Response by Zuflacht et al to Letter Regarding Article, “Psychiatric Hospitalization Increases Short-Term Risk of Stroke”

We thank Drs Liberman, Prabhakaran, and Newman-Toker for their thoughtful response to our article Psychiatric Hospitalization Increases Short-Term Risk of Stroke. Their primary critique of our analysis—that some patients receiving the diagnosis of a psychiatric condition who had a subsequent stroke were misdiagnosed at the index visit—represents an important limitation to our study. However, although we appreciate the authors highlighting this alternative hypothesis, it is unlikely to account for the magnitude of the association between psychiatric hospitalization and stroke risk seen in our study. Drs Liberman, Prabhakaran, and Newman-Toker cite 2 articles to support their claim that “altered mental status as well as acute confusional states and psychiatric conditions are common initial (incorrect) diagnosis given to hospitalized patients with missed ischemic strokes (false negatives) …