卒中后抑郁104例临床分析

目的 探讨卒中后抑郁(PSD)的发病率、发生时间、相关因素和治疗.方法 采用Hamilton抑郁量表,SDS抑郁自评量表,对我科268例脑卒中患者进行测查,分析PSD的发病率、发生时间、相关因素,并观察赛乐特治疗效果.结果 38.8%的患者(104例)件发抑郁,其中轻度26.5%,中度8.6%,重度3.7%.PSD多发生于卒中后1年内,3～6个月是高峰期.影响PSD发生的相关因素是家庭关系、文化程度、病灶数目和病灶部位.治疗后HAMD和NDS积分较治疗前明显减少(P＜0.01).结论 PSD发生率较高,它可能是神经生物学因素和社会心理学因素共同作用结论,早期诊治预后较好.     

卒中后抑郁的特点及其影响因素的研究

目的 研究卒中后抑郁(post- stroke depression,PSD)的特点和影响因素,为PSD的干预提供依据.方法 采用临床流行病学调查方法对门诊和住院的208例脑卒中患者进行PSD及其相关因素的现状调查,运用抑郁自评量表( SDS)、汉密尔顿抑郁量表(HAMD)对卒中患者进行评定,将研究对象分为非PSD组(SDS总分＜30分)和PSD组(SDS≥30分),再将PSD组进一步分为轻度抑郁症状亚组(HAMD评分＞7分且≤16分)和中-重度抑郁症状亚组(HAMD评分＞16分).结果 PSD的发生率为36.06％,其中轻度66.67％、中-重度33.33％;PSD的特点为以睡眠障碍、焦虑/躯体化障碍等为主要表现;卒中后抑郁发生的影响因素有病灶数目、心血管病史、抑郁症史、病灶部位以及脑卒中史.结论 PSD发生率较高,以睡眠障碍、焦虑/躯体化障碍等为主要表现,其发生是多种因素共同作用的结果.     

卒中后抑郁与脑损伤部位相关性的临床研究

目的探讨不同的脑损伤部位与脑卒中后抑郁病变的关系,探讨PSD的现况以及对结局的影响。方法收集2010年09月～2011年09月期间河北联合大学附属医院神经内科脑卒中患者300例,通过颅脑CT或MRI进行卒中病灶定位,采用Hamilton抑郁量表对卒中患者在发病14±2d及90±7d进行抑郁及程度的评价。对收集患者的相关临床指标如美国国立卫生院神经功能缺损评分(NIHSS)、改良Rankin量表评分(MRS)、简易精神状态检查表(MMSE)评分等相关因素进行统计分析。结果 140例脑卒中患者合并PSD,总发生率为46.67%,其中轻中度抑郁占46.00%,重度抑郁占0.67%;多发性、左侧半球、额颞叶、基底节区脑卒中患者PSD发生率高。结论脑卒中患者神经功能缺损程度评分越高,其患抑郁的程度也就越高。PSD发生与卒中类型无关,而与卒中部位、卒中残疾程度等因素有关。     

卒中后抑郁的临床特点及相关因素

目的探讨卒中后抑郁（PSD）的发生率、临床表现、相关因素和治疗情况。方法对114例脑卒中患者采用汉密尔顿抑郁量表（HAMD）等进行评定,分析符合PSD诊断的54例患者的临床特点。结果PSD的发生率为47.37%,以轻-中度抑郁为主,PSD的常见症状有全身症状、能力减退感、睡眠障碍、忧郁情绪、工作和兴趣减退等。结论卒中后抑郁的发生率高,神经功能缺损程度与卒中后抑郁的发生有密切关系。     

脑卒中后抑郁状态临床分析

目的了解脑卒中后抑郁状态(PSD)的发生率及其相关因素。方法采用HAMD抑郁量表美国国会卫生研究院神经功能缺损评分(NiHSS)、Barthe指数评分,分别对274例脑卒中患者进行测评。结果PSD总发生率为35.0%,其中轻度21.2%,中度10.6%,重度3.2%,对PSD影响最大的相关因素为脑卒中责任病灶,其次是神经功能缺损、心理创伤,与患者年龄和性别无关。结论上述相关因素是本组PSD患者的主要病因,为治疗和预防PSD提供参考价值。     

