Neuropsychiatric Sequela of Stroke: Mandatory Depression Screening on the Post-Stroke Patient

This presentation sheds light on the prevalence of post-stroke depression, its effects, and treatment recommendations. It emphasizes the significance of mandatory depression screening for post-stroke patients. The presentation also discusses the Planned Action Theory to develop activities that initiate change and the Knowledge Action Model to integrate theory and issue.

Neuropsychiatric Sequela of Stroke:
Mandatory Depression Screening on the
Post-Stroke Patient
Presented by:

Prevalence of Stroke
 15 million strokes each year worldwide (WSO, 2012)
 More than 795,000 strokes each year in the US
(NINDS, 2004).
 Disability and stroke is mainly caused by Neural
symptoms
 Chronic disabilities are primarily caused by Stroke
 Neuropsychiatric sequelae of stroke:
– pathologic affect, post-stroke dementia, post-stroke
depression, post-stroke lethargy. (Hackett, Yapa, Parag, &
Anderson, 2005)

Post-stroke Depression
 The most common type of neuropsychiatric sequela of
stroke.
 Estimated to be the second leading cause of disability
by 2020 (WHO, 2013)
 Depression affects post-stroke patients by
approximately one-third (Hackett et al., 2005)
 Post-stroke patients are 2.4 times likely to die within 10
years of diagnosis (Jia et al., 2006).
 33% of all stroke survivors exhibit depression
symptoms at anytime (Hackett et al., 2005)

Effects of Post-Stroke Depression
 Prolonged hospitalizations and longer
stay at rehabilitation facilities.
 14% prevalence in suicidal ideation (Jia
et al., 2006)
 Increased medication cost by 63%
compared to stroke patients (Husaini et
al., 2013).

Treatment Recommendations for
Post-stroke Depression
 The Canadian Best Practice
Recommendations for Stroke (Lindsay et
al., 2008)
 World Health Organization (WH0, 2012)
 Advanced Disease-Specific Care Certification
Requirements for Comprehensive Stroke Center
(CSC)

Compliance with Recommendations
In 2018:
– 395 patients admitted for ischemic stroke,
hemorrhagic stroke or transient ischemic attack
– Only 2% screened for depression
Not all stroke patients admitted at SDMC are
screened for depression
50% compliance (Hart & Morris, 2008).

Planned Action Theory to Develop
Activities that Initiate Change
Knowledge Action Model
(Field, Booth, Ilott, & Gerrish, 2014)

Integrating theory and issue
 Identify Issue
 Adapt knowledge
 Examine barriers
 Choose implementations
 Observe knowledge
 Assess outcomes
 Sustain knowledge
(Field, Booth, Ilott, & Gerrish, 2014)

Integrating theory and issue
Identify Problem
Post-depression
stroke
Failure to screen
stroke patients for
depression
Treatment options
that work
Adapt knowledge
 Implement
recommendations
 Screen post-
depression stroke
patients
 Referrals

Integrating theory and issue…
Assess barriers
Cost of screening
Training
Referral system
Further research
Select implementation
 Discuss the
significance with
stakeholders and
management
 Restructure referral
system
 Monitor outcomes

Integrating theory and issue…
Monitor knowledge
Observation
Active
measurement
Evaluate outcomes
 Quantitative methods
 Qualitative methods
 Formulation of
question of interest

Integrating theory and issue…
Sustain Knowledge
Resources
Policy integration
Leadership
Benefits and risks

Screening Protocol

Conclusion
 Post-depression stroke is a leading epidemic
that is lightly regarded
 Screening of stroke patients for any possibility
of depression is significant for effective
treatment of post-stroke depression patients
 Treatment protocol: Recommendations by the
World Stroke Organization (WSO, 2012)

References
Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a
citation analysis and systematic review. Implementation Science, 9(1), 172.
European Stroke Organisation (ESO) Executive Committee, & ESO Writing Committee. (2008). Guidelines
for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovascular
(Basel, Switzerland), 25(5), 457–507.
Hackett, M. L., Yapa, C., Parag, V., & Anderson, C. S. (2005). Frequency of depression after stroke: a
systematic review of observational studies. Stroke: A Journal of Cerebral Circulation, 36(6),
1330–1340.
Hart, S., & Morris, R. (2008). Screening for depression after stroke: an exploration of professionals’
compliance with guidelines. Clinical Rehabilitation, 22(1), 60–70.
Husaini, B., Levine, R., Sharp, L., Cain, V., Novotny, M., Hull, P., Moonis, M. (2013). Depression increases
stroke hospitalization cost: an analysis of 17,010 stroke patients in 2008 by race and gender.
Stroke Research and Treatment, 2013, 846732.
Jia, H., Damush, T. M., Qin, H., Ried, L. D., Wang, X., Young, L. J., & Williams, L. S. (2006). The impact of
poststroke depression on healthcare use by veterans with acute stroke. Stroke: A Journal of
Cerebral Circulation, 37(11), 2796–2801.
National Institute of Neurological Disorders and Stroke. (2004). What You Need to Know about Stroke.
Retrieved from Know stroke: http://stroke.nih.gov/materials/needtoknow.htm
World Health Organization. (2013). Gender and Women's Mental Health. Retrieved from World Health
Organization Mental Health: retrieved from
http://www.who.int/mental_health/prevention/genderwomen/en/
World Stroke Organization. (2012). World Stroke Campaign. Retrieved from https://www.world-
stroke.org/2016-12-19-10-55-24/post-stroke-checklist