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van Nimwegen D, Hjelle EG, Bragstad LK, Kirkevold M, Sveen U, Hafsteinsdóttir T, Schoonhoven L, Visser-Meily J, de Man-van Ginkel JM. Interventions for improving psychosocial well-being after stroke: A systematic review. Int J Nurs Stud 2023; 142:104492. [PMID: 37084476 DOI: 10.1016/j.ijnurstu.2023.104492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke. OBJECTIVE To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke. METHODS A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data. RESULTS In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery. DISCUSSION The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being. FUNDING AND REGISTRATION This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.
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Affiliation(s)
- Dagmar van Nimwegen
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Ellen Gabrielsen Hjelle
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Marit Kirkevold
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Thóra Hafsteinsdóttir
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Xia W, Xu Y, Gong Y, Cheng X, Yu T, Yu G. Microglia Involves in the Immune Inflammatory Response of Poststroke Depression: A Review of Evidence. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2049371. [PMID: 35958023 PMCID: PMC9363171 DOI: 10.1155/2022/2049371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Poststroke depression (PSD) does not exist before and occurs after the stroke. PSD can appear shortly after the onset of stroke or be observed in the weeks and months after the acute or subacute phase of stroke. The pathogenesis of PSD is unclear, resulting in poor treatment effects. With research advancement, immunoactive cells in the central nervous system, particularly microglia, play a role in the occurrence and development of PSD. Microglia affects the homeostasis of the central nervous system through various factors, leading to the occurrence of depression. The research progress of microglia in PSD has been summarized to review the evidence regarding the pathogenesis and treatment target of PSD in the future.
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Affiliation(s)
- Weili Xia
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Yong Xu
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Yuandong Gong
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Xiaojing Cheng
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Tiangui Yu
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Gongchang Yu
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
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Ryu YH, Kim SY, Kim TU, Lee SJ, Park SJ, Jung HY, Hyun JK. Prediction of Poststroke Depression Based on the Outcomes of Machine Learning Algorithms. J Clin Med 2022; 11:2264. [PMID: 35456358 PMCID: PMC9031547 DOI: 10.3390/jcm11082264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 12/19/2022] Open
Abstract
Poststroke depression (PSD) is a major psychiatric disorder that develops after stroke; however, whether PSD treatment improves cognitive and functional impairments is not clearly understood. We reviewed data from 31 subjects with PSD and 34 age-matched controls without PSD; all subjects underwent neurological, cognitive, and functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Korean version of the Mini-Mental Status Examination (K-MMSE), computerized neurocognitive test (CNT), the Korean version of the Modified Barthel Index (K-MBI), and functional independence measure (FIM) at admission to the rehabilitation unit in the subacute stage following stroke and 4 weeks after initial assessments. Machine learning methods, such as support vector machine, k-nearest neighbors, random forest, voting ensemble models, and statistical analysis using logistic regression were performed. PSD was successfully predicted using a support vector machine with a radial basis function kernel function (area under curve (AUC) = 0.711, accuracy = 0.700). PSD prognoses could be predicted using a support vector machine linear algorithm (AUC = 0.830, accuracy = 0.771). The statistical method did not have a better AUC than that of machine learning algorithms. We concluded that the occurrence and prognosis of PSD in stroke patients can be predicted effectively based on patients' cognitive and functional statuses using machine learning algorithms.
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Affiliation(s)
- Yeong Hwan Ryu
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea; (Y.H.R.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Seo Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea; (Y.H.R.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Tae Uk Kim
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea; (Y.H.R.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea; (Y.H.R.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Soo Jun Park
- Welfare & Medical ICT Research Department, Electronics and Telecommunications Research Institute, Daejeon 34129, Korea;
| | - Ho-Youl Jung
- Welfare & Medical ICT Research Department, Electronics and Telecommunications Research Institute, Daejeon 34129, Korea;
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea; (Y.H.R.); (S.Y.K.); (T.U.K.); (S.J.L.)
