When Disease Can Bring On PTSD

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When Disease Can Bring On PTSD

Postby drlynch on Sat Aug 24, 2013 4:56 pm

When Disease Can Bring On PTSD
Exploring Mental Effects of Stroke, Heart Attack, Cancer; Not Just a Soldier's Disorder

Post-traumatic stress disorder, most often associated with soldiers returning from the battle front, is increasingly being diagnosed in people with medical conditions from stroke and heart attack to cancer.
Nearly one in four stroke patients will develop significant PTSD symptoms within a year of experiencing the medical trauma, according to a study published last week in the online journal PLOS ONE. Symptoms of PTSD could include anxiety, flashbacks to a traumatic event and difficulty sleeping and nightmares.
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Margaret Cornelis
Peter Cornelis, of Wantagh, N.Y., said a recent study linking stroke with PTSD helps to explain the emotional turmoil he experienced after a series of strokes.
The risk for PTSD also applies to individuals who experience ministrokes, known as transient ischemic attacks, which don't typically result in sustained damage, the study found.
"More than 700,000 people in the United States have a stroke every year. So in the U.S. alone that's well over 150,000 people in a year" who may suffer stroke-related PTSD, said Donald Edmondson, assistant professor of behavioral medicine at Columbia University Medical Center and lead author of the study. He said that after a stroke or heart attack, people who are younger tend to fare worse psychologically and have a greater risk for developing PTSD.
The study follows similar research by Dr. Edmondson last year that found that one in eight people who experience a heart attack develop PTSD symptoms within a year. Those patients also are two times as likely to have a subsequent heart attack or die in one to three years.
Ralph Sacco, chairman of neurology at the Miller School of Medicine at the University of Miami, said he believes fear is usually what drives PTSD-like symptoms. For patients who have experienced milder strokes, there is the fear of having another event and of losing the ability to walk and talk, said Dr. Sacco, who wasn't involved in the study.
Often in caring for stroke patients, doctors focus on physical disabilities. "I think we don't think of the psychological impact of stroke and [ministrokes] enough," he said, adding that stroke patients also are at risk for depression.
Christina Michelena, a patient of Dr. Sacco, suffered from three mild strokes within a 24-hour period in September. Since then, the 26-year-old Miami resident said she has suffered from anxiety problems. "I had a hard time convincing myself that it wouldn't happen again," said Ms. Michelena, who works as a financial analyst. "I would find myself, all of a sudden, I couldn't breathe. Everything to me was a potential threat."
A therapist told her she was possibly suffering from PTSD. Ms. Michelena says she's learned from doctors how to calm herself down using different methods. She occasionally takes antianxiety drugs. "It normally happens during times when I'm alone and just sort of thinking to myself about things and I get worried," she said. "It's a hard thing to deal with."
PTSD affects about 7.7 million adults in the U.S., including military veterans, victims of sexual assault and others, according to the National Institute of Mental Health. Symptoms typically occur within three months of a traumatic event and last at least a month, but can appear later.
Diagnosis is usually done by psychologist or specialist in mental illness, and treatment generally includes seeing a psychologist and possibly medications for depression and anxiety.
Ian Kronish, an assistant professor of medicine at Columbia University Medical Center who worked on the recent stroke study, said no research has looked at whether stroke patients with PTSD should be treated differently than other PTSD patients. Doctors say if they get a stroke patient who has PTSD symptoms they refer them to a psychiatrist or psychologist and possibly prescribe antianxiety or depression medications.
The recent stroke research was a review of nine previous studies, called a meta-analysis, that involved a combined 1,138 patients. The researchers found about 23% of stroke or ministroke patients had PTSD symptoms within a year and 11% after one year. Dr. Kronish said a limitation of the research was that the number of participants was relatively small and there was a lot of variability across the studies with regard to PTSD prevalence. He also said most of the underlying studies used a questionnaire to diagnose PTSD rather than psychiatric interviews.
Dr. Edmondson said the next step in the research is to determine a more definitive rate of PTSD among stroke patients and examine whether this population is at a greater risk of having another stroke or dying.
Peter Cornelis, a 62-year-old in Wantagh, N.Y., said the PTSD study results could explain symptoms he had after six successive strokes and brain surgery several years ago. Mr. Cornelis, who was not officially diagnosed with PTSD, said he was highly emotional, withdrawn and anxious, particularly for the year a stroke left him paralyzed and unable to talk. Even today, Mr. Cornelis says his emotions run wild—he can cry at the drop of a hat or start laughing unexpectedly. He continues to see a neurologist and a psychologist.
"You're kind of waiting for the other shoe to drop," he said. "I've had a couple of instances where I thought I was having another stroke," Mr. Cornelis said.
One of the underlying studies, which involved 535 patients, found that people with PTSD symptoms after stroke were three times less likely to adhere to their medication regimen. "One of the cardinal symptoms of PTSD is avoidance of reminders" of the traumatic event, said Dr. Edmondson. "If I'm a stroke survivor, I can never get away from my heart beat, I can never get away from my blood pressure. So the very thing that's been traumatic to me, I'm sort of forced to be paying attention to."
Other research has linked cancer with PTSD, according to information from the National Cancer Institute. A study published this year in the Journal of the National Cancer Institute found that nearly one in four women diagnosed with breast cancer reported PTSD symptoms shortly after diagnosis. Studies have also shown PTSD symptoms following diagnoses of prostate cancer and lymphoma.
Lynne Padgett, program director for the National Cancer Institute, said most such studies have found associations between cancer and PTSD symptoms, not diagnoses.
Write to Sumathi Reddy at sumathi.reddy@wsj.com
A version of this article appeared June 2

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