TIA Increases Risk of PTSD

MedicalResearch.com Interview with:
Kathrin S. Utz, PhD
Department of Neurology
University of Erlangen-Nuremberg
Erlangen, German

Medical Research: What are the main findings of the study?

Dr. Utz: A transient ischemic attack is caused when there is a temporary disruption in the blood supply to a person’s brain. It causes the person to experience symptoms, similar to those of a stroke, such as speech and visual disturbance and numbness or weakness in the arms and legs. A transient ischemic attack is only temporary and people make a full physical recovery from it. We found, however, that a TIA is not without cost. Specifically, we found that such persons are at a greater risk of going on to develop the psychiatric condition known as posttraumatic stress disorder (PTSD). We found 1 in 3 patients develop it. PTSD, which is perhaps better known as a problem found in survivors of war zones and natural, can develop when a person experiences a frightening event that poses a serious threat. It leads the person to experience symptoms such as worry, nightmares, flashbacks and social isolation. We found that TIA patients who develop PTSD are also more likely to suffer from depression and anxiety symptoms. Taken together these symptoms pose a significant psychological burden for the affected patients and it therefore comes as no surprise that we also found TIA patients with PTSD have a measurably lower sense of quality of life than TIA patients who do not develop PTSD. We could also identify some potential risk-factors for the development of PTSD following a TIA. Younger patients and patients who overestimate their future stroke risk are more likely to develop PTSD. Also important in this context are the strategies that patients typically adopt to deal with stressful situations. Those patients who use certain types of coping strategies, such as denying the problem, blaming themselves for any difficulties or turning to drugs for comfort, face a greater risk of developing PTSD after TIA.


Medical Research: What was most surprising about the results?

Dr. Utz: Our study is the first to examine the frequency of PTSD in a group of patients who, at the time of assessment, had only experienced a TIA. Previous studies mixed together patients who had a TIA with patients who had a stroke, and with patients who had a TIA and also a stroke. This meant that it was impossible to tell whether any observed psychological problems were the consequence of a brain lesion, chronic disability, experience of the onset of neurological symptoms or resulted from the knowledge of an increased health risks. Therefore, in our study we excluded patients who were suspected of having had a stroke and focused on just those who had a TIA. We found about 30% of the TIA patients that we assessed were suffering from PTSD. This is 10 times more PTSD than would be expected based on general population estimates. Our result suggests that the experience of even transient neurological symptoms and/or the fear of future stroke are sufficient to trigger the development of PTSD.

Given that TIA patients experience only temporarily neurological symptoms which completely recover, without leaving brain lesions, the increased prevalence of PTSD and poor psychosocial outcome is noteworthy and deserves increased attention and prevention strategies. This means that brain lesions or disabilities cannot solely explain the increased prevalence of PTSD after neurological disorders.

Medical Research: What should clinicians and patients take away from your report?

Dr. Utz: A transient ischemic attack (TIA) is a fairly common neurological condition. Five out of 1000 people will experience a TIA at some point during their life. TIAs are brief episodes of stroke-like neurological symptoms such as sudden onset of numbness, weakness or paralysis, slurred speech, loss of language, sudden loss of memory, blurred vision, confusion, and severe headache. However, in contrast to a stroke, no residual impairment remains. Importantly, TIAs are considered to be a “warning sign” for a stroke. If left untreated patients who suffer a TIA are at an increased risk of suffering from a stroke in the future. For this reason it is important that patients experiencing a TIA should be referred to a neurological clinic. At the clinic risk factors for a future stroke will be assessed and steps will be undertaken to help the patient reduce their risk of suffering a stroke in future. This typically involves the administration of blood-thinning drugs, antihypertensive and/ or cholesterol-lowering medication.

If such a prevention therapy has been initiated, a TIA is seen as a fairly benign disorder at the moment. A few hours after the attack the neurological symptoms have typically resolved and so from a clinical point of view its main relevance comes from the fact that it provides an early warning of a potential future stroke. This warning is important since it allows clinicians to intervene to reduce the probability of a future stroke. However, we found that from a patient’s perspective a TIA is not so benign. While the neurological symptoms may have disappeared, serious psychological consequences of a TIA can be found three months after the event in around 30% of patients. For these patients a TIA is a very traumatic event that can leave them depressed, anxious and socially isolated. This shows that even a brief neurological disorder which in itself does not lead to chronic disability can be as traumatic as events such as traffic accidents and natural disasters. It is not yet entirely clear why some persons develop PTSD following a TIA, but others do not. However, what we do know at this stage is that younger patients and patients who in general find it difficult to cope with stress are more likely to develop psychological problems following a TIA. We also found that patients who overestimate their risk of suffering a future stroke are also more likely to show psychological problems. This suggests that we need to pay particular attention to younger patients and that teaching better stress-coping skills and careful briefing about the realistic stroke risk might offer a promising approach for the prevention of PTSD after TIA

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Utz: Future studies should include a longer follow-up assessment of the psychosocial outcome after TIA. We assessed the psychosocial status three months after a TIA; it would be interesting to know, how many of the patients still show PTSD, anxiety, depressive symptoms or reduced quality of life one year after a TIA. Furthermore, it would be of interest to investigate whether the training of adaptive stress-coping skills and the careful briefing about the realistic stroke risk can prevent PTSD after TIA.

Citation:

Increased Prevalence of Posttraumatic Stress Disorder in Patients After Transient Ischemic Attack
Ines C. Kiphuth, Kathrin S. Utz, Adam J. Noble, Martin Köhrmann, and Thomas Schenk

Stroke. 2014;STROKEAHA.113.004459published online before print October 2 2014, doi:10.1161/STROKEAHA.113.004459