警惕脑卒中后早期和晚期抑郁

脑卒中后抑郁是脑卒中后常见并发症之一,但在临床工作中易忽视,漏诊率和误诊率较高。脑卒中后抑郁直接影响脑卒中患者认知功能、康复、功能恢复和生活质量,与脑卒中高复发率、高病残率和高病死率密切相关。为提高对脑卒中后早期和晚期抑郁的认识与重视,本文综合国内外研究最新进展,就脑卒中后抑郁流行病学、发病机制、影响因素、筛查与诊断、治疗与预防等方面进行简要概述。     

脑卒中患者并发抑郁的临床研究进展

卒中后抑郁(PSD)是脑卒中患者病后的常见并发症,严重影响患者及家属的生活质量,阻碍患者神经功能的恢复,增加病死率。近年来随着脑卒中发病率的上升,PSD患者也日见增多,已经引起临床医生的普遍关注。当前,关于PSD的研究较多,但具体机制有待进一步阐明。本文从PSD的发病机制、治疗两个方面对其研究进展作一综述,并对其发展方向作出展望。旨在为PSD疾病的基础研究和临床治疗提供依据。     

首发脑卒中后抑郁相关因素的临床研究

目的研究生物、心理、社会因素与卒中后抑郁的关系。方法选择６２例单一首发病灶的脑卒中病人作为研究对象，用汉密顿抑郁量表、修订韦氏成人智力量表四合一简式、艾森克个性问卷（ＥＰＱ）、社会支持评定量表和老年抑郁量表作检测。结果１前部和皮质病灶抑郁分高于后部和皮质下；２抑郁与智力呈极显著负相关，与ＥＰＱＮ分、Ｐ分呈显著正相关；３多元回归分析发现生物、心理、社会因素均与卒中后抑郁有关。结论生物、心理、社会因素对脑卒中后抑郁的产生均有影响，临床医生应重视易患因素，早期治疗卒中后抑郁。     

脑卒中后抑郁与卒中部位关系探讨

目的 研究首发脑卒中患者第4周脑卒中后抑郁与卒中部位的关系.方法 共调查127例患者,其中113例完成所有调查,将诊断为PSD的患者列为PSD组,其余患者为非PSD组.比较2组的卒中性质和卒中部位.结果 从卒中病灶发生的部位看,左侧病灶发病率(59.18%)高于右侧病灶(38.16%),前部病灶(50.85%)高于后部病灶(29.63%).皮层病灶(57.14%)高于皮层下病灶(33.80%).2组病灶数目比较,多灶患者PSD的发生率(59.68%)明显高于单灶患者(37.25%)(P<0 .05).卒中性质与PSD无明显关系(χ2＝3.86,P>0.05).结论 脑卒中后抑郁与卒中部位存在关系.     

卒中后抑郁的评估进展

卒中后抑郁发病率较高,准确的评估有利于临床诊疗。目前,对卒中后抑郁的评估多依赖 量表。对于不影响语言表达的卒中患者,汉密尔顿抑郁量表、卒中后抑郁分级量表和蒙哥马利抑郁 量表应用最为广泛,且其信度和效度均较高。对于失语患者的卒中后抑郁评价量表虽然开发的比较 多,但临床应用相对较局限,其中卒中失语抑郁问卷和失语抑郁评估量表应用相对较多。目前针对卒 中后抑郁评估量表的应用人群、评估指标有所差异,在应用这些量表时,相比原发疾病,评估者更重 视抑郁情绪的问题,这可能会造成患者的不配合和排斥,从而影响量表评价的准确性,这些局限性 有待进一步研究解决。     

脑卒中后抑郁的随访研究

抑郁是卒中后常见的结果,本文综述了近十年来卒中后抑郁的发病规律、影像学改变、实验室进展、神经功能和生活自理能力康复的前瞻性随访研究的成果.     