288例脑卒中后抑郁的临床分析

目的探讨脑卒中后抑郁（PSD）的发生率及其主要相关因素。方法选择在本院住院确诊为脑卒中患者769例,采用汉密尔顿抑郁量表（HAMD）17项评分≥18分及卒中患者神经功能缺损程度进行评估。结果 PSD288例,发生率为37.45%,且与卒中性质、部位、程度、生化指标异常等密切相关。动态观察卒中患者CRP水平有助于早期发现PSP。结论预防性抗抑郁剂应用和抗抑郁剂治疗PSD,不仅减低PSD发生率,且有助于PSD和卒中患者神经功能的恢复。     

脑卒中急性期患者卒中后抑郁的发生率及其危险因素

目的 探讨脑卒中急性期患者卒中后抑郁(PSD)的发生率及其危险因素.方法 连续入组的发病24 h内入院的急性脑卒中患者127例,根据入院14 d内汉密尔顿抑郁量表(17项)和蒙哥马利抑郁量表评分分为PSD组和非PSD组,分析PSD与性别、婚姻状况、年龄、文化程度、卒中类型、病灶部位、脑梗死容积、高血压、糖尿病、冠心病、吸烟、饮酒、体质量指数(BMI)、卒中家族史、卒中病史、颈动脉斑块、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)和简易精神状态检查(MMSE)量表评分等临床因素的关系.结果 本组PSD发生率为37.0%(47例).PSD组脑梗死比率、伴高血压病比率、脑梗死容积、入院时NIHSS评分均明显高于非PSD组,BI和MMSE评分均明显低于非PSD组(P＜0.05～0.01).多因素Logistic回归分析显示脑梗死、高血压和入院时BI与PSD独立相关(OR=5.084,95%CI:1.255～20.592,P=0.023;OR=4.846,95%CI:1.447～16.225,P=0.010;OR=0.966,95%CI:0.951～0.981,P＜0.001).结论 脑卒中急性期患者PSD的发生率较高,脑梗死、高血压和入院时BI是PSD的独立危险因素.     

卒中后抑郁及其治疗对神经功能康复的影响

目的　观察卒中后抑郁(PSD)的发生率和相关因素;探讨百优解抗抑郁治疗对卒中后抑郁患者神经功能康复的影响。方法　选取急性脑卒中患者132例(脑梗死78例,脑出血54 例),分别在病程2周、1月、3月、6月、12月行PSD诊断、神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表( HAMD)评分,同时完成Zung’s 抑郁自评量表( SDS)和焦虑自评量表( SAS)。结果　(1)脑卒中患者中约44.70%出现抑郁症状;(2)卒中类型和性别与PSD发生率无相关性(P>0.05);(3)PSD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。(4)PSD与病变部位、病灶大小、病灶半球利性均无相关性(P >0.05);(5)百优解能明显改善病程3、6 月时神经功能缺损,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　卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者神经功能康复的速度和程度。抗抑郁治疗能在抑郁症状明显改善的同时,促进患者神经功能和日常生活能力的恢复。     

老年脑卒中后抑郁及相关影响因素分析

目的　了解老年脑卒中后抑郁 (PSD)的发生率及与性别、文化程度、病变部位、病灶数目、致残程度的关系 ,对日常生活能力恢复的影响。方法　采用老年抑郁量表对 96例脑卒中患者进行评定 ,分为抑郁组和非抑郁组进行分析比较。结果　共有 44例患者有抑郁症状 ,总发生率为 45 83 % ,女性患者、文化水平偏低、病变部位在左半球及多个病灶者发生率高 ,致残程度与PSD呈正相关。结论　老年PSD发生率高 ,是多种因素共同作用的结果 ,直接影响病人的生存质量及功能恢复。     

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.     

