Introduction: Studies in patients with stroke or subarachnoid hemorrhage have identified demographic characteristics that are associated with an increased risk of developing posttraumatic stress disorder (PTSD). Such risk factors have yet to be identified in the setting of intracerebral hemorrhage.
Methods: All patients presented to the Columbia Neuro-ICU with spontaneous-ICH between 2/2009 and 3/2012 were selected. Demographic, radiographic, and clinical variables were collected upon admission. Twenty-eight patients were able to complete the PCL-C, a 17-item, 5-point Likert scale per item questionnaire for PTSD, in a follow-up interview. Two PTSD definitions were used: a common definition of a sum score of = 30 on the PCL-C, and the DSM-IV definition of at least 1 item with = 3 points in questions 1-5, at least 3 items with = 3 points in questions 6-12, and at least 2 items with = 3 points in questions 13-17.
Results: Ten patients completed the questionnaire at 3-month follow-up, 6 at 6 months, and 12 at 12 months. There was no significant association between either definition of PTSD and time to follow-up. The median (IQR) PCL-C sum score for our cohort was 25.5 (21.0-32.5), and 8 (28.6%) had a PCL-C score = 30. White race (p = 0.038) was the only significant association with a PCL-C sum score of = 30. Three patients (10.7%) had PTSD consistent with the DSM-IV definition, and they only shared three symptoms (responses = 3): physical symptoms on remembrance, feeling emotionally distant, and hypervigilence.
Conclusions: In our cohort, a small percentage met the DSM-IV definition of PTSD, though an association between White race and a previously identified cutoff for likely PTSD was found. Further studies are needed to standardize the definition of PTSD in the setting of ICH and identify relevant predictors. Given previous research on the association of elevated PTSD symptoms and adverse outcomes in acute coronary syndrome patients, and the association between PTSD symptoms and nonadherence to medications in stroke patients, such research should be given high priority.
Patient Care: Physicians should be aware of the psychiatric as well as the physical effects of neurological diseases on patients. Given that intracerebral hemorrhage is a devastating stroke and neurological injury, it is important to be aware of mental health sequelae and for physicians to be able to recognize and address symptoms of psychiatric illness in their patients. Raising awareness of the impact of neurological injury on mental health will allow physicians to provide better and more complete care for their patients, and maximize the chance of a meaningful recovery to an acceptable quality of life.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the impact of intracerebral hemorrhage on the mental health of patients 2) Identify symptoms of Post-Traumatic Stress Disorder in patients who are recovering or have recovered from any neurological injury.