Clinical overview

1. Ahmed Elaghoury, EBPsych, ABPsych
Post stroke
depression, PSD
Clinical overview
Jan 2016, Jeddah

2. ❖ Most common neuropsychiatric complication after
Stroke.
❖ About 30 % of stroke pts: Acute phase
❖ About 50% of post stroke pts: chronic phase
J.M. Ferro (ed.), Neuropsychiatric Symptoms of Cerebrovascular Diseases. Springer-Verlag London 2013

3. How to diagnose?
❖ Challenging: many post stroke symptoms resemble
depressive episode
❖ First 2 m, Lt Frontal: cortical / sub
❖ Suicide ideation, ideas of reference, and pathological
guilt: very infrequent
❖ Vascular depression hypothesis: Burden of WMH
Fogel BS and Greenberg DB: Psychiatric care of the medical patient, 3rd ed, 2015. Oxford University Press

4. Outcome
❖ Prevention: Prophylactic AD
❖ “Early antidepressant treatment of PSD appears to enhance
both physical and cognitive recovery from stroke and might
increase survival up to 10 years following stroke.”
❖ Variable course: Mean = 40 wks, may be long lasting mood
ds
❖ According to:
❖ Lesion severity & location
❖ Impairment: physical / cognitive
Robinson RG, Jorge RE. Post-Stroke Depression: A Review. Am J Psychiatry. 2015 Dec 18:appiajp201515030363. [Epub ahead of print] PubMed PMID: 26684921.
Lyketsos CG et al (2008). Psychiatric aspects of neurologic diseases : practical approaches to patient care. Oxford, Oxford University Press

5. Other post stroke mood ds
❖ Anxiety
❖ Pathological laughing / crying: pseudobulbar affect
❖ Mania
❖ Pseudodementia

6. Pseudodementia
❖ Cognitive disorders resulting from functional disorders
❖ Common: depression, Ganser syndrome
❖ Severe cognitive and memory impairments often occur
during episodes of depression
❖ Suspect when: dementia syndrome appears suddenly in
an adult, especially an elderly adult.
❖ Remarkable response to ECT
Fink M. Electroconvulsive therapy: a guide for professionals and their patients. Oxford, 2009