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Aims and objectives: A pre-registered systematic review of post-stroke psychosis examining clinical characteristics, prevalence, diagnostic procedures, lesion location, treatments, risk factors, and long-term outcomes.
Background: Neuropsychiatric outcomes following stroke are common and severely impact quality of life. Previous reviews have focused on anxiety, depression and cognitive impairment in stroke but no systematic review has yet focused on post-stroke psychosis despite clear clinical need.
Methods: CINAHL, MEDLINE and PsychINFO were searched for studies on post-stroke psychosis published between 1975 and 2016. Reviewers independently selected studies for inclusion, extracted data, and rated study quality.
Results: Out of 2442 references, 75 met the inclusion criteria. Average age for post-stroke psychosis was 60.8 years with slightly more males than females affected. Average psychosis onset was 7.1 months after stroke. Neurological presentation was typical for stroke but a significant minority had ‘silent strokes’. The most common psychosis was delusional disorder, followed by schizophrenia-like psychosis and mood disorder with psychotic features. Mean prevalence was 4.1% (range 0.2% – 9.9%). 12 year incidence was 6.7%. Antipsychotic medication was commonly prescribed and the most frequent outcome was complete remission. Lesions were typically right hemisphere, particularly frontal, temporal and parietal regions, as well as the right caudate nucleus. Post-stroke psychosis was associated with poor functional outcomes and high mortality. Methodological quality of the studies was poor.
Conclusion: Psychosis considerably adds to illness burden of stroke. Delayed onset suggests a window for early detection and intervention. Studies on the safety and efficacy of antipsychotics in this population are urgently needed.
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