脑卒中后不同时段发生抑郁患者的头颅磁共振波谱分析

目的：应用磁共振波谱（MRS）技术探讨脑卒中后不同时段发生脑卒中后抑郁（PSD）脑N-天冬氨酸盐/肌苷（NAA/Cr）和胆碱/肌酐（Cho/Cr）的代谢改变。方法：急性脑卒中住院病例223例,脑卒中后72h予汉密顿抑郁量表（24项版）评分,≥8分者（PSD患者）根据病例编号,采用随机数字表法分为干预组（第1组）和对照组（第2组）;〈8分者1个月时再次评分,≥8分者再分为干预组（第3组）和对照组（第4组）;〈8分者2个月时再评分,≥8分者再分为干预组（第5组）和对照组（第6组）;〈8分者3个月再评分,≥8分组（第7组）、〈8分组（第8组）。干预组（1、3、5、7组）给予帕罗西汀20mg·d-1治疗。分别在72h、3个月对PSD患者行MRS（双侧颞叶海马、丘脑）检测。结果：①在NAA/Cr比值中：72h和3个月时,第4、6组颞叶海马、丘脑ROINAA/Cr比值低于第2组（P〈0.05）;而与第7组相比,P〈0.01;第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;各组患者各ROINAA/Cr比值72h与3个月比较,均差异无统计学意义。Cho/Cr比值中：第4、6组海马和丘脑ROICho/Cr比值高于第2、7组,且以海马更为显著（P〈0.01）;而第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;第4、6组右侧丘脑ROICho/Cr比值3个月较72h时增高。②3个月时第4、6组右颞叶ROICho/Cr高于第5组（P〈0.05）。③第7组72h、3个月时右海马ROICho/Cr比值高于第8组（P〈0.05）。结论：MRS在PSD早期诊断中价值有限,但对病程1和2个月时PSD的发生有较为肯定的预示意义;针对该人群进行早期干预对改善脑代谢具有积极意义。     

EEG Biofeedback on a Female Stroke Patient with Depression: A Case Study

ABSTRACT

Background. This single case concerns the treatment of a 71-year-old female stroke patient. The patient's MRI revealed that the location of the stroke was in the right side basal ganglia with damage extending into the anterior limb of the internal capsule. She presented with a virtual paralysis of the left side of her body (hemiplegia with immobilized left arm, contracted fist, minimal motor control over left leg, absence of muscle tonus in left side of face and slurred, monotonic speech).

Method. The client was provided with EEG biofeedback training on a one to two half-hour sessions per week schedule. Bipolar montages were used along with single site protocols. This was based largely on the idea of reciprocal communication loops between widely separated cortical generators. It was thought that encouraging communication between cortical sites would have a beneficial impact on impairments related to both functional and structural damage. EEG training protocols included SMR (12-15 Hz) enhancement at C4, C4-Pz and T3-T4 with theta suppression; beta (15-18 Hz) enhancement with theta suppression at C3, C3-Fpz and at C3-Fp1.

Results. Patient showed significant improvement in gross motor control and range of movement of left arm and leg. The most dramatic improvement was observed in speech (articulation, strength and tone). While substantial improvements were observed in motor ability, restoration of mood stability proved somewhat more elusive. Since she was receiving additional treatment (physical therapy and medication management), it is impossible to attribute the improvement in functioning solely to the EEG training. However, the consensus among the attending medical personnel was that the improvements noted above took place with unusual expeditiousness.

Discussion. When performing EEG biofeedback it may be most practical to adopt an “exercise model” approach in which the regulatory mechanisms in the brain are challenged through the sequential use of multiple protocol configurations. In this case several different training protocols proved useful in her ongoing recovery. While improvements in functioning were a result of a concerted effort involving multiple therapeutic interventions, it is likely that neurofeedback played a vital synergistic role.     

A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivors

OBJECTIVE: To conduct an initial assessment of the reliability and validity of the Brief Assessment Schedule Depression Cards (BASDEC) and the Beck Depression Inventory-Fast Screen (BDI-FS) to screen for depression in older stroke survivors. METHODS: Participants from four inpatient rehabilitation units completed the BASDEC and the BDI-FS together with the Hospital Anxiety and Depression Scale (HADS) for comparison. The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID) was then completed with all participants to ascertain a criterion depression diagnosis. The BASDEC and BDI-FS were subsequently completed for a second time. RESULTS: Forty-nine stroke survivors (M=78.80, SD=6.79 years) were included. The BASDEC and BDI-FS demonstrated acceptable internal consistency and test-retest reliability. The BASDEC (cut-off >or=7) resulted in a sensitivity of 1.0 and specificity of 0.95 for detecting major depression whereas the BDI-FS (cut-off >or=4) had a sensitivity of 0.71 and specificity of 0.74. When participants with minor depression were included in analyses, sensitivity lowered to 0.69 (specificity=0.97) for the BASDEC and 0.62 (specificity=0.78) for the BDI-FS. CONCLUSIONS: The BASDEC and BDI-FS were found to have acceptable reliability. The BASDEC demonstrated some advantage in criterion validity over the BDI-FS at the examined cut-offs.     

