脑卒中患者抑郁情绪的初步调查

脑血管病后出现的抑郁情绪是脑卒中常见的并发症 ,抑郁情绪在一定程度上影响卒中患者的肢体功能和社会生活能力的恢复。有流行病学调查发现 ,脑卒中后抑郁的发生率为 4 0 %～ 5 0 % [1] ,然而对脑卒中患者抑郁情绪的特点少有报道 ,为观察脑卒中对患者心理的影响 ,我们对 6 3例脑卒中患者的抑郁水平进行了分析。1　对象与方法1.1　研究对象6 3例患者均为我院住院患者 ,经颅脑ＣＴ或ＭＲ确诊。其中缺血性脑卒中 4 7例 ,出血性脑卒中 16例。首次发病 38例 ,两次及两次以上发病 2 5例。男性 4 0例 ,女性 2 3例。年龄最大 82岁 ,最小 38岁 ,平均 …     

5·12汶川地震前后灾区焦虑抑郁障碍病人症状对比研究

目的探索5.12汶川地震对幸存者焦虑和抑郁情绪的影响。方法通过对德阳市人民医院神经内科2007年5月12日～2009年5月12日的1298名就诊者,进行汉密尔顿焦虑量表和汉密尔顿抑郁量表评估病人的结果比较,以发现地震对幸存者的焦虑、抑郁情绪的影响。结果地震后单纯焦虑障碍发病率明显增加(P0.05),女性焦虑障碍和抑郁障碍的程度明显高于男性,并且地震对幸存者的认知障碍产生了比较大的影响。结论5.12汶川地震对灾区群众的情绪产生了较大影响。     

米氮平合并认知治疗对脑卒中后抑郁的疗效对照

目的 探讨米氮平合并认知治疗对脑卒中后抑郁的疗效.方法 对72例脑卒中后抑郁患者用米氮平治疗,部分病例合并认知治疗进行临床对照研究;采用汉密尔顿抑郁量表(HAMD)进行疗效评定.结果 两组均有效,合并认知治疗组起效快(P<0.05),疗效好.结论 米氮平合并认知治疗对治疗脑卒中抑郁疗效较好.     

氟西汀治疗脑卒中后抑郁的临床观察

脑卒中后抑郁已逐渐被人们所关注,约为22％～60％,发病机制多认为与大脑损害后引起去甲肾上腺素与5-羟色胺之间的平衡失调有关。现多用三环类抗抑郁药治疗,其副作用大,疗效欠佳。氟西汀是一种特异性,选择性5-羟色胺再摄取抑制剂。作者以此治疗脑卒中后抑郁,报告如下。 1 资料与方法 1.1 病例选择 选择标准:(1)符合中国精神疾病分类方案与诊断标准第     

西酞普兰及认知治疗对脑卒中后抑郁的疗效

目的 了解西酞普兰及认知治疗对脑卒中后抑郁的疗效。方法 对39例脑卒中后抑郁患者以西酞普兰治疗，其中部分病例合并认知治疗进行临床对照研究；采用汉密尔顿抑郁量表(HAMD)进行疗效评定。结果 两组均有效，合并认知治疗组起效早，疗效好。结论 西酞普兰合并认知治疗对治疗脑卒中后抑郁疗效较好。     

脑卒中后抑郁发生率及其相关因素的调查分析

目的 探讨脑卒中后抑郁的发生率及其相关因素.方法 选取2009年2月～2010年1月在本院神经内科明确诊断为脑卒中的住院病例180例,采用Zung氏抑郁自评量表(SDS)及脑卒中患者临床神经功能缺损程度评分标准对患者进行评估.结果 脑卒中后抑郁的发生率为43.33%,2次或2次以上发病与首次发病比较及神经功能中度缺损发病与轻度缺损发病比较,均具有明显统计学差异 (P<0.05).结论 脑卒中后抑郁的发生率较高,其可能与卒中发生次数、神经功能缺损程度等有关,应及时采取有针对性的措施.     

