The
brain is the most complex organ in the body. Stroke is caused by no oxygen to
the brain, without no blood flow to the brain it causes the cell to die. When the
stroke happens on the right side of the brain, the left side of the body gets impact.
The patient will have issues with speech and languages, loss of motion on the left
side; their behavior might alter. 
Majority of patients who suffers Ischemic stroke symptoms such as
suddenly confusion, the trouble of speaking, blurred vision or dizziness. Ischemic
stroke can last from 2-15 minutes.

Depression
after stroke is a genuine neuropsychiatric confusion with a high rate of
predominance following a stroke. The side effects of gloom after stroke are
like those of endogenous dejection; discouragement after stroke is portrayed by the fast improvement and
beginning of manifestations, a nonattendance of response to external components and restraint that can
influence a few territories (Sugawara et al.,2015).

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Emotional
changes following a stroke are once in a while tended to at the intense,
restoration or outpatient phases of intercession. To be sure, they regularly
stay undiscovered and therefore untreated, unless they are seen by medicinal
staff as sufficiently serious to warrant the mental audit. The care of
individuals with extreme enthusiastic issues is then overseen by specialists
and, where analyze are made, pharmacological and psychotherapeutic medicines
have been accounted for (George, Wilcock & Stanley 2001).

These
uplifted horribleness and mortality dangers, in conjunction with the general
increment in restorative usage recorded for geriatric depressive patients
without stroke, recommend that patients with Post Stroke Depression may
likewise be in danger for higher therapeutic services use after stroke than
those without post-stroke depression. Furthermore, although sorrow is
the most well-known emotional well-being condition after stroke, little
consideration has been given to another post-stroke
emotional well-being disorder. One reason for this is the high comorbidity of
other emotional wellness determined to have anxiety
( Ghose, Williams & Swindle 2005).

Confidence
has been recommended to be a possibly essential variable in the enthusiastic
change and practical result of beginning period survivors of stroke. Past work
has suggested that stroke negatively affects the survivor’s confidence and
lower confidence evaluations have been related to more prominent levels of
revealed depressive and uneasiness side effects self-consciousSC1  (Vickery et al.,2009)

Depression
in stroke patients, when contrasted and the individuals who are not
discouraged, have brought down survival rates; demonstrate less inspiration to
experience restoration; have more extensive healing facility stays and poorer
useful recuperation; and neglect to take part in recreational furthermore,
social interests. As the dominant part of recovery is accomplished at a
beginning period and as discouragement can weaken this recuperation, it is
proverbial that early finding and treatment of sorrow is imperative (Watkins et
al., 2007).

 

 

 

 

 

Method

Design

 Before the study conducts the patient magnetic resonance brain imaging (MRI) will illustration
where the stroke appears in the patient brain.
Physical strength will be measured by
Time Up and Go Time (TUG). The damage left from the stroke might cause
the patient to suffer from an emotional problem
such as anxiety.  The Hospital Anxiety
and Depression Scale will be used to for
the 150 stroke patients that are inpatient
to complete seven questions asking them
about their anxiety levels. Also, 150
outpatient post-stroke will complete nine
questions of their anxiety levels. The Patient Health Questionnaire depression scale
(PHQ-9) will be used. The total of
the duration of the study will be
approximately one year, from December 2017 until December 2018.

Participant

A total of 300 stroke patients who suffers from ischemic were conducted from the
study.  Stroke survivors will be a divided into
two groups. There will be a study that will be
conducted for inpatient and outpatient. 150 inpatient post-stroke
anxiety who are compared to 150
outpatient post-stroke anxiety.  In inpatient, there will be 85 male and 65
females, and outpatient there will be 95 male and 55 females. The age range of
the stroke patients are 23- 45 years old.
A cross section questionnaire and interview survey will be conducted by
inpatient and outpatient stroke survivors.

Hypothesis

                Outpatient
post-stroke patient will suffer more anxiety than inpatient post-stroke since
they are in the rehab they are getting 24 hours care their mind is occupied of
getting better, the therapist and doctors are keeping them busy.

 

Description

Post-stroke anxiety influences roughly two-thirds of ischemic stroke survivors, anxiety
frequently undiagnosed and insufficiently treated, and
is related with increased condition
and fatality after stroke. Anxiety screening after stroke is critical also it can be challenged by lack of cognitive and physical.

A stroke patient that comes through
the emergency room the doctor will check to see what type of stroke the patient
is having. CT scan is a very crucial test
for the patient. The CT scan detects what
kind of stroke the patient has. The moment the doctor bust the blood clot in
the patient brain, the patient should start therapy immediately. The patient
only stays in the hospital for four days, if the patient remains longer than four days that’s mean they
have other medical complication.  They
will transfer the patient to inpatient rehabilitation.

In inpatient rehabilitation, the patient will stay there for
a month to get thread for physical therapy, occupation therapy, and speech therapy. Therapy beings in the acute
care after the patient overall condition has been stabilized. The first thing
they should do is promote independent movement because the patient might be
paralyzed or have serious weakness. While the patient is in inpatient rehabilitation, the therapist will measure the
patient progress of balance, sit to stand and walking. While the patient is in
rehabilitation it will helps the stroke patient with relearn new skill of what
they lost.

Doctors primary responsibility is
to care for the patient general health and provide guidance. Sometime doctors
overlook the patient psychological wellbeing. The doctors only worrying about
the patient physical wellbeing they are neglecting the psychological apart. If
the patient is feeling frustrated and angry that stroke survivor will not be
able to improve his physical wellbeing.

