World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria; Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.
World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105622. doi: 10.1016/j.jstrokecerebrovasdis.2021.105622. Epub 2021 Jan 23.
Undetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria.
A prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I).
Forty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively.
This study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.
在撒哈拉以南非洲（SSA），亚急性期谵妄未被发现会导致较高的卒中后死亡率。本研究通过在尼日利亚检查卒中前精神症状与卒中后 3 个月和 12 个月死亡率之间的关联，对现有文献进行了补充。
前瞻性观察研究，使用意识模糊评估法（CAM）重复进行谵妄评估。根据精神障碍诊断与统计手册（DSM-V）第五版的标准，将符合标准的参与者和≥2 个核心谵妄特征的参与者归类为谵妄；使用神经精神问卷（NPI-Q）确定卒中前的精神症状。通过研究主管在医疗随访期间获取死亡率信息。使用多变量逻辑回归分析进行关联分析，并以 95%置信区间（CI）内的比值比（OR）表示。
在卒中后第一周提供数据的 150 名参与者中，有 45 名（30%）在一年随访时死亡。死亡组更有可能存在卒中前的精神症状（64.4%，p=0.005）和急性期谵妄（60.0%，p=0.002）。在校正年龄、教育程度、吸烟和卒中严重程度的影响后，卒中前的精神症状（OR=3.3，95%CI=1.3，8.2；OR=2.2，95%CI=1.0，4.6）和急性期谵妄（OR=3.1，95%CI=1.2，7.6；OR=3.4，95%CI=1.5，7.6）分别预测卒中后 3 个月和 12 个月的死亡率。
本研究发现，卒中前的精神症状和急性期谵妄独立预测卒中后 3 个月和 12 个月的死亡率。在卒中风险增加的人群中检测和治疗心理健康状况可能有助于降低 SSA 的卒中后死亡率。
