Psychological problems affecting the prognosis of stroke patients

BACKGROUND: It is believed that mental disorder influences the morbility and prognosis of cardio-cerebrovascular disease by biological factors.OBJECTIVE: To observe the characteristics of stroke patients complicated by psychological problems and the prognosis of such patients. DESIGN: Observational study. SETTING: Department of Neurology, Beijing Longfu Hospital. PARTICIPANTS: Totally 160 inpatients (46 males and 114 females) with stroke admitted to Department of Neurology, Beijing Longfu Hospital between June 2005 and June 2006 were recruited in this study. The involved patients all corresponded to the diagnosis criteria of cerebrovascular disease formulated in the 1995 National Conference of Cerebrovascular Disease and confirmed by skull CT or MRI examination. The age range was between 43 and 74 years. They all signed the informed consent for the detection and therapeutic regimen, and the application of this technique also gave the approval of the Ethics Committee of the hospital.METHODS: On admission, the patients were investigated on psychological problems using Hopkin symptom checklist. After admission, all the patients received oral administration of aspirin anti-platelet drugs and intravenous infusion of Fufang Danshen. Motor relearning program was used in the rehabilitation treatment for disability rehabilitation. Mental intervention was carried out in the end of observation period. On day 30 after admission, the recovery of two groups of patients was compared using activities of daily living scale, Scandinanvian Stroke Scale (SSS) and disability level. MAIN OUTCOME MEASURES: The activities of daily living were assessed with Barthel index. Higher scores of patients suggested better activities of daily living. For SSS, the higher points, the severer defect degree. The reduction of scores of neurologic impairment suggested that neurological function improved. Disability level was graded according to the method formulated in the Second National Cerebrovascular Conference.RESULTS: All the 160 involved stroke patients participated in the final analysis. ① Hopkin symptom checklist assessment results: Of the 160 stroke patients, 94 (58.7%) were assessed as having any psychological problems. In this study, psychological problems were more likely to be seen in female patients (74.4%) than in male patients (26.1%). Major psychological problems were depression (53.8%), compulsion (52.5%) and anxiety (46.2%). ② Comparison of prognosis of patients: Significant differences in activities of daily living-Barthel index, SSS scores and disability level were found between pre- and post-treatment periods. It indicates that stroke patients complicated by mental disorder had poor prognosis. CONCLUSION: The incidence of complicated psychologic obstacle is high in stroke patients, and its prognosis is inferior to that of patients who have no psychological problems.

Psychological problems affecting the prognosis of stroke patients