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Post-traumatic stress disorder common after stroke

One-third of people who survive a near fatal subarachnoid haemorrhage - a type of stroke that involves bleeding into the brain - experience the symptoms of post-traumatic stress disorder (PTSD), researchers at the Institute of Psychiatry (IoP) at King’s College London have found.  The study showed that PTSD impacted greatly on the stroke patients’ recovery and their ability to resume a normal life, even if the actual brain damage caused was minor.

Tests for PTSD are currently not part of the usual care of subarachnoid haemorrhage victims. The researchers, led by Dr Adam J Noble at the IoP, say the findings of the study point to the need for greater awareness of the condition following a haemorrhage and early testing using simple questionnaires. They suggest that PTSD treatment could alleviate fears of subarachnoid haemorrhage recurrence and promote better outcome.

In conducting the study, published in the August issue of Neurosurgery, Noble's team analyzed 142 patients who were assessed for PTSD symptoms up to 18 months after they had experienced a brain haemorrhage. The researchers noted that 34% met criteria for a diagnosis of PTSD. Their symptoms included intrusive thoughts, avoidant behaviors and hyper-alertness that interfered with their daily activities.

The trigger for these disabling symptoms was found to be the survivors' fear of having another brain haemorrhage, which is most often caused by a ruptured aneurysm. These fears may persist even though patients' risk for a recurrence remains low, at between one and three per cent.

Patients with PTSD symptoms were also more pessimistic about their odds of avoiding another stoke, as well as more fearful of experiencing other unrelated life-threatening events, such as a heart attack or lung cancer. Those patients who were deemed most fearful were less likely to be comforted by assurances from their doctors that they were unlikely to have a recurrence of the brain haemorrhage, the report indicated.

Dr Noble says: ‘The findings could lead to significant improvements in the recovery of subarachnoid haemorrhage patients. Doctors can identify those stroke victims most at risk by assessing how they deal with stress, denial, self-distraction and self-blame as some of the key signs of poor coping. These patients could then be offered pre-emptive treatment to teach them effective coping strategies.’

Treatment for PTSD, including psychological therapy and cognitive behavioural therapies, could help patients with ongoing fears of recurrent brain haemorrhage, reducing their negative thoughts and improving their daily functioning, the study concluded.

Strokes or cerebrovascular accidents are caused by lodging of a clot in brain vessels or a rupture and bleed from a cranial vessel. Although subarachnoid haemorrhage is a less common cause of stroke, the condition affects thousands of people each year. This type of stroke has a high cost for society because it afflicts much younger people than other types of stroke – most patients are around 55 – and a large proportion of these do not return to work following the haemorrhage.

This work was supported by grants from the Clarke Lister Brain Haemorrhage Foundation and Wolfson Development Fund. 

For full paper: Noble et al. ‘Subarachnoid Haemorrhage Patients’ Fears of Recurrence Are Related to the Presence of Posttraumatic Stress Disorder’, Neurosurgery (August 2011). DOI: 10.1227/NEU.0b013e318216047e

For further information please contact Kathleen Prior, Institute of Psychiatry, King’s College London on or 0207 848 5377

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