脑卒中后抑郁的随访研究

抑郁是卒中后常见的结果,本文综述了近十年来卒中后抑郁的发病规律、影像学改变、实验室进展、神经功能和生活自理能力康复的前瞻性随访研究的成果。     

脑卒中后抑郁93例特征分析

目的研究卒中后抑郁发生的相关因素。方法将230例脑卒中患者进行3次抑郁评定,共有93例脑卒中后抑郁(PSD)病人,对受教育程度、是否有家庭关爱、脑卒中的位置及患者是否有经济保障几方面进行分析。结果受教育程度高、无家庭关爱、额叶病灶、多发病灶、无经济保障者PSD的发生率高。结论对PSD病人一定多给予关爱,常规治疗的同时,予以抗抑郁治疗,同时加以心理方面的疏导,有利于脑梗死的恢复,减少卒中致残率。     

脑卒中后抑郁的相关因素分析

目的:探讨脑卒中后抑郁的相关因素。方法:采用汉密尔顿抑郁量表(HAMD)对198例脑卒中患者进行现状调查。结果:73例脑卒中患者有抑郁表现,发生率为36.9%,经Logistic多元回归分析,脑卒中后抑郁的相关因素有负性生活事件、心血管病史、抑郁症史、病灶数目、病灶部位以及脑卒中史。结论:脑卒中后抑郁的相关因素有负性生活事件,心血管病史,抑郁症史、病灶数目,病灶部位以及脑卒中史。脑卒中后抑郁的发生可能是神经生物学因素和社会心理学因素共同作用的结果。     

卒中后抑郁的评估和预测进展

卒中后抑郁是卒中常见并发症，现回顾近年来在抑郁量表方面的进展，重点综述PHQ-9、 HAM-D6 在抑郁筛查和评估上的价值，分析量表在筛查抑郁上存在的问题，并且综述了抑郁预测因子和 模型，以及事件相关电位（ERP）在筛查抑郁上的应用。     

脑卒中合并抑郁治疗前后对比分析

目的　观察、分析脑卒中后抑郁症状的干预对患者康复的影响。方法　脑卒中合并抑郁患者 33例 ,常规脑血管病治疗同时予抗抑郁药物治疗或心理疏导 ,于治疗第 1、2、4、6周末分别进行HAMD抑郁量表评分和神经功能缺损、生活能力状态评定。结果　于 6周末HAMD评分明显降低 (P <0 0 1) ,神经功能缺损和生活能力状态评定明显减低 (P <0 0 1) ,神经功能缺损评定与HAMD评分减低有相关性 (r=0 4 4 5 ,P <0 0 1)。结论　对脑卒中后抑郁症状的干预治疗 ,不但能有效改善抑郁症状 ,而且有利于患者神经功能缺损的康复和生活能力的提高。     

Pre-stroke sleep duration and post-stroke depression

ObjectiveSleep disturbance and depression are common in stroke patients, however, little is known about the role of sleep in post-stroke depression. This study examined the association between pre-stroke sleep duration and depression at 90 days post-stroke in a population-based bi-ethnic sample.MethodsThe study included 1369 stroke patients from the Brain Attack Surveillance in Corpus Christi project who survived 90 days post-stroke. Depression at 90 days post-stroke was assessed by the 8-item Patient Health Questionnaire, and pre-stroke sleep duration was self-reported shortly after stroke in reference to the pre-stroke state. Multiple imputation and inverse probability weighting were used to deal with missing data and attrition. Weighted logistic regression models were fit to examine the association between pre-stroke sleep duration and post-stroke depression.ResultsThe mean age was 68.2 years, and 63.6% were Mexican American. The prevalence of post-stroke depression was highest among participants reporting less than 6 hours of sleep before stroke (52.4%, 95% confidence interval = 45.7%–59.0%). Compared with participants reporting 7–8 hours of sleep before stroke, those with short sleep duration had significantly increased odds for post-stroke depression (odds ratio = 1.96; 95% confidence interval = 1.38–2.79), after adjustment for sociodemographic, stroke and pre-stroke characteristics including pre-stroke depression.ConclusionsPre-stroke short sleep duration may be an independent risk factor for post-stroke depression.     

Comparison of assessment measures for post-stroke depression

Depression is commonplace following stroke and is associated with increased morbidity and mortality. The objective of this study is to examine the sensitivity and specificity of four standardized measures for assessing depression in a stroke population. A total of 67 adults admitted to an inpatient rehabilitation unit with acute stroke were assessed with four standardized depression measures and by structured clinical interview as part of a cross-sectional study assessing cognitive and emotional functioning. Using DSM-IV criteria, major depression was present in 15% of the sample and minor depression in an additional 28%. The four depression measures yielded rates of depression ranging from 14% to 46% when their recommended clinical threshold scores were applied. The Center for Epidemiologic Studies Depression Scale (CES-D) had the greatest positive predictive value (PPV) at 28%. Cutoff scores were adjusted using receiver operating curve (ROC) analyses, and PPV ranged from 28% to 34% when using lower cutoff scores, representing an improvement for all measures. Common assessment measures yield significantly different classification rates for depression in persons with acute stroke. Traditional threshold scores for commonly used objective depression measures may not be optimally sensitive for detection of depression in stroke populations. Based on the findings of this study we recommend clinicians use the Geriatric Depression Scale-Short Form using a cutoff score of 3 or greater. Clinical and research implications are offered.     