Depression and Anxiety after Stroke in Young Adult Filipinos

Background and ObjectivesYoung adult patients may suffer from poststroke depression (PSD) and anxiety. Few studies have evaluated these important psychiatric conditions that may lead to adverse outcomes in young adults. We aimed to determine the prevalence of PSD and anxiety as well as to identify their predictors in a population of young Filipino adults (18-49 years old).MethodsWe performed a cross-sectional epidemiologic study in the largest tertiary hospital in the Philippines. The study involved the administration of a structured survey tool and review of medical records. The Hospital Anxiety and Depression Score – Pilipino version (HADS-P) was used to screen for anxiety and depression. Multivariable logistic regression analysis was performed to determine significant socio-economic and clinical risk factors of PSD and anxiety.Results114 young adult stroke patients were included. The prevalence of depression was 20.2% while that of anxiety was 34.2%. Significant predictors of PSD were the presence of anxiety (OR 1.84; CI 1.05-3.22), lower mRS scores (mRS 3-5 OR 5.52; 95% CI 1.09-8.03) and diabetes (OR 2.09; 95% CI 1.67-6.26). Meanwhile, significant predictors of poststroke anxiety included depression (OR 7.5; 95% CI 5.02-21.94) and dependency (Barthel Index scores 95-100; OR 0.94; 95% CI 0.89-0.99). Relationship status, educational attainment, stroke subtype and location were not found to be significant predictors of PSD and anxiety.ConclusionA significant proportion of young adults suffered from depression and anxiety after stroke. Clinicians should be aware of these psychiatric conditions that influence outcomes and quality of life of young adults with stroke.     

卒中后抑郁状态的发生率及相关因素研究

目的 了解卒中后抑郁状态（PSD） 的发生率及其相关因素。方法 采用Hamilton抑郁量素和自制一般情况调查表,对520例脑卒中患者进行调查评分,并用逐步Logistic回归统计方法对各相关因素进行分析。结果 PSD总发生率为34．2％,其中轻度20．2％,中度10．4％,重度3．7％。对PSD影响最大的相关因素是既往抑郁病史,其次是性别、家庭 和睦情况、合并疾病种类、神经功能缺损严重程度和卒中后病程。结论 上述因素是本组PSD患者的主要预测因素,为预防PSD提供参考依据。     

急性缺血性卒中后抑郁的相关危险因素分析

目的探讨急性缺血性卒中后抑郁(PSD)的发生率及其相关危险因素。方法 185例经CT或MRI证实的急性缺血性卒中患者根据精神障碍诊断和统计手册第5版(DSM-V)标准和24项Hamilton抑郁量表(HAMD)评分分为PSD组和non-PSD组;分析PSD社会人口学资料、血管危险因素、相关生化指标、NIHSS、Barthel指数(BI)、MMSE等相关因素对PSD的影响。结果本组PSD发生率为40.54%(75例),主要以轻、中度抑郁为主;与non-PSD组比较,PSD组患者糖尿病发生率高(P=0.044),神经功能缺损程度重、日常生活活动能力差(P=0.000,P=0.001),MMSE评分降低(P=0.000),而超敏C-反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平升高(P=0.000,P=0.006);其中BI、MMSE评分与HAMD评分呈负相关(均P0.05),而NIHSS评分、hs-CRP和Hcy与HAMD评分呈正相关(均P0.05);Logistic回归分析提示,低MMSE评分、高NIHSS评分及高hs-CRP和Hcy水平可能是急性缺血性PSD的独立危险因素。结论 PSD主要以轻、中度抑郁为主;PSD与糖尿病病史、认知功能障碍、神经功能缺损程度、hs-CRP和Hcy水平密切相关。     

