Post-stroke psychosis is a complex neurological complication affecting some stroke survivors. It involves significant disturbances in thought and perception, arising directly from the brain injury. This distinct neuropsychiatric manifestation can emerge following a cerebrovascular event, impacting a person’s reality and daily functioning.
Defining Post-Stroke Psychosis
Post-stroke psychosis is characterized by a disconnection from reality, involving disturbances in thought, perception, mood, and behavior. The DSM-5 classifies it as a psychotic disorder directly resulting from a stroke or transient ischemic attack (TIA). This distinguishes it from other common post-stroke changes, such as depression or delirium, by its specific presentation of psychotic symptoms. The prevalence of experiencing either delusions or hallucinations after a stroke is estimated to be around 4.86% among post-acute stroke patients. These symptoms can manifest relatively soon after the stroke, sometimes within a week, or they may appear weeks or even months later.
Common Manifestations
Individuals with post-stroke psychosis primarily experience hallucinations and delusions. Hallucinations are perceptions of things not actually present, affecting various senses. These can include seeing things (visual), hearing voices (auditory), or perceiving smells, tastes, or tactile sensations without external stimuli. These visual hallucinations can sometimes be related to vision loss after a stroke, where the brain generates images to fill in missing visual fields.
Delusions are strong, false beliefs held firmly despite clear evidence to the contrary. These can include persecutory delusions, where an individual believes others are trying to harm them, or delusional jealousy. Another specific type is Capgras syndrome, where the person believes a familiar individual has been replaced by an imposter, or reduplicative paramnesia, involving the belief that a place has been duplicated. Disorganized thinking, such as jumbled or incoherent speech, may also be present. Some individuals might also exhibit catatonic or inappropriate motor behaviors.
Identifying Contributing Factors
Several factors contribute to post-stroke psychosis. The location of the brain lesion caused by the stroke plays a significant role. An association is often seen with predominantly right-sided brain lesions, particularly in the frontal, temporal, and parietal regions, and the right caudate nucleus. Lesions in left cortical regions can also contribute.
Alterations in brain chemistry, specifically neurotransmitter imbalances, are also implicated. Dysfunctions in serotonergic neurotransmission and glutamate-mediated excitotoxicity are proposed mechanisms. Beyond direct neurological damage, other patient-specific factors can increase susceptibility. A pre-existing history of psychiatric conditions, such as depression, anxiety, or alcohol misuse, can elevate the risk. The severity or type of stroke, as well as the individual’s age, are additional considerations.
Diagnosis and Care Strategies
Diagnosing post-stroke psychosis involves a thorough clinical evaluation by neurologists and psychiatrists. This includes comprehensive assessments to identify symptoms and their onset in relation to the stroke. It is important to rule out other potential causes for psychotic symptoms, such as medication side effects, infections, or other neurological conditions like dementia or Parkinson’s disease. The diagnostic criteria outlined in the DSM-5 are often used to classify the condition as a psychotic disorder due to the stroke.
Care strategies involve a multidisciplinary approach. Medication, particularly antipsychotics, is a common treatment to manage psychotic symptoms. General antipsychotics like haloperidol, risperidone, quetiapine, and olanzapine have been used.
Psychotherapy, such as Cognitive Behavioral Therapy for Psychosis (CBTp), family therapy, and supportive psychotherapy, can complement medication by helping individuals process experiences and develop coping mechanisms. Ongoing support from a team including psychiatrists, neurologists, physical therapists, occupational therapists, and case managers is beneficial for both the individual and their caregivers. Early recognition and intervention are important for managing the condition and improving outcomes.