脑卒中后抑郁患者的康复护理干预疗效观察

目的探讨脑卒中后抑郁患者的康复护理干预疗效。方法选取我院收治的138例脑卒中后抑郁患者为研究对象,随机分为观察组和对照组各69例,对照组给予常规护理,观察组在对照组的基础上给予康复护理干预。2组分别于治疗前后汉密尔顿焦抑郁表、脑卒中临床神经功能缺损程度评分量表和日常生活能力量表评估,并对其结果进行比较分析。结果与治疗前比较,2组治疗后HAMD、ADL评分均明显减小,且观察组明显低于对照组,差异均有统计学意义(P0.05);2组治疗后的神经功能缺损评分均明显降低,且观察组明显低于对照组,差异均有统计学意义(P0.05)。结论康复护理干预可有效缓解脑卒中后抑郁患者的焦虑抑郁等不良情绪,提高患者生活质量,值得临床应用推广。     

氟西汀治疗脑卒中后抑郁疗效的Meta分析

目的系统评价氟西汀改善脑卒中后抑郁(PSD)患者抑郁情绪及促进缺损神经功能恢复的疗效。方法以脑卒中、抑郁及氟西汀等作为关键词在Cochrane图书馆、PubMed、维普及万方等数据库内检索所有关于氟西汀治疗PSD的随机对照试验(RCT),时限为1990-01—2015-05提取原始数据,并对纳入研究进行质量评估,采用RevMan5.2软件进行统计分析。结果共纳入6项临床RCT研究,共472例患者。Meta分析显示,治疗结束,干预组汉密尔顿抑郁量表(HAMD)减分率显著优于对照组,差异有统计学意义(RR=2.84,95%CI 2.16~3.73,P0.000 1);治疗结束,干预组卒中量表减分率优于对照组,差异有统计学意义(RR=1.61,95%CI 1.34~1.94,P0.000 1)。结论氟西汀不但可改善PSD患者抑郁情绪,亦可有效缓解患者神经功能缺损,促进其运动功能恢复。     

不同药物治疗脑卒中后抑郁症的对比研究

目的探讨不同药物治疗脑卒中后抑郁的临床效果及安全性。方法选取脑卒中后抑郁症患者183例,随机分为A、B 2组。A组95例,给予齐拉西酮治疗,B组88例,给予利培酮治疗。分别于治疗1周、2周、6周末时采用HAMD量表和HAMA量表对2组抑郁及焦虑程度进行评价,计算两项指标减分率,评价2组治疗效果;采用TESS量表对2组不良反应进行评价。结果治疗1周、2周和6周末2组HAMD减分率、HAMA减分率比较差异无统计学意义(P0.05)。2组痊愈率和有效率比较差异无统计学意义(P0.05);治疗1周、2周和6周末2组TESS得分比较差异有统计学意义(P0.05)。结论齐拉西酮与利培酮治疗脑卒中后抑郁患者疗效方面无明显差别,但齐拉西酮的不良反应更小,可作为首选药物应用。     

脑卒中后抑郁对神经功能恢复的影响

目的通过比较脑卒中病人出院时的治疗效果,评价脑卒中后抑郁对病人神经功能恢复的影响。方法根据焦虑/抑郁情绪测定量表测定得分将211例脑卒中病人分成抑郁组及非抑郁组,比较2组病人的治疗效果并评价其神经功能恢复情况。结果本组211例脑梗死病人发生抑郁症状59例（59/211）,发生率27.96%。出院时疗效对比：抑郁组治愈9例（15.3%）,非抑郁组50例（32.9%）;抑郁组好转32例（54.2%）,非抑郁组73例（48.0%）;抑郁组未愈18例（30.5%）,非抑郁组29例（19.1%）。2组总有效率分别为69.5%、80.9%,差异具有统计学意义（P〈0.05）,结果显示抑郁组神经功能恢复程度显著差于非抑郁组。结论脑卒中后发生抑郁将严重影响脑卒中病人神经功能的恢复进程,临床医生需给予足够重视。     

