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Anxiety Disturbances in Stroke Patients

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Neuropsychiatric Symptoms of Cerebrovascular Diseases

Part of the book series: Neuropsychiatric Symptoms of Neurological Disease ((NSND))

Abstract

Anxiety is present in at least 20 % of stroke patients already in the acute phase and once present tends to run a chronic course. Of the different anxiety disorders, generalized anxiety disorder is the most common. The concept of “post-stroke anxiety,” as a direct consequence of biological mechanisms associated to stroke is controversial. More likely, the etiology of anxiety after stroke is probably multifactorial, associated with, e.g., personality traits, psychosocial stressors, and yet unknown biological mechanisms. The role of the stroke lesion location is unknown, although posterior right hemisphere location has been suggested in generalized anxiety, right temporal location in panic disorder, and lesions affecting the frontal-subcortical circuitry in the obsessive-compulsive disorder (OCD). Compared to post-stroke depression, anxiety has been far less studied. Yet it has a strong negative impact on the quality of life of the stroke victims and their caregivers, and it is associated with impaired activities of daily living and probably also premature institutionalization. Although the validity of structured methods and rating scales is probably suboptimal, their routine use is recommended to improve detection of this often neglected disorder. There are no randomized controlled high-quality studies of the management or pharmaceutical treatment. In clinical practice most of the patients seem to benefit from the serotonin-selective reuptake inhibitors and other antianxiety drugs that are widely used in general psychiatry. However, neuroleptics, benzodiazepines, and tricyclic antidepressants should be used with caution in this fragile patient population.

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Authors and Affiliations

  1. Department of the Neuropsychiatry and Geriatric Psychiatry, Kellokoski Hospital, Kellokoski, 04500, Finland

    Risto Vataja MD, PhD

  2. Department of Neurology, Helsinki University Central Hospital, 00290, Helsinki, Finland

    Markku Kaste MD, PhD, FAHA, FANA, FESO

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  1. Risto Vataja MD, PhD
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Correspondence to Risto Vataja MD, PhD .

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  1. , Serviço de Neurologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, 1649-035, Portugal

    José M. Ferro

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Vataja, R., Kaste, M. (2013). Anxiety Disturbances in Stroke Patients. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_5

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