What happens after a stroke? Assessing and treating emotional changes post-stroke
Web chat on Monday 31 October, 12.30 to 1.30pm.
In recognition of World Stroke Day on Saturday 29 October, Ismalia de Sousa, clinical nurse specialist in stroke at Imperial College Healthcare NHS Trust, ran a live web chat on Monday 31 October.
Around 25 per cent of patients will have anxiety following a stroke, and depression can also be a challenging emotional consequence. During our live chat, we will be discussing the emotional challenges following a stroke, and how they affect patients, their families and carers and healthcare professionals. This will include:
What is a stroke and how many people does it affect?
What are the ways to assess and treat emotional changes post-stroke?
What are the emotional responses people may experience after a stroke?
How long does it take to recover from stroke?
What should patients and their families know about recovering from a stroke?
Ismalia qualified in Portugal, and has been a stroke specialist nurse for the last four years. She has worked in the stroke unit at the Trust for seven years. She is particularly interested in emotional problems after stroke, an interest that was triggered during one of the stroke support groups she manages. She, alongside her colleagues, are currently working on a pilot project to encourage staff to ask patients about their emotional well-being, and to listen carefully to their concerns and when appropriate, refer patients to Dr Graham Jensch, clinical psychologist, who can help them manage the emotional after-effects of stroke.
Ismalia was joined by Dr Graham Jensch, clinical psychologist, and Dr Zoe Brown to discuss the signs and symptoms of stroke as well as the challenges of recovery. Everyone, including patients, the public, GPs and other health workers were invited to submit questions. All questions could be submitted anonymously.
What happens after a stroke? Assessing and treating emotional changes post-stroke
Hello, welcome to the chat. Today we are discussing stroke and some of effects it has on mood, in recognition of World Stroke Day that was on Saturday 29 October.
We have Ismalia who is the CNS for stroke, Dr Zoe Brown, stroke registrar and Dr Graham Jensch, clinical psychologist and we will try to answer your questions today.
Comment From Anon
What causes a stroke?
Ismalia de Sousa:
Stroke is caused by interruption of the normal blood supply to the brain so the brain does not receive oxygen supply and areas become damaged, this can be caused either by a clot in the artery of the brain ischaemic stroke) or rupture of a blood vessel causing bleeding into the brain (haemorrhagic stroke).
Comment From Guest
My grandfather had a stroke and it was so distressing. Is there anything I can do to avoid having one too?
Ismalia de Sousa:
There are a number of reasons why stroke happen. Even though your grandfather had a stroke it doesn’t mean it will happen to you as well. Around 50 per cent of people in this country have high blood pressure which is the biggest risk factor for strokes. The first thing to do is ensure your blood pressure is under control and your GP or nurse can check that for you. In combination making health lifestyle choices is really important such as not smoking, regular exercise, moderate alcohol intake, cardio protective diet – reduction of salt intake and saturated fat (swapping bad fat for good fat like changing your cooking oils), and increase your daily intake of fruit and vegetables.
Other risk factors for stroke include high cholesterol and diabetes. If you have never been tested for these this can be done at your GP practice, it’s better to get treated early than to wait and become ill to find out.
Another big risk factor for stroke is a condition called Atrial Fibrillation which is a particular irregular heart beat which puts you at high risk of strokes. If you have this condition you may require anti coagulation (blood thinning). If you have any concerns about this you should discuss with your GP, medical practitioner or nurse.
Comment From Guest
I had a stroke a few months ago and although I don’t show any outward signs as a result of it - I’m terrified it will happen again, how can I control my anxiety?
Ismalia de Sousa:
When we get anxious our body responds with the flight or fight response which means the heart beats quicker, the breathing changes, you might start sweating and you might get some other physical symptoms.
People often get lots of catastrophic thoughts running through their mind which provokes the anxiety further. One way to deal with this is to use an abdominal breathing technique where you place one hand on your abdomen and slow your breathing down by getting your abdomen to rise and fall in a calm manner, whilst doing this try to focus on your breathing.
If you have any medical concerns or unanswered questions about why you had your stroke, discuss with your GP or stroke specialist. This may help with any uncertainty and allay any of your anxieties.
Comment From Guest
What is the anti-depressant/anti-anxiolytic of choice post stroke?
Ismalia de Sousa:
Royal College Physicans stroke guidelines recommend SSRIs as first choice in combination with psychological therapy and support.
Comment From Anon
How do you asses and treat emotional changes post-stroke?
Ismalia de Sousa:
Often it's around exploring the stroke survivors degree of distress and looking for certain symptoms such as: low mood, sleep disturbance, tiredness, lack of enjoyment in activities and avoidance of certain tasks. We often discuss with family or friends around any symptoms they have noticed, alongside certain questionaires (phq-9) or observational tools (sadq-10).