初发脑卒中后抑郁患病率及危险因素的随访研究

目的 探讨初发脯卒中后抑郁(PSD)在1年内各时期的患病情况及相关因素.方法 对初发的脑卒中患者66例在2周、3个月、6个月、12个月时进行随访,采用汉密尔顿抑郁量表(HAMD)、神经功能缺损量表、日常生活能力量表、社会支持量表及艾森克人格问卷评估患者,调查各随访时点PSD的患病率并对其相关因素进行Lo-gistic回归分析.PSD的定义为卒中后抑郁症状持续两周以上和评定时HAMD评分≥7分,但入组评定时抑郁症状持续不足两周者仍以PSD表示.结果 在初发脑卒中患者中,卒中后2周、3个月、6个月、12个月PSD的发生率分别为18.18%(12/66)、29.23%(19/65)、38.09%(24/63)、31.67%(19/60).首次评定时有3例未满足抑郁持续2周的严格定义,但3个月评估时仍为PSD.Logistic回归分析显示,卒中后2周PSD与女性、内向性格相关(b=-1.55,P=0.001;b=1.59,P=0.047);卒中后3个月时PSD与社会支持度低、神经功能缺损程度重及女性相关(b=-0.19,P=0.005;b=0.26,P=0.01;b:2.84,P=0.03);卒中后6个月时PSD与社会支持度低与神经功能缺损程度重相关(b=-0.24,P<0.001;b=0.35,P=0.004);卒中后12个月时PSD与社会支持度低与神经功能缺损程度重相关(b=-0.17,P=0.1301;b=0.33,P=0.002).结论 PSD患病率较高;不同时期的PSD的相关因素不同提示病因可能不同,支持卒中后抑郁的生物社会肉素发病机制.     

Gender differences in post-stroke depression: A longitudinal analysis of prevalence,persistence and predictive value of known risk factors

ABSTRACT

Post-stroke depression (PSD) is the most frequent psychiatric condition after stroke with a prevalence of approximately 33%. In the general population, depression is consistently reported to be more frequent in women than in men. Evidence about gender differences in PSD remains inconclusive and it is unknown if established risk factors exert gender-specific influence. The authors examined gender differences in PSD prevalence, persistence and influence of established risk factors using χ ²- and Welch’s t-tests and continuous-time structural equation modelling (CT-SEM). Patients (N?=?301) from the longitudinal Berlin-PSD-study were assessed six weeks (baseline), and up to four times during the first 2.5 years post-stroke using DSM-5 depression criteria and the Geriatric Depression Scale (GDS). Established risk factors were assessed at baseline. Women showed higher PSD prevalence and severity at baseline (p?<?.01) but not thereafter (p?≥?.43). CT-SEM analysis revealed that known risk factors predicted depression, yet predictive value and persistence did not differ between genders. Our results showed that established PSD risk factors influence both genders to a similar extent and that in contrast to depression in the general population, gender differences in PSD prevalence and severity disappeared within six months post-stroke. Thus, for reasons yet to be deciphered, gender differences in PSD appear to be time-dependent after stroke.     

卒中后急性期抑郁状态的相关因素临床分析

目的探讨脑卒中后急性期抑郁的发生率及相关因素。方法对139例住院诊断为脑卒中的急性期患者用自制的一般情况调查表及汉密尔顿抑郁量表、改良的爱丁堡斯堪的那维亚神经功能缺损评分表进行调查及评分。结果脑卒中后抑郁的发生率为35.97%,抑郁的发生与性别、职业、文化程度及病灶部位没有关系,与神经功能缺损及日常生活能力依赖有密切关系。结论脑卒中后抑郁是脑卒中的常见并发症,与神经功能缺损、日常生活能力依赖等有密切关系,为预防脑卒中后抑郁的发生提供依据。     

Association of post stroke depression with social factors,insomnia, and neurological status in Chinese elderly population

