Psychological
Factors in Neurology
Depression
is frequent after stroke, particularly in the acute phase during
hospitalization and the first few weeks after stroke. The presence of
depression is associated with poorer outcome, includ-ing higher later mortality
and functional status is improved with treatment of depression after stroke. A
negative attitude after stroke (i.e., feeling there is nothing one can do to
help oneself) is associated with decreased survival. Research has focused on
depression as a complication of stroke but there is also evidence that
depression and other psychological factors constitute risks for stroke,
consistent with widespread lay and folk beliefs regarding stress and stroke.
There is preliminary evidence that anger and hostility may pose a risk for
carotid atherosclerosis just as it may for coronary disease. Recent studies
have found depressive symp-toms increase the risk of stroke in older adults. As
with many other major medical illnesses, stroke patients with extensive social
sup-port have better functional outcomes than those who do not.
Depression
is common in Parkinson’s disease, may ante-date the development of motor
symptoms and is associated with cognitive dysfunction. Physicians observe that
depression and other psychological factors interact to affect the course and
out-come of Parkinson’s disease, but there has been little formal study of such
relationships. Depression is also common and erodes quality of life in multiple
sclerosis (MS) and in epilepsy. The study of depression as an independent risk
factor affecting the onset or course of neurological diseases is challenging
because depression may also be consequence of the disease, a psychologi-cal
reaction to the illness, or a complication of pharmacotherapy. In MS depression
may increase and its treatment decrease pro-duction of proinflammatory
cytokines. Depression is especially difficult to study in MS because of its
uncertain relationship to the MS-fatigue syndrome.
Patients
with chronic migraine headaches have often been described as having a “typical”
personality characterized as con-scientious, perfectionistic, ambitious, rigid,
tense and resentful, but controlled studies have not supported any consistent
conclu-sion. Specific personality traits in migraine appear more likely to be a
consequence rather than a cause of suffering from recurrent headaches. Migraine
and depression are highly comorbid. But there is no relationship between headache
frequency and the se-verity of psychological distress or personality
abnormality. Thus, the relationship between psychological factors and migraine
re-mains to be worked out.
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