantly correlated with lower SS-QOL12 scores indicating worsened quality of life (r= -0.709, P=.001) and higher PHQ9 scores representing more depressive symptoms (r= 0.727, P<0.001). The effect was most prominent in the SS-QOL-12 domains of mood, language, upper extremity function, and family roles (Table 1). Conclusion: PS-PTSD was found to be prevalent after stroke and TIA with 35% of patients having significant PTSD symptomology. These patients were also more likely to have concurrent depressive symptoms and worsened quality of life.

Effectiveness of repetitive transcranial magnetic stimulation combined with a brief exposure procedure for post-stroke posttraumatic stress disorder

The incidence of posttraumatic stress disorder (PTSD) following stroke ranges from 6.5 % to 25 %. Presently few studies have focused on its treatment. Repetitive transcranial magnetic stimulation (rTMS) is often applied as a rehabilitation method after stroke, and it also represents a novel approach to PTSD. The aim of this study was to explore the effect of rTMS (or combined with a brief stroke re-exposure) on treating post-stroke PTSD. Sixty participants with post-stroke PTSD were randomly assigned into three groups (rTMS + brief exposure group, TMS + BE; rTMS alone group, TMS; sham treatment group, ST) and received 10 sessions of treatment accordingly over two weeks. Changes in PTSD symptoms (Impact of Event Scale-Revised, IES-R) were evaluated at pre-treatment (T1), the end of the first (T2), and the end of the second treatment week (T3). At the three-month follow-up (T4), a PTSD interview and IES-R assessment were given. Results showed that from T1 to T3, IES-R (and its intrusion subscale) scores of TMS + BE group and TMS group were significantly lower than the ST group, and the effect remained at three-month follow-up. The treatment effect was comparable between TMS + BE group and TMS group at T3, however, it was better for TMS + BE group than TMS group at T2, indicating a brief exposure promotes the effect of rTMS. At follow-up, the rates of PTSD were lower in TMS + BE group and TMS group than ST group. In conclusion, rTMS can effectively treat post-stroke PTSD and the effects may be accelerated by combining a brief exposure procedure. Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100043444.

Psychometric properties of the post-traumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese stroke patients

BackgroundStroke is a devastating disease and can be sufficiently traumatic to induce post-traumatic stress disorder (PTSD). Post-stroke PTSD is attracting increasing attention, but there was no study assessing the psychometric properties of the PCL-5 in stroke populations. Our study was conducted to examine the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Chinese stroke patients.MethodsThis was a cross-sectional observational study conducted at our hospital. Three hundred and forty-eight Chinese stroke patients came to our hospital for outpatient service were recruited. They were instructed to complete the PCL-5 scales and were interviewed for PTSD diagnosis with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The cutoff scores, reliability and validity of the PCL-5 were analyzed.ResultsPCL-5 scores in our sample were positively skewed, suggesting low levels of PTSD symptoms. The reliability of PCL-5 was good. Exploratory and confirmatory factor analyses indicated acceptable construct validity, and confirmed the multi-dimensionality of the PCL-5. By CFA analysis, the seven-factor hybrid model demonstrated the best model fit. The PCL-5 also showed good convergent validity and discriminant validity. Receiver operating characteristic (ROC) analyses revealed a PCL-5 score of 37 achieved optimal sensitivity and specificity for detecting PTSD.ConclusionsOur findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.

Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage.