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
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Sarkar A, Sarmah D, Datta A, Kaur H, Jagtap P, Raut S, Shah B, Singh U, Baidya F, Bohra M, Kalia K, Borah A, Wang X, Dave KR, Yavagal DR, Bhattacharya P. Post-stroke depression: Chaos to exposition. Brain Res Bull 2020; 168:74-88. [PMID: 33359639 DOI: 10.1016/j.brainresbull.2020.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
Cerebral ischemia contributes to significant disabilities worldwide, impairing cognitive function and motor coordination in affected individuals. Stroke has severe neuropsychological outcomes, the major one being a stroke. Stroke survivors begin to show symptoms of depression within a few months of the incidence that overtime progresses to become a long-term ailment. As the pathophysiology for the progression of the disease is multifactorial and complex, it limits the understanding of the disease mechanism completely. Meta-analyses and randomized clinical trials have shown that intervening early with tricyclic antidepressants and selective serotonin receptor inhibitors can be effective. However, these pharmacotherapies possess several limitations that have given rise to newer approaches such as brain stimulation, psychotherapy and rehabilitation therapy, which in today's time are gaining attention for their beneficial results in post-stroke depression (PSD). The present review highlights numerous factors like lesion location, inflammatory mediators and genetic abnormalities that play a crucial role in the development of depression in stroke patients. Further, we have also discussed various mechanisms involved in post-stroke depression (PSD) and strategies for early detection and diagnosis using biomarkers that may revolutionize treatment for the affected population. Towards the end, along with the preclinical scenario, we have also discussed the various treatment approaches like pharmacotherapy, traditional medicines, psychotherapy, electrical stimulation and microRNAs being utilized for effectively managing PSD.
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Affiliation(s)
- Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Harpreet Kaur
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kunjan R Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.
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Hordacre B, Comacchio K, Williams L, Hillier S. Repetitive transcranial magnetic stimulation for post-stroke depression: a randomised trial with neurophysiological insight. J Neurol 2020; 268:1474-1484. [PMID: 33219421 DOI: 10.1007/s00415-020-10315-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Despite high incidence of depression after stroke, few trials have investigated the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS). Here, we aimed to evaluate clinical benefit of delivering a higher dose of rTMS compared to previous stroke trials. Secondary aims were to document adverse effects and investigate the role of functional connectivity as a potential mechanism of clinical response to rTMS treatment. METHODS Eleven chronic stroke survivors were recruited to a double-blind, Sham-controlled, randomised trial to investigate 10 sessions of high-frequency rTMS for depression. Clinical assessments were obtained at baseline, after treatment and a 1-month follow-up. Adverse events were documented at completion of the treatment. Resting electroencephalography recordings were performed at baseline and after treatment to estimate functional connectivity. RESULTS There were no differences in baseline characteristics between groups (all p ≥ 0.42). Beck Depression Inventory scores decreased for the Active rTMS group from baseline to 1-month follow-up (p = 0.04), but did not change for the Sham group at post-treatment or follow-up (p ≥ 0.17). Stronger theta frequency functional connectivity between the left frontal cortex and right parietal cortex was associated with lower baseline depression (r = - 0.71, p = 0.05). This network strength increased following Active rTMS, with change in connectivity associated with improvement in BDI scores (r = 0.98, p = 0.001). Adverse events were transient and minor and were not statistically different between groups (p ≥ 0.21). CONCLUSIONS Active rTMS significantly improved depression and was well tolerated. The mechanistic role of theta frequency functional connectivity appears worthy of further investigation. The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12619001303134) on September 23, 2019.
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Affiliation(s)
- Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Kristina Comacchio
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Lindy Williams
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Susan Hillier
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, City East Campus, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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Laures-Gore JS, Dotson VM, Belagaje S. Depression in Poststroke Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1798-1810. [PMID: 33181048 DOI: 10.1044/2020_ajslp-20-00040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.
