By Karen Sullivan

Stroke occurs when blood flow to a part of the brain is disrupted. The two broad categories of stroke, hemorrhage and ischemia, are opposite conditions in terms of etiology: hemorrhage is characterized by too much blood within the closed cranial cavity, while ischemia is characterized by too little blood to supply an adequate amount of oxygen and nutrients to a part of the brain. Approximately 80 percent of strokes are due to ischemia and 20 percent are due to hemorrhage. Stroke is the most common neurological disorder in the U.S. with approximately 795,000 strokes per year and approximately 15 million annually worldwide.

Stroke is a leading cause of serious, long-term disability in the U.S. In addition to physical and cognitive symptoms of stroke, depression and anxiety are common and one of the strongest predictors of disability in stroke survivors. Prevalence rates of post-stroke depression (PSD) vary but are estimated to occur in 9-40 percent of patients. PSD has been reported to have a negative impact on rehabilitation (participating in therapies) and functional outcome (returning to work, driving). Stroke survivors whose depression is treated with medication and/or counseling perceive their stroke recovery as significantly better and participate more in social activities than those without treatment. Prevalence rates of post-stroke anxiety (PSA) have been more consistent and range from 21-28 percent. PSA is more common in acute stroke recovery although there is a high degree of co-morbidity with depression (46-85 percent).

In recent years, symptoms of Post Traumatic Stress Disorder (PTSD) following stroke have been recognized with estimates ranging between 10-31 percent, in contrast to a 1-2 percent rate in the general population. PTSD is an anxiety disorder characterized by three symptoms: re-experiencing (e.g., re-living the event, feeling as though the event is happening again), emotional numbness (e.g., feeling cut-off from others, reluctance to discuss the event, avoiding reminders of the event) and hyperarousal (e.g., feeling “wound up,” having difficulty sleeping). PTSD can occur after an event involving the threat of death or serious injury that results in feelings of intense fear, helplessness or horror. Historically, PTSD has been conceptualized as occurring after an external event such as combat, rape, natural disaster or car accident. In the past 10 years, however, PTSD has been recognized as occurring following a range of medical diagnoses including cancer, cardiac arrest, brain tumor and stroke.

Negative thoughts about the self and world have been identified as a significant risk factor for PTSD following stroke.  For example, patients who strongly endorsed statements such as “Nothing good can happen to me anymore,” “I have permanently changed for the worse” and “I feel alone and set apart from others” are significantly more likely to develop symptoms of PTSD over the following weeks to months. PTSD is a managable disorder with treatment. The gold standard for treatment of PTSD is cognitive-behavioral therapy (CBT), which states that a person’s emotions and behaviors are influenced by their perception of events.  CBT is thought to be of particular value in treating PTSD due to its focus on negative thoughts.