Letter by Liberman et al Regarding Article, “Psychiatric Hospitalization Increases Short-Term Risk of Stroke”
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To the Editor:
We read with great interest the recent study by Zuflacht et al1 demonstrating that hospitalization for psychiatric disease increases short-term stroke risk and suggesting that acute psychological stress is a stroke trigger. This work is a potentially important contribution to the central question of why now? for incident stroke and, as the authors note, effectively avoids the problem of recall bias by using coded administrative claims data to detect psychiatric illness.
An alternative hypothesis, however, is that some patients labeled with psychiatric diagnoses who had a subsequent stroke were misdiagnosed at index visit. Although Zuflacht et al1 note that isolated psychiatric symptoms as the primary manifestation of stroke are rare, recent studies have found that altered mental status,2 as well as acute confusional states …