The purpose of this study was to investigate the association of post stroke depression (PSD) with social factors, insomnia, and neurological status among elderly Chinese patients with ischemic stroke. Six hundred and eight patients over 60 years of age, who had suffered from a first episode of ischemic stroke within 7 days, were enrolled into the study. They were divided into PSD and non-PSD groups according to the Self-rating Depression Scale (SDS) scores. The association of PSD with social factors, insomnia, and neurological status was analyzed using multivariable logistic regression analysis. Compared with the patients who did not develop PSD, those with PSD reported adverse life events more frequently, and more subjects with PSD lived alone, had left carotid artery infarction and cortical infarction (P < 0.05), history of insomnia, and high National Institute of Health Stroke Scale (NIHSS) scores and low Barthel Index (BI) scores (P < 0.01). The multivariable logistic regression analysis showed that the occurrence of PSD was associated with a history of insomnia (HR = 1.59, 95 % CI 1.12–2.36, P < 0.01), NIHSS scores (HR = 2.45, 95 % CI 1.42–3.91, P < 0.01) and BI scores (HR = 2.56, 95 % CI 1.39–4.25, P < 0.01). Insomnia and the degree of neurological deficit were associated with PSD in an elderly population of Chinese people.     

Mild depression in young adults with cerebral infarction at long-term follow-up: A population-based study

We sought to evaluate the prevalence of and risk factors for post-stroke depression (PSD) at long-term follow-up in young adults aged 15-49 years with first-ever cerebral infarction in a population-based study. Scores on Montgomery-Asberg Depression Rating Scale (MADRS) were obtained at follow-up (mean time 6.0 years after the stroke) and analysed in subgroups. MADRS scores were obtained in 196 of 209 surviving patients. PSD (MADRS>or=7) was detected in 56 patients (28.6%). None had severe PSD. Alcoholism (P=0.006), depressive symptoms any time before the index stroke (P=0.016), and severe neurological deficits on admission for the index stroke (P=0.043) were independently associated with PSD. PSD seems milder in young ischaemic stroke patients compared with older patients. Alcoholism, depression any time before the index stroke, and severity of neurological deficits on admission for the stroke increased the risk of developing PSD in the long run.     

Quantification of the risk of post stroke depression: the Italian multicenter observational study DESTRO

OBJECTIVE: The Italian multicenter observational study depression in stroke (DESTRO) aimed to identify risk factors for post stroke depression (PSD) and quantify the likelihood of it arising in various categories of patients. METHOD: Mood evaluation was performed in 1064 consecutive stroke patients by means of Beck Depression Inventory and Visual Analog Mood Scale. Depressive symptoms were classified using the DSM-IV and revised WHO criteria for depression in the course of a neurological disorder. RESULTS: Post stroke depression was seen in 36% of the survivors, with dysthymia by far the predominant form (80.7%). Female sex, disability, previous cerebrovascular or depressive episodes were significantly associated with an increased risk of depression. Combinations of these factors raised the risk of PSD exponentially, from 24.3 to 89.1%. The site of the stroke did not come into the uni- or multivariate analysis. CONCLUSION: At admission, it is possible to predict the likelihood of PSD and quantify the relative risk.     

高血压脑出血卒中后抑郁风险因素相关性研究

目的 探讨高血压脑出血患者卒中后抑郁相关影响因素。方法 前瞻性录入65例急性高血压脑出血患者临床和计算机断层扫描（computer tomography,CT）影像资料,评估患者发病14d和3个月卒中后抑郁发生情况及生存质量状况,对临床资料和CT影像特征与卒中后抑郁的关系进行单因素和多因素分析。结果 65例患者中有57例完成14d随访,53例完成3个月随访。脑出血发病14d和3个月卒中后抑郁的发生率分别为35.1%和38.9％。单因素分析显示入院后首次美国国立卫生研究院卒中量表评分（thenational institutes of health stroke scale, NIHSS）与高血压脑出血发病后14d卒中后抑郁相关（P =0.027）。性别、出血部位和出血量与脑出血发病后3个月卒中后抑郁相关：与非抑郁组比较,抑郁组患者男性比例较低（P =0.038）,基底节出血比例较高（P =0.031）,平均出血量大（P =0.046）。多因素分析显示出血量是高血压脑出血患者发病3个月卒中后抑郁的风险预测因素（P =0.049）。结论 NIHSS评分和CT影像特征可作为高血压脑出血卒中后抑郁的评价指标,将CT影像与神经功能缺损程度评分有机结合可为脑出血综合性治疗策略的建立提供客观依据。