Suicidal Ideation Higher Among Stroke Survivors

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Suicidal Ideation Higher Among Stroke Survivors than Among Those with History of Cancer

The global burden of stroke
Every year, 15 million people worldwide suffer a stroke. Nearly six million die and another five million are left permanently disabled. Stroke is the second leading cause of disability, after dementia. Disability may include loss of vision and / or speech, paralysis and confusion.

STROKE COMPARISONGlobally, stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause of death in people aged 15 to 59 years old.

Stroke is less common in people under 40 years, although it does happen. In young people the most common causes are high blood pressure or sickle cell disease.

In many developed countries the incidence of stroke is declining even though the actual number of strokes is increasing because of the ageing population.

In the developing world, however, the incidence of stroke is increasing. In China, 1.3 million people have a stroke each year and 75% live with varying degrees of disability as a result of stroke. The predictions for the next two decades suggest a tripling in stroke mortality in Latin America, the Middle East, and sub-Saharan Africa.

What happens in a stroke?
A stroke happens when the blood supply to the brain is blocked or when a blood vessel in the brain bursts. The loss of blood to the brain means a loss of oxygen and the brains cells become injured and die.

A stroke can kill or leave you with a permanent disability.

What is a TIA?
In a transient ischemic attack (TIA) there is a temporary interruption in the blood flow to a part of the brain. Most TIAs last only a few minutes. The warning signs of a TIA are the same as the warning signs of a stroke. TIAs are sometimes referred to as “warning strokes” as they may be an indication that a full, far more serious stroke is about the happen.

What is a stroke?
Ischemic stroke is accountable for 80% of all strokes. During an ischemic stroke the supply of blood and oxygen to the brain is blocked. This usually happens because of blood clots in an artery to the brain or a narrowing of the arteries (carotid stenosis) blocking or impeding the blood flow.

In a hemorrhagic stroke, an artery in the brain bursts. There are two main types of hemorrhagic stroke.

An intracerebral hemorrhage happens when a blood vessel in the brain leaks blood into the brain. A subarachnoid hemorrhage happens when there is bleeding under the outer membranes of the brain and into the thin fluid–filled space that surrounds the brain. This type of hemorrhage can cause extensive damage to the brain and is the most lethal of all strokes.

Warning signs of stroke
Knowing the warning signs of stroke and seeking immediate medical help can improve the outcome of the stroke. The symptoms of stroke appear suddenly and often there is more than one symptom at the same time. All strokes happen fast.

The warning signs of stroke are:
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

suicidal ideationOne in 12 adult stroke survivors in the United States claimed to have had thoughts of suicide within the 2-week period preceding their response to a broad-based Patient Health Questionnaire, according to data presented last week at the American Stroke Association’s International Stroke Conference 2013.

The prevalence of suicidal ideation (SI), among adults age 20 years or older with a self reported history of stroke was 7.8%, higher than SI reported by individuals with a history of MI (6.2%), diabetes (5.2%), and cancer (4.1%).

Individuals responding to the questionnaire were participants in the National Health and Nutrition Examination Survey from 2005 to 2010. Nearly 6 million US adults reported a history of stroke during that period.

Statistical modeling found that the following variables predicted SI among stroke survivors with 74% sensitivity and 81% specificity (overall accuracy of 80%) in decreasing order of importance: depression score, age, BMI, education level, income to poverty ratio, female sex, and marital status. The results suggest that screening for SI may be warranted during routine assessment of stroke patients.

 

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Yoga and Atrial Fibrillation: Calm for the Heart and the Mind

Atrial fibrillation (AF) is recognized as a national epidemic in the United States with incidence increasing as the population ages. Newer treatment options, including ablation therapy and novel oral anticoagulants, have begun to change the landscape of the disease; however AF continues to consume significant healthcare resources.

yogaAn intriguing study by Lakkireddy and colleagues1 called the Yoga My Heart Study and the first of its kind, suggests that regular practice of yoga may be an adjunctive non-pharmacologic alternative to help manage AF. The small cohort study was just published in the online version of Journal of the American College of Cardiology: 49 patients with paroxysmal AF and on a stable medical regimen were observed for a control period of 3 months.

Following this, they all received 3 months of intensive yoga training that included twice-weekly 60-minute sessions as well as educational DVDs to practice with at home.

Event rates, including number of symptomatic and asymptomatic AF episodes and symptomatic non-AF episodes were recorded by cardiac non-looping event monitors.

The average age of patients was 61 years and baseline average duration of AF was 5.3 years. At the end of the yoga intervention period, not only were there fewer non-AF-related symptoms reported (1.4 vs. 2.9) and fewer symptomatic and asymptomatic AF episodes (2.1 vs. 3.8), but there was also a decline in heart rate and systolic blood pressure values compared to those observed during the control period (P<.001). Twenty-two percent of patients who had documented AF during the control phase did not have any AF episodes during the yoga phase. Patients also reported significant improvements in multiple quality of life parameters, including physical function, general health, vitality, social functioning, and mental health.

Although the mechanism underlying these findings remains unclear, the authors propose several possible physiologic explanations: an increase in parasympathetic tone; enhanced balance between the 2 autonomic nervous system components; reduced systemic inflammation and oxidative stress; and, decreased progression of arrhythmia by preventing or attenuating atrial remodeling. The non-physiologic explanations put forth include the presence of a more supportive environment in the yoga studio, and formation of caring relationships and social interaction.

This is not the first demonstration of the use of yoga in the management of cardiovascular disease, but it is the first study to examine the effects in AF. Previous research has evaluated other non-invasive strategies, such as meditation, which in one study was associated with a significant reduction in the risk of all-cause mortality, MI, or stroke in African-American patients with documented coronary heart disease.2 Other outcomes, however, such as those from the recent HARMONY study,3 in which participants with stage 1 hypertension followed an intensive, 10-week mindfulness-based stress-reduction program, but did not achieve improved blood-pressure control,3 suggest that the Lakkireddy results may be a chance finding.

Although larger randomized controlled studies are needed to establish this relationship, and additional cost-effectiveness analyses are forthcoming, this study opens the door for physicians and patients to explore another non-pharmacologic option for managing the ever-rising burden of AF.

– By Payal Kohli, MD | February 19, 2013

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INFORMATION HERE: WORLDWIDE HEART & STROKE FEDERATION

References:
1. Lakkireddy D, Atkins D, Pillarisetti J, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: the YOGA my heart study. J Am Coll Cardiol. 2013; DOI: 10.1016/j.jacc.2012.11.060.
2. Schneider RH, Grim CE, Rainforth MV, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks. Circ Cardiovasc Qual Outcomes. Published online ahead of print November 13, 2012, DOI: 10.1161/CIRCOUTCOMES.112.967406.
3. Blom K, Baker B, How M, et al. Hypertension analysis of stress reduction using mindfulness meditation and yoga: Results from a randomized controlled trial. Canadian Cardiovascular Congress (CCC) 2012. Wednesday, October 31, 2012; Toronto, ON. Abstract 904.

heart-and-stroke-300x2971FEBRUARY is Heart & Stroke Month in CANADA – SUPPORT TODAY!

A stroke is a medical emergency. If any of these symptoms appear, don’t delay – get medical help immediately!

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