Background and Objective: The main objective of our study was to detail the frequency and clinical determinants of poststroke generalized anxiety disorders in a large, well-defined stroke cohort. Methods: A total of 277 stroke patients aged 55–85 were subjected to a comprehensive psychiatric evaluation between 3 and 4 months after ischemic stroke. Primary generalized anxiety disorder or generalized anxiety disorder due to stroke were diagnosed according to DSM-IV symptom criteria. Results: The frequency of any generalized anxiety disorder was 20.6% (n = 57). According to a logistic model, any generalized anxiety disorder was associated with a history of epilepsy, comorbid depressive disorder, severity of depression, severity of anxiety, and the use of anxiolytic drugs. A discriminant analysis identified four factors that distinguished the two diagnostic subgroups from one another: the level of psychosocial functioning (worse score in patients with generalized anxiety due to stroke), a history of migraine, anterior circulation stroke localization (more frequent in patients with generalized anxiety disorder due to stroke), and a history of insomnia (more frequent in patients with primary generalized anxiety disorder). Conclusions: Clinically significant anxiety is common in ischemic stroke patients and may hamper their rehabilitation.

Keywords:
Anxiety, Generalized anxiety, Stroke, Cerebrovascular disorders
1.
Robinson RG: Neuropsychiatric consequences of stroke. Annu Rev Med 1997;48:217–229.
2.
Robinson RG: The Clinical Neuropsychiatry of Stroke: Cognitive, Behavioral, and Emotional Disorders Following Vascular Brain Injury. Cambridge, Cambridge University Press, 1998.
3.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19.
4.
Beekman AT, Bremmer MA, Deeg DJ, Balkom AJ, Smit JH, Beurs ED, Dyck RV, Tilburg WV: Anxiety disorders in later life: A report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry 1998;13:717–726.
5.
Wise MG, Taylor SE: Anxiety and mood disorders in medically ill patients. J Clin Psychiatry 1990;51(suppl):27–32.
6.
Marcus S, Olfson M, Pincus H, Shear M, Zarin D: Self-reported anxiety, general medical conditions, and disability bed days. Am J Psychiatry 1997;154:1766–1768.
7.
Pohjasvaara T, Leppävuori A, Siira I, Vataja R, Kaste M, Erkinjuntti T: Frequency and clinical determinants of poststroke depression. Stroke 1998;29:2311–2317.
8.
Vataja R, Pohjasvaara T, Leppävuori A, Mäntylä R, Aronen H, Salonen O, Kaste M, Erkinjuntti T: Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry 2001;58:925–931.
9.
Leppävuori A, Pohjasvaara T, Vataja R, Kaste M, Erkinjuntti T: Insomnia in ischemic stroke patients. Cerebrovasc Dis 2002;14:90–97.
10.
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Dementia three months after stroke: Baseline frequency and effect of different definitions for dementia in the Helsinki Aging Memory Study (SAM) cohort. Stroke 1997;28:785–792.
11.
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years. Stroke 1997;28:729–735.
12.
Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental State’: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
13.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Rehabilitation 1965;4:61–65.
14.
Mäntylä R, Erkinjuntti T, Salonen O, Aronen HJ, Peltonen T, Pohjasvaara T, Standertskjöld-Nordenstam C-G: Variable agreement between visual rating scales for white matter hyperintensities on MRI. Comparison of 13 rating scales in a poststroke cohort. Stroke 1997;28:1614–1623.
15.
Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, and the TOAST Investigators: Classification of subtype of acute ischemic stroke: Definitions for use in a multicenter clinical trial. Stroke 1993;24:35–41.
16.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke: Background and study protocol. Stroke 1985;16:885–890.
17.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3, revised. Washington, American Psychiatric Association, 1987.
18.
World Health Organization: SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Geneva, WHO, 1992.
19.
Wing JK, Cooper JE, Sartorius N: Measurement and Classification of Psychiatric Symptoms: Instruction Manual for the PSE and CATEGO System. London, Cambridge University Press, 1974.
20.
Wing JK, Babor, T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N: SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 1990;47:589–593.
21.
Zung WWK: A rating instrument for anxiety disorders. Psychosomatics 1971;12:271–279.
22.
Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
23.
American Psychiatric Association: The Global Assessment of Functioning (GAF) Scale; in American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders ed 3, revised. Washington, American Psychiatric Association, 1987.
24.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
25.
BMDP New System for Windows. Los Angeles, BMDP, 1994.
26.
SPSS 10.0 for Windows, Chicago, SPSS Inc., 1999.
27.
SAS Version 8. SAS/STAT Users’s Guide. Cary, SAS Institute Inc., 1999.
28.
Starkstein SE, Cohen BS, Fedoroff P, Parikh RM, Price TR, Robinson RG: Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. Arch Gen Psychiatry 1990;47:246–251.
29.
Castillo CS, Starkstein SE, Fedoroff P, Price TR, Robinson RG: Generalized anxiety disorder after stroke. J Nerv Ment Dis 1993;181:100–106.
30.
Castillo CS, Schultz SK, Robinson RG: Clinical correlates of early-onset and late-onset poststroke generalized anxiety. Am J Psychiatry 1995;152:1174–1179.
31.
Åström M: Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke 1996;27:270–275.
32.
Sharpe M, Hawton K, House A, Molyneux A, Sandercock P, Bamford J, Warlow C: Mood disorders in long-term survivors of stroke: Associations with brain lesion location and volume. Psychol Med 1990;20:815–828.
33.
House A, Dennis M, Mogridge L, Warlow C, Hawton K, Jones L: Mood disorders in the year after stroke. Br J Psychiatry 1991;158:83–92.
34.
Burvill PW, Johnson GA, Jamrozik KD, Anderson CS, Stewart-Wynne EG, Chakera TM: Anxiety disorders after stroke: Results from the Perth Community Stroke Study. Br J Psychiatry 1995;166:328–332.
35.
Schultz SK, Castillo CS, Kosier JT, Robinson RG: Generalized anxiety and depression. Assessment over 2 years after stroke. Am J Geriatr Psychiatry 1997;5:229–237.
36.
Johnson GA, Burvill PW, Jamrozik KD, Anderson CS, Jamrozik K, Stewart-Wynne EG, Chakera TM: Screening instruments for depression and anxiety following stroke: Experience in the Perth community stroke study. Acta Psychiatr Scand 1995;91:252–257.
37.
Breslau N, Davis G: Migraine, physical health and psychiatric disorder: A prospective epidemiologic study in young adults. J Psychiatr Res 1993;27:211–221.
38.
Merikangas KR, Angst J, Isler H: Migraine and psychopathology. Results of the Zurich cohort study of young adults. Arch Gen Psychiatry 1990;47:849–853.
39.
Perini G, Tosin C, Carraro C, Bernasconi G, Canevini M, Canger R, Pellegrini A, Testa G: Interictal mood and personality disorders in temporal lobe epilepsy and juvenile myoclonic epilepsy. J Neurol Neurosurg Psychiatry 1996;61:601–605.
40.
Stavrakaki C, Vargo B: The relationship of anxiety and depression: A review of the literature. Br J Psychiatry 1986;149:7–16.
41.
Shimoda K, Robinson RG: Effects of anxiety disorder on impairment and recovery from stroke. J Neuropsychiatry Clin Neurosci 1998;10:34–40.
42.
Dennis M, O’Rrourke S, Lewis S, Sharpe M, Warlow C: Emotional outcomes after stroke: Factors associated with poor outcome. J Neurol Neurosurg Psychiatry 2000;68:47–52.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.