Psychiatric disorders in patients suffering from an acute cerebrovascular accident or traumatic injury, and their effects on rehabilitation: an observational study

Abstract

Background: The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes.

Aim: In this study our aims were: (1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; (2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables.

Design: The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here.

Setting: The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study.

Population: The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program.

Methods: The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the mini-international neuropsychiatric interview plus (MINI Plus) and, respectively, with the functional independent measure (FIM). In case of post-traumatic stress disorder (PTSD), severity was assessed through the Davidson's Trauma scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models.

Results: The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninety-three patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported by 55 patients (24.2%) Compared to the rest of the study population, these subjects had more psychopathologic complaints (P<0.001). Mean total FIM score was 54.4 (SD=17.8) and 61.2 (SD=19.6) in patients with and without psychopathology (P<0.01) Independent predictors of psychopathology included past psychiatric history, lower total FIM scores, and limb amputation. Depression was predicted by history of psychiatric disorders and lack of partner.

Conclusion: History of psychiatric disorders is the most relevant factor associated with psychopathology in patients with an acute cerebrovascular accident or traumatic injury, followed by lower total FIM scores, and type of pathologic event.

Clinical rehabilitation impact: The presence of psychiatric disorders may potentially influence the rehabilitation process and outcomes; thus their recognition and management are key factors during a rehabilitation program.