卒中后抑郁诊断及治疗的进展

卒中后抑郁（post—stroke depression,PSD）是指脑卒中后出现不同程度的抑郁症状且症状持续2周以上,其主要表现为情感低落、兴趣减退、悲观、厌世、烦躁、缺乏主动性以及全身疲劳等症状。     

卒中后抑郁治疗进展

卒中后抑郁（post-stroke depression,PSD）发病率高、漏诊率高、致残率高。重视PSD的治疗十分重要。本研究从药物治疗和非药物治疗进展两个方面进行综述。1药物治疗Starkstein等[1]认为去甲肾上腺素（NE）能和5-羟色胺（5-HT）能神经元胞体位于脑干,其轴突通过丘脑和基底核到达额叶皮质,     

预防卒中后抑郁的治疗

情绪异常是一种重要的卒中后遗症，可能会对恢复和转归产生影响。然而，抑郁和焦虑通常被忽视或不单独进行治疗。其中部分的原因是对卒中发病后早期抗抑郁治疗能否预防抑郁和改善转归还存在疑虑。     

卒中后抑郁状态对预后的影响及治疗进展

卒中后抑郁状态可以影响脑血管病患者的死亡率、生存质量、生活满意度和心理健康。文章就目前卒中后抑郁的临床治疗进展进行了综述。     

卒中后抑郁——需要更多关注

随着对卒中研究的日益深入,人们逐渐认识到卒中后伴发的情感障碍已成为严重影响卒中患者肢体功能、认知功能和社会功能的主要因素之一,其中卒中后抑郁(poststroke depression,PSD)是卒中后最为常见的情感障碍,PSD是由于卒中后导致的持续性的情感低落、兴趣减退为核心症状的心境     

卒中后抑郁

卒中后抑郁能阻碍患者日常生活能力和神经功能缺损恢复，造成卒中病程迁延，是影响卒中后患者生活质量的最主要原因之一。文章对卒中后抑郁的流行病学、发病机制和治疗等做了综述。     

卒中后抑郁的治疗干预

卒中后的抑郁和焦虑通常会被漏诊或不恰当的治疗。这可能反映了在伴有卒中相关残疾的老年患者中进行情绪异常诊断的困难，也反映了在这种情况下相关治疗疗效的不确定性。     

卒中后抑郁状态对预后的影响及治疗进展

卒中后抑郁状态可以影响脑血管病患者的死亡率、生存质量、生活满意度和心理健康。文章就目前卒中后抑郁的临床治疗进展进行了综述。     

卒中后抑郁的发病机制

抑郁是卒中的一种常见并发症,它与卒中互相影响,进一步降低了患者的生活质量。对于卒中后抑郁的发病机制尚无统一定论,可能与神经递质、颅内病变部位、炎性细胞因子和精神社会心理等因素有关。     

卒中后抑郁

卒中后抑郁能阻碍患者日常生活能力和神经功能缺损恢复,造成卒中病程迁延,是影响卒中后患者生活质量的最主要原因之一。文章对卒中后抑郁的流行病学、发病机制和治疗等做了综述。     

卒中后抑郁的相关因素

卒中后抑郁是急性卒中最常见的并发症之一,严重影响卒中患者的神经功能恢复,其相关因素繁多复杂,主要包括生物学因素和社会心理学因素。通过研究其相关因素,可以了解卒中后抑郁的流行趋势,指导其早期预防和治疗。     

Functional MRI,Drugs, and Poststroke Recovery

Stroke is the first cause of disability in industrialized countries. Thus, understanding the mechanisms of poststroke recovery appears to be crucial in improving motor performance and reducing disability in stroke patients. Strategies through which brain restores lost functions after ischemic lesions are numerous. The mechanisms underlying poststroke recovery, known as cerebral plasticity, are so far hypothetical. However, functional magnetic resonance imaging (fMRI) studies recently have provided new insights in to stroke recovery. This article sketches out the mechanisms that are thought to underly recovery and focuses on fMRI experimental studies that have investigated the influence of a number of drugs on functional recovery. Functional MRI is a valuable tool in understanding functional recovery and may help to disclose new therapeutical approaches.     

