From the Guidelines
Approximately 25% of patients with minor stroke require psychological follow-up in the acute phase, as depression is highly prevalent in the several months after stroke, affecting up to 25% of patients at 2 years. This need arises because even minor strokes can cause significant psychological distress, including symptoms of anxiety, depression, and post-traumatic stress disorder 1. Psychological assessment should ideally begin within the first few days after stroke diagnosis and continue throughout the acute recovery period (typically the first 2-4 weeks). The follow-up should include screening for mood disorders using validated tools such as the PHQ-9 for depression or GAD-7 for anxiety, with referral to mental health specialists when scores indicate moderate to severe symptoms.
Some key points to consider in the psychological follow-up of patients with minor stroke include:
- Early psychological intervention is important because emotional distress can negatively impact rehabilitation engagement, functional recovery, and quality of life 1.
- Addressing psychological needs during the acute phase may help prevent the development of chronic mental health conditions that affect approximately 25-30% of all stroke survivors long-term.
- Patients with pre-existing mental health conditions, limited social support, or significant lifestyle adjustments due to their stroke are at particularly high risk and may require more intensive psychological support.
- The prevalence of unmet needs in the months and years after hospital discharge ranges from 20% to 75%, highlighting the importance of ongoing assessment and support 1.
- While cognitive impairment is also a concern after stroke, with studies suggesting a high prevalence of post-stroke cognitive impairment (PSCI) in patients with mild stroke 1, the primary focus in the acute phase should be on addressing psychological distress and preventing long-term mental health complications.
From the Research
Psychological Follow-up in Minor Stroke Patients
- The need for psychological follow-up in patients with minor stroke is an important aspect of their care, as they may experience cognitive, emotional, and psychological impairments after the stroke event 2, 3.
- Studies have shown that patients with minor stroke may experience high levels of cognitive impairment, depression, anxiety, and fatigue, which can impact their quality of life and functional independence 2, 3.
- The prevalence of these impairments can vary over time, with some studies suggesting that cognitive impairment and depression may decrease over time, while anxiety and fatigue may persist 2, 3.
- A longitudinal study found that the prevalence of depression increased from 3 to 12 months after a minor stroke, highlighting the importance of monitoring for depressive symptoms throughout the rehabilitation period 3.
- Another study found that selective serotonin reuptake inhibitors (SSRIs) may be effective in preventing post-stroke depression, but did not improve functional independence 4.
Percentage of Patients Requiring Psychological Follow-up
- Unfortunately, the exact percentage of patients with minor stroke who require psychological follow-up in the acute phase is not clearly stated in the provided studies.
- However, the studies suggest that a significant proportion of patients with minor stroke may experience psychological and cognitive impairments, and therefore may benefit from psychological follow-up and support 2, 3.
- For example, one study found that 35.4% of patients still showed cognitive impairment at 12 months after a minor stroke, and 29.5% experienced fatigue 3.
- Another study found that 17% of patients experienced cognitive impairment as measured by the Mini-Mental State Examination, while 39% experienced cognitive impairment as measured by a neuropsychological test battery 2.