Screening for depression in primary care Development and validation of the Depression Scale,a screening instrument for depression

Depression is a common mental disorder; effective methods for treating it are also available. Its recognition and diagnosis are prerequisite to effective treatment. A majority of depressed patients are generally managed in the primary care setting; only a half of the cases, however, are identified at their first visit. Screening instruments to improve recognition of depression have therefore been developed. The Depression Scale (DEPS), consisting of 10 items, was developed and tested in primary care patients aged 18 to 64 years. Clinical assessments were made on the basis of Present State Examination interviews with 436 patients. The DEPS proved to be satisfactory. Increasing age and poor education had an adverse effect on the screening process, however. The sensitivity of the DEPS for clinical depression was 74% and the specificity for non-depression 85%. The sensitivity for severe depression was 84% and the specificity for symptom-free patients 93%. The DEPS seems to improve the recognition of depression in primary care and may also be suitable for screening depression in the general population and for identifying high-risk groups.     

Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults

Background: Few studies have evaluated the validation of 15-item Geriatric Depression Scale (GDS-15) in a heterogeneous population with different age, ethnicity and comorbidities of elderly users of social services in the community.

Aims: To assess the criterion validity and reliability of the GDS-15 and its equivalence across different gender, age groups, ethnicity and different comorbidities in community living elderly and nursing homes residents.

Method: A validation sample of non-demented 4253 elderly (age ≥ 60 years), who regularly use community based care corner, senior activity center, day care center, sheltered homes and nursing homes were interviewed using the GDS-15. Structured clinical interview (SCID) was used to make DSM-IV diagnosis of major depressive disorder (MDD).

Results: The overall sensitivity and specificity were 0.97 and 0.95, respectively (area under curve, AUC was 0.98). The overall Cronbach's alpha was 0.80, and intraclass coefficient of test-–retest reliability over 2 weeks was 0.83 and inter-rater reliability was 0.94 (intra-class) and 0.99 (Cohen's kappa). Although some items in the GDS-15 appeared to be biased by gender, age and ethnicity, there were no clinically significant differences in test performance among different age, gender, ethnicity and comorbidities at cutoff of 4/5.

Conclusions: The GDS-15 was a reliable and valid screening for MDD across different age, gender, ethnicity and chronic illness status in the community and social service setting.     

Screening for major depression in Asian-Americans: a comparison of the Beck and the Chinese Depression Inventory

OBJECTIVE: This study compares the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) and the Chinese Depression Inventory (CDI) in screening for depression among Chinese Americans. METHOD: Five hundred and three Chinese-Americans in primary care were administered the CBDI and the CDI for depression screening. The results were compared with standard semistructured interview. RESULTS: With empirically determined cutoff scores of the CBDI (> or =13) and the CDI (>/=16), both instruments have good sensitivity (0.78) and excellent specificity (0.91 and 0.93, respectively). The correlation between the total scores of the two instruments was high (0.785, P < 0.01). The areas under the Receiver Operating Characteristic (ROC) curve of the CBDI and the CDI were 0.94 and 0.95, respectively, and were not significantly different. CONCLUSION: When administered by interviewers, the CBDI and the CDI have comparable effectiveness. Low participation among Chinese-Americans with self-report measures limits both scales as efficient depression screening instruments.     

English adaptation,international harmonisation,and normative validation of the Language Screening Test (LAST)

Background: The Language Screening Test (LAST) is a unique bedside tool, designed to rapidly and reliably evaluate aphasia during the acute and chronic phases of stroke. Two equivalent reliable and validated versions of the LAST exist in French.

Aims: Our objective was to conduct a linguistic adaptation for English (LASTen) through a process of translation, international harmonisation, and normalisation in multiple English-speaking countries.