Post-traumatic stress disorder (PTSD) can develop after stroke attacks, and its rate ranges from 4 to 37% in the stroke population. Suffering from PTSD not only decreases stroke patient’s quality of life, but also relates to their non-adherence of treatment. Since strokes often recur and progress, long-term medical management is especially important. However, previous studies generally focused on the epidemiological characteristics of post-stroke PTSD, while there are literally no studies on the psychological intervention. In our study, 170 patients with a first-ever stroke during the acute phase were recruited. They were randomized into Psycho-therapy group 1 and Control group 1, and were administered with preventive intervention for PTSD or routine health education, respectively. At 2-month follow-up, PTSD symptoms were evaluated. Participants who were diagnosed with post-stroke PTSD were further randomized into Psycho-therapy group 2 and Control group 2, and received supportive therapy or routine health counseling, respectively. At 6-month follow-up (1°month after the therapy was completed), PTSD symptoms were re-evaluated. Our results showed that at 2-month, the PTSD incidence in our series was 11.69%, and the severity of stroke was the only risk factor for PTSD development. The preventive intervention was not superior to routine health education for PTSD prevention. At 6-month, results indicated the supportive therapy did have a fine effect in ameliorating symptoms for diagnosed PTSD patients, superior to routine health counseling. Thus, our study was the first to provide evidence that the supportive therapy was effective in treating post-stroke PTSD early after its diagnosis. This clinical trial was preregistered on www.chictr.org.cn (ChiCTR2100048411).

Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style.

Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke. Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients. Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08-21.34]; P<0.01) compared with low-anxious and repressive coping styles, after adjusting for age, education, stroke severity, brain atrophy, and depression. In our cohort, PTSD was a common sequela among stroke survivors. We suggest that risk factors for PTSD development include stroke severity, white matter damage, and premorbid coping styles. Early identification of at-risk patients is key to effective treatment.

Post-stroke alexithymia - a review.

The goal of this study is a review of the literature on the role of alexithymia among stroke patients, especially assessing its impact on the process of convalescence, psychiatric comorbidity and clinical outcomes. Organic alexithymia is a common post-stroke complication, which interferes with many aspects of health among stroke survivors, with interleukin-18 having an important role in the appearance and depth of alexithymia. Post-stroke patients suffering from alexithymia are more prone to depression, manifestations of which may differ from the symptoms of this shown by the non-alexithymic post-stroke population. Alexithymia is also the cause of more severe symptoms of stroke itself, as well as more severe symptoms of post-stroke post-traumatic stress disorder. It is often associated with right-hemisphere lesions, but there are findings which show that left brain insult may also be the cause; the explanation is that information transfer from right to left hemisphere causes disturbances in emotional awareness. Alexithymia plays an important role in the health of post-stroke patients. Assessment of the trait should be considered in their population, since it plays an important role in terms of predicting psychiatric comorbidity and severity of stroke complications, which transfers to treatment choice. Further research is required to examine other post-stroke psychiatric comorbidities associated with alexithymia and to closely determine the response of rehabilitation, including pharmacological treatment and psychological therapy.

1154 Self-reported Sleep Duration And Quality Are Associated With Post-traumatic Stress Disorder Following Stroke

Abstract Introduction Up to one in eight patients may experience post-traumatic stress disorder (PTSD) within the year following a stroke or transient ischemic attack (TIA). Sleep disturbance is a chief complaint in PTSD and is common following stroke. We therefore examined whether sleep was associated with post-stroke PTSD. Methods The Reactions to Acute Care and Hospitalization (REACH)-Stroke study is an observational cohort study examining factors related to long-term health outcomes following stroke/TIA. Typical sleep duration (self-report) and quality (1: very good to 4: very bad) over the month following hospital discharge was assessed at 1-month follow-up. At 1 month, patients also completed the PTSD checklist for DSM-5 (PCL-5 cued to the stroke/TIA event). Binary logistic regression was conducted, producing odds ratios (OR) on the association between sleep within the month following discharge and PTSD symptoms at 1 month post-stroke, controlling for age, sex, and race/ethnicity. Results Analyses included 459 patients (age: 61.1 ± 15.6 y, 53.2% female). Short sleep (&amp;lt;7 h/night) and poor sleep quality (fairly/very bad) was reported in 49.2% and 25.5% of patients, respectively. Elevated PTSD symptoms (PCL-5 score ≥30) at 1 month were reported in 10.9% of patients. Sleep was significantly shorter and worse quality in those with PTSD vs. without (p-values&amp;lt;0.001). Short sleep duration vs. not short duration throughout the month following discharge was significantly associated with elevated PTSD symptoms at 1-month (OR=3.34, 95% CI: 1.51-7.38, p=0.003). Poor sleep quality (fairly or very bad rating) vs. good sleep (fairly or very good rating) was also significantly associated with elevated PTSD symptoms at 1-month (OR=2.23, 95% CI: 1.13-4.41, p=0.021). Conclusion Patients with short duration and poor quality sleep in the month following stroke are at an increased risk of having elevated PTSD symptoms. Understanding factors related to the development of post-stroke PTSD is important since PTSD in stroke survivors can reduce quality of life, contribute to non-adherence to prescribed medications, and increase risk of recurrent stroke and/or cardiovascular events. Future studies should be conducted to determine whether sleep is a modifiable determinant of PTSD symptoms after stroke. Support R01HL141494, R01HL132347

