INCIDENCE OF POST STROKE PSYCHIATRIC EMERGENCIES AND EVALUATION TIMELINES IN SPECIALIZED STROKE CENTERS CROSS-SECTIONAL PREVALENCE STUDY FROM QUETTA PAKISTAN

Abstract

Background: Stroke is one of the leading causes of mortality and long-term disability worldwide. Beyond neurological impairment, stroke survivors frequently experience psychiatric emergencies including acute delirium, severe depression with suicidal ideation, psychosis, agitation, anxiety disorders, and behavioral disturbances. These conditions are often under recognized in low- and middle-income countries, resulting in delayed psychiatric consultation and poorer functional outcomes. Evidence regarding the burden of post-stroke psychiatric emergencies and the timeliness of psychiatric evaluation in Pakistan, particularly in specialized stroke centers, remains limited. Objective: To determine the incidence of post-stroke psychiatric emergencies and evaluate psychiatric consultation timelines among patients admitted to specialized stroke centers in Quetta, Pakistan. Methods: A cross-sectional prevalence study was designed for educational purposes using a fictional dataset representing 250 adult patients admitted to specialized stroke centers in Quetta between January and December 2025. Demographic characteristics, stroke subtype, psychiatric emergency presentations, psychiatric consultation requests, consultation timelines, and clinical outcomes were analyzed. Descriptive statistics summarized patient characteristics and psychiatric diagnoses. Chi-square tests and multivariable logistic regression were used to identify factors associated with delayed psychiatric evaluation (>48 hours). Statistical significance was considered at p < .05. Results: Among the cohort of 250 patients, 72 (28.8%) experienced at least one psychiatric emergency during hospitalization. The most frequently observed psychiatric presentations were delirium (38.9%), severe depression with suicidal ideation (22.2%), acute agitation (16.7%), anxiety disorders (11.1%), psychosis (8.3%), and manic symptoms (2.8%). Only 40.3% of psychiatric consultations occurred within the first 24 hours, whereas 34.7% were performed after 48 hours. Delayed psychiatric evaluation was significantly associated with advanced age, hemorrhagic stroke, severe neurological impairment, intensive care unit admission, and multiple medical comorbidities (p < .05). Patients receiving psychiatric evaluation within 24 hours demonstrated shorter hospital stays and fewer behavioral complications than those with delayed assessment. Conclusion: The findings suggest that psychiatric emergencies may affect nearly one-third of hospitalized stroke patients, with substantial delays in specialist psychiatric assessment. Early integration of consultation-liaison psychiatry into multidisciplinary stroke care may facilitate timely identification, improve patient safety, optimize rehabilitation outcomes, and reduce hospital burden. Prospective multicenter studies in Pakistan are warranted to establish the true epidemiology of post-stroke psychiatric emergencies and evaluate interventions aimed at improving psychiatric referral pathways.