Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
Division of Psychiatry, University College London, London, UK.
J Neurol Neurosurg Psychiatry. 2018 Aug;89(8):879-885. doi: 10.1136/jnnp-2017-317327. Epub 2018 Jan 13.
A preregistered systematic review of poststroke psychosis examining clinical characteristics, prevalence, diagnostic procedures, lesion location, treatments, risk factors and outcome. Neuropsychiatric outcomes following stroke are common and severely impact quality of life. No previous reviews have focused on poststroke psychosis despite clear clinical need. CINAHL, MEDLINE and PsychINFO were searched for studies on poststroke psychosis published between 1975 and 2016. Reviewers independently selected studies for inclusion, extracted data and rated study quality. Out of 2442 references, 76 met inclusion criteria. Average age for poststroke psychosis was 66.6 years with slightly more males than females affected. Delayed onset was common. Neurological presentation was typical for stroke, but a significant minority had otherwise 'silent strokes'. The most common psychosis was delusional disorder, followed by schizophrenia-like psychosis and mood disorder with psychotic features. Estimated delusion prevalence was 4.67% (95% CI 2.30% to 7.79%) and hallucinations 5.05% (95% CI 1.84% to 9.65%). Twelve-year incidence was 6.7%. No systematic treatment studies were found. Case studies frequently report symptom remission after antipsychotics, but serious concerns about under-representation of poor outcome remain. Lesions were typically right hemisphere, particularly frontal, temporal and parietal regions, and the right caudate nucleus. In general, poststroke psychosis was associated with poor functional outcomes and high mortality. Poor methodological quality of studies was a significant limitation. Psychosis considerably adds to illness burden of stroke. Delayed onset suggests a window for early intervention. Studies on the safety and efficacy of antipsychotics in this population are urgently needed.
一项针对中风后精神病的预先注册的系统综述，研究了临床特征、患病率、诊断程序、病变部位、治疗方法、风险因素和预后。中风后的神经精神结局很常见，严重影响生活质量。尽管临床需求明确，但以前没有专门针对中风后精神病的综述。对 CINAHL、MEDLINE 和 PsychINFO 进行了检索，以查找 1975 年至 2016 年期间发表的关于中风后精神病的研究。综述者独立选择纳入的研究，提取数据并评估研究质量。在 2442 篇参考文献中，有 76 篇符合纳入标准。中风后精神病的平均年龄为 66.6 岁，受影响的男性略多于女性。发病时间较晚。神经学表现典型的中风，但少数人有其他“无声中风”。最常见的精神病是妄想障碍，其次是类精神分裂症样精神病和伴有精神病特征的心境障碍。估计妄想的患病率为 4.67%（95%CI 2.30%至 7.79%），幻觉为 5.05%（95%CI 1.84%至 9.65%）。12 年的发病率为 6.7%。没有发现系统的治疗研究。病例研究经常报告抗精神病药物治疗后症状缓解，但仍严重关切不良结局代表性不足的问题。病变通常位于右半球，特别是额叶、颞叶和顶叶以及右侧尾状核。总的来说，中风后精神病与不良的功能预后和高死亡率相关。研究方法质量差是一个显著的局限性。精神病大大增加了中风的疾病负担。发病时间较晚表明有早期干预的窗口期。迫切需要在这一人群中开展关于抗精神病药物安全性和疗效的研究。
