Even a minor stroke might lead to stress and anxiety
Karin J.M. McCoy, PhD
A stroke, or brain attack, is caused by bleeding inside thehead or sudden loss of blood flow to the brain. A stroke cancause brain cells to die, so a person with a stroke might haveparalysis, loss of feeling, speech problems, or memory and reasoningproblems. The damage left by a stroke might also cause emotionalproblems such as depression. In this issue of Neurology, researchersin Switzerland1 looked for evidence that people who have hada stroke might have anxiety. Specifically, these researcherswanted to know whether living through the experience of a strokemight have caused an anxiety problem called posttraumatic stressdisorder, or PTSD. This is a condition that can happen aftera life-threatening or traumatic event, when the person feelsas though he or she is re-experiencing the event. Usually theperson does not want to think about what happened because itmakes him or her feel numb or nervous and uncomfortable. Moreinformation about PTSD can be found on the next page.
The researchers had the idea that even a minor stroke couldbe a frightening enough event to result in PTSD. The researchersthought that if people did not know what was happening to themwhen they had a stroke, and if they reacted strongly with fearor worry, they might have some nervous anxiety about the stroke.Also, the researchers thought that if patients did not rememberexactly what happened, or if they were not aware of the causeof their stroke, they might have more fear and worry about it.These ideas were put to the test in this research.
Approximately 1 year after having a nonsevere stroke, 49 patientscompleted three questionnaires asking them about the impactof their stroke, the trauma of the experience, and their memoriesof the stroke event itself. In addition, the same patients participatedin an evaluation of their memory and their depression and anxietylevels. Magnetic resonance brain imaging (MRI) showed wherethe stroke occurred in their brains. The information from allthese tests and questionnaires was examined to determine whetherthere were any patterns.
The researchers found that 1 year after their stroke, 15 (31%)of the study participants showed signs of PTSD. Specifically,many things reminded them of the feelings they had during theirstroke or they had unwanted thoughts and memories about thestroke they could not get rid of, even when they tried to avoidthinking about it. The patients with PTSD symptoms tended tobe the ones who were concerned about death or felt helplessand hopeless at the time of the stroke. Most of the study participantshad minor neurologic problems with very little physical disabilityand most of them had very good recollections of the stroke event.They said that they knew what was happening to them when theywere experiencing the stroke. The PTSD symptoms did not dependon their memory of the stroke event or their general memoryoverall. Also, PTSD symptoms did not depend on where in thebrain the stroke happened, although some of the unwanted thoughtsmay be related to strokes in a particular area of the braincalled the basal ganglia.
If you had a stroke and it was a frightening event that stillbothers you, it might be worthwhile to talk with your doctorabout being evaluated to see whether you have an anxiety problem,such as PTSD. Additional information about this is on the nextpage.
PTSD stands for posttraumatic stress disorder. It is a lastingreaction to a traumatic event. Surviving a life-threateningsituation that causes extreme fear, helplessness, or horrorcan lead to a severe emotional reaction. Having this kind ofreaction does not mean the person is crazy or weak. He or sheis reacting to a horrible situation. Probably everyone woulddevelop PTSD if exposed to severe enough trauma.
Survivors of trauma often re-experience the trauma. It is areaction of the body and mind, as they try to cope with thetrauma. Unfortunately, it can make trauma survivors feel worse.They might feel as though they are living through it all overagain, with the same mental, emotional, and physical experiencesthat happened the first time. They might have upsetting memories,images, or thoughts when they are awake, or nightmares and baddreams might disrupt their sleep. They might feel panicky orthey might feel as though they are in danger even when theyknow they probably are not.
Thinking about the trauma and feeling in danger is upsetting,so people often try to avoid reminders of the trauma to reducethe times when they feel they are reliving it. They may avoidthinking about anything or anyone that might remind them. Shuttingdown and feeling emotionally numb, or feeling disconnected fromother people, might also be a way to try to avoid the trauma.Many times trauma survivors do not even realize they are doingthis. All the avoiding might seem to help, but it makes it harderto deal with the event in the long run. Instead, these avoidingattempts might lead to depression, despair, hopelessness, personalitychanges, trouble in relationships, social isolation, physicalhealth problems, and trouble with alcohol and drug use.
The kinds of events that might trigger PTSD are ones that involvedeath or serious injury, or some other kind of threat to yourselfor other people. Examples include violent assault, kidnapping,torture, natural or manmade disasters, severe car accidents,being diagnosed with a serious illness, life-threatening medicalconditions such as heart attack and severe injuries, war, orunexpectedly seeing a dead body. Even though people often thinkof PTSD in association with war or sexual assault, there aremany other events that might cause it too.
Everyone who lives through a horrifying experience will havea reaction to it, and this reaction may include distress andavoidance. Reliving the event in thoughts, images, and dreamsmay contribute to the healing process and provide a way to overcomethe trauma. This normal response will usually disappear gradually,over time.
For about 8% of men and 20% of women the symptoms persist andbecome chronic. It can be hard to predict who will get PTSD,since it can happen to anyone with severe enough trauma. Peoplewho already had depression or anxiety might have an especiallyhard time coping with a traumatic event. Sometimes people experiencemore than one event like this in their life, and each one becomesharder to deal with.
The most successful treatments are cognitive-behavioral therapyand medication. Excellent results have been obtained with somecombinations of exposure therapy and cognitive restructuring.Sertraline (Zoloft) and paroxetine (Paxil) are selective serotoninreuptake inhibitors (SSRIs) that are the first medications tohave received FDA approval as indicated treatments for PTSD.
The following questions are a very brief screening for PTSD.
In your life, have you ever had an experience that was so frightening,horrible, or upsetting, that, in the past month, you:
Had nightmares about it or thought about it when you did notwant to?
Tried hard not to think about it or went out of yourway toavoid situations that reminded you of it?
Were constantlyon guard, watchful, or easily startled?
Felt numb or detachedfrom others, activities, or your surroundings?
If you answered yes to 3 or more, this does not mean that youhave PTSD, but it means that you should ask your doctor aboutgetting a referral to be evaluated for PTSD. If you have it,treatment will make a big difference in your life.
Talk with your doctor. Mention the symptoms you are noticing.You do not have to tell your doctor the details of the traumaif you are uncomfortable talking about it. Your doctor willbe able to refer you to a mental health provider who can doan assessment and help with treatment options.
Bruggimann L, Annoni JM, Staub F, von Steinbüchel N, Van der Linden M, Bogousslavsky J. Chronic posttraumatic stress symptoms after nonsevere stroke. Neurology 2006;66:513–516.[Abstract/Free Full Text]
Top.
How could a stroke...
How was the research...
