Mental health challenges of stroke patients

One of the most popular aphorisms is that the mind and the brain are two sides of the same coin. This is a very pregnant and provocative scientific statement that elicits much controversy in the pursuit of the care of the brain and the mind. This is very crucial when there is a disease of the brain, with florid behavioural and cognitive abnormalities. The psychiatrist recognises the brain as the substrate for the elaboration of symptoms of mental illness, whether at the structural, physiological or biochemical levels. One of the most outstsanding breakthroughs in clinical psychiatry is the discovery of the antipsychotic that exerts its therapeutic efficacy by manipulating some biochemical properties of regions of the brain that coordinate behaviour and emotion. Even for extremely abstractive and sophisticated tasks of enormous social significance, certain networks and circuits have been localised secondary to intense physio-biochemical activities in particular regions of the brain. As I write this piece, some parts of my brain are more active, which clearly illustrates that the mind, essentially, is a functional elaboration of the brain. Countless debates among philosophers abound, but this assertion has been empirically demonstrated. One of those clinical scenarios consequent on this paradigm occurs when a patient is diagnosed of having stroke by the attending physican. Stroke, simply defined, is the sudden loss of blood supply to an area of the brain, resulting in permanent tissue damage. It is about the most common neurological disorder that accounts for half of illnesses of sudden onset in most medical wards. The compromise of the blood supply could have been as a result of direct damage of the bloood vessel or blockage; however, what is crucial here is brain tissue damage. The clinical presentation of stroke is therefore a product of the particular region of the brain that is affected, the extent of damage that has occured and, invariably, the function that the area subserves. While the relatives, the attending physician, speech therapist and physiotherapists may be justifiably concerned about the loss of motor function, the attendant mental health challenges also require attention. Beyond the recorvery of motor functions, there should be an adequate plan to attend to issues of the mind arising as a loss of function, loss of role and loss of status. One can imagine a versatile professional lawn tennis or football player coming down with stroke, with loss of function in his limbs such that he is confined to the wheelchair and cannot play; or a musician who cannot sing again as a result of stroke affecting his ability to execute speech. Thesame goes for a caterer who cannot use her hand again. In fact, the list is endless. The central theme, however, is the loss of function that invariably leads to loss of role, loss of relevance, loss of self esteem, with grave implication for the psychological wellbeing of such individuals. From the basic psychological principle of loss, symptoms of depression are, as expected, very common, which may present early or come after six months of experiencing stroke. Almost two-thirds of stroke patients may have come down with depressive illness in the first two years. It is usually characterised by daytime variation of moods, weight loss because of loss of appetite, loss of self esteem and extreme withdrawal from social activities. For some, ideas of suicide and feelings of regret and guilt may predominate later. Another prominent mental health challenge in this group of patients is anxiety disorder, usually present with undue fearfulness, nightmares, disturbed sleep and tension. Emotionalism, characterised by irresistible crying, can be very common, usually triggered by sad or other emotional events and in most patients, under some degree of involuntary control. In some folks, there may be a gradual but signifcant loss of memory, just like in cases of dementia caused by degenerative changes in the brain. Such patients may miss their way in the house or accuse folks wrongly of stealing their money or other vital documents. It can be as bad as not being able to remember where they once worked and they may not be able to recognise children and relatives. They may not be able to agree to a will they have written and may totally deny ever seeing the lawyer, which can be of grave social and legal concern. The care givers are usually at the receiving end of some of their occasional emotional outbursts, at times complicated by loss of memory. While focus on the recovery of the motor function is very crucial, an all-embracing management of their mental health challenges may significantly improve their quality of life, even if they are left with some motor deficit. Attending physicians may need to invite mental health experts to compliment their efforts in giving a wholesome care for these patients. Culled from punchnigeria