What percentage of patients with minor stroke require psychological follow-up in the chronic phase of stroke?

From the Guidelines

Approximately 25% of patients with minor stroke require psychological follow-up in the chronic phase of stroke, as depression is highly prevalent and continues to affect up to 25% of patients at 2 years post-stroke. This need for psychological support often stems from the development of post-stroke depression, anxiety, or adjustment disorders that may not be immediately apparent during the acute recovery phase. Even patients with seemingly minor physical impairments can experience significant psychological distress as they adjust to life after stroke and confront potential cognitive changes, fatigue, or subtle neurological deficits that impact their daily functioning. Psychological follow-up typically involves screening for depression and anxiety using standardized tools like the PHQ-9 or GAD-7, followed by appropriate interventions such as cognitive behavioral therapy, medication (such as SSRIs like sertraline 50-100mg daily or escitalopram 10-20mg daily if depression is diagnosed), or support groups 1. Early identification and treatment of psychological issues is crucial as they can significantly impact rehabilitation outcomes, quality of life, and long-term recovery. Healthcare providers should incorporate routine psychological screening at follow-up appointments, particularly at the 3-month, 6-month, and 1-year marks post-stroke, even for patients with minor strokes who appear to be physically recovering well.

Some key points to consider in the management of post-stroke psychological issues include:

• Screening for depression and anxiety using standardized tools
• Providing appropriate interventions such as cognitive behavioral therapy or medication
• Identifying and addressing unmet needs, which can be remediable gaps between what a patient would like to be able to do or experience and what they are currently doing or experiencing
• Referring patients to physical, speech, or occupational therapy as needed to improve functional impairments and promote health and wellbeing 1.

It is essential to prioritize the psychological well-being of patients with minor stroke, as the consequences of untreated depression and anxiety can be severe and long-lasting. By incorporating routine psychological screening and providing appropriate interventions, healthcare providers can significantly improve rehabilitation outcomes, quality of life, and long-term recovery for these patients.

From the Research

Psychological Follow-up for Minor Stroke Patients

• The need for psychological follow-up in patients with minor stroke is significant due to the potential for long-term psychological, cognitive, and physical impairments 2.
• Studies have shown that a substantial proportion of patients with minor stroke experience anxiety, depression, and other psychological issues that can negatively impact their rehabilitation and outcomes 3, 4.
• Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year, with many experiencing fatigue, psychological, and cognitive impairments 5.
• The current treatment goal for TIA and minor stroke patients is secondary stroke prevention, but this may not be sufficient if patients experience psychological or cognitive impairments 5.

Percentage of Patients Requiring Psychological Follow-up

• While the exact percentage of patients with minor stroke requiring psychological follow-up is not specified in the provided studies, the evidence suggests that a significant proportion of patients experience psychological issues that require attention 3, 2, 4.
• A study on cognitive-behavioral therapy for managing depressive and anxiety symptoms after stroke found that CBT showed large effects on reducing overall anxiety and depression symptoms 3.
• Another study highlighted the importance of addressing residual problems, including psychological impairments, in patients with TIA and minor stroke 2.
• The role of rehabilitation psychology in stroke care is crucial in identifying and managing psychological issues that can negatively impact rehabilitation outcomes 4.