Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

Table 1 Features of neuropsychiatric disorders after stroke

Disorders	Prevalence/ frequency, %	Main clinical manifestations	Screening tools	Identification	Management and treatment
Depressive disorders after stroke	5-84	Depressed mood; marked reduction in interest or pleasure in activities; decreased/increased appetite/weight; insomnia or hypersomnia; psychomotor agitation/retardation; loss of energy/fatigue; feelings of worthlessness/inappropriate guilt; loss of concentration; appear pessimistic about health issues/recurrent thoughts of death or suicide	Center for epidemiological studies-depression scale; hospital anxiety depression scale; Hamilton depression rating scale; beck depression inventory; geriatric depression scale; PHQ-9	According to the DSM-5 classification, PSD is defined as a depressive disorder due to TIA or stroke.	SSRIs and SNRIs; psychological intervention; mental and physical exercise; neuromodulation
Anxiety disorders after stroke	20-24	Prominent anxiety; excessive fear, worry, and concern about health issues; intense dread or uneasiness; panic attacks, or obsessions or compulsions predominate	Hamilton anxiety scale; hospital anxiety and depression scale-anxiety subscale	According to the DSM-5 classification, PSA is defined as an anxiety disorder due to TIA or stroke.	SSRIs; Tricyclic antidepressant; benzodiazepines; “Z-drugs" (zolpidem, zaleplon and eszopiclone); psychological interventions; mind-body interventions
PTSD after stroke	8.3-29.6	Intrusive memories; alterations in physical reactions and arousal; avoidance; negative alterations in cognition and mood	PTSD checklist for a stressor, TIA or stroke as stressor; clinician administered PTSD scale; impact of events scale-revised; posttraumatic stress diagnostic scale; structured clinical interview for DSM	PTSD is related to TIA or stroke which creates psychological trauma in response to actual or threatened death, serious injury, and adverse life events.	Psychotherapeutic approach procedures; antidepressants, anxiolytics sympathetic inhibitor, antipsychotics, anticonvulsants, and sedative drugs
Psychosis and psychotic disorders after stroke	4.67-5.05	Hallucinations or delusions; disorganized speech; catatonic or inappropriate motor behavior	Neuropsychiatric inventory	According to the DSM-5 classification post-stroke psychotic disorders are defined as psychotic disorders due to TIA or stroke.	Antipsychotic drugs; neuromodulation and psychosocial therapy; psychological intervention

TIA: Transient ischemic attacks; SSRIs: Selective serotonin reuptake inhibitors; SNRIs: Serotonin-norepinephrine reuptake inhibitors; PSD: Post-stroke depressive; PSA: Post-stroke anxiety; PTSD: Post-traumatic stress disorder; PHQ-9: 9-item patient health questionnaire; DSM-5: Diagnostic and statistical manual of mental disorders.