Early psychological intervention in stroke patients independent in activities of daily living to reduce symptoms of anxiety and depression of influence on long-term functional outcome.

Stroke frequently affects mood and behaviour. The negative impact of mood and
adjustment disorders on recovery and reintegration has been recognized. Major
improvement in stroke prognosis has been achieved by the implementation of
stroke units in the hospital and increased use of thrombolysis. Therefore the
proportion of patients with favorable outcome has been rising. Patients with
mild stroke (hemorrhagic or ischemic, subarachnoid hemorrhages) or Transient
Ischemic Attack (TIA) are expected to return to their normal pre-stroke status
relatively quick and are mostly discharged directly to their home environment,
often without follow-up consultation by a rehabilitation physician. These
patients however, often struggle to regain their pre-morbid functional status
despite little or no physical disabilities. Anxiety and depression are thought
to be of influence on functional outcome in patients with mild stroke and TIA.
There are only few studies regarding these subjects in the general stroke
population, and even less evidence can be found in the mild stroke group.

We believe that early detection and treatment of anxiety and depression in mild
stroke and TIA patients may improve functional outcome. Thereby reducing the
needs for intensive and expensive rehabilitation diagnostics and treatment in a
later phase when patients get stuck in their work and social life. Therefore we
have developed an early individual psychological intervention aimed at reducing
symptoms of anxiety and depression. This prospective cohort study in minor
stroke patients is designed to examine the feasibility of such a psychological
intervention in an early phase.

Primary: to determine whether an early psychological intervention poststroke
in order to reduce symptoms of anxiety and depression, is feasible.

Secondary: To evaluate if an early individual psychological intervention in
patients independent in activities of daily living poststroke leads to a
reduction of symptoms of anxiety and depression after 6 months poststroke.

The study is designed as a prospective cohort study.

Four to six weeks after discharge home the patients will visit a psychologist
at the department of rehabilitation. At the first visit, symptoms of anxiety
and depression will be analysed using questionnaires and also the potential
risk factors for anxiety and depression will be assessed; psychiatric history,
coping-strategies, the patient*s cognitions to disease processes and the amount
of social support that is perceived will be assessed. The influence of possible
cognitions and misconceptions to the disease and occurrence of anxiety and
depression after TIA/minor stroke are examined. In the second and third visit
the psychologist will educate the patient about general brain functioning and
the influence of stroke; also the possible development of anxiety after stroke
is discussed with patient and caregiver. Active coping strategies will be
promoted and illness perceptions will be reviewed. These sessions are tailored
to the patients* needs and questions. If, after 3 visits, the psychologist
finds continuation of psychological support advisable, the patient will be
referred for further treatment.

Burden: All patients will receive questionnaires to fill out at home and return
back to the investigators. The total duration of completing the questionnaires
is estimated at 1.0 to 1.5 hours. Travelling costs for the outcome assessments
will be reimbursed. Questionnaires will be send back in envelopes with a
freepost number.

Potential risks: No risks are associated with psychological counselling.

Potential benefits for the patients: Considering the positive effects of
psychological counselling known from preliminary research it can be concluded
that the benefits outweigh the burden associated with this study.