A new study has found that the deep fear of recurrence experienced by many survivors of a type of stroke known as subarachnoid hemorrhage (SAH) is related to the presence of post-traumatic stress disorder in these patients.

A subarachnoid hemorrhage is a stroke usually caused by an aneurysm that has ruptured, causing bleeding in between the brain and its surrounding tissues. While potentially life-threatening, recurrences are rare, and survivors are traditionally advised to return to normal life after recovery. Despite such reassurances, however, patients often experience intense fears that they will suffer another brain hemorrhage. This emotional reaction leads many to restrict their activities, avoid being alone in case another bleed occurs, seek constant reassurance, and misinterpret any physical problems as indicators of an impending recurrence. Their recovery is hampered by chronic fatigue, poor quality of life, sleep problems, and an overly negative outlook.

PTSD Resultant of Subarachnoid Hemorrhaging

One-third of SAH survivors develop this disproportionate fear of recurrence, though not due to a lack of knowledge about their condition and prognosis. Rather, as lead researcher Adam J. Noble of King's College London and his European colleagues hypothesized, such fears are related to survivors developing Post-traumatic Stress Disorder, or PTSD, after experiencing the medical trauma of a brain bleed.

PTSD is a psychiatric condition triggered after an individual has experienced a traumatic event. A type of anxiety disorder, it is characterized by feelings of extreme fear and can manifest in recurrent nightmares, flashbacks, detachment from others, emotional numbing, hyper-alertness, and angry outbursts. It has also been associated with pessimistic perceptions about the future, with many patients believing they are at greater risk than others of experiencing new harmful events.

Assessing Stroke Survivors

To test their hypothesis, scientists assessed 142 patients for up to 18 months for symptoms of PTSD. They compared the cognitive functions and self-reported ratings about future health beliefs and fears of patients with and without confirmed PTSD diagnoses. They also questioned participants about the effectiveness in their current treatments in increasing their confidence levels and reducing their fears of having another brain hemorrhage.

Their findings revealed that, although the participants were clinically and cognitively comparable, those with PTSD had significantly higher fears of recurrence and exhibited greater pessimism about their chances of experiencing another SAH. They also were less optimistic about their chances of surviving lung cancer and heart attacks, two serious yet unrelated medical events. Furthermore, patients who reported the highest fear levels reported that their current treatments were the least helpful.

Researchers concluded that the fear of recurrence among subarachnoid hemorrhage survivors is related to PTSD; they also suggested that specific treatments for the psychiatric condition could alleviate the anxiety and promote better outcomes for subarachnoid hemorrhage survivors than past methods of simply providing scientific information and medical reassurances. Established PTSD therapies that address recurring and persistently negative thoughts and help patients resume daily activities would be beneficial, the authors stated. Specifically, they recommended such PTSD treatments as Cognitive Behavioral Therapy, eye-movement desensitization and reprocessing techniques, and adjuvant medication as needed.

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