STROKE MOOD SCREENING on an inpatient unit

Gurr, B.
1
& Muelenz, C.
2


1
Neuropsychology Department, Poole Stroke Unit, Poole, United Kingdom;
2
Psychology Department, Johannes Gutenberg University, Mainz,
Germany
This poster describes the implementation and evaluation of a mood screening
pathway in a hospital-based stroke unit. The pathway is evaluated against the
criteria of the national stroke guidelines, particularly the National Stroke
Sentinel Audit (Royal College of Physicians, 2008). The pathway takes into
account that all patients need to be assessed on admission ensuring that early
discharged patients wont be missed; that some patients present with significant
health problems which provide challenges for the assessment method and that
patients responses may be due to the hospital admission per se.

The mood screening pathway (figure 1) consists of a number of stages and
involves members of the team working with the patients according to their
stage in rehabilitation (nurses, occupational therapists, rehabilitation therapists,
neuropsychologists). Patients' cognitive and language abilities are taken into
account by providing a choice of mood measures.

Stage One
Monitoring of patients psychosocial needs as part of the Integrated Care
Pathway on admission to the unit.
Stage Two
Adapted Yale Questions administered by occupational therapists.
Stage Three
Formal mood assessments administered to participants of psychosocial
groups.
Stage Four
Referral to neuropsychologist for formal mood assessments.
Stage Five
Team discusses outcomes and treatment plans.
References
The study
1. Background
2. Method
3. Results
4. Discussion
2012 Ninth World Congress on Brain Injury
March 21-25, 2012, Edinburgh
Contact: Dr Birgit Gurr Consultant Neuropsychologist
Neuropsychology Service Dorset Healthcare, University Foundation Trust
Poole Community Clinic Shaftesbury Road Poole BH15 2NT
birgit.gurr@dhuft.nhs.uk
STROKE MOOD SCREENING
Preventing and detecting early treatment of post-stroke depression is a public
health priority because a large percentage of patients are affected. The
standards for the diagnosis of poststroke depression are the diagnostic criteria
by the DSM-IV (1994). Nonetheless, poststroke depression takes
heterogeneous presentations. Assessments of mood disorders should take
place in collaboration between professionals of a multidisciplinary team,
patients and relatives. The assessments provide validated information about
patients psychological condition and should result in an effective treatment of
depression.
The National Stroke Sentinel Audit Phase II (Royal College of Physician, 2008)
reported that the median for stroke units to assess mood was 67.8% and that
one quarter of stroke units achieve 86.6% of mood assessments.
Consequently, this Stroke Mood Screening Pathway (88.9%) performed within
the top quarter of stroke units in the UK.
The pathway methods appear patient- and staff-centred allowing assessments
to be tailored to the appropriate rehabilitation stage, administered by the
corresponding member of staff. This approach requires a solid collective
knowledge of psychological conditions and application of universal methods.
For rehabilitation purposes, it appears crucial that holistic theoretical models for
assessment and treatment of the condition are tested and validated. This is
furthermore important for all other psychological consequences of stroke,
including combinations of psychological and cognitive impairments (i.e.
executive problems).
Gurr, B. (2011). Stroke Mood Screening on an inpatient stroke unit. British Journal of Nursing, 20(2), 94-100.
Royal College of Physicians (2008). National Stroke Sentinel Audit, Phase II, Intercollegiate Stroke Working
Party, Clinical Effectiveness and Evaluation Unit, London.
Figure 2: Percentage of mood
screenings undertaken
Outlook
A mood screening pathway was established to screen all patients immediately
following admission to the stroke unit. The evaluation sample included 271
medical records (36.42% of all admissions during the evaluation period) of
patients with a diagnosis of any type of stroke (excluding TIAs).
Figure 2 shows a frequency analysis of the mood screening methods applied
to the evaluation sample. The outcome revealed that the Stroke Mood
Screening pathway met the target of assessing every patient in 88.9% of
cases.
This type of mood screening pathway ensured that all suitable patients were
included and enabled the identification of mood disturbances at a very early
stage. Reassessments were conducted according to patients rehabilitation
stage by the most appropriate member of the team.
The evaluation also highlighted administrative weaknesses which highlighted
opportunities for improving team-efficiency.
Good communication pathways between rehabilitation staff and easy referral
routes to neuropsychology made rapid and efficient responses to emerging
mood problems possible.
Figure 1: Stroke Mood Screening Pathway
Measures:

Adapted Yale Question
Hospital Anxiety
and Depression Scale
Brief Assessment
Depression Cards
Depression Intensity
Analogue Scale
Observation Tool
for Nursing Care

Patient admitted to
the Stroke Unit
Multi -
disciplinary
Meetings

Mood outcomes

Treatment
decisions

Treatments

Reassessments
(after two weeks )






Psychosocial Groups
Application of psychological assessments
including standardised questionnaires
OT Initial Assessment
Have you ever had problems with anxiety
or depression in the past?
Do you feel anxious or depressed now
due to your stroke/this situation?

1:1 Psychology
Formal mood
assessments

Psychosocial Observations
by any stroke team member
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10
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90
100
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