Posttraumatic stress disorder linked to persistent fears of recurrent SAH

One-third of patients who have survived a life-threatening subarachnoid hemorrhage (SAH) have disabling symptoms of posttraumatic stress disorder (PTSD), reports a study in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The high rate of PTSD helps to explain why some patients have persistent fears of recurrent SAH—even after being reassured that their risk of suffering another brain hemorrhage is low. "PTSD treatment could alleviate fears of SAH recurrence and promote better outcome," according to the new study, led by Adam J. Noble, Ph.D., of King's College London.

Posttraumatic Stress Disorder Linked to Persistent Fears of Recurrent SAH

The researchers studied the relationship between fear of recurrence and PTSD in SAH survivors. Subarachnoid hemorrhage is a type of stroke in which there is bleeding into the brain, most commonly caused by a ruptured aneurysm. For some SAH survivors, recovery is hampered by fear that they will suffer another SAH. Although they're at higher risk than the general population, the absolute risk is low—between one and three percent.

However, some patients have persistent fear of recurrent SAH, despite reassurance. These fears can become a disabling problem, causing patients to limit their activities and putting a strain on family relationships.

In the study, 142 patients underwent a standard assessment of PTSD symptoms at up to 18 months after surviving an SAH. About one-third of patients met criteria for a diagnosis of PTSD, based on symptoms such as intrusive thoughts, avoidant behaviors, and hyperalertness that interfere with daily functioning. First described in combat veterans, PTSD can develop after exposure to many different kinds of traumatic events.

The patients with PTSD were more fearful of recurrent SAH and more pessimistic about their likelihood of having another brain hemorrhage. Over 30 percent rated themselves "extremely fearful" of a further SAH. They were also more fearful of other life-threatening diseases unrelated to SAH, such as lung cancer or a heart attack.

Patients with PTSD and high levels of fear were less likely to find their current treatment helpful—including reassurance from health professionals that they were unlikely to suffer another brain hemorrhage. Rather than reflecting lack of knowledge, their fears appear to have a psychological origin—"and therefore [are] not easily modifiable through provision of information and reassurance," Dr. Noble and coauthors write.

The researchers suggest that enhanced treatment targeting the underlying PTSD could be helpful for patients with persistent fears of recurrent SAH. Psychological therapies for PTSD are effective for most patients, reducing negative thoughts and interference with daily functioning. "Offering patients with PTSD an established treatment for it may reduce fear and improve outcome," Dr. Noble and colleagues conclude.