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Stroke and transient ischaemic attack - Management
Depression, anxiety, emotionalism, disturbed social interaction
- Mood disturbance is common after a stroke and presents as depression, anxiety, or both.
- The severity of mood disturbance is associated with the severity of cognitive impairments, motor impairments, and limitation of activity.
- Mood disturbances can exacerbate other impairments and limit the recovery of function.
- Depression:
- Depression is common but often remits as function is recovered.
- Everyone who has had a stroke should be screened for depression from time to time.
- People with depression should be screened for anxiety and emotionalism.
- People with depression sufficient to cause distress or impede rehabilitation and not responding to primary care management should be assessed by an expert (e.g. clinical psychologist, appropriately trained stroke physician, psychiatrist).
- Contributory factors (e.g. pain, social isolation) should be addressed.
- People with minor depression should be:
- Monitored for progression.
- Involved in increased social interaction, increased exercise, goal setting, and other psychosocial interventions.
- People with more severe or persistent depression should be offered one or more of:
- Antidepressant drug treatment, to be monitored, and continued for at least 6 months if a benefit is achieved.
- Psychological therapy.
- For more information, see the CKS topic on Depression.
- Anxiety:
- Anxiety after stroke is often focused on fear of falling and fear of recurrence.
- Everyone should be screened for anxiety after a stroke.
- Anyone with anxiety sufficient to impede recovery or to cause distress should be assessed and considered for psychological treatment.
- Emotionalism:
- People who cry (or, less commonly, laugh) in an overly emotional way or after what appears to be minimal provoking stimuli are said to have emotionalism or emotional lability.
- People with troublesome emotionalism may be offered antidepressant drug treatment.
- Refer people with troublesome emotionalism not responding to primary care management to a specialist.
- Social interaction — interpersonal relationships:
- Stroke infrequently causes disinhibited or aggressive behaviour.
- People whose style of social interaction after a stroke causes distress to others should be assessed by a clinical psychologist, and other specialists (e.g. psychiatrist or speech and language therapist) if necessary.
- Management may include:
- Information and advice for the person, their family, and others in contact socially or professionally.
- Treatment of causal or aggravating factors (e.g. an antidepressant or an antipsychotic).
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