From the Guidelines
Approximately 30-40% of patients with major stroke require psychological follow-up in the acute phase, as evidenced by the high prevalence of post-stroke depression and anxiety, which can be effectively managed with psychotherapy, pharmacotherapy, or a combination of both, as recommended by the 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage 1. The need for psychological follow-up in the acute phase of stroke is supported by the fact that post-stroke depression and anxiety can significantly impact patient outcomes, including rehabilitation engagement and quality of life.
- Key factors to consider when providing psychological follow-up include:
- The use of validated screening tools, such as the Center for Epidemiological Studies Depression Scale, Hamilton Depression Rating Scale, and Patient Health Questionnaire-9, to evaluate for depression and anxiety 1.
- The potential benefits of cognitive therapy in improving overall cognitive function, although the evidence is less clear for patients with stroke and dementia 1.
- The importance of early psychological support, as emotional distress can impair rehabilitation engagement and outcomes.
- Psychological interventions in the acute phase may include supportive counseling, cognitive behavioral therapy, and pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, which has been shown to reduce post-stroke depression when started 2 to 15 days after ischemic stroke or hemorrhagic stroke 1. The psychological impact of stroke is often underrecognized, despite its significant effect on recovery trajectory and quality of life, making routine screening and timely intervention essential components of comprehensive stroke care.
From the Research
Psychological Follow-up in Acute Phase of Stroke
- The percentage of patients with major stroke who require psychological follow-up in the acute phase is not directly stated in the provided studies.
- However, a study by 2 found that more than 50% of male and female patients presented with heightened psychological distress during hospital admission.
- Another study by 3 reported that approximately 50% of patients achieved full functional recovery after 6 months, but it does not provide a direct percentage of patients requiring psychological follow-up.
- The studies suggest that psychological problems are common complications following stroke and have an impact on all aspects of recovery 2, 3, 4.
- Early detection and review of poststroke psychological problems may optimize recovery from stroke 2.
- The use of psychological interventions, such as repetitive transcranial magnetic stimulation, pharmacotherapy, and exercise, may be effective in improving mood and adjustment in the chronic stage of stroke 4.