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.