早期干预治疗对脑卒中后抑郁患者生活质量的影响

目的 探讨早期干预治疗对脑卒巾后抑郁患者生活质量的影响.方法 选用抑郁自评量表(SDS)筛选评定出脑卒中后抑郁患者246例.分为2组,其中治疗组154例.口服抗抑郁药物治疗;对照组92例,未进行抗抑郁治疗.采用汉密顿抑郁量表(HAMD)、修订的Banhel指数(MBI)、生活质量指数(QLI)量表对两组患者在治疗前和治疗后1个月、3个月和6个月进行评分,对所得结果进行统计学分析.结果 治疗组与对照组相比.治疗后1个月、3个月、6个月HAMD量表评分明显减低,差异有统计学意义(P(0.05);MBI量表评分和QH量表评分明显提高,差异均有统计学意义(P(0.05).结论 早期干支治疗脑卒中后抑郁不仅可以改善患者抑郁状态,而且还可以促进患者躯体功能恢复,改善患者主观生活满意度.提高患者生活质量.     

强化心理治疗联合万拉法新对卒中后抑郁患者神经缺损的影响

目的 探讨强化心理治疗联合万拉法新对急性卒中后抑郁患者神经缺损的影响.方法 将126例急性脑卒中后并发早发性抑郁症患者按入选顺序随机分为对照组、万拉法新组和强化心理治疗+万拉法新组(联合治疗组),每组各42例.在治疗前,治疗4周、6周及90 d随访时对各组患者分别采用汉密尔顿(HAMD)抑郁量表、美国国立卫生研究院卒中(NIHSS)量表及Barthel指数量表进行疗效评价.结果 治疗前3组患者NIHSS评分及Barthel指数评分差异无统计学意义(P>0.05),治疗4周、6周及90 d随访时联合治疗组HAMD评分、NIHSS评分及Barthel指数评分较对照组、万拉法新组明显改善,差异均有统计学意义(P<0.05).结论 强化心理治疗作为抗抑郁药物治疗的辅助措施能显著增加卒中后抑郁患者的康复机会,疗效也更持久和稳定,能明显提高卒中患者的生活质量.

Abstract：

Objective To evaluate the effect of Venlafaxine plus psychotherapy on neurologic defect of patients with post-stroke depression (PSD). Methods One hundred and twenty-six patients with PSD were equally randomized into control group (treating with ordinary medicine and rehabilitation), Venlafaxine treatment group (ordinary treatment combined with venlafaxine) and therapeutic alliance group (ordinary treatment combined with venlafaxine and psychotherapy). The Hamilton Depression Rating Scale (HAMD), Barthel index (BI) and NIHSS were employed to evaluate the treatment efficacy before the treatment, 4 and 6 week and 90 d after the treatment. Results No significant differences in NIHSS scores and Brothel indexes among the 3 groups were noted before the treatment (P>0.05). Four and 6 week and 90 d after the treatment, the HAMD scores, NIHSS scores and Barthel indexes in the therapeutic alliance group improved significantly as compared with those in control group and Venlafaxine treatment group (P<0.05). Conclusion Strengthening psychotherapy, as an assistant measure of anti-depression drug therapy, can obviously increase the rehabilitation patents'chances and heal efficacy. It is lasting, stable, and worth to popularizing, and can improve the life quality of stroke patients.     

Perceived stress and depression in left and right hemisphere post-stroke patients

Although it is well accepted that depression and stress are closely related in the general adult population, this link is less understood in post-stroke patients. Due to the high occurrence of depression in post-stroke patients it is important to look closely at this possible association. The current study explores perceived stress and depression in post-stroke patients. Nineteen left hemisphere (LH) stroke patients and 12 right hemisphere (RH) post-stroke patients were assessed for depression, perceived stress, and neurological functioning with the Stroke Aphasia Depression Questionnaire, the Perceived Stress Scale, and the Scandinavian Stroke Scale once per month for three months. Perceived stress and depressive symptoms were significantly correlated for both stroke groups. Neurological functioning was not correlated with either depressive symptoms or perceived stress in either stroke group. The perception of stress may be a more critical variable in developing post-stroke depression than neurological functioning is in stroke patients. Routine screening of perception of stress may need to occur in post-stroke patients to avoid development of depression.