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Nwafor, D.C.; Kirby, B.D.; Ralston, J.D.; Colantonio, M.A.; Ibekwe, E.; Lucke-Wold, B. Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage. Encyclopedia. Available online: https://encyclopedia.pub/entry/44793 (accessed on 16 August 2024).
Nwafor DC, Kirby BD, Ralston JD, Colantonio MA, Ibekwe E, Lucke-Wold B. Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage. Encyclopedia. Available at: https://encyclopedia.pub/entry/44793. Accessed August 16, 2024.
Nwafor, Divine C., Brandon D. Kirby, Jacob D. Ralston, Mark A. Colantonio, Elochukwu Ibekwe, Brandon Lucke-Wold. "Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage" Encyclopedia, https://encyclopedia.pub/entry/44793 (accessed August 16, 2024).
Nwafor, D.C., Kirby, B.D., Ralston, J.D., Colantonio, M.A., Ibekwe, E., & Lucke-Wold, B. (2023, May 24). Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage. In Encyclopedia. https://encyclopedia.pub/entry/44793
Nwafor, Divine C., et al. "Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage." Encyclopedia. Web. 24 May, 2023.
Neuropsychiatric and Neurocognitive Sequelae Following Subarachnoid Hemorrhage
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This entry is adapted from the peer-reviewed paper 10.3390/jvd2020014

Subarachnoid hemorrhage (SAH) is a medical emergency that requires immediate intervention. The etiology varies between cases; however, rupture of an intracranial aneurysm accounts for 80% of medical emergencies. Early intervention and treatment are essential to prevent long-term complications. Treatment of SAH has drastically improved, which is responsible for the rapid rise in SAH survivors. Post-SAH, a significant number of patients exhibit impairments in memory and executive function and report high rates of depression and anxiety that ultimately affect daily living, return to work, and quality of life.

subarachnoid hemorrhage (SAH) rehabilitation neuropsychiatric

1. Introduction

Subarachnoid hemorrhage (SAH) is a devastating condition with high mortality and morbidity rates and is often accompanied by significant physical, behavioral, and neurocognitive comorbidities [1]. These comorbidities present acutely (within three months) and persist long-term (up to two years) post-SAH [2][3]. The behavioral and neurocognitive sequelae associated with SAH include psychological distress affecting mood and anxiety, post-traumatic stress disorder (PTSD), social dependence, fatigue, and alterations in sexual function [3][4].
Regardless of SAH severity, a significant number of SAH patients develop neurocognitive and behavioral psychosocial issues due to several mechanisms that may include: organic brain injury secondary to vascular disruption; the unmasking of underlying neuropsychiatric conditions; development of PTSD following hospitalization; and associated life stressors (e.g., unemployment, etc.) [5][6]. 

2. Depression

Depression has been reported after SAH and appears to persist [7]. The frequency of depression following SAH is variable and depends on the timing of assessment following the SAH ictus. A recent meta-analysis by Tang et al. showed that the overall pooled frequency of depression was 26.3% post-SAH. Furthermore, the progression of depression from months to years in the SAH ictus also depended on the assessment tools utilized [8]. In another study, depressed mood occurred in 47% of patients during the first year of recovery post-SAH; notably, in the same study, non-Caucasian ethnicity was a risk factor for developing depression post-SAH [9]. Other premorbid conditions, including a prior history of mood disorders, tobacco use, alcohol use disorder, illicit drug use, chronic obstructive pulmonary disease, and non-English fluency, have been shown to increase the risk of depression following SAH [7][8]. Additionally, patients with posterior circulation aneurysm rupture have been shown to have significantly more problems with depression [10].
Depression significantly affects the patient’s quality of life, employment, and functional outcomes following SAH [9][11]. The mechanism for depression post-SAH remains unclear; some studies have proposed a link between low basal cortisol levels and depression post-SAH [12][13]. Given this association, future studies are warranted to investigate the contributions of the hypothalamic-pituitary-adrenal (HPA) axis in post-SAH-associated depression.
Despite the prevalence of depression post-SAH, there is a paucity of data on the treatment of post-SAH depression. In the general population, selective serotonin receptor inhibitors (SSRIs) are the first-line antidepressant drugs used to manage depression [14]. Given the risk of intracerebral hemorrhage (ICH) with SSRIs within the first month of use, the optimal initiation of antidepressants while exploring other pharmacological and multimodal treatment strategies needs to be studied in SAH survivors [15]. Such options for multimodal therapy may include light and music therapy, motivational interviewing, transcranial magnetic stimulation, ecosystem-focused therapy, etc.

