Akin Ojagbemi1, Toyin Bello2, Mayowa Owolabi3, Olusegun Baiyewu4. 1. World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria; Department of Psychiatry, College of Medicine University of Ibadan, Nigeria. Electronic address: aa.ojagbemi@ui.edu.ng. 2. World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria. 3. Division of Neurology, Department of Medicine, College of Medicine University of Ibadan, Nigeria. 4. Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.
Abstract
BACKGROUND: Undetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria. METHODS: A prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I). RESULTS: Forty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively. CONCLUSION: This study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.
BACKGROUND: Undetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria. METHODS: A prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I). RESULTS: Forty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively. CONCLUSION: This study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.
Authors: R C Kessler; N A Sampson; P Berglund; M J Gruber; A Al-Hamzawi; L Andrade; B Bunting; K Demyttenaere; S Florescu; G de Girolamo; O Gureje; Y He; C Hu; Y Huang; E Karam; V Kovess-Masfety; S Lee; D Levinson; M E Medina Mora; J Moskalewicz; Y Nakamura; F Navarro-Mateu; M A Oakley Browne; M Piazza; J Posada-Villa; T Slade; M Ten Have; Y Torres; G Vilagut; M Xavier; Z Zarkov; V Shahly; M A Wilcox Journal: Epidemiol Psychiatr Sci Date: 2015-02-27 Impact factor: 6.892
Authors: Eric L Stulberg; Liming Dong; Alexander R Zheutlin; Sehee Kim; Edward S Claflin; Lesli E Skolarus; Lewis B Morgenstern; Lynda D Lisabeth Journal: J Am Heart Assoc Date: 2019-08-19 Impact factor: 5.501