Skip to main content
SpringerLink
Log in

Psychiatric Complications of Strokes

  • Chapter
Book cover Psychiatry for Neurologists

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Depression is the most frequent psychiatric complication of stroke lesions, and is present in about 40–50% of patients with acute strokes. Depression usually lasts for about 3–12 months, and is associated with more severe physical and cognitive impairments, poor quality of life, and relatively higher mortality. Depression after stroke is readily treated with selective serotonergic reuptake inhibitors (SSRIs) and tricylcic antidepressants (TCAs). Pharmacological treatment may not only improve mood, but may also result in a relatively greater recovery from physical and cognitive deficits, and reduced mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Robinson RG. The Clinical Neuropsychiatry of Stroke. Cambridge: Cambridge University Press; 1998.

    Google Scholar 

  2. Burvill PW, Johnson GA, Jamrozik KD, Anderson CS, Stewart-Wynne EG, Chakera TM. Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry 1995;166:320–327.

    PubMed  CAS  Google Scholar 

  3. Fuh JL, Liu HC, Wang SJ, Liu CY, Wang PN. Poststroke depression among the Chinese elderly in a rural community. Stroke 1997;28:1126–1129.

    PubMed  CAS  Google Scholar 

  4. Herrmann M, Bartels C, Wallesch CW. Depression in acute and chronic aphasia: symptoms, pathoanatomical-clinical correlations and functional implications. J Neurol Neurosurg Psychiatry 1993;56:672–678.

    PubMed  CAS  Google Scholar 

  5. Kotila M, Numminen H, Waltimo O, Kaste M. Depression after stroke: results of the FINNSTROKE Study. Stroke 1998;29:368–372.

    PubMed  CAS  Google Scholar 

  6. Paradiso S, Robinson RG. Gender differences in poststroke depression. J Neuropsychiatry Clin Neurosci 1998;10:41–47.

    PubMed  CAS  Google Scholar 

  7. Hayee MA, Akhtar N, Haque A, Rabbani MG. Depression after stroke-analysis of 297 stroke patients. Bangladesh Med Res Counc Bull 2001;27:96–102.

    PubMed  CAS  Google Scholar 

  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition. Washington, DC: Amer Psychiatric Pub; 1994.

    Google Scholar 

  9. Paradiso S, Ohkubo T, Robinson RG. Vegetative and psychological symptoms associated with depressed mood over the first two years after stroke. Int J Psychiatry Med 1997;27:137–157.

    Article  PubMed  CAS  Google Scholar 

  10. Fedoroff JP, Starkstein SE, Parikh RM, Price TR, Robinson RG. Are depressive symptoms nonspecific in patients with acute stroke? Am J Psychiatry 1991;148:1172–1176.

    PubMed  CAS  Google Scholar 

  11. World Health Organization. Schedules for Clinical Assessment in Neuropsychiatry. Version 2.0. Geneva: World Health Organization; 1994.

    Google Scholar 

  12. Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 1992;49:624–629.

    PubMed  CAS  Google Scholar 

  13. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.

    PubMed  CAS  Google Scholar 

  14. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:551–571.

    Google Scholar 

  15. Zung WW, Richards CB, Short MJ. Self-rating depression scale in an outpatient clinic. Further validation of the SDS. Arch Gen Psychiatry 1965;13:508–515.

    PubMed  CAS  Google Scholar 

  16. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.

    Article  PubMed  CAS  Google Scholar 

  17. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139–145.

    Article  PubMed  CAS  Google Scholar 

  18. Radloff LA. The CES-D Scale, a self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1:385–401.

    Article  Google Scholar 

  19. Ross ED, Rush AJ. Diagnosis and neuroanatomical correlates of depression in brain damaged patients. Arch Gen Psychiatry 1981;38:1344–1354.