Post-traumatic Stress Disorder Following Acute Stroke

Stroke is a devastating event that annually affects over 800,000 million individuals in the USA and is associated with significant individual and social costs. In this narrative review, we summarize current evidence regarding post-traumatic stress disorder (PTSD) following acute stroke. In addition to the long-term physical consequences, it is increasingly recognized that psychological distress is common after stroke and transient ischemic attack (TIA). Nearly 1 in 4 survivors of TIA and stroke report elevated symptoms of PTSD in the first year following their cerebrovascular event. Those individuals with PTSD symptoms are at elevated risk for not only sustained psychological distress but also increased risk for non-adherence to medication. Factors in the emergency department, such as crowding, may influence the development of PTSD following acute stroke and TIA. We also summarize the rationale and clinical importance of developing and implementing quantitative predictive models of post-stroke PTSD symptoms in the ED setting. The potential of promising early interventions to prevent PTSD critically hinges on the accurate and precise identification of patients at risk for PTSD. Predictive modeling of PTSD risk may greatly facilitate the prospective management of mental health care in ED patients after stroke.

Prevalence and correlates of post-traumatic stress disorder after ischaemic stroke.

Although most often considered a consequence of traumatic event, post-traumatic stress disorder (PTSD) also occurs after illness. The aim of this study was to establish prevalence of PTSD in patients with ischaemic stroke (IS) and its correlation to lesion location, degree of disability, age, gender and marital status. The study included 85 patients with IS. PTSD was diagnosed using a modified version of the PTSD Checklist Specific for a stressor (PCL-S). Depression and anxiety were assessed using Hospital Anxiety and Depression Scale (HADS). We defined stroke localisation as right cerebral hemisphere, left cerebral hemisphere, brainstem and cerebellum. Stroke severity was measured using the modified Rankin scale (mRS). Demographic information including age, gender and marital status was collected from medical history. Of the 85 patients with IS, 11 (12.9%) fulfilled PCL-S criteria for PTSD. We found a positive correlation between PTSD and higher degree of disability, P < 0.001. Patients with PTSD had lesions more frequently localised in the right cerebral hemisphere and the brainstem. We found no statistically significant correlation of PTSD with age, gender and marital status. Our results show that a significant number of IS patients develop PTSD after IS. Determining correlates of post-stroke PTSD can help to identify those at higher risk for its development. If proven by additional large sample studies, more patients can benefit from screening for the PTSD symptoms.

Correction to: Poststroke Post-Traumatic Stress Disorder: A Review.

In the article by Garton et al, “Poststroke Post-Traumatic Stress Disorder: A Review,” which published online …

Poststroke Post-Traumatic Stress Disorder: A Review.

