Ahmed Elaghoury, EBPsych, ABPsych

Post stroke depression, PSD

Clinical overview Jan 2016, Jeddah

❖ 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

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

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

Other post stroke mood ds

❖ Anxiety ❖ Pathological laughing / crying: pseudobulbar

affect ❖ Mania ❖ Pseudodementia

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 ECTFink M. Electroconvulsive therapy: a guide for professionals and their patients. Oxford, 2009