Poststroke depression: Diagnosis of depression, phenomenology and specificity of depressive symptoms

Abstract

THE DIAGNOSIS OF DEPRESSION: Depressive disorder is nowadays diagnosed by the two widely used diagnostic systems--International Classification of Diseases of the World Health Organisation, 10th revision and the Diagnostic and Statistical Manual Criteria of the American Psychiatric Organisation, 4th edition. The criteria for depressive disorder used in these two systems are almost identical. The dignosis of depression may be difficult to establish in stroke patients, especially in patients with aphasia/dysphasia, anosognosia and other cognitive dysfunction. Major vs. minor poststroke depression, specificity and sensitivity of depressive symptoms: The phenomenology of major poststroke depression has been found to be similar to that of primary depression, and it appears that minor and major are not stages of the same continuum, but rather separate entities. Contrary to common opinion, non specific somatic symptoms do not hinder the diagnosis of poststroke depression and can be highly discriminative and crucial in the evaluation of poststroke depression. Studies have shown that a valid diagnosis of poststroke depression may be established successfully using structured or semistructured neuropsychiatric interviews, according to the current Diagnostic and Statistical Manual Criteria. It appears that no new diagnostic tools specific for major depression in stroke patients are necessary. The existing diagnostic procedures will fail to diagnose or misdiagnose depression only in few stroke patients.