Emotional disturbances in patients in the remote postoperative period after surgical treatment of cerebral aneurysms

Aneurysmal subarachnoid haemorrhage is one of the most severe forms of cerebral stroke, associated with a high mortality and disability rate. Development of emotional disorders (anxiety and depression), as well as functional and cognitive deficits, interfere with resocialisation of patients who have undergone surgery for a cerebral aneurysm, and impair quality of life and exacerbate cognitive impairment.

Objective: to investigate the prevalence of emotional disturbances in the remote postoperative period after surgical treatment of cerebral aneurysms (CA).

Material and methods. The prevalence and severity of emotional disturbances in the remote postoperative period after surgical treatment of CA was analysed, mean time after surgery was 3.5 years. Two hundred and one patients underwent surgery for a CA rupture, 110 for a non-ruptured aneurysm. On admission to hospital for surgical treatment, patients underwent a clinical and diagnostic examination to confirm the diagnosis and determine the extent, timing and type of intervention. In the remote postoperative period, the degree of limitation of self-care and functional capacity (using the Barthel Index and the modified Rankin Scale), cognitive functioning (using the MoCA test) and emotional domain (using the HADS scale) were assessed.

Results. In the remote postoperative period following surgical treatment of CA, subclinical and clinically significant anxiety was found in 110 (36.3%) patients and depression – in 117 (38.6%). The severity of anxiety and depressive disorders did not decrease over time. The mean score on the HADS anxiety scale during the first year after surgery was 5.9±2.8; after 5 years and more – 6.1±3.4. The mean score on the depression scale in patients tested within 1 year after surgery was 7.3±3.3; after 5 years and more – 6.7±3.5. A correlation was found between the severity of vasospasm and anxiety disorders in the remote postoperative period: anxiety symptoms predominated in patients with normal linear blood flow velocity compared to patients diagnosed with vasospasm (p=0.03). The condition of patients at hospital discharge was also associated with the severity of anxiety symptoms in the remote postoperative period: as the Glasgow Outcome Scale (GOS) score increased, so did the severity of anxiety disorders. A statistically significant correlation was found between the groups of patients with a GOS score of 3 and 5 points (p=0.016). A significant predominance of anxiety and depressive disturbances was found in female patients in the remote postoperative phase of surgical treatment (p<0.001 and p=0.002, respectively). Conclusion. Emotional disturbances in patients who underwent surgery for CA persist for a long time, with anxiety disorders predominating in patients without overt neurological disorders during hospitalization. Both anxiety disorders and depressive disorders occur most frequently in female patients. The persistence of emotional disturbances over a long period of time after the exclusion of the aneurysm from the circulation shows the need for their correction in terms of 0.001 and p=0.002, respectively).

Conclusion. Emotional disturbances in patients who underwent surgery for CA persist for a long time, with anxiety disorders predominating in patients without overt neurological disorders during hospitalization. Both anxiety disorders and depressive disorders occur most frequently in female patients. The persistence of emotional disturbances over a long period of time after the exclusion of the aneurysm from the circulation shows the need for their correction in terms of patient's social adaptation.

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