BOCA RATON, FLA. – A group of researchers is looking at how patients who undergo endovascular coiling for aneurysmal subarachnoid hemorrhage fare psychologically in the years after the procedure.
The findings indicate that although the aneurysms were successfully repaired, some patients manifest clinical levels of anxiety and depression, as well as some deficits on a quality of life assessment scale, according to Dr. Antonio DeSimone, who presented his results at the annual meeting of the Society of Neurointerventional Surgery meeting.
“Our findings underline the need for focused interventions because of possible psychological morbidity even in good-outcome subjects,” says Dr. DeSimone, a neuroradiologist at the San Giovanni Bosco Hospital in Naples, Italy.
In one study, a group of 30 subjects was selected from a database of 248 subjects who had undergone coiling for intracranial aneurysms from June 2002 to February 2009. Patients had good outcomes with resumption of normal activities, had no evidence of aneurysm recurrence, and at least 1 year had elapsed since treatment.
On the Hospital Anxiety and Depression scale, seven patients (23%) showed anxiety in the clinical range while three other patients (10%) had borderline scores. Four patients (13%) had scores within the clinical range for depression, and an additional five patients (17%) had borderline symptoms.
The same group of subjects was asked to complete the validated Italian version of the Medical Outcome Study 36-item short form questionnaire (SF-36), a widely used tool for assessing quality of life. No difference was noted between the overall scores of the patients versus those of a reference population.
Patients who had undergone coiling did show significant deficits in some domains, such as social functioning (P less than .05), role limitations because of emotional problems (P less than .05), and mental health (P less than .01).
“After an aneurysm is secured either by coiling or clipping, a sympathetic physician must give patients a chance to share their subjective feelings. In most cases, this is enough.
But a competent physician/neurologist can also screen out the patients–according to our data, up to one-third even in those rated as 'good outcome'–who definitely need structured psychological support,” Dr. DeSimone said.
He points out that these patients and their families live in a disconcerting state of limbo and suggests that psychological support be made available to aneurysm patients.