Psychological and Psychiatric Triggers and Risk Factors for Stroke

Abstract

Recent evidence suggests that psychiatric and/or psychological factors could be independent risk factors for stroke. Some of these factors may act as stroke triggers producing short-term physiological changes that may directly lead to stroke onset. Most data is related to four distinct domains: (1) depression and/or anxiety and related syndromes, (2) personality and character traits, (3) psychological stress, and (4) psychotropic medication. Some factors (e.g., depression) are closely related to stroke risk, and there is some evidence that psychological stress could be an important risk factor. However, many studies have methodological limitations (small sample size, lack of adjustment for stroke risk factors, or residual confounding) and lack of standardized definition and/or measurement. Data about stroke triggers is scarce but epidemiological studies suggest a triggering effect of acute or subacute life stress exposure. The potential pathophysiological ways by which psychiatric and/or psychological factors may promote stroke include a higher frequency of unhealthy behaviors and direct biological effects on the cardiovascular system, notably through activation of the sympathetic nervous system. More research is still needed to improve measurement and to better investigate the impact of psychiatric and/or psychological factors. The clarification of pathophysiological mechanisms could help to consider preventive strategies.