While the stroke patient is laying
in the hospital bed feeling frustrated and angry, thinking what is next for
them. Now they are getting comprehended what happened to them. The stoke survivors
are thinking when I am going back to work. If the patient cannot go back to their
old job, what are they going to do for money. How they going to support their
family. they don’t want to be a burned to anyone. The patient start getting
anxiety attack by thinking about their new life. The stroke survivor stops
progressing in therapy and stop eating. The therapist will the gave the patient
the hospital anxiety depression scale it depends on the result the might
prescribe medication.

The stroke survivor is out of
inpatient rehabilitation, now the patient is home. They are going to outpatient
rehab three days a week. When they are in therapy their mind is focus on
getting better.  When they are at home
they are worrying about their health and how they going to resume their lives.
The patient is in the house grief about their physical and mental health, and
playing the blaming game. The patient will start crying they don’t want to eat
they just want to lay in bed not doing anything. In their mind they think they
will never be normal.

Now patient been home for three
months, no more therapy the patient been discharge from outpatient therapy for
the last two months. Now he or she are in denial. They are in the house all
day, only time the patient goes outside is when they are going to doctor’s
appointment. In their mind they cannot see any progress they have made because the
stroke survivors speech still has the slurred, they can’t feel the sensation in
their left hand and they not able to walk without a walker. The stroke patients
get angry because he or she have lost their independent, they must dependent on
someone to help them do the basic of essential such as getting dress and beating.
The patient will be trying to speak but not able to put word together. The
patient start getting frustrated and the middle of nowhere they start crying.

five months pass the patients only
gain 50 percent muscle strength on their life side. The stroke survivor is
happy to see that they are regain some type of muscle strength. The stroke
patient start feeling sad because they are seen people going back to their
normal activities, they are not able to regain their normal activities back.
the stroke patient used to like doing home exercise to rebuild their muscle
strength back. As time goes by they lost interest in the home exercise.  The patient used to enjoy playing with their
children, suddenly they stop playing with the kids.  Now only thing the wants to do is sit by the
window and stare at the window. The patient energy start decreasing and they
having difficult time going to sleep. The patient is stressing about finances,
how they going to pay for medical bill and how they going to support their
family because they are not able to go back to work yet. Even though the car is
in the drive way they are not able to drive it. Every major move they made they
need someone assistance. The patient seen all this limitation they must go
through, they are feel worthless.   

Nine months after the post stroke
the patient wants to resume work. Before the patient need to go back to work
they need to be aware of their limitation, the work they used to do, they might
not to be able to complete the task. When the patient resumes back to work it
was not easy getting around the company. 
The patient will try to type a simple sentence in the computer their
left arm gets tired quickly, patient often become exhausted when they are doing
simple task.  While the patient is back
at work, the patient will have issue communicate with their coworker. Vice
versa the patient is having difficulty understanding what the coworkers are
saying to them.

Now the patient had to resign for
their job position because they are not able accomplish their duties. Now
anxiety step in, the patient feels like a failure. They are asking themselves
question why are they still alive they should have die. The patient does not
want to be bothering to do anything. They withdraw of the things they like to
do. The patient start getting jitteriness and loss of appetite. Patient is
losing weight to fast in a short period of time. When the patient sees others
are going to work, the patient will start throwing up. The patient is not
sleeping so there is dark stress under patient eyes. The patient is fear that
they might never work again. Patient is worrying about they can get another
stroke again. The men are afraid to have sex they might get a stroke during
sex. 

  Patient
family see how the patient withdraw themselves from activities and all they do
is stare at the window. The family can set up and find support group. Stroke
support group will help the patient to see they are not alone their others in
the same position as them. They will hear other people stories.  From their stories they will find strength
and they will be able to make friends. They have a haven to go to.

Two month later patient is feeling
better, the patient has a better understand of their condition. The patient is
volunteering at the center where they attend support group. The patient is
working part time job three days a week. Now patient is feeling better, the
patient stops watch their diet, stop exercising and stop taking the medication.  The patient will skip doctor’s appointment
and sometimes they might even go. Three weeks later the patient had another
stroke in the right side of the brain. This time is going to take them longer
to recover.

Result

Total of 300 patients were enroll
in the study, 150 are outpatients and 150 are inpatient. The age range of the stroke
patients is 23 to 45 the majority of patient are males. Females who are married
(60%) male who are married (40%), stroke patient who live alone (20%) and
patient that lives in the urban areas (55%). Seventy percent of the stroke
patients has highest level of education, twenty percent of stroke patients has a
high school education. Ten percent of the stroke patients has no education. Forty
five percent of the stroke patient had a current job and the rest of the stroke
patient had no job.

Analysis results will primary be
base on the sign of the stroke symptom with only 75 patients have CT scan done.
85% of the CT scans will confirm ischemic stroke, while 1% will show sign of hemorrhagic
stroke.  

Inpatient

Thirty-five percent of the stroke
patient will be able to recognize their anxiety of the stroke, by responding
yes or no to the question. Seven-five strove survivor will perceive their
anxiety as being serious. Forty percent will mention lack of energy, withdraw
from love one and fear. Other factors will mention by the patient how long is
the recovery are will they be able to go back to normal life. Twelve percent of
the stroke patient mention other alternative medicine and faith.  

Outpatient

                Sixty
percent of the stroke patients will be able to recognize their anxiety of the
stroke patients by responding yes or no to the question. Twenty percent will perceive
their anxiety as being serious. Fifty percent will mention loss of interest,
lack of energy, low self-esteem, sadness, lack of concentration and weight
loss. Other factors will mention by the patient when are they going back to
work. Patient will ask will they be able to drive again, and will they be able
to speak clearly? Forty percent of the stroke survivor mention other alternative
treatment such as therapy and faith healing and other.

 SC1