As a hospital team we always encourage everyone to ask the question: "how are you feeling?" And if difficulties are noticed then a referral to a clinical psychologist may be warranted.
Comment From Anon
How does a stroke affect people emotionally?
Ismalia de Sousa:
About 33 per cent of people have some kind of emotional difficulties post stroke. Some people become low in mood which can have a significant impact on their functioning (please see the answer to the previous question) and recovery. For some people it can take several weeks or months for these symptoms to start. However, for a lot of people having some of symptoms is a normal part of the recovery process and we advise people to seek help from their GP, nurse or stroke team if these symptoms persist.
Comment From Guest
What is best way to treat insomnia post stroke?
Ismalia de Sousa:
It is important to have a regular routine at night time incorporating relaxing activities such as: taking a bath, listening to relaxing music and winding down before bedtime. Try not to nap in the day and if you find yourself awake in the night don't just stay in bed. Try to get up after 30 minutes and do something relaxing before going back to bed. Try to avoid taking sleeping tablets and only use them as a short term measure.
Comment From Guest
I want to get the quality of my life back after having a stroke what changes can I make to try and achieve that?
Ismalia de Sousa:
It's important to try to re-engage with meaningful activities on a day to day basis. When we feel depressed one of the most common ways depression affects us is through a lack of enjoyment in activities. However, when this happens we get stuck in a cycle of low mood feeding avoidance which only makes the symptoms worse. We advise talking to family and friends about these difficulties and again if they persist speak to your GP or nurse for a referral to a suitable service for psychological therapy.
Comment From Anon
How long can it take to recover from stroke?
Ismalia de Sousa:
This is highly variable and every individual is different. Some people have minimal effects and recover quickly but for others recovery can be a slow process and require lots of rehabilitation. Unfortunately if the stroke has been severe they may never fully return to their previous function.
Comment From Anon
How do you know if you are having a stroke? What are the symptoms?
Ismalia de Sousa:
The most common symptoms are covered in the FAST mnemonic - Face, Arm, Speech, Time. This means sudden drooping of one side of the face , sudden weakness or change in feeling in one arm or leg, or sudden difficulty speaking/slurred speech. If you do experience at least one of these symptoms or see someone with these symptoms you should dial 999. Treatments are most effective when started quickly. Other symptoms of stroke that are less common are: sudden problems of vision, sudden vertigo (room spinning), sudden loss of balance.
Comment From Anon
I've been told people who think they are having a stroke might actually be having a really bad migraine. Is this true? And how can you tell the difference?
Ismalia de Sousa:
This is a complex issue. Sometimes migraine can indeed mimic symptoms of stroke. However, if you have symptoms which are not usual for your migraines and are suggestive of stroke, then we would always recommend getting medical attention asap. It is not always easy to tell the difference yourself.
Comment From Guest
I'm in my early 40s - at what age would you say people typically become at risk of a stroke?
Ismalia de Sousa:
Stroke risk increases with age. However 25% of strokes occur in people under 65yrs and can occur at any age. The risk factors for stroke at a younger age are sometimes different and they may require different investigations. If you are worried about risk of stroke then please see the answer to the question above about reducing stroke factors.
Comment From Guest-2016
Before any ambulance arrives, is there anything you can do to minimise permanent damage from a stroke?
Ismalia de Sousa:
Unfortunately not, the best thing to do is get to hospital asap. We do not recommend taking any treatments yourself until we know exactly what is happening as they may cause more harm.
Comment From Guest
Which one is more dangerous: high systolic blood pressure or high diastolic blood pressure for the risk of having stroke?
Ismalia de Sousa:
We should be aiming for a combined blood pressure of below 130/80 following a stroke. Both are equally important. Some people may have different targets due to specific medical reasons, if you have been given a different target you should discuss this with your doctor or nurse.
Comment From Tanya
If you have been diagnosed with high blood pressure and given tablets to control this but change your diet take regular exercise and it is at a good level for a long period of time can you then be weaned off the blood pressure tablets or is it something that is taken for life?
Ismalia de Sousa:
The important thing is to achieve the target blood pressure. If you are able to do this without medication that is ok. However, most people find, particularly after a stroke, that medications are needed to achieve the target. It is best to discuss your medications with a heath care professionals rather then stopping them yourself as you may be putting yourself at risk.
Ismalia de Sousa:
Thank you for taking part. Sorry if we didn't get time to answer your question - you can get more information from the Stroke Association www.stroke.org.uk and for younger stroke survivors: Different Strokes www.differentstrokes.co.uk.
