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*Ajiboye PO 1, Abiodun OA 1, Tunde-Ayinmode MF 1, Buhari OIN1, Sanya EO 2, Wahab KW 2
1. Department of Behavioural Sciences, University of Ilorin/ University of Ilorin Teaching Hospital, Ilorin,
Kwara State, Nigeria.
2. Department of Medicine, Neurology division, University of Ilorin/ University of Ilorin Teaching Hospital,
Ilorin, Kwara State, Nigeria.
Abstract
Back ground: Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated
with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning
of stroke survivors.
Objective: To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology
outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin- Nigeria.
Methods: All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed
for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year
(March 2009 to February 2010).
Results: Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study
population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use
(2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and
sociodemographic variables were not significantly associated with psychiatric morbidity.
Conclusion: Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these
psychiatric co- morbidities could thus help to improve the overall quality of life of these patients.
Key words: Psychiatric, morbidity, stroke patients, neurology, Nigeria
African Health Sciences 2013; 13(3): 624 - 631http://dx.doi.org/10.4314/ahs.v13i3.15
Introduction
The World Health Organization defines Stroke as PSD is one of the commonest
rapidly developing clinical signs of focal (or global neuropsychiatric complications associated with
) disturbance of cerebral function, with symptoms stroke. Prevalence rate varies depending on the setting
lasting 24 hours or longer or leading to death with in which the patient was examined. Studies from
no apparent cause other than of vascular origin1. developed countries have reported prevalence rates
Stroke is the most common cause of mortality of 21.6% for major depression and 20.0% for minor
worldwide and the third most common in developed depression in acute rehabilitation hospitals 6-12, and
countries 2, 3 . Stroke produces a wide range of 24.0% and 23.0% respectively in the outpatient clinics
mental/emotional disorders 4, 5 . Some of the in which duration of stroke varies between 3 months
neuropsychiatric disorders associated with stroke and 3 years8, 13-18. Significant association between lesion
include post stroke depression (PSD), mania, Bipolar location and development of PSD has been reported
disorder, anxiety disorder, apathy without especially during the first few months following
depression, psychotic disorder, pathological affect stroke8, 19, and the most frequently associated lesion
and catastrophic reaction5. location is left- anterior lesion4. The time since
*Corresponding author: occurrence of stroke appears to be the most crucial
Peter .O. Ajiboye variable in determining whether there is increased
Department of Behavioural Sciences, frequency of mood disorders among patients with
University of Ilorin/ University of Ilorin Teaching injury or dysfunction to the frontal regions of the
Hospital left hemisphere4. In addition, physical disability has
P. O. BOX 825 GPO, Ilorin significant association with a greater frequency in
Ilorin, Kwara State, Nigeria PSD20. Patients with PSD with left hemispheric
Telephone: - +2348037211707 lesions have also been shown to have significantly
E- mail: poboye203@yahoo.com more cognitive impairment on Mini Mental State
Table 3: Comparison of clinical variables of stroke patients with psychiatric morbidity and stroke
patients without psychiatry morbidity attending UITH neurology clinic (March 2009- February
2010)
Clinical variables Stroke patients with Stroke patients X2 P value
psychiatric morbidity without psychiatric
N= 30 (%) morbidity
N = 53 (%)
Neurological diagnosis
Left hemispheric stroke 17 (56.7) 30 (56.6) 4.212 0.239
Right hemispheric stroke 11 (36.6) 22 (41.5)
Lacuna stroke 2 (6.7) 0
SAH 0 1 (1.9)
Physical disability
No disability 0 2 (3.8) 2.467 0.651
Left hemi paresis 12(40) 18(34)
Right hemi paresis 15(50) 26 (49)
Expressive dysphasia 3 (10) 5 (9.4)
Facial nerve palsy 0 2 (3.8)
Hypertension
Yes 21 (70) 39 (73.6) 0.123 0.726
No 9 (30) 14 (26.4)
Diabetes
Yes 4 (13.3) 9 (17.0) 0.225 0.635
No 26 (86.7) 44 (83.0)
Alcohol use
Yes 5 (16.7) 3 (5.7) 1.588 0.208
No 25 (83.3) 50 (94.3)
Cigarette smoking
Yes 1 (3.3) 3 (5.7) 0.226 0.634
No 29 (96.7) 50(94.3)
SAH - Subarachnoid haemorrhage
Discussion
The prevalence of psychiatric morbidity recorded interview was conducted and stroke patients who
in this study was 36.0%. This prevalence is higher died within 30 days of their index stroke from the
than prevalence of 9.1% reported by Williams et al commencement of the study were excluded from
37
, similar to 36.6% reported by Almeida et al38, but the study. Patients who had diagnosis recorded
lower than 49-54.7% reported by other researchers against their names could have been those with severe
39-40
. All the other reports were from the developed illness and under diagnosis would therefore have
countries. Methodological differences and the settings accounted for the low prevalence rate reported 37.
under which the studies were conducted could have On the other hand, Almeida et al 38, in a study
partly accounted for the wide variations in prevalence conducted in Western Australian among stroke
rates from the different studies. For instance, a patients, prospectively followed up the patients for
prevalence of 9.1% was obtained by extracting data 2 years following the index stroke and recorded a
from the United States Department of Veterans psychiatric morbidity rate of 36.6%. Also, Beghi et
Affairs administrative database; no structured al 39 in a study from Italy conducted over a period