One in 4 Stroke Survivors Have PTSD: Take Home Messages
1 in 4 Stroke Survivors Suffer PTSD, Researchers Find
Up to 300,000 stroke survivors in the United States are likely to develop post-traumatic stress disorder each year.
By Jennifer J. Brown, PhD
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In the first year following a stroke, 23 percent of stroke and mini-stroke survivors develop post-traumatic stress disorder (PTSD) — which is dramatically higher than the 3.5 percent incidence of PTSD in the general population each year, according to a review published in the journalPLOS ONE.
Stroke patient Peter V. Cornelis of Wantagh, N.Y., is a case in point. The 62-year-old is a six-time stroke survivor. His strokes left him paralyzed and unable to speak. “It was almost catastrophic for me,” Cornelis said about his experience.
After the stroke, he re-experienced the trauma of the event repeatedly and avoided things that reminded him of the stroke — classic symptoms of PTSD. “It’s almost equivalent to being in the shell of a body and trying to relate to the environment,” as Cornelis described it.
It was problems with memory that first led him to a psychologist for help. Asked if counseling helps with the PTSD symptoms, Cornelis said, “We are still working on it, but yes, indeed it does.”
Study author Ian Kronish, MD, MPH, who is at the Center for Behavioral Cardiovascular Health at Columbia University Medical Center in New York City, said that for patients after stroke, “PTSD impairs quality of life, and is comparable to, or more disabling than depression.” Kronish and others conducted a meta-analysis that looked at nine studies including more than 1,000 stroke survivors, to compare PTSD rates within a year of stroke, which is how they came up the 23 percent incidence of PTSD symptoms.
Recognizing Symptoms of PTSD Following Stroke
In the United States, 795,000 people have strokes every year, and 500,000 have mini-strokes, leaving hundreds of thousands at risk for PTSD. While patients and caregivers may know and expect that depression could occur after stroke, they may not be expecting PTSD.
“Right now I don’t think there is a lot of awareness that this [PTSD] is a possible complication after stroke," said Kronish. He added that PTSD after stroke is “a very new concept, interesting and novel to neurologists and psychiatrists we spoke with. This type of research is something we want patients to be aware of.”
Hallmark symptoms of PTSD after stroke are:
- Re-experiencingthe event, nightmares, thinking about it all the time
- Avoidingcertain things that are reminders of the scary symptoms of stroke
- Being hyper-vigilant, feeling on edge like something bad is about to happen
Doctors and other healthcare providers may not think of PTSD first when caring for a stroke survivor, because care for stroke happens in varied kinds of practices: “I think patients with stroke get taken care of by different types of providers," Kronish said. "Rehabilitation may be in a facility. In transient ischemic attack, mini-stroke, specialists should be on the lookout for these kinds of symptoms, and general doctors also need to be aware."
By knowing the signs of PTSD, you can help identify them in a person you're caring for following a stroke. Kronish recommends asking questions to help identify any persistent trauma as PTSD, so the stroke survivor can get the appropriate mental health care.
"If they see their family member is not acting like themselves, family members can observe that," he said. "Try to open communication with the stroke survivor by asking:
- Are you having nightmares?
- How are you coping with the stroke?
- How does it make you feel?
- Do you think about it all the time?
- Are you taking your medications?"
A key reason to help stroke survivors cope with PTSD, according to Kronish’s research, is to ensure they take stroke-preventive medications.
"People who had high levels of PTSD symptoms had three times the chance of being nonadherent with their medications," Kronish said. Lapses in taking medications can increase the chances of having another stroke. "People may live with a lot of anxiety about having another stroke," he noted. Sticking with a medication plan is one important way to reduce the risk of having another stroke.
Effective Treatment for PTSD after Stroke
Behavioral therapy is used to treat PTSD across a number of medical conditions, like cancer, for example. "In most cases PTSD is treatable through behavioral therapy," Kronish said.
Other types of therapy may help as well. In addition to seeing a counselor during his recovery, stroke survivor Peter Cornelis turned to art, which helped him recover and cope with his PTSD symptoms. "I believe that the creative part of the brain, when exercised, promotes neuroplasticity, nerve growth in the brain," Cornelis said. And this, in turn, may help with stroke recovery.
Cornelis' artwork accomplishments have inspired him to share his positive experience with others. He is now "in the early stages of starting a free online course for traumatic brain injury (TBI) patients, in hopes of making a connection, to teach people to try to overcome the ravages of stroke."
PHOTO CREDIT: Peter V.
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