Anxiety and depression in stroke: An evaluation of these psychopathologies on outcomes of stroke type using the National Inpatient Sample.

BACKGROUND: Anxiety and depression have been reported to complicate the course of stroke. This study evaluated the association of anxiety and depression independently on ischemic vs non-ischemic stroke. METHODS: A cross-sectional survey of 4,983,807 admissions for acute stroke from 1994 to 2013 in the National Inpatient Sample compared stroke patients with depression and anxiety to stroke patients with no psychiatric comorbidities. The database was operationalized based on the inclusion/exclusion criteria approved by the Southern Illinois University School of Medicine Institutional Review Board. RESULTS: Patients with anxiety and depression were more likely to have an ischemic stroke (OR 1.64; 95% CI, 1.61 to 1.68) vs a non-ischemic stroke (OR 1.25; 95% CI, 1.23 to 1.27). Inpatient mortality was significantly less in both the depression and anxiety groups compared to the control group. CONCLUSIONS: Psychiatric disorders (anxiety and depression) may increase the risk of ischemic stroke; however, depressed and anxiety patients with ischemic stroke were less likely to die from stroke. Further well-designed studies are necessary to explore these findings.

Evaluation of a Model of Integrated Care for Patients With Chronic Medical and Psychiatric Illness.

BACKGROUND: Chronic illnesses are prevalent in general medical and psychiatric practices, causing significant disease burden to care givers and providers. Systems of care that treat individuals with mental illness are often separate from general medical systems of care. OBJECTIVE: This study sought to compare the quality of life, satisfaction with care, and utilization of care in patients with comorbid chronic medical and mental illnesses. METHODS: A total of 64 participants from an integrated medicine and psychiatry clinic (med/psych), were compared with 52 patients from separate internal medicine and psychiatry clinics (within the same institution) for quality of life, satisfaction with care, and utilization of care. RESULT: Patients receiving integrated care reported being more satisfied with care compared with patients treated separately. There were no differences in quality of life between the groups. A nonsignificant trend toward fewer emergency room visits and fewer hospital stays for the integrated care group compared with the separate care group was observed. CONCLUSION: This study demonstrated that integrated care for psychiatric and medical disorders improved the patients׳ experience of care and therefore may have positively affected the outcome of care. Further work is needed to compare medical and psychiatric comorbidities and costs of care and quality measures in these 2 groups.