Advertisement

Understanding Mental Health Needs After Mild Stroke

Published:February 09, 2019DOI:https://doi.org/10.1016/j.apmr.2018.12.017
      Each year approximately 305,000 people in the United States have a mild stroke.
      • Wolf T.J.
      • Baum C.
      • Connor L.T.
      Changing face of stroke: implications for occupational therapy practice.
      A mild stroke occurs when a doctor identifies a lesion in a person’s brain using a brain scan, but the person is still able to do everyday activities, such as getting dressed.
      • Hu X.
      • Heyn P.C.
      • Schwartz J.
      • Roberts P.
      What is mild stroke?.
      After a mild stroke (even months or years later), you may experience mental health conditions due to brain damage caused by the stroke or the stress of being in the hospital. Your mental health is just as important as your physical health. If you are experiencing mental health concerns, it is important that you get the help you need. This handout is designed to help people with mild stroke and their care partners identify and get appropriate care for mental health conditions following a mild stroke.

      How can I recognize mental health concerns?

      People with mental health conditions report feeling not like themselves. If you are experiencing mental health problems, you might feel sad, unmotivated, tired, or anxious. While everyone feels some of these emotions from time to time, you should seek help if you experience signs or symptoms of a mental health condition over several weeks, if your mental health impacts your ability to do your regular activities, or if you notice changes in your personality. Table 1 describes the signs and symptoms of different mental health conditions that commonly affect people after mild stroke.
      Table 1Mental health conditions associated with mild stroke
      Mental Health ConditionPercentage of People With Mild Stroke With This Condition:Signs or Symptoms May Include:
      Depression
      • Shi Y.
      • Xiang Y.
      • Yang Y.
      • et al.
      Depression after minor stroke: prevalence and predictors.
      • Altieri M.
      • Maestrini I.
      • Mercurio A.
      • et al.
      Depression after minor stroke: prevalence and predictors.
      30%-40%
      • Feeling of sadness
      • Loss of interest in usual activities
      • Difficulty paying attention
      • Eating a lot more or a lot less than usual
      • Sleeping a lot more or a lot less than usual
      • Feeling unmotivated or “forgetful”
      • Feeling hopeless
      • Having thoughts of hurting oneself
      Anxiety
      • Schöttke H.
      • Giabbiconi C.-M.
      Post-stroke depression and post-stroke anxiety: prevalence and predictors.
      • White J.H.
      • Attia J.
      • Sturm J.
      • Carter G.
      • Magin P.
      Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study.
      20%-50%
      • Worrying a lot about everyday things
      • Worrying about things related to the stroke (for example, worrying about being able to do previous activities, or worrying about having another stroke)
      • Unable to stop or control worrying
      • Feeling tense, restless, or exhausted
      • Experiencing unusual muscle aches, pains or headache
      Post-traumatic stress disorder
      • Bruggimann L.
      • Annoni J.M.
      • Staub F.
      • von Steinbüchel N.
      • Van der Linden M.
      • Bogousslavsky J.
      Chronic posttraumatic stress symptoms after nonsevere stroke.
      • Edmondson D.
      • Richardson S.
      • Fausett J.K.
      • Falzon L.
      • Howard V.J.
      • Kronish I.M.
      Prevalence of PTSD in survivors of stroke and transient ischemic attack: a meta-analytic review.
      • Favrole P.
      • Jehel L.
      • Levy P.
      • et al.
      Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study.
      5%-30%
      • Feeling tense or “on guard” all of the time
      • Difficulty sleeping
      • Nightmares
      • Thinking a lot about the stroke
      • Feeling angry or irritable
      Fatigue
      • Moran G.M.
      • Fletcher B.
      • Feltham M.G.
      • Calvert M.
      • Sackley C.
      • Marshall T.
      Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.
      20%-40%
      • Becoming tired easily, even after doing things that used to be easy
      • Difficulty doing multiple things at once
      • Difficulty paying attention
      Sleep disorder
      • Kim J.
      • Kim Y.
      • Yang K.I.
      • Kim D.
      • Kim S.A.
      The relationship between sleep disturbance and functional status in mild stroke patients.
      50%-70%
      • Difficulty falling asleep or staying asleep

      Is it possible to have more than 1 mental health condition?

      Yes, it is possible to have more than 1 mental health condition because these conditions are often interrelated. For example, if you are not sleeping well, you may feel fatigued and depressed. Also, the experience of having a stroke can be stressful and can worsen existing mental health conditions.

      Toughing it out vs getting help

      It is important to recognize that mental health concerns are common among stroke survivors and nothing to be ashamed of. Having a stroke is a both major life event and a disruption in brain activity. Having mental health concerns is not a sign of weakness or cause of shame. It just means you need a little extra help. Never be ashamed to get the help and support you need. Talk to your health care provider know if you are experiencing mental health concerns.

      What will my health care provider do?

