Psych Vivas · Consultation-liaison psychiatry
Stroke and post-stroke psychiatry — structured clinical viva
Fellowship viva covering post-stroke depression frequency, the lesion-location evidence, screening with aphasia, Robinson prevention, and FLAME versus FOCUS, AFFINITY and EFFECTS.
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FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CL psychiatry registrar. The stroke rehab team refers a 71-year-old man 5 weeks after ischaemic stroke (left MCA, residual aphasia and hemiparesis). Issues: suspected post-stroke depression with passive suicidal ideation; staff citing 'left frontal so he must be depressed'; and a request for fluoxetine to improve motor recovery. Discuss epidemiology, mechanisms and lesion location, screening with aphasia, and treatment and trial evidence.
Interpretation
Reveal interpretationShowHide
Why it matters. Post-stroke depression affects approximately one third of stroke survivors at any one time after stroke, and carries a higher risk of suboptimal recovery, recurrent vascular events, poor quality of life and mortality.[1]
References13ShowHide
- [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]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]Carson AJ, MacHale S, Allen K, Lawrie SM, et al. Depression after stroke and lesion location: a systematic review Lancet, 2000.PMID 10963248
- [4]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
- [5]FOCUS Trial Collaboration Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial Lancet, 2019.PMID 30528472
- [6]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
- [7]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
- [8]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
- [9]Robinson RG, Jorge RE Post-Stroke Depression: A Review Am J Psychiatry, 2016.PMID 26684921
- [10]Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke, 2026.PMID 41582814
- [11]Villa RF, Ferrari F, Moretti A Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacology & therapeutics, 2018.PMID 29128343
- [12]Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet. Neurology, 2011.PMID 21216670
- [13]Mikami K, Jorge RE, Moser DJ, et al. Increased frequency of first-episode poststroke depression after discontinuation of escitalopram. Stroke, 2011.PMID 21868736