Stroke Depression Research Articles

Efficacy of Fluoxetine for Post-Ischemic Stroke Depression in Tanzania

ObjectivePost-stroke fluoxetine trials are primarily conducted in high-income countries. We characterize post-ischemic stroke depression in fluoxetine-treated and -untreated study participants in urban Tanzania. MethodsAdults (>18 years old) within 14 days of CT-confirmed acute ischemic stroke onset were enrolled at Muhimbili National Hospital, Tanzania. The fluoxetine-treated group took 20mg fluoxetine daily for 90 days in a phase II trial and were compared to fluoxetine-untreated historical controls. The primary outcome was depression at 90 days, measured by the Patient Health Questionnaire-9 (PHQ-9). PHQ-9 scores were compared between fluoxetine-treated and -untreated groups. A score >=9 points was considered to reflect depression. A multivariable linear regression model assessed associations with post-stroke PHQ-9 scores. ResultsOf the fluoxetine-treated (n=27) and -untreated (n=32) participants, the average age was 56.8 years old (39% women, 100% Black/African). The average presentation NIHSS score was 12.1 points and modified Rankin Scale (mRS) score was 3.5. The average mRS score at 90-day follow-up was 2.3. There was no significant difference between 90-day PHQ-9 scores in the fluoxetine-treated (mean=4.1 points, standard deviation=3.2; 11% depression) and untreated (mean=4.4, standard deviation=4.8; 19% depression) groups, p=.69. In the multivariable analysis, older age (β=0.08, p=.03) and higher NIHSS score (β=0.15, p=.04), but neither fluoxetine (β=0.57, p=.59) nor sex (β=-0.51, p=.63), were significantly associated with more depressive symptoms. ConclusionsOur findings parallel results from trials from higher income settings that fluoxetine does not significantly improve post-ischemic stroke depression, although our sample size was small. More work is needed to depict the longitudinal nature and treatment of post-stroke depression in Sub-Saharan Africa.

Stroke as an Antecedent Risk Factor for Depression among Post-Menopausal Women

BackgroundAs many as one out of every three individuals develop depression after stroke. Numerous studies have also shown a link between depression and increased rates of mortality after stroke. Additionally, the risk factors and characteristics of stroke are different between men and women. However, the association between stroke and depression has not been investigated in postmenopausal women in a nationally representative sample.MethodsThe association between currently active depression [score ≥ 10 on a Patient Health Questionnaire (PHQ)-9 scale] and self-reported history of stroke were assessed among participants from the 2005-2010 National Health and Nutrition Examination Survey (NHANES). All post-menopausal women from the nationally representative NHANES study were included in the analysis. Multivariable complex samples logistic regression was used to calculate multivariate-adjusted odds ratios (ORs) of depression.ResultsOut of the 3,636 (representative sample=44,110,822) postmenopausal women, the mean age was 62.6 ± 0.33. The ethnic distribution was 77.3% non-Hispanic Whites, 10.9% non-Hispanic Blacks, 7.5% Hispanics, and 4.3% other nationalities. In age-adjusted analysis, individuals with a history of stroke had 2.5-fold higher odds of active depression than those without a history of stroke (OR 2.57, 95% CI 1.57-4.19, p < .001). Controlling for vascular risk factors (diabetes, hypertension, C-reactive protein, and BMI) of depression and socio-demographic risk factors (age, ethnicity, and income level) attenuated the effect (OR 2.16, 95% CI 1.17-3.99, p < .05).ConclusionsA significant association between previous stroke and current depression was found in this population, independent of vascular disease risk measures among post-menopausal women. These findings highlight the possible importance of screening for and treating depression among stroke survivors. Longitudinal studies need to be conducted assessing the mental health impact of stroke.Key messages Occurrence of stroke may lead to an increased likelihood of depression, especially among post-menopausal women.Due to the global COVID-19 pandemic, surveillance efforts should include mental health complication including those related to stroke.

Intervention Effect of Rapid Rehabilitation Nursing Combined with Continuous Nursing after Discharge on Patients with Cerebral Infarction in Recovery Period and the Changes in Motor Function, Mental State, and Quality of Life.

