(A) Mental health guidance for healthy people People emphasize the importance of diet and exercise in stroke prevention, but in fact, mental health care also plays an important role in stroke prevention. In 1959, American scholars suggested that people with type A personality are prone to cardiovascular diseases such as hypertension and coronary heart disease. The main characteristics of Type A personality are: strong personality, high ambition, aggressive, stubborn, argumentative, impatient, nervous, impulsive, loud, hurried, competitive, and aggressive (Friedman and Rosenman 1959). Another risk factor for stroke is stress, also known as stress (Tsutsumi, Kayaba et al. 2009). Stress is now a part of our daily life. Many physicians believe that even in the absence of hypertension, stress alone can cause impaired vascular function and inflammatory responses in blood vessels, all of which can trigger a stroke. Some studies have found that stroke patients have a significantly higher rate of negative events (such as death of a relative, unemployment, etc.) than normal people a year ago, and if the patient is also a type A personality, the risk of stroke is doubled. Therefore, we should pay attention to avoiding negative events and improving character defects as much as possible. When a person is nervous and irritable can induce a stroke, showing a mental health problem, there is also biological evidence. When the body is in a stressful state such as tension, irritability, or irritability, the body is sympathetically excited, the hypothalamic-pituitary-adrenal axis (HPA axis) activity is enhanced, hormone secretion such as adrenaline is elevated, heart rate is accelerated, and blood pressure is elevated. increased HPA axis activity causes hypercortisolism, which in turn can cause centripetal obesity and metabolic abnormalities. If this phenomenon occurs frequently, as we age and our body organs age, the blood vessels, heart and brain in the body become weak, which can easily lead to hypertension, diabetes, coronary heart disease and stroke. Healthy people can prevent the occurrence of stroke from the following aspects: 1, work and rest, according to their ability: some people forget to sleep, overload the work, resulting in the collapse of the body, died young, but lost the durability of the work. Only a good rest to work better, “sharpening the knife does not miss the woodcutter”. After a busy period of time, give yourself a vacation. Do not let the mind is full of all kinds of unfinished work, to a period of time to focus on one thing, each time is to do the thing of the moment, to avoid making yourself always feel that there are many things not done, always in a state of tension, anxiety. 2, cultivate your body and mind, peace of mind: through reading and learning, learn the excellent qualities of others, improve their own shortcomings, cultivate some hobbies, enrich their spiritual life, cultivate sentiment, improve their moral quality, do not like things, not to their own sadness. Do not be furious, and be tolerant of others and restrain yourself. Some people are more sensitive to the words and actions of others, if you think that others are not good for you and angry, you should review yourself to see if you have negative thoughts or feelings. Learn to express love and affection for your spouse, children, friends, colleagues or small animals. When encountering bad stimuli or stress, you should control your emotions and consciously control yourself not to get angry; when the emotions are extremely sad, you can divert your attention, such as visiting friends and relatives, watching movies, listening to music and other diversions; when there is going to be a conflict with someone, you can leave the scene, hide temporarily, and come back when the conflict disappears; if you encounter something worrying, you can find your spouse, children If you encounter something worrying, you can find your spouse, children, friends, colleagues and so on to talk about it, venting out these worries. 3, self-relaxation, do not stress: in the presence of tension, anxiety or conflict, first deep breath, learn to self-relaxation. Usually you can learn to do slow, rhythmic deep breathing, and at the same time to meditate in your head “relax”, “quiet”. Learn muscle relaxation, from the top of the head to the toes of the muscles to relax, pay attention to experience the difference between tension and relaxation, slowly practice, and finally the whole body will become more and more relaxed. Self-massage can also play a relaxing role. People don’t have to relax when they are quiet or alone, they can relax when they are watching TV, riding in the car, or even in a meeting, and they can relax at any time of the day. When irritable and filled with thoughts of negative things in life, physical activity is a very good way to help yourself, such as planting flowers, running, doing yoga, doing calisthenics, and engaging in home decor to distract yourself. Some people can relax by imagining a calm sea, a peaceful sky, some people can relax by listening to music, some people communicate with others, etc. You can try various relaxation methods and find the kind that suits you to loosen up your emotions, and don’t let the tension affect your rest and sleep. In short, you should keep your mental health, make yourself happy and energetic; avoid bad emotions such as