    PubMed  CAS  Google Scholar 

  20. Gainotti G, Azzoni A, Razzano C, Lanzillotta M, Marra C, Gasparini F. The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients. J Clin Exp Neuropsychol 1997;19:340–356.

    PubMed  CAS  Google Scholar 

  21. Carson AJ, MacHale S, Allen K, et al. Depression after stroke and lesion location: a systematic review. Lancet 2000;356:122–126.

    Article  PubMed  CAS  Google Scholar 

  22. Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomoclinical correlates of major post-stroke depression. Br J Psychiatry 1999;175:163–167.

    PubMed  CAS  Google Scholar 

  23. Narushima K, Kosier JT, Robinson RG. A reappraisal of poststroke depression, intra-and inter-hemispheric lesion location using meta-analysis. J Neuropsychiatry Clin Neurosci 2003;15:422–430.

    PubMed  CAS  Google Scholar 

  24. Shimoda K, Robinson RG. The relationship between poststroke depression and lesion location in long-term follow-up. Biol Psychiatry 1999;45:187–192.

    Article  PubMed  CAS  Google Scholar 

  25. Ballard C, McKeith I, O’Brien J, et al. Neuropathological substrates of dementia and depression in vascular dementia, with a particular focus on cases with small infarct volumes. Dement Geriatr Cogn Disord 2000;11:59–65.

    Article  PubMed  CAS  Google Scholar 

  26. Mayberg HS, Robinson RG, Wong DF, et al. PET imaging of cortical S2 serotonin receptors after stroke: lateralized changes and relationship to depression. Am J Psychiatry 1988;145:937–943.

    PubMed  CAS  Google Scholar 

  27. Ramasubbu R, Flint A, Brown G, Awad G, Kennedy S. Diminished serotonin-mediated prolactin responses in nondepressed stroke patients compared with healthy normal subjects. Stroke 1998;29:1293–1298.

    PubMed  CAS  Google Scholar 

  28. Morris P, Hopwood M, Maguire K, Norman T, Schweitzer I. Blunted prolactin response to D-fenfluramine in post-stroke major depression. J Affect Disord 2003;76:273–278.

    Article  PubMed  CAS  Google Scholar 

  29. Starkstein SE, Fedoroff JP, Price TR, Leiguarda R, Robinson RG. Apathy following cerebrovascular lesions. Stroke 1993;24:1625–1630.

    PubMed  CAS  Google Scholar 

  30. Starkstein SE, Fedoroff JP, Price TR, Leiguarda R, Robinson RG. Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale. J Neuropsychiatry Clin Neurosci 1993;5:189–194.

    PubMed  CAS  Google Scholar 

  31. Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 1993;150:286–293.

    PubMed  CAS  Google Scholar 

  32. Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence. Neurology 2000;54:1805–1810.

    PubMed  CAS  Google Scholar 

  33. Starkstein SE, Fedoroff JP, Price TR, Leiguarda R, Robinson RG. Anosognosia in patients with cerebrovascular lesions. A study of causative factors. Stroke 1992;23:1446–1453.

    PubMed  CAS  Google Scholar 

  34. Morris PL, Shields RB, Hopwood MJ, Robinson RG, Raphael B. Are there two depressive syndromes after stroke? J Nerv Ment Dis 1994;182:230–234.

    Article  PubMed  CAS  Google Scholar 

  35. House A, Dennis M, Mogridge L, Warlow C, Hawton K, Jones L. Mood disorders in the year after first stroke. Br J Psychiatry 1991;158:83–92.

    PubMed  CAS  Google Scholar 

  36. Kauhanen M, Korpelainen JT, Hiltunen P, et al. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875–1880.

    PubMed  CAS  Google Scholar 

  37. Clark MS, Smith DS. Changes in family functioning for stroke rehabilitation patients and their families. Int J Rehabil Res 1999;22:171–179.

