Post-stroke psychosis: causes of aggression, symptoms and treatment

A stroke does not go unnoticed. This pathology is characterized by complications of mental and neurological etiology. Specialists pay the main attention to confusion. In almost 30% of patients, aggression is recorded after a stroke. In connection with the irreversible violation of cerebral circulation, ridiculous judgments are also traced, the acuity of hearing and vision worsens. There is a delusional state and hallucinations after a stroke in the elderly.


Statistics of mental disorders after a stroke


During the period of post-stroke rehabilitation, symptoms of aggression and delirium appear in at least a third of patients. The cause of the pathology is a severe lesion of different parts of the brain due to hemorrhages in the temporo-parietal and occipital regions.

Doctors identify the main factors that cause psychosis after a hemorrhagic stroke. These are dementia, the age group of patients over 65 years old, a history of diagnosed neurological diseases, kidney failure, prolonged emotional stress, metabolic disorders of various types. Brain dysfunction and delirium after a stroke are more common in male patients.

Post-stroke psychosis has a delayed onset. These are complications that first make themselves felt after 6-12 months. Although aggression and hallucinations after a hemorrhagic stroke can develop in 5-10 years.


Symptoms of post-stroke psychosis


After a stroke, gradually and imperceptibly, the patient’s psyche and thinking begin to change. These are lonely episodes in the form of forgetfulness, confusion, obsessive anxiety, and disruption of the sleep-wake cycle. A person sleeps little at night, but because of the accumulated physical fatigue, go to bed during the day. Complains of nightmares, disturbing thoughts, phobias develop for the first time. Then, post-stroke psychosis develops a persistent and pronounced character.


The elderly appear unusual behavior for him:

  • unmotivated anger and aggression even towards relatives;
    “complex” character;
    he constantly makes remarks, reproaches, accuses;
    the patient is no longer able to cope with his duties at work.

If in the early stages only people from the inner circle become the object of attacks, then in the future the disease will only progress. Remarks to strangers begin. Conflict situations with neighbors are becoming more frequent.

Hypo- and hyperactive forms


Post-stroke psychosis and the level of its manifestation depends on the damage to the brain – on the localization of circulatory disorders. In some patients, after a while, a sharp inhibition in behavior is recorded. Others, on the contrary, are too excited and aggressive.

Doctors define two forms of delirium (madness):

  • Hypoactive confusion is characterized by lethargy, detached behavior, and indifference to family life. The speech of such patients is poor, and the phrases are meaningless. They do not remember events well and get tired quickly. In the morning, patients are lethargic and sleepy, and the peak of active behavior falls in the evening.
    The hyperactive form of psychosis after a stroke is the cause of the patient’s fussy and aggressive personality. If an elderly person is advised to adhere to bed rest, then he is constantly nervous, tossing and turning and changing positions. Motor and speech excitement: the patient talks a lot, shouts out words, is overly cheerful or anxious. All symptoms are especially active at night. Hallucinations, obsessive thoughts appear in a bedridden patient.


Types of psychosis after a stroke


After six months or a year, psychosis becomes chronic. Patients who stay for a long time on treatment in a clinic or living in a nursing home have persistent paranoid delusions. This is an obsessive opinion that they want to poison them, harm them, steal their valuables and savings. Patients hide things, refuse to eat, drink. They can only be cared for by trained medical personnel.


People who have had a stroke are diagnosed with hypochondriacal delusions. An elderly person constantly thinks that he has some kind of serious illness, but doctors are unable to diagnose him.

In the post-stroke psychotic state, patients usually develop residual delusions. It borders on constant aggression and typical content, more typical for older men. The most common scenarios are pseudo -pictures of the spouse’s infidelity.

Less commonly, patients have auditory or visual, tactile hallucinations. Older people begin to see fictitious personalities, to conduct dialogues with them.

