The prevalence and evolution of neuropsychiatric symptoms following a stroke warrant periodic psychiatric screenings, two experts recently told Psychiatric Times. Everybody who has had a stroke is at risk for a wide variety of emotional disorders ranging from depression, to pathological laughing and crying, to agnosia, said Robert G. Robinson, M.D., head of the department of psychiatry and Paul W. Penningroth professor of psychiatry at the University of Iowa. Robinson is known for his pioneering work in psychiatric disorders following stroke.
"All patients should be examined following stroke and at some regular intervals during the first couple of years for neuropsychiatric disorders," he said. Such disorders "are very common in the [post-stroke] population and can negatively impact" patients' physical recovery, cognitive recovery and, ultimately, their survival.
Donald M. Hilty, M.D., associate professor of clinical psychiatry at the University of California, Davis, School of Medicine and co-author of a recent article on poststroke neuropsychiatric illness (Bourgeois et al., 2004), said the need for better detection and periodic testing was particularly important for poststroke depression. The depression may not initially be present. Instead, it "may show up in a month, three months or six months." So, if clinicians screen for depression in the months after a stroke, they would likely identify several more cases.
Longitudinal studies have shown that about half the cases of depression occur in the first month following a stroke and the other half occur anywhere up to two years later, Robinson said.
Whether the delayed onset of depression is related to pathophysiological changes in the brain following a stroke or psychological responses to the impairments produced by stroke is a matter for further research, according to both Hilty and Robinson.
"My guess is that there are probably a number of patients who are developing late-onset depression that is related to psychological factors," said Robinson. "But we have also found in patients with delayed-onset depression ... that they have injury to the left frontal area of the brain. This finding suggests there may be biological and physiological changes occurring in the brain following stroke that lead to the development of delayed-onset depression."