Objective To explore the effect of rapid rehabilitation nursing combined with continuous nursing after discharge on patients with cerebral infarction (CI) in recovery period and its influence on motor function, mental state, and quality of life. Methods From January 2018 to December 2020, 136 patients with CI in recovery period were selected and randomly divided into control group (n = 68) and observation group (n = 68). The control group was given routine nursing, and the observation group was given rapid rehabilitation nursing combined with continuous nursing after discharge. The general clinical data of the two groups were recorded, and the nursing efficiency, modified Barthel index scale (MBI), stroke patients motor assessment scale (MAS), self-rating anxiety and depression scale (SAS and SDS), and quality of life assessment scale (QLI) were compared between the two groups. Results The nursing effective rate of the observation group (94.12%, 64/68) was higher than that of the control group (82.35%, 56/68) (P < 0.05). The MBI score, MAS score, and QLI score in the observation group were higher than those in the control group, while the SAS and SDS scores in the observation group were lower than those in the control group (P < 0.05). Conclusion Rapid rehabilitation nursing combined with continuous nursing after discharge can promote the rapid recovery of patients with CI in recovery period, which can improve the patient's motor function, reduce unhealthy psychology, and improve the quality of life.

Burden of depression and predictors among Ethiopian stroke survivors: Cross-sectional study

Backgroundstroke is a common cause of mortality and morbidity in low- and middle-income countries. It is a very sudden episode in the patients’ lives and can lead to multiple psychosocial, social, and economic consequences, and psychiatric problems. poststroke depression is the most common and major neuropsychiatric consequence of stroke that affects one-third of stroke survivors. The aim of this study to assess the burden of depression and its predictors among stroke survivors with local version validated Patient Health Questionnaire. MethodsAn institutional-based cross-sectional study was conducted among stroke patients at selected tertiary level hospitals. Data were collected by interview method using structured questionnaires, and patient medical record reviews and data were recruited by using consecutive sampling method. Bivariate and multivariable binary logistic regression model analysis was used with SPSS version 23 to identify factors associated with depression. ResultsA total of one hundred eighty stroke patients participated in the study with a response rate of 88.2%. The overall prevalence of depression is 49.6% (95% CI: 42.8, 56.7). Occupation, marital status, level of education of stroke patients was significantly associated with post stroke depression with P < 0.05. ConclusionThe study findings presented that nearly half of the stroke patients suffered from post stroke depression. Post-stroke depression was strongly associated with patient occupation, marital status, and level of education There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.

The association between hemogram parameters and post stroke depression

Post-stroke depression (PSD) is the most common psychological consequence among stroke patients. Currently, patients with PSD has been reported with decreased quality of life, poor functional outcomes and increased mortality. Early recognition and diagnosis of PSD with accurate identification of novel risk factors is essential for clinicians

Psychiatric morbidity among the patient of first ever ischaemic stroke

Stroke is the most common cause of mortality worldwide and a serious cause of disability in the community. Stroke affects not only physical but also emotional, psychological, cognitive and social aspects of patients. Some of the neuropsychiatric disorders associated with stroke include post stroke depression (PSD), anxiety disorder, psychotic disorder. Aims and objectives: To evaluate psychiatric morbidity among the patients of first ever ischemic stroke.

Association between air pollution and post stroke depression & cognitive decline

Stroke affects the cognitive domain, which includes attention, memory, language, and orientation. Air pollution is one of a variety of man-made environmental disasters that are currently taking place all over the world. To examine the associations of gaseous air pollutants and climate change (humidity& temperature) and depression including cognitive decline.

526 - Stroke survivor depressive symptoms and anger expression: A Literature review

Background:After stroke, patients may have to accept and face many changes and complications that affect their quality of life. Consequently, they may feel a variety of emotions such as fear, anxiety, denial, depression, anger, rage. Depression is the most common complication after stroke. Anger often occurs in the acute phase of stroke but also during the chronic phase of the patient’s recovery.Objective:To explore the relationship between depressive symptoms and anger expression among stroke survivors.Method:A literature review was conducted in PubMed and Scopus database.Results:Patients, who exhibited more depressive symptoms, seemed to control less their anger. Further research has shown the effectiveness of both pharmacological and other therapeutic interventions that have a simultaneous effect on both reducing anger expression and level of depression. The way individuals express their anger remain a crucial question. There are three main categories of anger expression. Individuals may anger-out when they tend to openly express anger, usually in negative and aggressive ways, or they anger-in when they experience but suppress the open expression of anger. Finally, individuals may control their anger. The main goal of an individual in this case is to reduce and eliminate these feelings, so the expression of anger could be more controlled.Conclusions:Given all the negative effects of post stroke depression and anger, as those emotional states are responsible for a wide range of health-related behaviors, it is important to incorporate the above concepts in both theoretical and practical fields of health sciences in order to reduce their impact and improve the quality of services provided in post stroke rehabilitation programs.

Functional Disability After Ischemic Stroke: A Community-Based Cross-Sectional Study in Shanghai, China.