3. Anxiety

Given the strong association between anxiety and depression, assessing anxiety in patients post-SAH is paramount. Similar to depression, the prevalence of anxiety post-SAH is dependent on the study tools utilized and the timing of the assessment. For instance, Barlet et al. showed a pooled anxiety prevalence of 32.2%, 19.2%, 40.5%, and 47.6% prevalence at 3, 6, 12, and 24 months, respectively, post-SAH. Using the State Trial Anxiety Inventory method, the overall increased anxiety burden post-SAH showed statistically increased anxiety symptoms of 39%, 41%, and 54% at 3 months, 1 year, and >2 years follow-up, respectively, post-SAH [16]. Passive coping strategies, unemployment at 6 months, and a prior history of a psychiatric disorder were associated with an increased risk of an anxiety disorder post-SAH [11]. Additionally, patients with posterior circulation aneurysm rupture have been shown to have significantly more problems with anxiety [10]. Further research is needed to delineate the brain circuits and neurochemical factors that perpetuate anxiety post-SAH.

4. PTSD

PTSD post-SAH is prevalent and associated with poor quality of life despite relatively good clinical outcomes [17][18][19]. The prevalence of PTSD following SAH ranges from 18–37% [17][18]. The variability in prevalence arises from differences in the assessment tools utilized and the timing of assessment. Importantly, significant others/caregivers (e.g., spouses, etc.) of patients who survived SAH have been shown to have increased symptomatology of PTSD. This finding is important given that PTSD in this subgroup could interfere with effectively administering care to SAH patients [20][21].
While the underlying mechanism for PTSD following SAH remains unclear, some studies have suggested that PTSD post-SAH may result from the patient’s adjustment to the experience of having had a SAH and the fear of recurrence [19][22][23]. Risk factors for PTSD post-SAH are similar to those for depression and anxiety. Notably, patients with a history of psychiatric disorders are more at risk of developing PTSD following SAH [17].

5. Sexual Dysfunction

Brain injury can affect the way patients express their sexuality. Many patients following brain injury have reported reduced sexual drive, reduced arousal, impotence, or increased compulsive sexual behaviors [24]. Sexual dysfunction as it relates to SAH is understudied; several studies have shown that both men and women report sexual dysfunction and dissatisfaction following stroke [25][26][27]. These findings become relevant when caring for patients post-SAH, since SAH can cause stroke secondary to hemorrhagic ischemia [28]. In another study, 9 of 19 women (47%) reported having sexual dysfunction according to the female sexual function index (FSFI) following an aneurysmal SAH (aSAH). Interestingly, all 19 of the women reported having hypoactive sexual desire disorder. The authors also noted that 7 of 14 men had erectile dysfunction using the International Index of Erectile Function (IIEF) [4]. While the exact mechanisms responsible for sexual dysfunction post-SAH remain unclear, some studies have suggested that hypothalamo-pituitary dysfunction may contribute to impaired sexual function post-SAH [29][30].

6. Cognitive Dysfunction

Cognitive dysfunction is a common issue following SAH due to the diffuse brain injury that occurs during the initial insult. Various cognitive domains may be affected, including memory, language, spatial processing, and executive function, even if patients appear relatively clinically normal at discharge [31]. Furthermore, many of these complications are long-term and continue to affect patients in the months following discharge, appearing to have a significant impact on quality of life and return to work [32][33][34]. In a retrospective study, 94.6% of patients evaluated 3 months post-SAH had at least one cognitive deficit, the most common being memory [35]. Despite the high probability of cognitive deficits in the SAH population, these complications go underreported [36].

References

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  13. Kreitschmann-Andermahr, I.; Poll, E.; Hutter, B.O.; Reineke, A.; Kristes, S.; Gilsbach, J.M.; Saller, B. Quality of life and psychiatric sequelae following aneurysmal subarachnoid haemorrhage: Does neuroendocrine dysfunction play a role? Clin. Endocrinol. 2007, 66, 833–837.
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  15. Renoux, C.; Vahey, S.; Dell’Aniello, S.; Boivin, J.F. Association of Selective Serotonin Reuptake Inhibitors With the Risk for Spontaneous Intracranial Hemorrhage. JAMA Neurol. 2017, 74, 173–180.
  16. Ackermark, P.Y.; Schepers, V.P.; Post, M.W.; Rinkel, G.J.; Passier, P.E.; Visser-Meily, J.M. Longitudinal course of depressive symptoms and anxiety after aneurysmal subarachnoid hemorrhage. Eur. J. Phys. Rehabil. Med. 2017, 53, 98–104.
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Subjects: Neurosciences
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Divine C. Nwafor
,
Brandon D. Kirby
,
Jacob D. Ralston
,
Mark A. Colantonio
,
Elochukwu Ibekwe
,
Brandon Lucke-Wold
View Times: 280
Revisions: 2 times (View History)
Update Date: 25 May 2023
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