Psychiatric Illness May Increase Short-term Stroke Risk

Short-term stroke risk appears higher in patients hospitalized for or in those who receive emergency room treatment for psychiatric disorders, according to research presented at the American Stroke Association’s 2017 International Stroke Conference.

Researchers analyzed the Healthcare Cost and Utilization Project database for California and found 52,068 patients with stroke between 2007 and 2009. Of these patients, 3337 were either hospitalized or treated in the emergency department for depression, anxiety, posttraumatic stress disorder or other psychiatric disorders.

“Psychological distress may send the body’s fight-or-flight response into overdrive, causing increased blood pressure,” which is the number 1 risk factor for stroke, according to a news release.

Using a case-crossover analysis, Jonah P. Zuflacht, lead researcher and a fourth-year medical student at Columbia University’s College of Physicians and Surgeons in New York City, and colleagues found that psychiatric distress leading to a hospital visit increased the odds of stroke, the leading cause of disability in the country, within 5 periods. (According to the American Heart Association’s Heart Disease and Stroke Statistical Update, 795,000 Americans have a stroke every year, causing 129,000 deaths.)

The odds of a stroke were:

• 3.48 times higher within 15 days,
• 3.11 times higher within 30 days,
• 2.41 times higher within 90 days,
• 2.23 times higher within 180 days, and
• 2.61 times higher within 360 days.

“Psychologic distress may also cause changes within cells that trigger inflammation and oxidative stress,” according to the news release, “both of which are thought to increase stroke risk.”

Zuflacht acknowledged that patients undergoing psychological distress might forget to take prescribed medication to reduce stroke risk. He also cited other limitations on the research, including reliance on the patient’s subjective recall of distress. In addition, detailed information about each patient was lacking, which might suggest other factors that increase stroke risk or provide insight into which psychiatric conditions had a stronger association with stroke than others. Researchers also did not include data on psychiatric conditions from outpatient settings in their study.

“Healthcare professionals should listen to their patients for symptoms of psychiatric illness, especially in those who may be at increased risk of stroke,” Zuflacht said in the news release. “A patient with high blood pressure, high cholesterol and six months of depressive symptoms should raise concerns regarding possible stroke risk.”

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