Objective: This study aimed to understand the demographics, functional disabilities, cognitive impairment, and depressive mood among stroke patients and to explore the correlation between functional disability and the other health conditions so as to provide some data for community rehabilitation among stroke patients.Methods: A cross-sectional study was conducted to investigate the functional status of ischemic stroke patients with stroke history between 1 month and 2 years by applying the modified Rankin Scale (mRS). Data were collected during October 2016 and January 2017 from 11 communities in two districts of Shanghai, China. We used face-to-face questionnaire interviews to collect information on sociodemographics, vascular risks associated with stroke, cognitive function [Mini-Mental State Examination (MMSE)], and depression [Patient Health Questionnaire-9 (PHQ-9)]; and we applied SPSS 24.0 for data analysis.Results: In this study, 305 patients with ischemic stroke were finally recruited, including 189 (61.97%) men, with an average age of 67 years. According to the mRS score, ischemic stroke patients were divided into patients without symptoms (controls, mRS = 0), patients without obvious disability (mRS = 1), and patients with mild to severe disability (mRS = 2–5). Ischemic stroke patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function, and depression status. Compared with patients without symptoms (mRS = 0), patients with mRS = 1 had a lower MMSE score [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26–0.90]; and patients with mRS = 2–5 had a lower MMSE score [OR = 0.16, 95% CI: 0.08–0.33], had a higher PHQ-9 score [OR = 5.36, 95% CI: 2.19–13.11], and were more likely to have previous stroke history [OR = 2.18, 95% CI: 1.01–4.79].Conclusion: Lower degrees of functional independence are related to cognitive impairment, as well as the previous stroke history and depression status.

The Role of Pharmacological Therapy and Psychotherapy in Post Stroke Depression

The most prevalent emotional illness following a stroke is post-stroke depression. Some of the symptoms of post-stroke depression include loss of interest, decreased energy, decreased appetite, problems sleeping, self-blame, and even suicide thoughts. To overcome the symptoms of post-stroke depression requires comprehensive management. In the PSD population, antidepressant medication has demonstrated to be effective. In order to obtain comprehensive health services, rehabilitation activities are also required as one of the therapies in the psychological sector of patients with post-stroke depression.

The new thoughts on the prevention and control of acute stroke:from "post stroke depression" to "stroke with depression"

卒中肆虐全球，已上升为我国成人致死、致残的首位病因。抑郁不仅是卒中的危险因素和并发症状，更是加重卒中病情并危及患者生命的重要致病因素。抑郁可能发生在卒中前或卒中后。病程中卒中和抑郁常常交互影响，但抑郁对卒中的次生损害却多被忽略，常导致卒中患者瘫痪加重和病死率增高，并使卒中复发增多而加大了卒中二级预防的难度。既往“卒中后抑郁”的概念中，卒中和抑郁被认为是两种独立的疾病，该概念临床应用受限并常延误患者的诊治。因此，我们提出“卒中伴抑郁”的新观念，更加强调治疗抑郁对紧急救治卒中损害所带来的更多获益，从而使急性卒中的防治步入崭新的时代。.

COGNITIVE BEHAVIOURAL THERAPY TO REDUCE DEPRESSION IN POST STROKE PATIENTS: A SCOPING REVIEW

Background: Post-stroke depression is one of the psychological disorders that is often experienced by post-stroke patients. Depression is more than just sadness. People with post-stroke depression will experience a lack of interest and pleasure in daily activities, weight loss or excessive sleep, lack of energy, inability to concentrate, feelings of worthlessness or guilt and recurring thoughts of death or suicide. Based on several types of post-stroke depression management, psychosocial interventions have been shown to reduce the likelihood of developing post-stroke depression. One of the interventions to reduce post-stroke depression is cognitive behavioral therapy.&#x0D; Objective: This scoping review aims to identify the effectiveness of cognitive behavioral therapy to reduce depression in post-stroke patients.&#x0D; Design: This study used a scoping review through a review of articles on cognitive behavioral therapy that has been used to reduce depression in post-stroke patients.&#x0D; Data Sources: Search for articles accessed through a database, including: CINAHL, MEDLINE, Academic search ultimate, PubMed, and google scholar with a range of search years 2011-2020.&#x0D; Review Methods: Quality appraisal assessment for each selected study was conducted using the Preferred Reporting Items for scoping review (PRISMA) method.&#x0D; Results: The results of this literature review show that cognitive behavioral therapy to reduce depression in post-stroke patients can change thoughts, feelings and behaviors to influence each other. The relationship between thoughts, feelings and behavior greatly influences respondents in dealing with post-stroke conditions with a positive way of thinking so that it will accelerate or help the post-stroke recovery process. The way to implement cognitive behavioral therapy is to be given as many as 12 sessions in 25-35 minutes each session. Cognitive behavioral therapy can be done in a hospital and has a significant post-stroke depression rate with p &lt;0.01.&#x0D; Conclusion: Cognitive behavioral therapy can be given as an intervention to reduce depression in post-stroke patients including cognitive behavioral therapy, duration of cognitive behavioral therapy and sessions in cognitive behavioral therapy.&#x0D; &#x0D; Keywords: Cognitive behavioral therapy, post stroke depression.