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Affiliation(s)
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta
- Gerontology Institute, Georgia State University, Atlanta
| | - Samir Belagaje
- Departments of Neurology and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
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Corallo F, Scarfì C, Arcadi FA, Formica C, Di Cara M, Palmeri R, Romeo L, Lo Buono V, Bramanti P, Marino S, De Cola MC. Role of functional pharmacological therapy in post-stroke depression: a narrative review. J Int Med Res 2020; 48:300060520950557. [PMID: 33081542 PMCID: PMC7588775 DOI: 10.1177/0300060520950557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective We conducted a narrative review to investigate whether antidepressant therapy, including the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) or the use of supportive drugs (i.e., citicoline or choline alfoscerate) as a substitute for antidepressant therapy, reduces depression in patients with cerebrovascular diseases. Methods A systematic search of the PubMed and Web of Science databases was performed, including review articles and other studies to identify additional citations. Only 4 of 1566 publications met the inclusion/exclusion criteria and were selected. Results Studies showed that post-stroke depression (PSD) could be treated with antidepressant therapy, as well as supportive drugs such as citicoline or choline alfoscerate, which may have antidepressant effects. Conclusions The findings support the efficacy of citicoline as a treatment for depression. Studies aimed to discover the characteristics of these psychostimulants in relation to PSD treatment should be performed.
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Affiliation(s)
- Francesco Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Chiara Scarfì
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | | | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Marcella Di Cara
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Laura Romeo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
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Extradural Contralateral C7 Nerve Root Transfer in a Cervical Posterior Approach for Treating Spastic Limb Paralysis: A Cadaver Feasibility Study. Spine (Phila Pa 1976) 2020; 45:E608-E615. [PMID: 31770316 DOI: 10.1097/brs.0000000000003349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Anatomic study in nine fresh-frozen cadavers. OBJECTIVE To confirm the anatomical feasibility of transferring the extradural ventral roots (VRs) and dorsal roots (DRs) of contralateral C7 nerves to those of the ipsilateral C7 nerves respectively through a cervical posterior approach. SUMMARY OF BACKGROUND DATA The contralateral C7 nerve root transfer technique makes breakthrough for treating spastic limb paralysis. However, its limitations include large surgical trauma and limited indications. METHODS Nine fresh-frozen cadavers (four females and five males) were placed prone, and the feasibility of exposing the bilateral extradural C7 nerve roots, separation of the extradural C7 VR and DR, and transfer of the VR and DR of the contralateral C7 to those of the ipsilateral C7 on the dural mater were assessed. The pertinent distances and the myelography results of each specimen were analyzed. The acetylcholinesterase (AChE) and antineurofilament 200 (NF200) double immunofluorescent staining were preformed to determine the nerve fiber properties. RESULTS A cervical posterior midline approach was made and the laminectomy was performed to expose the bilateral extradural C7 nerve roots. After the extradural C7 VR and DR are separated, the VR and DR of the contralateral C7 have sufficient lengths to be transferred to those of the ipsilateral C7 on the dural mater. The myelography results showed that the spinal cord is not compressed after the nerve anastomosis. The AChE and NF200 double immunofluorescent staining showed the distal ends of the contralateral C7 VRs were mostly motor nerve fibers, and the distal ends of the contralateral C7 DRs were mostly sensory nerve fibers. CONCLUSION Extradural contralateral C7 nerve root transfer in a cervical posterior approach for treating spastic limb paralysis is anatomically feasible. LEVEL OF EVIDENCE 5.
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White J, Greer K, Russell G, Lalor A, Stolwyk R, Williams C, Brown T, Haines T. 'Factors affecting services offered to older adults with psychological morbidity: an exploration of health professional attitudes'. Aging Ment Health 2019; 23:132-139. [PMID: 29105507 DOI: 10.1080/13607863.2017.1393797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Poor collaboration between the multiple services involved in hospital discharge planning may contribute to suboptimal patient outcomes post discharge. This study aimed to explore clinician (medical, allied health and nursing) attitudes towards the management of the older patient with psychological morbidity during and following hospitalization. METHODS Focus groups were held with 54 health professionals comprising of 7 from acute, 20 from subacute (geriatric assessment and rehabilitation), and 27 from community care settings. A qualitative study using focus groups of clinicians from a range of disciplines working within a large Australian health care service. Data were analysed using an inductive thematic approach with constant comparison. RESULTS Key themes included: (1) Clinician decision making towards psychological morbidity; (2) Supply of people with specialised skills dealing with psychological morbidity; (3) Confidence and capability; (4) Facilitating continuity of care; and (5) Perception of depression and aging. CONCLUSIONS Clinicians across healthcare settings are uniquely placed to identity psychological morbidity in older patients and make appropriate referrals for support. Management and referral making for older patients with psychological morbidity can be enhanced by routine education for clinicians and the introduction of clinical pathways. This has potential to improve management of psychological morbidity; however, evaluation of impact on patient outcome is required. Specifically, there is a need for greater access for counselling services.