      To diagnose a mental health condition, your health care provider may ask you some questions or have you fill out a survey to determine if you have a mental health condition. Sometimes, they may refer you to another health care professional like a psychologist, psychiatrist, neurologist, or counselor. Learn more about mental health conditions and take online screenings using resources like http://www.mentalhealthamerica.net/mental-health-screening-tools.

      What is the treatment for mental health conditions?

      The good news is that treatment can help people with mental health conditions feel better. There are a variety of treatment options available to you depending on your symptoms. Talk to your health care professional about what treatments might be right for you. Treatments range from exercise or attending a support group to intensive talk therapy with a mental health professional or medication changes.
      Table 2 describes some of the different treatments your help care team might recommend to address your mental health concerns. It is important to note that mental health treatments can take several weeks to start working. Once started, mental health treatment should not be stopped without talking to the health care team.
      Table 2Mental health treatments for people with mild stroke
      What is the Name of the Treatment?Who Benefits From the Treatment?What Would the Treatment Look Like for You?
      Self-Care
       Exercise
      • Deslandes A.
      • Moraes H.
      • Ferreira C.
      • et al.
      Exercise and mental health: many reasons to move.
      People with all mental health conditionsExercise promotes good mental health. You would engage in a range of physical activity such as
      • Fast-paced (aerobic) exercise (eg, a brisk walk or dancing)
      • Strength training (eg, lifting weights)
      • Stretching (eg, yoga)
      You should check with your doctor to make sure it is safe to engage in different types of physical activity. Some exercises may need to be modified due to the mild stroke.
       Pacing for fatigue
      • Zedlitz A.M.
      • Rietveld T.C.
      • Geurts A.C.
      • Fasotti L.
      Cognitive and graded activity training can alleviate persistent fatigue after stroke.
      People with fatiguePacing is a strategy developed in collaboration with a health care professional. You would learn the amount of energy you have in a typical day and then plan your day accordingly.
       Socialize with friends and family and continue regular routinesPeople with anxiety or depressionYou would try to maintain your routines, like getting out of bed and getting dressed at the same time every day. You would also work to remain engaged in your previous social activities, such as going to religious services or civics groups.
       Support groups for people with mild stroke and their family members
      • Morris R.
      • Morris P.
      Participants’ experiences of hospital-based peer support groups for stroke patients and carers.
      • Ch’Ng A.M.
      • French D.
      • McLean N.
      Coping with the challenges of recovery from stroke.
      People with mental health conditions and family membersYou and your family members would share your stroke recovery story to a group of peers. You would hear your peers’ stories and learn what strategies they have found most helpful.
      Talk Therapy
       Acceptance & commitment therapy
      • A-Tjak J.G.
      • Davis M.L.
      • Morina N.
      • Powers M.B.
      • Smits J.A.
      • Emmelkamp P.M.
      A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.
      People with anxiety or depressionYou would talk with a psychologist or counselor to recognize your reactions to life events. Then you would select actions that are consistent with your goals and values.
       Behavioral activation
      • Mazzucchelli T.
      • Kane R.
      • Rees C.
      Behavioral activation treatments for depression in adults: a meta-analysis and review.
      People with depressionYou would talk with a psychologist or counselor to identify activities that you used to enjoy. Then you would try to re-engage and become more active.
       Cognitive-behavioral therapy
      • Lincoln N.B.
      • Flannaghan T.
      Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial.
      People with anxiety, depression, sleep issues, or fatigueYou would talk with a psychologist or counselor to identify negative thoughts. Then you would finding new positive ways to think and develop new coping strategies.
      Medications
       Medications for stroke and side effects of medicationsPeople with all mental health conditionsPeople with mild stroke often get medications to manage their health and reduce the risk of having another stroke. In some people, their existing medications can cause side effects (like fatigue and depression). A doctor and pharmacist would evaluate your current medications and may adjust medications to improve mental health.
       Medications for mental health
      National Institute of Mental Health
      Mental health medications.
      People with all mental health conditionsDoctor may prescribe a new medication specifically for the treatment of mental health issues.

      What should I do in a mental health crisis?

      A metal health crisis is when a person feels like hurting themselves or someone else. If you are having a mental health crisis, you should get help immediately. You can talk to a friend or family member or a trusted health care professional. If you want to talk to someone anonymously, you can contact the Crisis Hotline 1-800-273-TALK (8255) or text 741741. In case of emergency, you should call 911.
      Resources
      Tabled 1
      ResourceDescriptionContact
      If you want more information…
       American Stroke AssociationLearn more about stroke and find stroke-based supports.http://www.strokeassociation.org
       National Alliance on Mental IllnessLearn more about mental health conditions, treatment options, local support services, legal issues, and support for family members.Text NAMI to 741741

