Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- 79 Physiology of the cerebral circulation
- 80 Stroke syndromes
- 81 The treatment of acute ischemic stroke
- 82 Behavioural manifestations of stroke
- 83 Intracerebral hemorrhage
- 84 Aneurysms and arteriovenous malformations
- 85 Hereditary causes of stroke
- 86 Preventive management of stroke
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
82 - Behavioural manifestations of stroke
from PART X - CEREBROVASCULAR DISORDERS
Published online by Cambridge University Press: 05 August 2016
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- 79 Physiology of the cerebral circulation
- 80 Stroke syndromes
- 81 The treatment of acute ischemic stroke
- 82 Behavioural manifestations of stroke
- 83 Intracerebral hemorrhage
- 84 Aneurysms and arteriovenous malformations
- 85 Hereditary causes of stroke
- 86 Preventive management of stroke
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
Summary
Introduction
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.
Epidemiology
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).
Diagnosis
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).
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- Diseases of the Nervous SystemClinical Neuroscience and Therapeutic Principles, pp. 1371 - 1382Publisher: Cambridge University PressPrint publication year: 2002