Methods & Procedures: There were four progressive stages in the adaptation of the LASTen including a series of sequential evaluations to identify problematic items, with selection of alternatives by consensus and in collaboration with the original LAST developers. First, three Canadian translators independently adapted the 29 items of the original LAST into English, resolving discrepancies by consensus to produce adaptation I. Evaluations of adaptation I involved ratings of translation difficulty and multidisciplinary expert panel review to produce adaptation II. Evaluations of adaptation II included ratings of translation quality by three different translators followed by healthy native speaker testing in Canada to produce adaptation III. Evaluations of adaptation III included expert review in Australia, Canada, England, and the USA for cultural acceptability and naturalness, followed by healthy native speaker testing in all the four countries to produce adaptation IV. Adaptation IV constituted a linguistically valid LASTen for four English dialects. We documented consensus decisions to modify or retain problematic items. We evaluated group differences using the Kruskal–Wallis test for continuous variables and chi-squared analyses for frequency variables with statistical significance of alpha ≤.05.

Outcomes & Results: During the translation and the evaluations, we reconsidered 22 of the 29 items, revising 20 to produce adaptation IV of the LASTen. Normative testing in the four English-speaking countries involved 109 participants (mean age 60 years, SD ±16.1). Fifty-five percent were women, and 32% lacked postsecondary education. Fourteen participants made errors across nine items. There were no significant differences in errors for age, sex, or country. However, participants with postsecondary education made fewer errors than those without (p = .04).

Conclusions: We achieved a linguistically compatible adaptation of the French LAST for English, confirming naturalness and cultural appropriateness in healthy native speakers of four English dialects. Our systematic multistep approach delineates rigorous methods for the adaptation of aphasia tools. Our normative validation of the LASTen in healthy native speakers of English provides the impetus for its validation in stroke patients within the four English-speaking countries.     

Psychosocial,Physical, and Autonomic Correlates of Depression in Korean Adults: Results from a County-Based Depression Screening Study

Objective

We aimed to investigate the prevalence and psychosocial and neurophysiological correlates of depression in a large county-based cohort of Korean adults.

Methods

We recruited 2355 adults from a rural county-based health promotion program. The following psychometric scales were used: the Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depression, the General Health Questionnaire (GHQ) was used to evaluate stress, and the Medical Outcome Study Social Support Survey (MOS-SSS) was used to determine perceived social support. Heart rate variability (HRV) was used to assess neurophysiological properties. The psychosocial and neurophysiological variables of adults with depression (CES-D score ≥25) and without depression (CES-D score <25) were statistically compared. A logistic regression model was constructed to identify factors independently associated with depression.

Results

We estimated that 17.7% of the subjects had depression, which was associated with old age, being female, being single, less religious affiliation, high education, low body mass index (BMI), low levels of aerobic exercise, low social support, and a low HRV triangular index. The explanatory factors of depression included high education, less religious affiliation, low levels of current aerobic exercise, low BMI, and low social support.

Conclusion

Given the relatively high prevalence of overall depression, subsyndromal depression should also be regarded as an important issue in screening. The independent factors associated with depression suggest that practical psychosocial intervention, including brief psychotherapy, aerobic exercise, and other self-help methods should be considered. In addition, the HRV results suggest that further depression screening accompanied by neurophysiological features would require fine methodological modifications with proactive efforts to prevent depressive symptoms.     

Inter-rater reliability of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in the acute phase after stroke

Background: Before implementation of the new scale, the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS), to clinical practice, it is fundamental to analyze its measurement properties.Objective: To examine the inter-rater reliability of the SwePASS in the acute phase after stroke.

Methods: Day 3 to day 7 after admission to a stroke unit, 64 persons with stroke were assessed twice, using the SwePASS, by two physiotherapists. Inter-rater reliability was determined using percentage-agreement and the rank-invariant method: relative position, relative concentration, and relative rank variance.

Results: The raters showed a percentage agreement of ≥75% in the assessments using the SwePASS. For 9 of the 12 items, the percentage agreement was >80%. For 8 of the 12 items, there was a statistically significant change in position, revealed in relative position values between 0.08 and 0.15. Three items had statistically significant positive relative concentration values between ?0.11 and 0.10. Except for a statistically significant negligible relative variance value of 0.01 for the items 1 and 8, there was no relative variance.

Conclusions: The SwePASS shows an acceptable inter-rater reliability, albeit with potential for improvement. The reliability can be improved by a consensus how to interpret the scale between the raters prior to implementation in the clinic.     

Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample

The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors,‘depression’ and ‘anxiety’, while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.     