ecstasy, anger, sorrow, thinking, sadness, fear and fright. How to control one’s emotions is related to one’s education level, ideological awareness, moral quality, personal will and other comprehensive factors, so it is advocated to constantly cultivate one’s body and improve one’s ability to adapt and resist stress (Wang Xiaodao, Li Xintian, et al. 2000). (b) Mental health guidance for people at risk of stroke The people at risk of stroke are patients with hypertension, hyperglycemia and hyperlipidemia. These diseases are physical and mental diseases and are complex and chronic. These stroke risk groups may have different psychological problems at different stages of the disease. When the disease is first diagnosed is, a variety of emotional and behavioral problems may occur at the stage of disease progression to the development of complications and at the stage when lifestyle changes (instituting strict dietary control, exercise, smoking cessation, and alcohol cessation) are required. Studies have found that the incidence of depression and anxiety in patients decreases as patient compliance with medical care increases. It has also been suggested that the incidence of diabetes in patients with mood disorders is 1.5-2 times higher than in patients without mood disorders. Patients with chronic anxiety and depression have increased HPA axis activity, causing hypercortisolism, which further affects abnormal glucose metabolism, aggravating diabetes and inducing diabetic complications. Chronic anxiety and depression increase platelet agglutination, increase inflammatory factors and damage the function of vascular endothelial cells, all of which are risk factors for cardiovascular and cerebrovascular diseases. In addition, people with anxiety and depression usually have problems with their lifestyles, such as smoking, reluctance to be active, and unhealthy eating habits, which are risk factors for hypertension, hyperglycemia, hyperlipidemia, and obesity. These undesirable factors form a vicious cycle process. Therefore, if you wish to prevent the occurrence of these diseases, you must break all the links in the chain of these vicious circles. (C) Mental health guidance for people with stroke The most common psychological disorders after stroke are the occurrence of anxiety and depressive symptoms, which means that emotional problems are most commonly seen. The incidence of depression after stroke is significantly higher, ranging from 20-60%. Post-stroke depression in turn predicts a poor prognosis for stroke and increases the rate of death after stroke. Therefore, prevention of post-stroke mood disorders is important (Ghose SS, Williams LS et al. 2005). Depression is easy to occur after stroke, including bad mood, cheerfulness, feeling that life has lost its meaning, so they become uninterested in anything and their physical strength is not as good as before, they may have self-blaming thoughts and feel sorry for dragging down their family members, these are the subjective feelings of the patient. Family members observe that the patient becomes less talkative, reluctant to meet people, hides inside the house as a whole, decreases the amount of food, does not sleep well, often sighs, and in severe cases, has suicidal thoughts and behaviors. After a stroke, anxiety may also occur, such as worrying that the patient will not get well or that his or her children will have accidents. stay at home alone, etc. Some patients may become irritable and easily provoked because of nervousness and depression. When the symptoms are mild, they can be relieved through self-adjustment and psychotherapy. When the symptoms are more severe, it has caused the neurotransmitters in the brain to become abnormal. At this time, perhaps the patient is suffering from anxiety disorder or depression disorder again, so these symptoms should be recognized early and timely consultation should be made to a specialized hospital to avoid the generation and deterioration of mental disorders. If any of these conditions occur, you should first visit a psychiatrist to determine whether a depressive disorder or anxiety disorder has occurred and whether medication or psychotherapy is needed. Psychotherapy should be done after excluding the disorders that require medication, so that the diagnosis and treatment of the disorder will not be delayed by taking the opposite course in the mistaken belief that only psychotherapy is effective. It is now believed that anxiety disorders and depression disorders are caused by abnormalities in neurotransmitters in the brain, mainly pentraxin (5-HT), norepinephrine (NE), and dopamine (DA) transmitters. There are many types of drugs available for the treatment of anxiety and depression, and the common ones are pentraxin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine. Pentazocine and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, duloxetine. The exact medication to be taken needs to be decided by a physician in a psychiatric specialty, depending on each individual’s situation (Benjamin J. Sadock, Virginia Alcott Sadock et al. 2009). What can be done to maintain the psychological and spiritual health of stroke patients? Prevention from the individual, family, and societal perspectives is advocated. (1) Prevention from the individual perspective Patients should maintain an active treatment mindset and not be discouraged. When a patient has the disease, his relationship