    Article  PubMed  CAS  Google Scholar 

  38. Lafgren B, Gustafson Y, Nyberg L. Psychological well-being 3 years after severe stroke. Stroke 1999;30:567–572.

    Google Scholar 

  39. Carod-Artal J, Egido JA, Gonzalez JL, Varela de Seijas E. Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit. Stroke 2000;31:2995–3000.

    PubMed  CAS  Google Scholar 

  40. Bosworth HB, Horner RD, Edwards LJ, Matchar DB. Depression and other determinants of values placed on current health state by stroke patients: evidence from the VA Acute Stroke (VASt) study. Stroke 2000;31:2603–2609.

    PubMed  CAS  Google Scholar 

  41. Singh A, Black SE, Herrmann N, et al. Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study. Stroke 2000;31:637–644.

    PubMed  CAS  Google Scholar 

  42. Parikh RM, Lipsey JR, Robinson RG, Price TR. Two-year longitudinal study of post-stroke mood disorders: dynamic changes in correlates of depression at one and two years. Stroke 1987;18:579–584.

    PubMed  CAS  Google Scholar 

  43. Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke 1998;29:618–624.

    PubMed  CAS  Google Scholar 

  44. Morris PL, Raphael B, Robinson RG. Clinical depression is associated with impaired recovery from stroke. Med J Aust 1992;157:239–242.

    PubMed  CAS  Google Scholar 

  45. Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993;24:976–982.

    PubMed  CAS  Google Scholar 

  46. Chemerinski E, Robinson RG, Arndt S, Kosier JT. The effect of remission of poststroke depression on activities of daily living in a double-blind randomized treatment study. J Nerv Ment Dis 2001;189:421–425.

    Article  PubMed  CAS  Google Scholar 

  47. Starkstein SE, Robinson RG, Price TR. Comparison of patients with and without poststroke major depression matched for size and location of lesion. Arch Gen Psychiatry 1988;45:247–252.

    PubMed  CAS  Google Scholar 

  48. Bolla-Wilson K, Robinson RG, Starkstein SE, Boston J, Price TR. Lateralization of dementia of depression in stroke patients. Am J Psychiatry 1989;146:627–634.

    PubMed  CAS  Google Scholar 

  49. Downhill JE Jr, Robinson RG. Longitudinal assessment of depression and cognitive impairment following stroke. J Nerv Ment Dis 1994;182:425–431.

    Article  PubMed  Google Scholar 

  50. Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR. Association of depression with 10-year post-stroke mortality. Stroke 1993;150:124–129.

    CAS  Google Scholar 

  51. House A, Knapp P, Bamford J, Vail A. Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 2001;32:696–701.

    PubMed  CAS  Google Scholar 

  52. Lipsey JR, Robinson RG, Pearlson GD, Rao K, Price TR. Nortriptyline treatment of post-stroke depression: a doubleblind study. Lancet 1984;1:297–300.

    Article  PubMed  CAS  Google Scholar 

  53. Andersen PS, Oster A, Johansen LK, et al. Citalopram for post-stroke pathological crying. Nucleic Acids Res 1993;21:4491–4498.

    Article  PubMed  Google Scholar 

  54. Robinson RG, Schultz SK, Castillo CS, et al. Nortriptyline versus fluoxetine in the treatment of depression and in shortterm recovery after stroke: a placebo-controlled, double-blind study. Am J Psychiatry 2000;157:351–359.

    Article  PubMed  CAS  Google Scholar 

  55. Wiart L, Petit H, Joseph PA, Mazaux JM, Barat M. Fluoxetine in early poststroke depression: a double-blind placebocontrolled study. Stroke 2000;31:1829–1832.

    PubMed  CAS  Google Scholar 

  56. Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Early fluoxetine treatment of post-stroke depression-a three-month double-blind placebo-controlled study with an open-label long-term follow up. J Neurol 2003;250:347–351.

