Post stroke psychiatric syndrome: a clinical study

Amrendra K. Singh, Gyanendra Raghuvanshi


Background: Various psychiatric symptoms are seen after strokes which are usually deserted due to poor familiarity about it, hence better knowledge and understanding of various post stroke psychiatric manifestations may help in early identification and management of it. The aim of present research is to study the demographic and clinical profile of various post stroke psychiatric manifestations.

Methods: The study was conducted on ninety patients developing psychiatric symptoms after stroke. Detailed socio-demographic characteristics, clinical profile along with psychiatric assessment were recorded in proforma specially designed for the study.

Results: Bulk of this post- stroke psychiatric subjects (45%) was in the age range of 61-80 years of which male and female were 29% and 16% respectively.  Most of patients (90%) were residing at rural areas. 47.8 % patients were belonging to lower middle socio-economic status.  Majority of subjects (42.8%) were unemployed followed by farmer and skilled worker (20% each), and most of the patients were right handed (97.8%). On clinical parameters maximum subjects (52.2) developed post stroke major depression followed by depression mixed with anxiety (16.6%). Rest of patients suffered from organic anxiety disorder (8.8%), vascular dementia (10%), amnestic syndrome (5.5%), post stroke psychosis (3.3%), organic manic disorder (2.2%), pathological laughter and crying (1.1%).

Conclusions: Huge number of patients (52.9%) developed psychiatric problems of diverse nature among patients with stroke syndrome. depression was most common post stroke psychiatric manifestation, followed by mixed anxiety with depression.  Generally the post stroke psychiatric manifestations are unrecognized and untreated, which has adverse impact on process of stroke rehabilitation. Thus a detailed psychiatric evaluation is mandatory in all patients of stroke syndrome to rule out psychiatric illness.


Clinical profile, Depression, Post stroke psychiatric syndrome, Sociodemographic

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Hatano S. Experience from a multicentre stroke register: a preliminary report. Bullet World Health Org. 1976;54(5):541.

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997 May 24;349(9064):1498-504.

Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017 Jul;48(7):1744-51.

Ferro JM, Caeiro L, Figueira ML. Neuropsychiatric sequelae of stroke. Nature Rev Neurol. 2016 May;12(5):269.

Hackett ML, Köhler S, T O'Brien J, Mead GE. Neuropsychiatric outcomes of stroke. Lancet Neurol. 2014 May 1;13(5):525-34.

Linden DE, Fallgatter AJ. Neuroimaging in psychiatry: from bench to bedside. Frontiers Human Neurosci. 2009 Dec 23;3:49.

Rizvi S, Kherani D, Zaheer S, Jilani TN, Dar K. Post Stroke Psychiatric Syndromes. 2018,9(5).

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clini Psychiatry. 1998;59:22-33.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov 1;12(3):189-98.

Hamilton M. A rating scale for depression. J Neurol, Neurosurg, Psychiatr. 1960 Feb;23(1):56.

Young RC, Biggs JT, Ziegler VE, Meyer DA. Young Mania Rating Scale. In: Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association; 2000: 540-542.

Hamilton MA. The assessment of anxiety states by rating. Br J Medi Psychol. 1959 Mar;32(1):50-5.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatr. 1961 Jun 1;4(6):561-71.

Montgomery SA, Åsberg MA. A new depression scale designed to be sensitive to change. Br J Psychiatr. 1979 Apr;134(4):382-9.

Robinson RG, Spalletta G. Poststroke depression: a review. Canad J Psychiatr. 2010 Jun;55(6):341-9.

Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatr. 2016 Mar 1;173(3):221-31.

Nagaraja D, Gururaj G, Girish N, Panda S, Roy AK, Sarma GR, Srinivasa R. Feasibility study of stroke surveillance: data from Bangalore, India. Indian J Medi Res. 2009 Oct 1;130(4):396.

K Park. Park’s Textbook of preventive and social medicine. In: 24th ed. Jabalpur, India: published by M/s Banarsidas Bhanot (Jabalpur); 2015:744.

Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circulat Res. 2017 Feb 3;120(3):472-95.

Ayerbe L, Ayis S, Wolfe CD, Rudd AG. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. The Br J Psychiatr. 2013 Jan;202(1):14-21.

Rajashekaran P, Pai K, Thunga R, Unnikrishnan B. Post-stroke depression and lesion location: a hospital based cross-sectional study. Ind J Psychiatr. 2013 Oct;55(4):343.

Starkstein SE, Cohen BS, Fedoroff P, Parikh RM, Price TR, Robinson RG. Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. Arch Gen Psychiatr. 1990 Mar 1;47(3):246-51.

Kim JS. Post-stroke mood and emotional disturbances: pharmacological therapy based on mechanisms. J Stroke. 2016 Sep;18(3):244.

Nakling AE, Aarsland D, Næss H, Wollschlaeger D, Fladby T, Hofstad H, et al. Cognitive deficits in chronic stroke patients: neuropsychological assessment, depression, and self-reports. Demen Geriatr Cognit Diso Extra. 2017;7(2):283-96.

Boone KB, Miller BL, Lesser IM, Mehringer CM, Hill-Gutierrez E, Goldberg MA, Berman NG. Neuropsychological correlates of white-matter lesions in healthy elderly subjects: a threshold effect. Arch Neurol. 1992 May 1;49(5):549-54.

McKay E, Counts SE. Multi-infarct dementia: A historical perspective. Demen Geriatr Cognit Diso extra. 2017;7(1):160-71.

Heiss WD, Rosenberg GA, Thiel A, de Reuck J. Neuroimaging in vascular cognitive impairment: a state-of-the-art review. BMC Medi. 2016 Dec;14(1):174.

Broomfield NM, Quinn TJ, Abdul-Rahim AH, Walters MR, Evans JJ. Depression and anxiety symptoms post-stroke/TIA: prevalence and associations in cross-sectional data from a regional stroke registry. BMC Neurol. 2014 Dec 1;14(1):198.

Castillo CS, Starkstein SE, Fedoroff JP, Price TR, Robinson RG. Generalized anxiety disorder after stroke. J Nerv Mental Dis. 1993 Feb;181(2):100-6.

Danet L, Barbeau EJ, Eustache P, Planton M, Raposo N, Sibon I, et al. Thalamic amnesia after infarct: the role of the mammillothalamic tract and mediodorsal nucleus. Neurol. 2015 Dec 15;85(24):2107-15.

Devine MJ, Bentley P, Jones B, Hotton G, Greenwood RJ, Jenkins IH, et al. The role of the right inferior frontal gyrus in the pathogenesis of post-stroke psychosis. J Neurol. 2014;261(3):600-3.

McMurtray AM, Sultzer DL, Monserratt L, Yeo T, Mendez MF. Content-specific delusions from right caudate lacunar stroke: association with prefrontal hypometabolism. J Neuropsychiat Clini Neuroscie. 2008 Jan;20(1):62-7.

Kang SY, Paik JW, Sohn YH. Restlessness with manic episodes due to right parietal infarction. J Mov Disor. 2010 May;3(1):22.

Parvizi J, Coburn KL, Shillcutt SD, Coffey CE, Lauterbach EC, Mendez MF. Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatr Clini Neuroscie. 2009 Jan;21(1):75-87.