among family members, colleagues and friends changes, and the situation in social life and work changes. For example, a person who was very capable, who could work, who could do housework, who was needed by others, now becomes physically weak, the decline of social function, unable to work, unable to take care of his family, and becomes a person who needs to be taken care of by others. Some patients worry that they will die soon and become unconfident, fearful and scared. Therefore, it is important to overcome negative thinking and to anticipate that the disease will progress in a good direction. Some studies have shown that if one always anticipates in a negative direction it will put a heavy mental burden on the patient, and when one is under this mental burden for a long time, the immune function of the body will be low and the chance of getting sick will increase. If the patient can eliminate negative thinking and make the most optimistic prediction, he can change his attitude towards the same thing, eliminate his pessimistic and anxious mood, and things will develop in a good direction instead. For example, if a patient’s limbs are temporarily paralyzed because of a stroke, don’t be overly anxious and don’t keep thinking, “How can I live after I’m paralyzed?” Instead, a plan should be made to gradually restore the function of the limbs through step-by-step rehabilitation (Gilbert, 2000). (2) Prevention from the family perspective Family members should not keep complaining because of the patient’s illness, but should encourage and support the patient to come out from the shadow of the illness as soon as possible. Patients will definitely have heavy concerns and increased worries after getting sick. For example, after the patient has gotten sick, the most worried is to find trouble for spouse and children; some people worry that they are sick, children and other family members have no one to take care of them; some people worry that they will be disliked by their families and do not want to take care of themselves; some people worry that it is difficult to solve family matters in the future, such as the allocation of property, etc. At this time, family members should solve the patient’s worries and help the patient to actively treat. At the same time, the other extreme should be prevented. Some patients’ family members are overly concerned about the patient, always afraid of not taking good care of the patient, and give up their own work to take care of the patient, which in turn causes pressure to the patient. At this time, the family should actively communicate with the patient to understand their worries and help solve the patient’s worries. In short, family support and care play a very important role in the physical and psychological recovery of stroke patients. (3) Prevention from a social perspective Advocate that society should not discriminate against stroke patients and create more convenient public facilities to facilitate the rehabilitation of social functions of these patients. Patients who are unable to work because of their illness reduce their interactions with their former friends and colleagues. Advocate for participation in new community activities and meeting new friends to avoid loneliness and thus reduce the occurrence of mental disorders. Some studies have found that good friendship relationships not only provide patients with emotional support, but also prevent diminished social functioning. After a stroke, patients may have physical disabilities or a decline in brain activity, be reluctant to communicate with the outside world, become isolated and closed off from others, and become easily bored. In response, multi-functional rehabilitation institutions should be established, rehabilitation professionals should be trained, and rehabilitation skills should be improved. It is recommended that various media be used to promote knowledge about stroke rehabilitation and to strengthen health education so that patients have the opportunity to receive proper medical guidance, change their previous poor lifestyle, try to have more contact with the outside world, and participate in various rehabilitation activities (Burns 2009). At the same time, community services are being developed to help patients and their families to solve practical difficulties and to establish rehabilitation training bases to reduce disability, thus implementing tertiary prevention of stroke. (Huang Yueqin, Song Yuqing) References: Benjamin J. Sadock, Virginia Alcott Sadock, et al. (2009). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry Lippincott Williams & Wilkins. Friedman, M. and R. Rosenman (1959). “Association of specific overt behaviour pattern with blood and cardiovascular findings.Journal of the American Medical Association 169: 1286C1296 Ghose SS, Williams LS, et al. (2005). “Depression and other mental health diagnoses after stroke increase inpatient and outpatient medical utilization three years poststroke. “Med Care 43 (12): 1259-1264. Gilbert, P. (2000). Coming out of depression, China Light Industry Press. Tsutsumi, A., K. Kayaba, et al. (2009). “Prospective study on occupational stress and risk of stroke.” Arch Intern Med 169(1): 56-61. Wang, H. D., Li, X. T., et al. (2000). Middle Aged and Mental Health, China Environmental Science Press, China Workers Press. Burns. David (2009). Handbook of anxiety regulation, Xue Lin Publishing House.