Stroke and post-stroke psychiatry

Meet the patient

A 68-year-old former teacher, ten days out from a right middle cerebral artery infarct, will not engage with physiotherapy. The nurses have written "low mood, refusing care." Her son says she cried through breakfast for no reason, has not slept since admission, and told him the family "would manage better" without her.[1][7]

Three questions will decide her discharge, and they are the three the examiner will ask you: is this depression, grief or delirium?, is she safe tonight?, and can she consent to the PEG? Everything below is the consultant answer to those three.[1][4][7]

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1. [1]Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke, 2017.PMID 27932603
2. [2]Hackett ML, Pickles K Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies Int J Stroke, 2014.PMID 25117911
3. [3]Kutlubaev MA, Hackett ML Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies Int J Stroke, 2014.PMID 25156411
4. [4]Ayerbe L, Ayis S, Wolfe CD, Rudd AG Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis Br J Psychiatry, 2013.PMID 23284148
5. [5]Mitchell AJ, Sheth B, Gill J, Yadegarfar M, et al. Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder Gen Hosp Psychiatry, 2017.PMID 28807138
6. [6]Carson AJ, MacHale S, Allen K, Lawrie SM, et al. Depression after stroke and lesion location: a systematic review Lancet, 2000.PMID 10963248
7. [7]Robinson RG, Jorge RE Post-Stroke Depression: A Review Am J Psychiatry, 2016.PMID 26684921
8. [8]Villa RF, Ferrari F, Moretti A Post-stroke depression: Mechanisms and pharmacological treatment Pharmacol Ther, 2018.PMID 29128343
9. [9]Robinson RG, Jorge RE, Moser DJ, Acion L, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial JAMA, 2008.PMID 18505948
10. [10]Mikami K, Jorge RE, Moser DJ, Arndt S, et al. Increased frequency of first-episode poststroke depression after discontinuation of escitalopram Stroke, 2011.PMID 21868736
11. [11]Allida SM, Hsieh CF, Cox KL, Patel K, et al. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke Cochrane Database Syst Rev, 2023.PMID 37417452
12. [12]Allida S, Cox KL, Hsieh CF, House A, et al. Pharmacological, psychological and non-invasive brain stimulation interventions for preventing depression after stroke Cochrane Database Syst Rev, 2020.PMID 32390167
13. [13]Chollet F, Tardy J, Albucher JF, Thalamas C, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial Lancet Neurol, 2011.PMID 21216670
14. [14]FOCUS Trial Collaboration Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial Lancet, 2019.PMID 30528472
15. [15]AFFINITY Trial Collaboration Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial Lancet Neurol, 2020.PMID 32702334
16. [16]EFFECTS Trial Collaboration Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial Lancet Neurol, 2020.PMID 32702335
17. [17]Stangeland H, Orgeta V, Bell V Poststroke psychosis: a systematic review J Neurol Neurosurg Psychiatry, 2018.PMID 29332009
18. [18]Paolucci S Epidemiology and treatment of post-stroke depression Neuropsychiatr Dis Treat, 2008.PMID 18728805