卒中后失语患者心理障碍影响因素及情欲顺势心理治疗

目的 探讨脑卒中后失语患者心理障碍的影响因素,并研究情欲顺势心理治疗对失语患者的临床效果.方法 选取2008月8月--2012年8月来我院住院治疗的83例脑卒中后失语症患者作为研究对象,随机分为观察组和对照组,对照组进行常规心理护理干预,观察组加用情欲顺势心理治疗,对比两组治疗后的GSI得分及临床疗效.选取同期来我院治疗的脑卒中无失语患者60例（无失语组）作为对比分析,研究影响失语患者心理障碍的影响因素.结果 失语症患者心理障碍主要表现为抑郁、焦虑、敌对、恐惧、偏执等,其中抑郁和焦虑情绪观察组比无失语组患者更为严重,两组差异具有统计学（t=2.858,2.909;P＜0.05）;其中脑部双侧病变发生心理障碍的严重程度最高.治疗后观察组总有效率为94.0％,对照组为81.7％,观察组明显高于对照组,两组相比差异具有统计学意义（x2=8.171,P＜0.05）,治疗8周后观察组GSI得分明显低于对照组,两组间差异具有统计学意义（t=6.898,P＜0.05）.结论 脑卒中后失语患者更容易出现心理障碍,发生心理障碍的机制与病变部位有关;通过情欲顺势心理治疗可以改善患者的心理状态,提高患者的生活质量.     

冠状动脉旁路移植术后患者情绪障碍发生特征及影响因素

目的:探讨冠状动脉旁路移植术后患者情绪障碍发生特征及影响因素。方法:选取2018年1月1日-6月30日在我院行冠状动脉旁路移植术的200例冠心病患者作为研究对象,以有、无情绪障碍将其分为研究组114例和对照组86例,采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)对两组焦虑、抑郁症状情况进行调查,并采用单因素分析以及Logistic逐步回归分析患者冠状动脉旁路移植术后患者情绪障碍发生影响因素,并对调查结果进行分析。结果:冠状动脉旁路移植术后情绪障碍发生率为57.00%,抑郁症状得分为(18.14±3.56)分;单因素分析结果显示:性别、医疗费用支付方式、既往合并抑郁病史等因素与冠状动脉旁路移植术后情绪障碍相关(χ~2=13.142,P0.001;χ~2=3.949,P=0.047;χ~2=5.235,P=0.022);Logistic逐步回归分析结果显示:女性、既往抑郁病史为冠心病患者经冠状动脉旁路移植术后情绪障碍发生的独立预测因素[Or=2.14(1.33～3.44),Or=2.18(1.33～3.56)]。结论:冠状动脉旁路移植术后患者焦虑、抑郁症状发生率较高。     

脑卒中后抑郁与应对方式及社会支持关系的研究

目的:探讨脑卒中后抑郁与应对方式及社会支持的关系。方法:采取病例对照研究,用医学应对问卷(MCMQ)和社会支持评定量表(SSRS)对78例脑卒中后抑郁和65例不伴有抑郁的脑卒中患者进行测评。结果:抑郁组面对因子分显著低于非抑郁组(P<0.05),而屈服因子分显著高于非抑郁组(P<0.01);抑郁组社会支持总量、主观支持、支持利用度因子分均低于非抑郁组(P<0.01)。结论:采取消极的应对方式和社会支持不足可能是脑卒中后抑郁发生的原因之一。     

儿童情绪障碍相关因素的LOGISTIC回归分析

情绪障碍是儿童期常见的心理障碍之一 ,对儿童的生活和社会功能有着明显影响。本文就综合性儿科医院心理门诊中儿童情绪障碍患者的有关资料进行对照研究 ;采用Ｌｏｇｉｓｔｉｃ回归多因素分析方法 ,对引起儿童情绪障碍的相关因素作一初步分析。1　对象和方法1.1　对象病例组来源于上海医科大学儿科医院心理咨询门诊来访者 ,共 88例 ,男 :4 0例 ;女 4 8例。采用ＩＣＤ- 10精神与行为障碍分类诊断标准进行诊断。其中广泛性焦虑障碍 14例 ,惊恐障碍 6例 ,混合性焦虑抑郁障碍 9例 ,恐怖性焦虑障碍 5例 ,社交恐怖症5例 ,学校恐怖症 8例 ,分离性焦…     