Despite a recent decline in mortality,1 cerebrovascular disease (stroke) remains the fifth leading cause of death in the United States and the leading preventable cause of disability.2 Furthermore, quality of life (QOL) after stroke depends on more than retention of physical functioning and ability.3 Psychological health and well-being are known to associate with QOL outcomes,4 for example, an estimated 30% of stroke survivors develop depression.5 Although poststroke depression (PSD) is a well-researched and established phenomenon,6–8 far less is known about the development of poststroke post-traumatic stress disorder (PTSD).9 Researchers have hypothesized that acute medical conditions such as asthma attack10 and myocardial infarction11 can precipitate PTSD, but PTSD specifically after a stroke has only been formally conceptualized for <2 decades.12 Despite the relative paucity of research on post-stroke PTSD, this article attempts to consolidate what is currently known: elaborating on the construct of poststroke PTSD, weighing the conflicting prevalence reports in the literature, exploring identified or hypothesized pre-morbid and post-morbid predicting factors, and summarizing promising future directions for research. Identifying gaps or conflicting findings may facilitate future studies to identify risk factors for poststroke PTSD and establish a more efficacious management strategy. Stroke is one of the leading causes of disability in adults.2 With estimated prevalence rates of 20% to 65%, depression is a pervasive consequence of stroke that has been linked to cognitive deficits including memory, nonverbal problem solving, attention, and psychomotor speed.13 Likewise, depressive symptoms experienced up to 12 months after hospitalization for subarachnoid hemorrhage (SAH) are tightly associated with QOL, more so than both demographic variables and hemorrhage severity.14 But PSD is not the only mental health outcome that may follow stroke; poststroke PTSD has similarly been shown to impact mental health and …

Correlates of Post-traumatic Stress Disorder in Stroke Survivors

Post-traumatic stress disorder (PTSD) can occur after life-threatening events, including illness, but correlates of PTSD after stroke or transient ischemic attack (TIA) have not been well described. We measured the prevalence of stroke-induced PTSD with the PTSD Checklist Specific for stroke (PCL-S) in adults who had a stroke or TIA within 5 years. A PCL-S score of 50 or more indicated likely PTSD. We tested for potential predictors of stroke-associated PTSD, including demographics, stroke history, disability, medical comorbidities, depression, and emotional support and then examined the association between poststroke PTSD and measures of physical and mental health. Of 535 participants, 95 (18%) had a PCL-S score of 50 or more; the mean score was 35.4±13.7 (range 17-80 of 85). In logistic regression analysis, low income (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.01-3.61), recurrent stroke or TIA (OR 1.86, 1.10-3.16), more disability (OR 1.79, 1.43-2.23), and increased comorbidities (OR 1.90, 1.05-3.45) were independently associated with PTSD. Older age (OR .93, .90-.95), marriage or partnership (OR .52, .28-.98), and having emotional support (OR .25, .11-.54) were protective against developing PTSD. Participants with likely PTSD had worse physical andmental health. In this racially and ethnically diverse cohort ofstroke and TIA survivors, stroke-induced PTSD was associated with younger age, recurrent strokes, greater disability, and comorbidities. PTSD was associated with a substantially increased physical, mental, and quality of life burden in this already vulnerable population. Having social support was protective, suggesting a potential target for intervention.

Does post-traumatic stress disorder occur after stroke: a preliminary study.

Psychological reactions after stroke have been recognized for some time. The present study examined whether psychological symptoms consistent with post-traumatic stress disorder (PTSD) could occur after stroke as a consequence of the sudden and unpredictable occurrence of a life-threatening internal stressor. Sixty-one patients who had experienced a first-ever stroke or transient ischaemic attack were assessed using standard self-report clinical measures for anxiety, depression and PTSD. Those patients who fulfilled criteria on at least one PTSD self-report measure were subsequently assessed using a structured clinical interview for PTSD. Six (9.8%) patients fulfilled criteria for PTSD. No significant differences were found between the post-stroke PTSD group and the non-PTSD group in terms of premorbid health and lifestyle, or experiences of adverse life events. Significant differences were noted with respect to self-reported post-stroke mental health and premorbid neuroticism. The post-stroke PTSD group also scored consistently higher on measures of anxiety, depression and psychiatric caseness. The results of this study demonstrate a number of close similarities between post-stroke PTSD and classical PTSD. We therefore conclude that PTSD or a PTSD-like syndrome can occur after stroke.