Case Report on a Misdiagnosed Case of Subcortical Vascular Dementia – the Importance of Sound Knowledge of Psychiatry With Proper History Taking

Psychiatric symptoms at presentation may often be missed, if not suspected or specifically explored. A missed psychiatric diagnosis may lead to dire consequences in terms of poor quality of life and function for the patient, affecting overall quality of healthcare provided. This lady presented with depressive symptoms after multiple strokes and was initially diagnosed as post stroke depression. However, after it was observed that she did not show any improvement in symptoms despite being on antidepressants, subsequent further investigations revealed a history more suggestive of subcortical vascular dementia. Consequently, detailed neuropsychological and neuropsychiatric assessments, including NUCOG, and relevant investigations including MRI brain scans were performed suggesting a diagnosis of vascular dementia. This case illustrates that an insufficiently thorough assessment and treatment process results in unnecessary morbidity, prolongs duration of illness, and increases social and occupational dysfunction to the patient. Hence, it further underscores the need to perform a thorough history, physical examination and relevant investigations to ensure organic etiologies are ruled out in clients with relevant sociodemographic and clinical risk factors.

Magnitude of Post Stroke Depression (PSD) and its Association with Socio-Demographic and Disease Related Factors in Stroke Survivors Visiting Tertiary Care Hospitals

Objective: To determine the magnitude of Post Stroke Depression (PSD) and its association with socio-demographic and disease related factors in stroke survivors visiting tertiary care hospitals Materials and Methods: A cross-sectional descriptive study was conducted in three major tertiary care hospitals from November 2018 to April 2019 on 120 stroke survivors. A valid and reliable self administered Siddiqui Shah Depression Score (SSDS) scale was used as a study tool. A non probability purposive sampling technique was used. Demographic information, including age, gender, marital status, income status, education, family system was obtained. Disease associated factors, including duration after stroke, co-morbidity, level of dependency were measured. Depression level was evaluated via SSDS translated into Urdu. SPSS ver. 20 was used to analyse the data. Results: In a sample (n = 120) stroke survivors, Post Stroke Depression (PSD) was found in 70.8%. Of the 120 stroke survivors, 66(55%) were male and 54(45%) were female. The mean age of the respondents was 47.43+11.83 years. Data was analyzed via SPSS 20 and Chi-Square test was applied showing a significant association with age of stroke survivor (p = 0.001) and education status (p = 0.003) while other demographic variables were found non-significant. In disease related factors, duration after stroke was depicted a significant association with PSD (p = 0.033) and level of dependency was found significant to great extent with P-value 0.001. Conclusion: In conclusion, timely diagnosis, family support, social acceptance, and rehabilitation may help the sufferer may improve the quality of life among stroke survivors.

Post Stroke Depression: Determination of Risk and Frequency of the Depression in Stroke Patients

Objective: In this study we will determine risk and frequency of the depression in stroke patients associated with quality of life.&#x0D; Methodology: Study duration was from January 2020 to December 2020. An observational Cross Sectional Study was conducted on 105 patients. Study conducted in Medical units PUMHS Hospital Nawabshah. After the consent of patient, Detailed history, complete CNS examination CT Scan Brain was done. Data were analyzed by using SPSS 15 version Depression was assessed by instrument beck depression inventory.&#x0D; Results: Age ranged from 48-68 years, 58 males, 48 females, Education of the patient 66 were uneducated, 17 primary pass and 22 middle pass. occupation of the patient 41 were unemployed, 40 were housewife and 24 were self employed. Depression level was 20 patients with borderline depression, 59 with moderate depression and 26 with severe depression.&#x0D; Conclusion: Post stroke depression is major problem after survival. Proper Treatment of stroke and depression can be prevented from complications and quality of life can be improved. Antidepressant drugs after acute stroke cognitive function can be improved with decreased mortality.