    Article  PubMed  CAS  Google Scholar 

  57. Reding MJ, Orto LA, Winter SW, Fortuna IM, Di Ponte P, McDowell FH. Antidepressant therapy after stroke. A doubleblind trial. Arch Neurol 1986;43:763–765.

    PubMed  CAS  Google Scholar 

  58. Gonzalez-Torrecillas JL, Mendlewicz J, Lobo A. Effects of early treatment of poststroke depression on neuropsychological rehabilitation. Int Psychogeriatr 1995;7:547–560.

    Article  PubMed  CAS  Google Scholar 

  59. Gainotti G, Antonucci G, Marra C, Paolucci S. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry 2001;71:258–261.

    Article  PubMed  CAS  Google Scholar 

  60. Narushima K, Kosier JT, Robinson RG. Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. J Nerv Men Dis 2002;190:296–303.

    Article  Google Scholar 

  61. Kimura M, Robinson RG, Kosier JT. Treatment of cognitive impairment after poststroke depression: a double-blind treatment trial. Stroke 2000;31:1482–1486.

    PubMed  CAS  Google Scholar 

  62. Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Am J Psychiatry 2003;160:1823–1829.

    Article  PubMed  Google Scholar 

  63. Palomaki H, Kaste M, Berg A, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry 1999;66:490–494.

    Article  PubMed  CAS  Google Scholar 

  64. Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics 2003;44:216–221.

    Article  PubMed  CAS  Google Scholar 

  65. Kneebone II, Dunmore E. Psychological management of post-stroke depression. Br J Clin Psycol 2000;39(Pt 1):53–65.

    Article  Google Scholar 

  66. Lincoln NB, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke 2003;34:111–115.

    Article  PubMed  CAS  Google Scholar 

  67. Mant J, Carter J, Wade DT, Winner S. Family support for stroke: a randomised controlled trial. Lancet 2000;356:808–813.

    Article  PubMed  CAS  Google Scholar 

  68. Chemerinski E, Robinson RG, Kosier JT. Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke 2001;32:113–117.

    PubMed  CAS  Google Scholar 

  69. Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR. Association of depression with 10-year post-stroke mortality. Am J Psychiatry 1993;150:124–129.

    PubMed  CAS  Google Scholar 

  70. Robinson RG, Schultz SK, Castillo C, et al. Nortriptyline versus fluoxetine in the treatment of depression and in short term recovery after stroke: a placebo controlled, double-blind study. Am J Psychiatry 2000;157:351–359.

    Article  PubMed  CAS  Google Scholar 

  71. Narushima K, Robinson RG. The effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression. Is there a time-related therapeutic window? J Nerv Ment Dis 2003;191:645–652.

    Article  PubMed  Google Scholar 

  72. Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and post-stroke depression: a placebo controlled trial of antidepressants. Am J Psychiatry 2003;160:1823–1829.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Psychiatry and Clinical Neurosciences, Fremantle Hospital, University of Western Australia, Fremantle, Australia

    Sergio E. Starkstein MD

  2. Department of Psychiatry, University of Western Australia and Fremantle Hospital School of Psychiatry and Clinical Neurosciences, Fremantle, Australia

    Robert G. Robinson MD

Authors
  1. Sergio E. Starkstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert G. Robinson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Neurosciences, University of California, San Diego

    Dilip V. Jests MD

  2. Department of Psychiatry and Neurosciences, VA San Diego Healthcare System, San Diego, CA

    Dilip V. Jests MD

  3. Parkinson’s Disease and Movement Disorders Center, NeuroHealth, Warwick, RI

    Joseph H. Friedman MD

  4. University Medical School, Providence, RI

    Joseph H. Friedman MD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Starkstein, S.E., Robinson, R.G. (2006). Psychiatric Complications of Strokes. In: Jests, D.V., Friedman, J.H. (eds) Psychiatry for Neurologists. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59259-960-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-960-8_12

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-483-8

  • Online ISBN: 978-1-59259-960-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation