Stroke is capable of producing a varied spectrum of neurobehavioral syndromes that may come to the attention of the mental health professional evaluating psychiatric symptoms in elderly individuals. The neurobehavioral effects may include affective or psychotic symptoms and may occur immediately after the stroke or months to years later. The presence of underlying (or pre-existing) brain disease may have an adverse effect on the resolution of the neuropsychiatric symptoms. Although there are no treatment response studies in the area of psychosis following stroke, the response of poststroke depression to antidepressants makes attempted pharmacologic treatment of symptoms justified.