Astheno-emotional disorder after aneurysmal subarachnoid hemorrhage. Classification, outcome, and relation to anxiety and depressive disorders

Abstract

BackgroundPsychiatric symptoms such as fatigue, concentration and memory difficulties, anxiety, and depressiveness are frequently reported after aneurysmal subarachnoid hemorrhage (aSAH) and in various other neurological diseases. These symptoms may indicate the presence of organic psychiatric disorders (OPDs), such as the Astheno-Emotional (AE-) disorder, of anxiety or depressive disorders, or both, but psychiatric classification and differentiation between such disorders have seldom been used in follow-up studies of neurological disease. AimsTo study the AE-disorder described in Lindqvist & Malmgren s (LM) diagnostic system for organic psychiatry in terms of outcome, reliability, validity and relation to anxiety and depressive disorders, and to compare the coverage for OPDs between the LM, ICD-10, and DSM-IV systems in a prospective study after aSAH.Patients & MethodsTwo cohorts of patients admitted due to aSAH were assessed by repeated clinical interviews during the first year after surgery (n=119). Psychiatric disorders were diagnosed according to the LM, ICD-10, and DSM-IV systems. The reliability of the AE-disorder was evaluated by joint-interviews (n=33) and the validity by assessments of symptomatology (Comprehensive Psychopathological Rating Scale), clinical course, predictors (age, bleeding severity and hypertension), and social outcome (Glasgow Outcome Scale - GOS).ResultsThe frequencies of AE-disorder at 3, 6, and 12 months were 60%, 49%, and 38%, respectively. The agreement for AE-disorder was 85%, the kappa coefficient 0.65, and the systematic disagreement was negligible. The most frequent AE-disorder symptoms were mental fatigability and concentration and memory difficulties. Persistent AE-disorder was significantly associated with hypertension before the bleeding, and with impaired social function after the bleeding ( moderate disability on GOS). The AE-disorder showed a significantly higher coverage than corresponding ICD-10 and DSM-IV diagnoses, but the coverage for other OPDs did not differ between the systems. An association between persisting AE-disorder and development of anxiety or depressive disorders (19% of all patients) was found with a relative risk of 3.5 (95%CI 1.05-11.7).ConclusionAE-disorder, the most common psychiatric disorder after aSAH, can be diagnosed with high reliability, impairs social outcome, has a higher coverage than corresponding ICD-10 and DSM-IV diagnoses, and is most likely a vulnerability factor for development of anxiety and depressive disorders.