      1-800-950-NAMI (6264)

      https://www.nami.org/
       Mental Health AmericaTake a screening test for mental health conditions and use the database to find local mental health resources.http://www.mentalhealthamerica.net
      If you want to talk to someone…
       National Stroke AssociationPeople with mild stroke, caregivers, and family members can speak with call-center volunteers.1-800-STROKES (787-6537), menu option 3

      http://www.stroke.org/stroke-resources/stroke-help-line
       Stroke Family WarmlinePersons who have questions about stroke or who just want to talk to another stroke survivor or family member can contact the Stroke Family Warmline.1-888-4-STROKE (7653)
      If you are having a crisis…
       National Suicide Prevention HotlinePersons who feel like hurting themselves can reach out to the National Suicide Prevention Hotline at any time of day or night.1-800-273-TALK (8255)

      Text 741741

      https://suicidepreventionlifeline.org/

      Authorship

      This page was developed through the Health Wellness Taskforce of the American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group by Alexandra L. Terrill, PhD, Jaclyn K. Schwartz, PhD, OTR/L (e-mail address: [email protected] ), and Samir Belagaje, MD.

      Disclaimer

      This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.

      Acknowledgment

      Dr Terrill received NIH NCMRR award number R03HD091432 (PI: Terrill).

      References

        • Wolf T.J.
        • Baum C.
        • Connor L.T.
        Changing face of stroke: implications for occupational therapy practice.
        Am J Occup Ther. 2009; 63: 621-625
        • Hu X.
        • Heyn P.C.
        • Schwartz J.
        • Roberts P.
        What is mild stroke?.
        Arch Phys Med Rehabil. 2017; 98: 2347-2349
        • Shi Y.
        • Xiang Y.
        • Yang Y.
        • et al.
        Depression after minor stroke: prevalence and predictors.
        J Psychosom Res. 2015; 79: 143-147
        • Altieri M.
        • Maestrini I.
        • Mercurio A.
        • et al.
        Depression after minor stroke: prevalence and predictors.
        Eur J Neurol. 2012; 19: 517-521
        • Schöttke H.
        • Giabbiconi C.-M.
        Post-stroke depression and post-stroke anxiety: prevalence and predictors.
        Int Psychogeriatr. 2015; 27: 1805-1812
        • White J.H.
        • Attia J.
        • Sturm J.
        • Carter G.
        • Magin P.
        Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study.
        Disabil Rehabil. 2014; 36: 1975-1982
        • Bruggimann L.
        • Annoni J.M.
        • Staub F.
        • von Steinbüchel N.
        • Van der Linden M.
        • Bogousslavsky J.
        Chronic posttraumatic stress symptoms after nonsevere stroke.
        Neurology. 2006; 66: 513-516
        • Edmondson D.
        • Richardson S.
        • Fausett J.K.
        • Falzon L.
        • Howard V.J.
        • Kronish I.M.
        Prevalence of PTSD in survivors of stroke and transient ischemic attack: a meta-analytic review.
        PLoS One. 2013; 8e66435
        • Favrole P.
        • Jehel L.
        • Levy P.
        • et al.
        Frequency and predictors of post-traumatic stress disorder after stroke: a pilot study.
        J Neurol Sci. 2013; 327: 35-40
        • Moran G.M.
        • Fletcher B.
        • Feltham M.G.
        • Calvert M.
        • Sackley C.
        • Marshall T.
        Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.
        Eur J Neurol. 2014; 21: 1258-1267
        • Kim J.
        • Kim Y.
        • Yang K.I.
        • Kim D.
        • Kim S.A.
        The relationship between sleep disturbance and functional status in mild stroke patients.
        Ann Rehabil Med. 2015; 39: 545
        • Deslandes A.
        • Moraes H.
        • Ferreira C.
        • et al.
        Exercise and mental health: many reasons to move.
        Neuropsychobiology. 2009; 59: 191-198
        • Zedlitz A.M.
        • Rietveld T.C.
        • Geurts A.C.
        • Fasotti L.
        Cognitive and graded activity training can alleviate persistent fatigue after stroke.
        Stroke. 2012; 43: 1046-1051
        • Morris R.
        • Morris P.
        Participants’ experiences of hospital-based peer support groups for stroke patients and carers.
        Disabil Rehabil. 2012; 34: 347-354
        • Ch’Ng A.M.
        • French D.
        • McLean N.
        Coping with the challenges of recovery from stroke.
        J Health Psychol. 2008; 13: 1136-1146
        • A-Tjak J.G.
        • Davis M.L.
        • Morina N.
        • Powers M.B.
        • Smits J.A.
        • Emmelkamp P.M.
        A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.
        Psychother Psychosom. 2015; 84: 30-36
        • Mazzucchelli T.
        • Kane R.
        • Rees C.
        Behavioral activation treatments for depression in adults: a meta-analysis and review.
        Clin Psychol Sci Pract. 2009; 16: 383-411
        • Lincoln N.B.
        • Flannaghan T.
        Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial.
        Stroke. 2003; 34: 111-115
      1. National Stroke Association. Medications.
        (Available at:) (Accessed June 13, 2018)
        • National Institute of Mental Health
        Mental health medications.
        (Available at:) (Accessed June 13, 2018)