首发脑卒中患者认知功能障碍与抑郁和脑损伤部位的关系

目的 :探讨急性期脑卒中病人的认知功能障碍与抑郁和脑损伤部位的关系。方法 :选择 62例单一首发病灶的脑卒中病人作为研究对象 ,用修订韦氏成人智力量表四合一简式 ,汉密顿抑郁量表和神经功能缺损评定等方法进行检测。结果 :1 前部卒中病人FIQ (总智商 ) ,VIQ (语言智商 )和V (词汇 )分显著低于后部 (P <0 0 5or 0 0 1) ;2 抑郁组智力各分非常显著低于正常组 (P <0 0 1) ,非抑郁组PIQ (操作智商 ) ,PA (图排 )和PC (填图 )分显著低于正常组 (P <0 0 5or 0 0 1,抑郁组和非抑郁组智力比较未发现差异 (P >0 0 5 ) ;3 多元逐步回归分析发现智力与抑郁 ,年龄和受教育程度有关。结论 :前部卒中和抑郁的病人更易产生认知功能障碍     

急性高血糖脑卒中后抑郁患者的特点和临床转归

目的:分析急性高血糖脑卒中抑郁患者的特点,并探究其临床转归情况。方法:从我院接收的急性高血糖脑卒中患者中抽选出92例作为本次研究的分析对象,其中,46例为急性高血糖脑卒中抑郁患者(观察组),其余46例为普通高血糖脑卒中患者(对照组)。患者入院后,分别观察其临床症状的差异情况,并采用日常生活能力评定(ADL)与简明智能量表(MMSE)分别评价两组患者的日常生活能力与认知功能情况。给予两组患者相同的急性高血糖脑卒中治疗方案,且比较两组患者治疗前后的脑卒中神经功能缺损以及相应的临床转归情况。结果:与对照组相比,观察组存在明显的情绪低落、焦虑、食欲减退、失眠或睡眠倒错等临床症状,其ADL评分明显高于对照组(t=3.27,P0.05);MMSE评分明显高于对照组(t=5.38,P0.05)。观察组患者的神经功能缺损评分下降幅度较小,且痊愈率、缠绵率明显高于对照组的对应值;其死亡率、后遗率明显低于对照组(χ~2=15.525;P0.05)。结论:与急性高血糖脑卒中相比,急性高血糖脑卒中抑郁患者的疾病情况更加严重,治疗治疗过程中,其经功能缺损情况恢复速率较为缓慢,且临床转归情况不甚理想。     

Increase of medical hospital length of stay by depression in stroke and amputation patients: a pilot study.

Past studies have found that medical patients with the diagnosis of depression (comorbidity) have longer hospital lengths of stay (LOS) than those without the diagnosis of depression. This suggested that scores on a depression scale would be positively correlated with LOS. On a rehabilitation ward, 14 stroke and 17 amputee patients were given the Geriatric Depression Scale (GDS) and lengths of stay were recorded. Correlations between GDS scores and LOS were +0.575 for stroke and +0.266 for amputee patients, both in the hypothesized direction. Explanations considered included: (1) depression and medical illness each produce morbidity which summate to require increased LOS; (2) depression delays medical recovery as well as the appearance of medical recovery, and (3) discharge planning is complicated by depression. When depression is associated with inpatient medical illness, DRGs may need to be reevaluated.     

卒中后抑郁对住院患者康复的影响

目的 :探讨卒中后的抑郁状态 (PSD)对住院患者早期康复的影响。方法 :采用汉密顿抑郁量表 (HAMD)、神经功能缺损评分表 (NFA)、生活能力指数 (BI)和自制随访调查表对 67例急性期卒中患者进行测评和随访。结果 :急性期PSD发生率为 3 7 3 % ,以轻、中度为主。PSD组的平均总住院时间明显高于非PSD组。随访 6个月后发现 ,PSD组的BI和NFA的改善明显低于非PSD组。结论 :PSD不仅阻碍患者的神经功能缺损和生活能力恢复 ,而且还使住院时间延长     

Comparison of cognitive impairment associated with major depression following stroke versus traumatic brain injury