Patients after a stroke do not immediately change in their behavior. And relatives rarely associate the appearance of delayed psychoses with vascular pathologies in the brain. At the first stage of post-stroke psychosis, sharp mood swings, unjustified outbursts of aggression, severe fatigue and apathy appear.

Manifestations of mental disorders are individual. In a patient, disorders make themselves felt over a different time period. All mental disturbances become sudden.

Inappropriate behavior can manifest itself in one of the forms of post-stroke psychosis:

  • Excitation . The state is recognized as the usual fussiness in words and actions, as well as the desire to constantly break something, destroy it. Furniture in the house interferes with such a person, he constantly shifts objects to new places, makes the bed several times a day, constantly throws out garbage.


  • Brad . The desire to form certain judgments without supporting them with sound logic. It is impossible for the patient to prove the fallacy of his conclusions. He firmly believes in his arguments. Men will watch their spouses for hours, hack phone access to prove their wife’s infidelity. At the same time, the patient lives in a constant feeling of anxiety, fear, panic. Against this background, unreasonable aggression develops.
    Hallucinations . The patient lives in an illusory world and is not able to distinguish it from the real one. Attacks of hallucinations are already becoming more pronounced and frequent.


Post-stroke disorders also include depressive states. They are typical for 55-60% of patients. Depression does not come after a stroke. First depressive disorders are quite rare. They occur in 5-8% of cases and are associated with the affected left hemisphere and the presence of speech dysfunctions.

If the patient had lesions in the right hemisphere and established cerebral atrophy, then they develop delayed depression. It is later and develops no earlier than 6-12 months after the stroke.


The life of an elderly person after a stroke suffers on all fronts. The depressive state is aggravated by social changes:
the patient loses the ability to perform work duties;
he goes through a difficult stage of domestic adaptation;
life expectancy of such patients is reduced;
the quality of life decreases due to the deterioration of the financial condition;
refusal of loved ones to communicate or provide assistance in care.

Therefore, the most important stage of therapy is the prevention of mental disorders. It is important to screen after a stroke using effective neuropsychological techniques.


Any disorders are detected at an early stage, so it is possible to provide the patient with timely assistance.


Aggression after a stroke: what to do for relatives


At the first stage after a stroke, it is difficult to recognize the development of dementia or psychosis in time. The task of relatives is to be attentive to an elderly family member. It is important to record any changes in character, to track forms of behavior that are atypical for him. Watch your emotional states.

Lack of appetite, detachment, ignoring the immediate environment are typical early symptoms of the development of post-stroke psychosis.


If these typical behavioral traits were noticed, then relatives should contact a specialist as soon as possible. At first, it may be a neurologist who will assess the severity of the condition of an elderly patient in time. Many relatives are hesitant to go for a consultation directly to a psychiatrist.

Although it is a specialist of this profile who works with manifestations of aggression, depression and agitation in patients. If the manifestations of post-stroke psychosis are stopped in time, then this disease can be controlled in the future. And an elderly family member will not have to be sent to a psychiatric clinic for treatment.


7 tips for relatives who are faced with bouts of aggression of the patient


  1. Provide, as far as possible, the safety of the elderly relative and his entourage. Temporarily isolate him in a separate room. Most importantly, remove all dangerous objects and do not try to calm yourself with force.
    2. Call an ambulance or a psychiatrist at home. Try not to do this in front of the patient. Elderly people with post-stroke psychoses develop paranoia and obsessive-compulsive disorder. They can be sure that relatives want to harm them.
    3. Do not panic yourself and do not talk with a sick relative in a raised voice. Until a specialist arrives, you need to reduce the stressful situation, tension in the house. Be patient and calmly answer all the relative’s questions – even if he repeats them and asks many times.
    4. Take care of a well-lit room for a sick relative. Dim, muffled light only intensifies panic, fear, confusion, aggression. It is in the dark that patients after a stroke show hallucinations.
    5. Do not leave a sick person in a state of psychosis in the room himself. Make sure that he is guarded by 1-2 physically strong assistants. They should control the patient’s behavior and prevent them from approaching windows and doors. A large number of people in the room also increases aggression.
    6. Observation of an elderly relative with signs of psychosis should be continuous. He must be accompanied to the bathroom or toilet, not allowing him to close from the inside. Depressive states also provoke suicidal thoughts, a desire to injure oneself.
    7. Approach the patient correctly. Do not make sudden movements, do not shout anything. Approach from the side so as not to get an unexpected blow. Patients in a state of psychosis are overly agitated. Even if your relative does not have the desire to purposefully cripple you, he can do this due to frequent and sharp waving of his hands.