The development of a brief screening instrument for depression and suicidal ideation for elderly: the Depression and Suicide Screen

The early detection of depression and suicidal ideation is essential for the prevention of suicide in the community. This study therefore aimed to develop a brief screen for depression and suicidal ideation that can be easily administered in primary-care settings. The Self-rating Depression Scale (SDS), the Hospital Anxiety and Depression Scale (HADS) and a modified version of the Composite International Diagnostic Interview (CIDI) were administered by 353 residents of a single community aged 64 years and over. A five-item screen was derived from SDS and HADS, using CIDI as the external criterion (study 1). The scale was modified so that it was more appropriate for our use, and was labeled the Depression and Suicide Screen (DSS). Its validity and reliability were examined among a further 382 residents of the same community aged 64 years and over, using the Short-Form Geriatric Depression Scale (GDS-S) as the external criterion (study 2). The DSS was internally consistent (Cronbach's alpha=0.62). Its reliability in detecting depression (defined as >or= 6 in GDS-S) and suicidal ideation (screened out by the inquiry by our trained staff) was 0.768 and 0.721, respectively. For depression, the sensitivity was 0.705; specificity, 0.729; positive predictive value (PPV), 0.446; negative predictive value (NPV), 0.888; and the overall diagnostic power, 0.723. For suicidal ideation, its sensitivity was 0.698; specificity, 0.693; PPV, 0.317; NPV, 0.926; and overall diagnostic power, 0.694. The DSS demonstrated a reasonable level of sensitivity and specificity in identifying both depression and suicidal ideation among the elderly within a community.     

Screening for depression among first-visit psychiatric patients: Comparison of different scoring methods for the Center for Epidemiologic Studies Depression Scale using receiver operating characteristic analyses

Abstract The present paper aims to compare the ability of eight scoring methods for the Center for Epidemiologic Studies Depression Scale (CES-D), one of the most widely used self-report inventories for depression, to screen for a major depressive episode. The subjects were 591 patients who constituted representative samples of the first-visit patients to 23 psychiatric hospitals and clinics all over Japan. The criterion diagnoses were given by a semi-structured interview with established inter-rater reliability. The eight alternative scoring methods included the conventional Likert method, which gives the weights 0,1,2 and 3 to the four anchor points of the CES-D; the presence method, which gives the weights 0, 1, 1 and 1, respectively; the GHQ method, which gives the weights 0, 0, 1 and 1, respectively; the persistence method, which gives the weights 0, 0, 0 and 1, respectively; 10-item version, 5-item version, single-item version and the algorithmic method. On the basis of the receiver operating characteristic (ROC) analyses, it was found that the traditional Likert scoring method of the full CES-D performed best in detecting major depressive episodes among first-visit psychiatric patients. The presence method, the GHQ method and the 10-item version appeared to have a similar ability. The persistence method, the 5-item version and the single-item version resulted in significantly worse performance.     

Screening for depression: Clinical validation of geriatricians’ diagnosis,The Brief Assessment Schedule Depression Cards and the 5-item version of the Symptom Check List among non-demented geriatric inpatients

In this study, two screening instruments for depression and geriatricians' diagnosis were compared against the Geriatric Mental State Schedule (GMS), a standardized semi-structured psychiatric interview. The Brief Assessment Schedule Depression Cards (BASDEC) achieved 91% sensitivity and 85% specificity using a cutoff score of 7. Its receiver operating characteristics (ROC) had an area under the curve (AUC) of 0.88, with 95% confidence intervals of 0.78 and 0.98. The 5-item version of the Symptom Check List (SCL-5) achieved 77% sensitivity and 74% specificity using a cutoff score of 10. Its AUC was 0.77, with 95% confidence intervals of 0.63 and 0.90. The p-value of the statistical difference between the two AUCs was 0.0554. The geriatricians' diagnosis had a kappa agreement coefficient of 0.39, sensitivity of 55% and specificity of 96%. They missed 45% of depressed patients. Routine screening with BASDEC would considerably improve the detection of depression. Even among those patients who did not appear depressed to the geriatricians, BASDEC would detect one case in every 10 patients.     

Intravenous Thrombolysis Is Safe and Effective for the Cryptogenic Stroke in China: Data From the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Background

The intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) therapy is safe and efficient during the treatment of acute ischemic stroke. Nonetheless, the different outcomes among various stroke subgroups have limited data with regard to the safety and efficacy of cryptogenic stroke (CS). The present study compared the safety and efficacy when IVT with rt-PA was used for the treatment of CS and the other stroke subtypes.