Frequency and predictors of post-traumatic stress disorder after stroke: A pilot study
Introduction
Post-traumatic stress disorder (PTSD) is defined as the development of psychological and physical symptoms following exposure to one or more traumatic events [1]. PTSD symptoms include intrusive recollections, avoidance and numbing symptoms, and hyperarousal [2]. PTSD can have a major impact on the quality of life and is frequently associated with depression and cognitive dysfunction [3]. PTSD has mainly been reported after external trauma, but, more recently also, after some acute medical conditions or internal trauma like myocardial infarction and subarachnoid hemorrhage [4], [5].
Stroke is an acute life-threatening disease, that carries a risk of recurrence and persistent disability. The most reported psychological manifestations following stroke are depression and anxiety disorders, affecting 20–30% of victims [6], [7], [8]. Because of its sudden onset and severe consequences, ischemic stroke (IS) or transient ischemic attack (TIA) could be also identified as an acute internal traumatic event. According to 4 studies, post-stroke frequency of symptoms of PTSD (sPTSD) ranged from 5.6% to 31% [9], [10], [11], [12]. Those studies did not evaluate the persistence of symptoms lasting ≥ 1 month, which defines the DSM-IV formal diagnosis of PTSD (fdPTSD). To date, complete DSM-IV criteria of PTSD have never been applied in any study on stroke or TIA patients.
PTSD risk factors include pretrauma, peritrauma and posttrauma variables. Negative affect and cognitive appraisal of stroke seem to constitute significant predictors of sPTSD after a stroke [10], [11]. The impact of initial stroke characteristics on sPTSD development has never been fully investigated.
Our objective was to assess the sPTSD and fdPTSD frequencies, 1–6 months after nondisabling IS or TIA. In addition, we sought to identify factors predictive of sPTSD and fdPTSD, especially those related to stroke characteristics and fear reaction during the traumatic event.
Section snippets
Patients
During a 4-month period (11/2006–02/2007), consecutive ambulatory adults (> 18 years), followed at the outpatient clinic of Tenon Hospital, 1–6 months after hospitalization in the stroke unit for a first-ever IS or TIA, were asked to participate in a psychological evaluation. TIA was defined as a transient episode of neurological dysfunction caused by focal brain ischemia, without acute infarction on brain imaging. Exclusion criteria were: very disabling stroke (modified Rankin scale (mRS) > 3), non
Results
Among the 94 patients who fulfilled the inclusion criteria, 40 patients (42.6%), 30 with IS and 10 with TIA, accepted to participate after giving their informed consent. Their clinical data are given and compared in Table 1 (details of psychological data are reported in the Appendix). The mean time to hospitalization and mean time to psychological testings were respectively 8.5 ± 13 h and 116 ± 60 days, without statistical difference between groups.
Discussion
The prevalence of PTSD frequency in our stroke population was clearly higher than the 1.9% estimated PTSD in the European general population [24]. In our cohort of 40 patients evaluated 1–6 months after nondisabling IS or TIA, 25% had sPTSD, among whom 10% had fdPTSD. sPTSD occurred more frequently in women and was frequently associated with depression or anxiety disorder. We were unable to identify any stroke feature associated with an increased risk of sPTSD or fdPTSD. The main predictor of
Conflict of interest
No conflict of interest to declare.
Financial disclosure
None to declare.
Funding/support
None.
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2020, Journal of Psychosomatic ResearchCitation Excerpt :Our data was unable to demonstrate this. One previous study with stroke and TIA patients shows similar results [44]. Furthermore, the duration of TIA symptoms and affected circulatory territory was not associated with the development of post-TIA PTSD symptoms in our study.