Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage

NO! You're trying to solve a secondary problem, solve the primary problem of 100% recovery and you don't need to worry about these secondary problems. DO YOU NOT UNDERSTAND?

Supportive psychological therapy can effectively treat post-stroke post-traumatic stress disorder at the early stage

Che Jiang^1†, Zhensheng Li^2†, Chenggang Du³, Xiwu Zhang¹, Zhuang Chen¹, Gaoquan Luo¹, Xiaona Wu¹, Jiajia Wang¹, Yan Cai¹, Gang Zhao^1*‡ and Hongmin Bai^1*‡

• ¹Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
• ²Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
• ³Department of Health Service, General Hospital of Southern Theatre Command, Guangzhou, China

Post-traumatic stress disorder (PTSD) can develop after stroke attacks, and its rate ranges from 4 to 37% in the stroke population. Suffering from PTSD not only decreases stroke patient’s quality of life, but also relates to their non-adherence of treatment. Since strokes often recur and progress, long-term medical management is especially important. However, previous studies generally focused on the epidemiological characteristics of post-stroke PTSD, while there are literally no studies on the psychological intervention. In our study, 170 patients with a first-ever stroke during the acute phase were recruited. They were randomized into Psycho-therapy group 1 and Control group 1, and were administered with preventive intervention for PTSD or routine health education, respectively. At 2-month follow-up, PTSD symptoms were evaluated. Participants who were diagnosed with post-stroke PTSD were further randomized into Psycho-therapy group 2 and Control group 2, and received supportive therapy or routine health counseling, respectively. At 6-month follow-up (1°month after the therapy was completed), PTSD symptoms were re-evaluated. Our results showed that at 2-month, the PTSD incidence in our series was 11.69%, and the severity of stroke was the only risk factor for PTSD development. The preventive intervention was not superior to routine health education for PTSD prevention. At 6-month, results indicated the supportive therapy did have a fine effect in ameliorating symptoms for diagnosed PTSD patients, superior to routine health counseling. Thus, our study was the first to provide evidence that the supportive therapy was effective in treating post-stroke PTSD early after its diagnosis. This clinical trial was preregistered on www.chictr.org.cn (ChiCTR2100048411).

Introduction

Post-traumatic stress disorder (PTSD) is a mental disorder which may develop after individuals exposed to traumatic events. The common events include accidents, combat, physical attack, childhood abuse, robbery, natural disasters, and so on. According to the Statistical Manual of Mental Disorders-version 5 (DSM-5) (American Psychiatric Association [APA], 2013), PTSD is characterized by four clusters of symptoms including persistent intrusive memories, avoidance of reminders, negative alterations in mood and cognition, and hyper-arousal (American Psychiatric Association [APA], 2013). PTSD is also associated with increased risk of drug abuse, suicide, and other mental disorders (Kessler et al., 1995). In the general population, the lifetime incidence of trauma exposure is estimated to be over 50%, and the incidence of PTSD to be 3–7% (McManus et al., 2007; Kessler et al., 2017).

Stroke presents one of the leading causes of death and disability worldwide (Béjot et al., 2016). Secondary psychological symptoms such as depression and anxiety commonly occur (Towfighi et al., 2017). Stroke features sudden onset of neurologic deficits and is potentially life-threatening, thus conforms to the definition of traumatic events in post-traumatic disorder (PTSD). Emerging studies have focused on post-stroke PTSD in the past two decades. The prevalence of PTSD (or PTSD symptom) in stroke population ranged from 4 to 37% (Garton et al., 2017), and even mild stroke (Bruggimann et al., 2006) and transient ischemic stroke (TIA) (Kiphuth et al., 2014) can cause PTSD. Since strokes often recur and progress, long-term medical management is especially important. Suffering from PTSD not only decreases stroke patient’s quality of life (QOL) (Noble et al., 2008), but also relates to their non-adherence of treatment (Kronish et al., 2012; Edmondson et al., 2013a).

Psychotherapies for prevention or treatment of PTSD primarily include exposure therapy, cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR). After treatment, although most patients can attain clinically meaningful symptom improvement, approximately two-thirds retained PTSD diagnosis (Maria et al., 2015). On the other hand, there are also pharmacotherapeutic ways for the management of PTSD, such as selective serotonin reuptake inhibitors (SSRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), anticonvulsants, antidepressants, and benzodiazepines (Akhtar and Pilkhwal Sah, 2021). Yet, they showed limited efficacy, excessive adverse effects, and lower patient compliance. As for post-stroke PTSD, previous studies generally focused on the rate and risk factors, while there are literally no studies on its prevention or treatment (Garton et al., 2017). Compared with PTSD caused by non-medical factors, post-stroke PTSD has its unique pathophysiological characteristics and may require different psychological therapies.

Within the first 3°months of a traumatic event, the traumatic memory remains fragmented (Van der Kolk, 1994; Foa et al., 2010; Shapiro, 2012). Early psychological intervention conducted during this period may keep these memories from accumulation (McFarlene, 2010), so it is crucial for the prevention and treatment of PTSD. Thus, our study focused on the early psychological intervention for the prevention and treatment of post-stroke PTSD. It is argued that stroke patients’ maladaptive coping strategies and their exaggerated belief of stroke’s harmfulness may be the main cause for PTSD. Therefore, extended health education in the acute stage of the stroke, guiding patients to adopt suitable coping styles, and correctly understand the risk of stroke seems likely to help prevent secondary PTSD (Noble et al., 2008; Kiphuth et al., 2014). As for the treatment of post-stroke PTSD, we hypothesized that supportive therapy with medical counseling implemented early after the PTSD diagnosis may be effective. In our prospective clinical trial, we showed the efficacy of supportive therapy, but not extended health education.

More at link.