Stroke's Paranoia: Understanding The Unexpected Mental Impact

Strokes are known to cause emotional and behavioural changes in survivors, and they can have a significant impact on the brain. In fact, up to one in 20 people will suffer from 'psychotic symptoms' following a stroke, such as hallucinations or delusions. Delusions are strong beliefs about something that is untrue, and they can cause fear or paranoia. These symptoms can start weeks or even months after a stroke and may occur even without any physical symptoms.

Hallucinations and delusions are common post-stroke psychosis symptoms

Experiencing hallucinations and delusions is a known consequence of strokes, with up to one in 20 people suffering from these "psychotic symptoms". Hallucinations can be either auditory or visual. Visual hallucinations can be caused by a loss of vision, where the brain generates images to "fill in the gaps" in a person's field of vision. They can also be caused by damage to the midbrain, which can result in vivid and colourful hallucinations of animals, patterns or shapes. Auditory hallucinations can include hearing voices, music or odd sounds.

Delusions are strong beliefs about something that is untrue. For example, someone might think they are being spied on or that someone is trying to harm them. Other types of delusions include:

• Persecutory delusions: the belief that someone is trying to harm you
• Delusional jealousy: becoming very jealous of someone or something
• Capgras syndrome: believing that someone else is an imposter
• Reduplicative paramnesia: thinking that there are two copies of a place, such as a room or house

These symptoms can start soon after a stroke, but they can also begin weeks or even months later. They may be more common with certain types of stroke, but they can also happen alongside "silent strokes", which are due to very small blockages or bleeds in the brain without obvious physical symptoms.

Delusions can include paranoia, such as the belief that someone is trying to harm you

A stroke can sometimes lead to delusions, which are strong beliefs about something that is untrue. Delusions can include paranoia, such as the belief that someone is trying to harm you. This is known as a persecutory delusion. Up to one in 20 people will suffer from 'psychotic symptoms' following a stroke, and these symptoms can start weeks or even months after the stroke itself.

Delusions are often a result of damage to the brain, which can occur during a stroke. This damage can cause changes in behaviour and emotions, as the brain controls these things. The effects of a stroke can vary depending on the area of the brain that is injured and the chemical changes that occur.

Other causes of delusions include other conditions of the brain, such as dementia, Parkinson's disease, and brain tumours, as well as serious infections, alcohol or drug misuse, and rare side effects of medication.

If you or someone you know is experiencing delusions or other psychotic symptoms, it is important to contact a medical professional as soon as possible. Early treatment is often more effective, and symptoms usually become less intense over time. Treatment options can include medication or psychological therapy.

Hallucinations can be visual or auditory

Experiencing hallucinations is a possible outcome of a stroke. Hallucinations can be visual or auditory, and they can start soon after a stroke or even weeks or months later. Visual hallucinations can be due to a loss of vision, which is also known as Charles Bonnet syndrome. In this case, the brain generates images to fill in the missing areas of the person's vision. These hallucinations can last for several months and can appear as simple patterns or complex images of people, places, and objects. On the other hand, vivid and colourful visual hallucinations can also occur when there is damage to the mid-brain, often involving scenes with animals, people, and patterns. These hallucinations can disappear within a few weeks but may also persist for longer. Auditory hallucinations involve hearing sounds or voices, which may seem to come from inside or outside one's head. They can include voices, music, or odd sounds and can be heard alongside visual hallucinations.

It is important to note that hallucinations are not limited to the sense of sight and hearing. A stroke can also cause hallucinations in other senses, such as smell, taste, or touch. For example, an individual may experience abnormal nerve sensations like burning or pricking of the skin or aching limbs. Hallucinations can be a distressing and frightening experience, and it is recommended to seek medical help as soon as possible if they occur.

Post-stroke psychosis can have a delayed onset, sometimes occurring months after the stroke

A stroke can cause psychosis, which includes paranoia, in some cases. Post-stroke psychosis can have a delayed onset, sometimes occurring months after the stroke. This delayed onset is a window for early intervention.

Post-stroke psychosis is a known consequence of stroke, affecting a significant minority of stroke survivors. It is characterised by hallucinations, delusions, or both. Hallucinations are sensory perceptions that aren't there, and delusions are strong beliefs about something that is untrue. Delusions can include paranoia, such as the belief that someone is trying to harm you.

The average time between a stroke and the onset of post-stroke psychosis is around 6 months, but this can vary. Some studies report an average onset of 2 days, while others find that psychosis can occur several months or even years after a stroke. This delay suggests that early detection and intervention are possible and necessary.

The risk of post-stroke psychosis is higher in people with certain risk factors, such as hypertension, hyperlipidaemia, and diabetes mellitus. Additionally, the type of stroke may play a role, with ischaemic strokes being more common in people who develop post-stroke psychosis than haemorrhagic strokes. However, more research is needed to fully understand the risk factors and causes of post-stroke psychosis.

The treatment for post-stroke psychosis typically involves antipsychotic medication, such as haloperidol and risperidone. However, these medications can have side effects, and there is a lack of clinical research on their effectiveness in treating post-stroke psychosis specifically. Psychological treatments, such as cognitive behavioural therapy, may also be beneficial.

Post-stroke psychosis is associated with poor functional outcomes and high mortality

Experiencing paranoia after a stroke is not uncommon. Up to one in 20 people may suffer from "psychotic symptoms" following a stroke, such as hallucinations or delusions. Delusions are strong beliefs about something that is untrue, which may cause fear or paranoia. For example, someone might think that someone is trying to harm them. These symptoms can occur even if the stroke victim does not experience any physical symptoms, and they may not start until weeks or even months after the stroke.

The high mortality rate associated with post-stroke psychosis may be due to a variety of factors, including unhealthy lifestyle choices, antipsychotic side effects, suicide, and physical illnesses, including cardiovascular illnesses. Additionally, the use of antipsychotic medications to treat post-stroke psychosis may also contribute to the high mortality rate, as these medications can increase the risk of stroke.

The poor functional outcomes associated with post-stroke psychosis may be due to the impact of psychosis on the individual's ability to cope with the consequences of the stroke. The individual may become more dependent on assistance in their everyday life and may struggle with social interaction and participation.

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