Psychosis after a stroke in an elderly person – treatment


At the first stages, assistance for this category of patients is reduced to complex psychopharmacotherapy . Depending on the general condition, the duration of the symptoms of post-stroke aggression, the doctor will prescribe special antipsychotic drugs. They effectively and sufficiently in a short period of time relieve acute conditions and symptoms of post-stroke psychosis.

For a patient who is first admitted to the clinic for treatment, modern diagnostics is necessary. The goal is to determine the degree of disturbances in the functioning of the brain. Doctors determine how psychosis in a particular patient is associated with the development of vascular pathologies.

When it was possible to stop the acute phase of the disease, a new type of medication is prescribed. They are needed for successful rehabilitation and protection against relapses in the future. During this period of therapy, general strengthening and dehydration agents are traditionally prescribed .

As soon as a stable effect of remission is fixed with the help of drug therapy, social rehabilitation and psychotherapy are carried out with the patient.

All patients with post-stroke psychoses suffer from asociality. Their minds are dominated by the idea that they are a burden for others, relatives. Such patients withdraw into themselves even in the first stages after a stroke. The depression will worsen in the future.

The task of psychotherapists is to teach an elderly person to live with his illness. This will help not so sharply feel the decline in the quality of life. The approach to the treatment of post-stroke psychosis and aggression should be comprehensive and lengthy. A neurologist and a psychiatrist work individually with an elderly person. Such a patient needs constant qualified medical care. It is recommended to place it in a specialized medical center or a nursing home.

Treatment of post-stroke psychosis in a hospital

Patients who have had a stroke fall into a severe category of patients. They need round-the-clock medical supervision and timely assistance. Inpatient treatment may be temporary for the period of the acute phase of the disease and rehabilitation. Permanent residence of the patient within the walls of specialized institutions is recommended. People with aggression, anxiety and depressive states, dementia are unbearable for relatives.

In the absence of medical knowledge, relatives are unable to help an elderly patient in moments of exacerbation.

Special institutions and medical centers provide assistance in several areas. What are the advantages of treating post-stroke psychosis in a hospital setting:

  • 24/7 medical support and condition monitoring;
    specially equipped wards with the possibility of lighting at night;
    personnel who act strictly according to instructions;
    calm, quiet atmosphere without unnecessary noise, annoying factors.

In addition to classical drug therapy, additional rehabilitation methods are also practiced in special institutions . They help to improve the mental state, socialize the patient and prepare him for work adaptation.

Effective measures during the recovery phase:

  • sessions of music or art therapy ;
    attending a massage for physical and emotional relaxation;
    laser therapy;
    treatment with aromatherapy methods;

In order for post-stroke treatment and recovery to be effective and stable, an appointment with a psychiatrist is needed not only for an elderly patient. Doctors also provide psychological assistance to family members for whom changes in the consciousness of a loved one were also a stressful situation.

A psychiatrist gives valuable advice on how to provide support and attention to an elderly relative. Thanks to a comprehensive and modern approach in the treatment of post-stroke psychosis, it is possible to minimize the manifestations of aggression, anxiety, and delusional states. Elderly people can feel the joy of life again. And occupational therapy, sports, visiting creative circles, communication with peers gives chances for effective prevention and reducing the risk of developing depression.

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