Psychological adjustment and depression after SAH
In the chronic state after SAH, increased irritability, changes of personality, loss of interests and initiative, social problems and emotional disturbances frequently persist (Hütter, 1998; Ogden, Utley and Mee, 1997; Hütter, Gilsbach and Kreitschmann, 1995; Säveland et al., 1992; 1986; Stegen and Freckmann, 1991; Maurice-Williams et al., 1991; Vilkki et al., 1990; Sonesson et al., 1989; 1987; Bornstein et al., 1987; Ljunggren et al., 1985). These psychological disturbances and subjective complaints are also present when the degree of neurological and/or cognitive impairments is relatively mild (Hütter, 1998; Hütter, Gilsbach and Kreitschmann, 1995; Stegen and Freckmann, 1991; Vilkki et al., 1990; Ljunggren et al., 1985). Ropper and Zervas (1984) investigated a series of 112 consecutive cases after aneurysm rupture presenting with a good neurological recovery and detected in 25% of their patients, substantial emotional disturbances. Ljunggren et al. (1985) reported that 25% of their SAH patients with a good neurological result (GOS = I) complained of emotional problems in a clinical interview. Säveland et al. (1986) determined that of 21 patients after SAH and aneurysm rupture 5 (24%) exhibited severe psychosocial impairments. Taking into account the neuropsychological result, in a consecutive series of 87 patients after aneurysm rupture, only 33% exhibited a good neurological and psychosocial result (Säveland et al., 1986). Bornstein et al. (1987) also found frequent emotional disturbances in SAH patients who had been investigated by means of a clinical interview and the Minnesota Multiphasic Personality Inventory (MMPI). In a further study Vilkki et al. (1990) described changes of personality and emotional problems in a sample of patients after SAH investigated by means of standardized personality tests. In 32% of the patients, Vilkki et al. (1990) found significant changes of personality. In a collective of 87 patients after SAH with a mostly good neurological recovery (GOS = I), Stegen and Freckmann (1991) observed in almost all of their patients (98%) changes in social behavior, a deteriorated mood in 51% and depression in 36% of them. Mercier et al. (1991) found in 35% of their patients three months after aneurysm rupture evidence for changes of personality and emotional disturbances. Ogden, Henning and Mee (1993a) reported that one year after SAH, mostly as a consequence of aneurysm rupture, 14.6% of their patients exhibited a clinically significant depression in the BDI. Tidswell et al. (1995) found among 37 patients after aneurysm rupture 16% with a significant depression according to the criteria of the BDI. In patients with ruptured ACoA aneurysms, a statistically insignificant trend toward a lower level of depression was seen (p = 0.06). Ogden, Mee and Henning (1994) found in 19% of their patients one year after the acute hemorrhage a clinically relevant depression by means of the BDI.
KeywordsChronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Psychological Adjustment Emotional Disturbance Aneurysm Rupture
Unable to display preview. Download preview PDF.