national-clinical-guidelines-for-stroke-fourth-edition

F Within Step 2 care, patients identified as having symptoms of mood disorder should
be offered a more detailed assessment, seeking information on past history, potential
causes and impact, and treatment preferences.
G In patients with mild or moderate symptoms of mood disorder, patients and carers
should be provided with information, support and advice about the mood disorder as
the first line of intervention. This may be from within the MDT by nominated staff
who are suitably trained and supervised, and may also involve the voluntary sector.
H Within Step 3 care, patients with severe or persistent symptoms of mood disorder
should be considered for referral to a specialist in the management of mood disorder
in stroke.
I Psychological or pharmaceutical treatment (or a combination) for mood disorder
should be provided if: recommended by a clinician with expertise in managing mood
disorder after stroke; or, as the second line of intervention, if the patient has not
responded to information, support and advice. Any treatment should be monitored
for effectiveness and kept under review.
J Any patient assessed as having a cognitive impairment should be considered for
referral to a specialist in cognitive aspects of stroke.
K Patients identified as having cognitive impairment or mood disorder should be
reassessed before discharge decisions are taken.
6.34.2 Sources
A Cicerone et al 2008; Salazar et al 2000; consensus
B–C Consensus
D National Institute for Health and Clinical Excellence 2010d; consensus
E–K Consensus
6.35 Depression and anxiety
6 Recovery phase from impairments and limited activities: rehabilitation
Mood disturbance is common after stroke and may present as depression or anxiety, both
of which may be part of a single emotional response to stroke, and one that varies from
patient to patient. The severity of mood disturbance is associated with the severity of
cognitive and motor impairments and activity limitation. Furthermore, depression may
exacerbate other impairments, limit functional recovery and be associated with increased
mortality rates (House et al 2001; Morris et al 1993). Although they are closely linked,
depression and anxiety are usually considered separately.
Depression occurs frequently after stroke, and commonly persists for up to 1 year if
untreated (Hackett et al 2005; Hackett et al 2008a; House et al 2001). Anxiety is also
common and may persist; it may be evident for the first time some months after stroke,
for example after discharge from hospital (Campbell Burton et al 2012). Patients troubled
by psychological distress that does not meet diagnostic criteria should still have their
needs identified and addressed. A majority of long-term stroke survivors with emotional
needs reported that they did not receive adequate help to deal with them (McKevitt et al
2011).
© Royal College of Physicians 2012 113