Post – Stroke Depression: A Review

Post – Stroke Depression: A Review

Admission National Institutes of Health Stroke Scale Associated with Higher Rates of Post Stroke Depression Independent of Imaging Characteristics (4903)

Admission National Institutes of Health Stroke Scale Associated with Higher Rates of Post Stroke Depression Independent of Imaging Characteristics (4903)

Constructing a hospital post-stroke depression management protocol by studying the management of post-stroke depression in a hospital setting

IntroductionA stroke is a potentially debilitating event which can render the victim unable to perform many tasks and functions, significantly decreasing their quality of life. This, in addition to emotional/mental changes post-stroke, can lead to a phenomenon known as “post stroke depression” (PSD), characterised by persistent low mood following a stroke.ObjectivesThis study aims to amalgamate recommendations based on national guidelines and previous literature, in addition to an original inpatient study of stroke patients within a hospital, to construct a standardised protocol of the management of PSD in the hospital setting.Methods248 patients who had been treated for stroke within a hospital were analysed using hospital notes to assess for incidence of PSD, in-hospital management, and outpatient follow-up. In addition a literature search was conducted and national guidelines were consulted to develop a PSD management protocol. Figure 1: Post stroke depression management protocol.ResultsWhile 8% (20/248) of stroke patients experienced low mood immediately post stroke, 45% (9/20) of these patients did not receive any therapy or drug treatment, 80% (16/20) did not receive any outpatient monitoring of their mood and 100% of patients received no outpatient monitoring of newly commenced antidepressants.ConclusionsUsing the results and literature search, a PSD management protocol, encompassing both appropriate in-hospital therapy and robust outpatient monitoring, was developed (Figure 1). We hope that through this, hospital care of PSD can be improved and optimised, in order for victims of PSD to receive the best possible, evidence-based care available to treat this potentially devastating condition.DisclosureNo significant relationships.

Cerebral small vessel disease: A review.

Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. The changes affect arterioles, capillaries and small veins supplying the white matter and deep structures of the brain. It is the most common incidental finding on brain scans, especially in people over 80 years of age. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of CSVD. The nomenclature and radiological phenotypes of CSVD were published in 2013 based on the unified position of the so-called Centres of Excellence in Neurodegeneration. The disease is characterized by a diverse clinical and radiological picture. It is primarily responsible for stroke incidents, gait disturbances, depression, cognitive impairment, and dementia in the elderly. The CSVD contributes to about 20% of strokes, including 25% of ischemic strokes and 45% of dementias. Common causes of CSVD include arteriosclerosis, cerebral amyloid angiopathy (CAA), genetic small vessel angiopathy, inflammation and immune-mediated small vessel diseases, and venous collagenosis. There is no causal treatment and management is mainly based on combating known risk factors for cardiovascular disease (CVD).

Abstract P212: Admission National Institutes of Health Stroke Scale Associated With Higher Rates of Post Stroke Depression Independent of Imaging Characteristics

Introduction: The etiology of post-stroke depression (PSD) is still not fully understood. It is well known that leukoaraiosis is associated with cognitive decline and depression, but currently unclear if lacunar strokes, thought to be caused by small vessel disease, have higher rates of PSD. A better understanding of PSD etiology can lead to improved treatment of PSD and subsequently better stroke recovery. Methodology: Out of 159 patients that were successfully contacted via phone within 3 months of discharge, there were 22 identified as having an acute stroke or TIA and scored ≥ 2 on the Patient Health Questionnaire (PHQ) assessment. MRI brain was reviewed for stroke size, location, periventricular and deep white matter fazekas score, number of microbleeds, and chronic lacunar strokes. Admission and discharge National Institutes of Health (NIH) stroke scale and stroke etiology were also recorded. Results: There was a significantly positive correlation between NIH score at admission and PHQ2 score (r = 0.184, p =0.044), demonstrating that patients with NIH ≥ 6 are 4.6 times more likely to develop PSD than a patient with NIH &lt; 6 (Odds ratio (OR) = 4.6, CI [1.284-16.591]). There was no significant difference between PSD incidence in stroke size or location. Although not statistically significant, there was a suggestion of more PSD seen in cortical, cardioembolic, and cryptogenic strokes as well as fazekas score ≥ 2 and old lacunar infarcts. The table summarizes characteristics of the 7 TIA and 15 stroke patients suffering from PSD with PHQ ≥ 2: Conclusion: Initial NIH significantly predicted PSD irrespective of leukoaraiosis. This study was limited by the small sample size which could be due to under-diagnosis of PSD. In conclusion, admission NIH is associated with higher rates of PSD, but the underlying etiology is likely multifactorial given the suggestion of higher rates of PSD with higher fazekas score, and cortical, cardioembolic, and cryptogenic strokes.