The link between stroke and vascular dementia is known;1 reports of psychological disturbance as a direct consequence of brain insult is noted. For example de Groot et al,2 found white matter lesions after depressive episodes in patients with yet more curious phenoma emerging during counselling.
After working at the Neurorehabilitation Unit, Brighton, it was noted that stroke patients contended with an unusual legacy of past traumas. Disclosed psychological problems originated many years previously: childhood sexual abuse or the re-living of events gave rise to classical post-traumatic stress disorder (PTSD). A proportion are expected to present with psychological difficulties unrelated to their current condition.
Importantly, symptoms similar to PTSD have been seen in patients diagnosed with cancer.3 The shock of receiving a diagnosis can be as powerful as a natural disaster or a traumatic road traffic accident. Reports of PTSD in cancer survivors is recognised4 and around 20% are varying with type of cancer and the methodology of the study.5 Yet no work has been published describing whether it is the same or responds to the same treatment as PTSD following other traumas.
Possibly, PTSD symptoms after stroke may be delayed onset of past psychological traumas. Equally compelling is that chemical/neuroanatomical changes ‘trigger’ previously unresolved traumatic symptoms as with white matter lesions signalling depressive episodes. Adjustment to loss of previous functional abilities or brain-chemical instability may explain some presentations.
The author and colleagues are considering the efficacy of psychological approaches to treating PTSD in cancer survivors in a randomised control trial this year. Further work will consider stroke patients and the need for staff awareness of this phenomenon.
- © British Journal of General Practice, 2010.
