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Neurorehabilitation and Neural Repair
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Neuropsychiatric Problems Interfering with Inpatient Stroke Rehabilitation

Michael J. Reding

Cornell University Medical College at The Burke Rehabilitation Center, White Plains, NY 10605

Charles Gardner

Cornell University Medical College at The Burke Rehabilitation Center, White Plains, NY 10605

Brian Hainline

Cornell University Medical College at The Burke Rehabilitation Center, White Plains, NY 10605

Orrin Devinsky

Cornell University Medical College at The Burke Rehabilitation Center, White Plains, NY 10605

The current study was designed to assess the frequency of neuropsychiatric behavior problems occurring following stroke and to evaluate the utility of current Diagnostic and Statistical Manual-3 Revised (DSM-3R) criteria to categorize them. Forty-four patients with stroke requiring inpatient rehabilitation were prospectively screened using a behavioral checklist scored at two-week intervals by physical and occupational therapists. Thirty-one patients (70 percent) had behavioral problems noted by their therapists and were referred to the participating psychiatrist. Of these thirty-one patients, seventeen were diagnosed as having an organic mood syndrome with depression, five had multi-infarct dementia, four had post-stroke delirium, one had organic anxiety syndrome, one had an adjustment reaction not otherwise specified, and six had no psychiatric disorder identified. Behavioral signs and symptoms due to post-stroke depression, anxiety, delirium, and dementia appear well categorized by DSM-3R criteria. Five behavioral problems were identified which were inconsistently coded using DSM-3R diagnoses: distractibility (N = 19), neglect of neurologic impairment (N = 14), impulsivity (N = 11), somnolence (N = 6), and irritability (N = 4). Future research concerning the impact of these problems on stroke rehabilitation outcome will be aided by an increased general awareness of their prevalence, development of consistent diagnostic criteria, standardized symptom severity scales, and plausible treatment intervention strategies.

Key Words: Cerebrovascular disorders • Rehabilitation • Depression • Dementia • Delirium • Attention deficit disorder.

Neurorehabilitation and Neural Repair, Vol. 7, No. 1, 1-7 (1993)
DOI: 10.1177/136140969300700102
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