One in Four Stroke Patients Suffers From PTSD

Stroke is the medical name for a life-threatening situation that occurs when the flow of blood to the brain gets blocked or when one of the brain’s arteries bursts open or springs a leak. People who experience a stroke—or a related event called a transient ischemic attack (TIA)—have significantly heightened risks for developing the mental health condition known as post-traumatic stress disorder (PTSD), according to a study published in 2013 in the journal PLOS ONE. In addition, people who develop PTSD in the aftermath of a stroke or TIA have much higher chances of failing to comply with the treatment needed to avoid the onset of another stroke or transient ischemic attack.

Stroke Basics

Strokes come in two basic varieties, known as ischemic strokes and hemorrhagic strokes. People who experience ischemic strokes develop a blockage in one the arteries that feed oxygen-filled blood to the brain’s tissues. This type of stroke causes harm because it robs the brain’s cells of the oxygen they need to do their most basic jobs. People who experience hemorrhagic strokes develop relatively small leaks or relatively large ruptures in a brain artery. This type of stroke causes harm because the pressure of blood building up abnormally in the brain’s tissues disrupts and damages the brain’s cells. Transient ischemic attacks occur when temporary artery blockages hinder blood flow for brief  periods of time. While not true strokes, TIAs indicate the presence of steeply elevated stroke risks.

PTSD Basics

Post-traumatic stress disorder gets its name because it arises in the aftermath of unusually stressful life events. Prior to 2013, the American Psychiatric Association (APA) classified PTSD as a type of mental health problem called an anxiety disorder. However, the APA now includes the disorder in a newly established category of conditions called trauma- and stressor-related disorders. The symptoms of PTSD—including an uncontrolled reliving of a traumatic event, avoidance of stress triggers, and an unusually hyper-alert mental state—are classically associated with situations or circumstances such as combat exposure, natural disaster exposure, terrorism exposure, life-threatening accidents, physical or sexual abuse during childhood, and physical or sexual assaults during adulthood. However, some people also develop PTSD in the aftermath of traumatic health events, especially events involving the cardiovascular (heart and blood vessel) system.

PTSD Rate in Stroke Victims

In the study published in PLOS ONE, a team of researchers from Columbia University Medical Center analyzed nine studies, which together included 1,138 people who lived through either a stroke or a transient ischemic event. After making this analysis, the researchers concluded that 23 percent of stroke and TIA survivors develop clear symptoms of PTSD within a 12-month period following their physical health crises. Past this 12-month point, 11 percent of stroke and PTSD survivors still experience long-term or chronic PTSD symptoms. Because of the relatively large numbers of people in the U.S. who have strokes or experience TIAs, the figures uncovered by the study’s authors indicate that almost 300,000 survivors of these physical crises develop PTSD-related symptoms every year.

Reduced Participation in Treatment

In a second study, published in 2013 in the British Journal of Health Psychology, a team of researchers from Columbia University Medical Center examined the patterns of treatment compliance in a group of 535 stroke and transient ischemic attack survivors. Some of these survivors had symptoms of PTSD, while others did not. The authors of the study concluded that roughly one-third of all stroke and TIA patients unaffected by post-traumatic stress disorder fail to follow the long-term treatment plans established by their doctors. In contrast, two-thirds of stroke and TIA patients affected by PTSD fail to follow their doctor-established long-term treatment plans.

Treatments used to prevent further problems in people with histories of strokes or TIAs include anti-clotting medications, high blood pressure medications and LDL cholesterol-lowering statin medications. When the authors of the study asked PTSD-affected stroke and TIA survivors why they failed to follow their treatment plans, almost 40 percent of the respondents cited a concern about the effects of these medications as their primary reason for noncompliance. By comparison, the roughly 60 percent of PTSD-affected individuals who did not express these concerns had a much higher chance of sticking to their treatments than the individuals who did express these concerns. The authors of the study believe that their findings may help doctors and mental health professionals devise ways to work around the medication concerns in stroke and TIA survivors with PTSD and provide improved long-term care.

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