Psychosocial integrated assessment in stroke patients: a case report

Introduction: the biopsychosocial reintegration of stroke patients requires a multidisciplinary and integrated assessment including the evaluation of psychosocial factors. This is illustrated through a clinical case report concerning a hospitalized patient. Case description: the patient was a middle-aged married woman who had a left haemorrhagic stroke; the lesion is sub-cortical and medial in the basal ganglia lenticular region. She did not have a severe motor impairment but the cognitive profile showed some executive and working memory deficits that negatively affected the rehabilitation process. She presented severe hypertension which was caused by a renal artery stenosis diagnosed during her hospital stay. In order to assess the psychosocial factors, both observer-rated (Structured Clinical Interview for DSM-IV and Diagnostic Criteria for Psychosomatic Research-DCPR) and self-rated (Symptom Questionnaire-SQ, Psychosocial Index-PSI, Affective Neuroscience Personality Scales-ANPS and Family Assessment Device-FAD) instruments were used. DSM-IV Minor Depression and Alexithymia, according to DCPR were found. The patient showed high scores in SQ-Anxiety, Depression and Somatic Symptoms total scales and in ANPS-Fear subscale, while low scores in ANPSSeeking, Play and Spirituality subscales were found. Family functioning was characterized by emotional over-involvement, as evidenced by high scores in FAD-Affective Involvement scale. When PSI scales were considered, work-related stressful life situations and high psychosocial distress emerged. Comment: this case report enlightens the complex interconnection among biological, neurological, neuropsychological, and psychosocial aspects. An integrated and comprehensive assessment is essential to ensure an intervention properly targeted to the characteristics of stroke patient and to provide the best possible treatment outcome.