Several studies have reported an association between cognitive impairment and major depression following stroke but failed to find a similar association among patients with traumatic brain injury (TBI). This study examined the hypothesis that age differences between stroke and TBI patients would account for the differences in the effect of major depression on cognitive function. We examined subjects' cognitive function using the Mini-Mental State Examination and compared findings among patients with stroke or TBI. Results indicated that stroke patients with major depression (N = 73) were significantly older and more cognitively impaired than similar TBI patients (N = 35), even after matching patients for lesion volume and years of education. After matching for age, however, there was no association of major depression with cognitive impairment in this relatively young stroke population. These findings support the hypothesis that age, presumably related to physiological response to brain injury, accounts for differences in the effect of major depression on cognitive function between stroke and TBI patients.     

脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

Post-activation depression of the soleus H-reflex in stroke patients

PURPOSE: We examined post-activation depression in 35 stroke patients and 10 healthy subjects, and investigated whether their clinical symptoms were correlated to post-activation depression. METHODS: Post-activation depression of the soleus H-reflex evoked by electrical stimulation of the common peroneal nerve with supramaximal intensity of motor response on the tibialis anterior muscle. RESULTS: Post-activation depression was decreased on the affected side of the stroke patients. There was a significant difference between the affected and unaffected sides of the patients with post-activation depression, but no difference between the unaffected sides of the patients and healthy subjects. The presence of ankle clonus and the decrease in post-activation depression were correlated. CONCLUSION: Decreased post-activation depression in stroke patients suggests that a mechanism other than postsynaptic inhibition, such as reciprocal Ia inhibition and Ib inhibition, and presynaptic inhibition, may contribute to the exaggerated stretch reflexes, in particular, the manifestation of clonus.     

Dose response to adjunctive light therapy in citalopram-treated patients with post-stroke depression. A randomised, double-blind pilot study

BACKGROUND: Post-stroke depression affects the outcome of stroke rehabilitation and is observed in approximately 30% of all stroke patients. We investigated whether the addition of light treatment to medical antidepressants influences the course of depression as measured by the Hamilton Depression Scale. METHODS: The effect of a combination of light therapy and citalopram in stroke victims receiving citalopram was examined by use of two different doses of light therapy under double-blind conditions. Altogether, 63 patients were included in the study. The mean age was 74.9 years. RESULTS: After 4 weeks of therapy, the 6-item subscale of the Hamilton Depression Scale showed a statistically significantly larger improvement in patients receiving high-intensity light treatment compared to those treated with medium-intensity light (p < 0.05). CONCLUSION: This pilot study demonstrates a dose response effect of light used as an adjunct therapy to antidepressants in post-stroke patients with major depression.     

Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke - the Sydney Stroke Study

BACKGROUND: The frequency and clinical, neuropsychological and neuroimaging correlates of apathy in patients who have had a stroke are inadequately defined.METHOD: A total of 167 consecutive patients admitted to the stroke units of two university hospitals after an ischaemic stroke and 109 controls received extensive medical, psychiatric and neuropsychological assessments; a subset received a magnetic resonance imaging (MRI) scan. The groups were matched for sex and age. Patients were assessed 3-6 months after their stroke. The sample for this study comprised 135 patients and 92 controls who completed the Apathy Evaluation Scale (AES).RESULTS: Apathy was present in 26.7% of stroke patients compared to 5.4% of controls. Apathetic stroke patients were older, more functionally dependent and had lower Mini-Mental State Examination (MMSE) scores than those without apathy. Apathy was not associated with risk factors for cerebrovascular disease or stroke severity. There was a weak but significant correlation between apathy and self-reported depression but not with clinician-rated depression. Neuropsychologically, after correction for age, premorbid intelligence (IQ) and depression, apathy was associated with reduced attention and speed of information processing. On neuroimaging there were trends for associations of apathy with the extent of hyperintensities in the right hemisphere and right fronto-subcortical circuit, but not with total stroke volume or number of strokes.CONCLUSIONS: Apathy is common following a cerebrovascular event. Presence of apathy may be related to older age and right fronto-subcortical pathway pathology, rather than stroke severity. It is associated with functional impairment and cognitive deficits.