西酞普兰治疗急性卒中后抑郁的疗效及其对卒中康复的影响

目的观察西酞普兰治疗急性卒中后抑郁的疗效及其对卒中康复的影响。方法105例急性卒中后抑郁患者随机分为西酞普兰组(52例)和对照组(53例),2组均接受常规药物治疗,治疗组同时加用西酞普兰治疗。治疗前后应用Hamilton抑郁量表(HRSD)评价抑郁状况,治疗前、治疗后4周和12周采用简易智能状态量表(MMSE)、中国卒中量表(CSS)和Barthel指数(BI)评价患者的认知和神经功能状况。结果治疗组1例死亡,1例失访;对照组2例死亡,2例失访。治疗后12周时西酞普兰组治愈率和总有效率分别为64%和96%,显著高于对照组的16·33%和57·44%(P<0·05)。治疗后4周和12周时西酞普兰组MMSE评分较对照组显著增加(P<0·01)。治疗后4周时,两组CSS和BI评分均有改善,但无显著性差异;治疗12周后西酞普兰组CSS和BI评分均优于对照组(P<0·01)。西酞普兰的主要不良反应为中枢神经系统和消化系统反应,但症状轻微。结论西酞普兰治疗卒中后抑郁安全有效,且能改善12周时的认知功能、神经功能和转归。     

Treatment of Late-Life Depression Alleviates Caregiver Burden

OBJECTIVES: To describe the burden experienced by family caregivers of older adults with depression and to examine the positive effects on caregivers of treating late-life depression.
DESIGN: Two-phase treatment study for major depressive disorder (MDD) that included 6 weeks of open treatment with antidepressant medication for all older patients followed by 16 weeks of randomized treatment for patients who were partial responders, comparing a combination of medication and interpersonal psychotherapy with medication alone.
SETTING: Primary care and university late-life mental health research clinic.
PARTICIPANTS: Adults aged 60 and older participating in a randomized trial for treatment of MDD who enrolled in a family caregiver study and their caregiver (N=244 dyads).
MEASUREMENTS: Improvement in patient symptoms during open treatment (lower scores on the Hamilton Rating Scale for Depression (HRSD)) and remission of depression during randomized treatment (3 consecutive weekly HRSD scores of ≤7) were examined as predictors of lower general caregiver burden and burden specific to patient depression.
RESULTS: Caregivers reported a moderate to high level of general caregiver burden on average. Change in patient depression during open treatment was associated with significantly decreased depression-specific burden (β=−0.22, P =.001) and a trend toward lower general burden (β=−0.08, P =.08). Caregivers of patients who remitted showed significantly decreased depression-specific burden ( F (1,76)=4.27, P =.04).
CONCLUSION: Treatment of late-life depression has benefits that extend to the family members on whom patients depend. Caregiver education and support may strengthen these effects.     

帕金森病伴抑郁症状的研究现状

从发病机制、相关性及治疗3个方面。对帕金森病伴抑郁症状的研究现状进行了概述。     

Effect of Care Setting on Evidence-based Depression Treatment for Veterans with COPD and Comorbid Depression

Background Patients with chronic obstructive pulmonary disorder (COPD) frequently have co-occurring depressive disorders and are often seen in multiple-care settings. Existing research does not assess the impact of care setting on delivery of evidence-based depression care for these patients. Objective To examine the prevalence of guideline-concordant depression treatment among these co-morbid patients, and to examine whether the likelihood of receiving guideline-concordant treatment differed by care setting. Design Retrospective cohort study. Patients A total of 5,517 veterans with COPD that experienced a new treatment episode for major depressive disorder. Measurements and Main Results Concordance with VA treatment guidelines for depression; multivariate analyses of the relationship between guideline-concordant depression treatment and care setting. More than two-thirds of the sample was over age 65 and 97% were male. Only 50.6% of patients had guideline-concordant antidepressant coverage (defined by the VA). Fewer than 17% of patients received guideline recommended follow-up (≥3 outpatient visits during the acute phase), and only 9.9% of the cohort received both guideline-concordant antidepressant coverage and follow-up visits. Being seen in a mental health clinic during the acute phase was associated with a 7-fold increase in the odds of receiving guideline-concordant care compared to primary care only. Patients seen in pulmonary care settings were also more likely to receive guideline-concordant care compared to primary care only. Conclusions Most VA patients with COPD and an acute depressive episode receive suboptimal depression management. Improvements in depression treatment may be particularly important for those patients seen exclusively in primary care settings. This study was funded by the VA Health Services Research & Development Service.