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Affiliation(s)
- Jennifer White
- a Allied Health Research Unit , Monash University , Cheltenham , Australia
| | - Kath Greer
- b Allied Health Research Unit , Monash Health , Cheltenham , Australia
| | - Grant Russell
- c School of Primary and Allied Health Care , Monash University , Frankston , Australia
| | - Aislinn Lalor
- d Occupation Therapy, Faculty of Medicine Nursing and Health Sciences , Monash University , Frankston , Australia
| | - Rene Stolwyk
- e Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia
| | | | - Ted Brown
- g Occupation Therapy, Faculty of Medicine Nursing and Health Sciences , Monash University , Frankson , Australia
| | - Terrence Haines
- c School of Primary and Allied Health Care , Monash University , Frankston , Australia.,h Allied Health Research Unit , Monash Health , Cheltenham , Australia
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Deng L, Qiu S, Yang Y, Wang L, Li Y, Lin J, Wei Q, Yang L, Wang D, Liu M. Efficacy and tolerability of pharmacotherapy for post-stroke depression: a network meta-analysis. Oncotarget 2018; 9:23718-23728. [PMID: 29805769 PMCID: PMC5955092 DOI: 10.18632/oncotarget.23891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/13/2017] [Indexed: 02/05/2023] Open
Abstract
Background Post-stroke depression (PSD) occurs in approximately one third of stroke survivors, leading to great disability and mortality. As there is no consensus on the optimal pharmacological treatment for PSD, we aimed to evaluate the relative efficacy and tolerability of the available pharmacological interventions. Materials and Methods We did a network meta-analysis to incorporate evidence from relevant trials providing direct and indirect comparisons. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Embase and the reference lists of relevant articles up to March, 2017 for randomized controlled trials (RCTs), for different pharmacotherapies of PSD. For efficacy analysis, the primary outcome was the mean change in Hamilton Depression Scale (HAMD) score between baseline and endpoint. For tolerability analysis, the outcome was presented by the discontinuation for any reason. This study is registered with PROSPERO, number CRD42016049049. Results From a total of 869 citations, 15 RCTs with 876 participants were included. 13 drugs were considered. For efficacy, paroxetine ranked the best for HAMD reduction, followed by imipramine, reboxetine, nortriptyline, citalopram and fluoxetine at the end of treatment. However, duloxetine ranked the best at 4-week and 8-week duration for HAMD reduction. For tolerability, paroxetine ranked the best but there is no significant result between any comparisons. Conclusions Paroxetine is probably the best option to consider for patients with PSD. To get a quicker relief of depression, duloxetine might be useful for its rapid onset of antidepressant action. The tolerability was comparable among all the antidepressants. But more high-quality RCTs are needed.
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Affiliation(s)
- Linghui Deng
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Yang
- Kidney Research Institute, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxiao Li
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Lin
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deren Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Liu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Deng L, Sun X, Qiu S, Xiong Y, Li Y, Wang L, Wei Q, Wang D, Liu M. Interventions for management of post-stroke depression: A Bayesian network meta-analysis of 23 randomized controlled trials. Sci Rep 2017; 7:16466. [PMID: 29184194 PMCID: PMC5705605 DOI: 10.1038/s41598-017-16663-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023] Open
Abstract
Post-stroke depression (PSD) is an important complication of stroke, leading to increased disability and mortality. Given that there is no consensus on which treatment is optimal for PSD, we aimed to evaluate the relative efficacies of available pharmacological and non-pharmacological interventions. We conducted a network meta-analysis to incorporate evidence from relevant trials and provide direct and indirect comparisons. We searched PubMed, Cochrane Library Central Register of Controlled Trials, and Embase until November 1, 2016 for randomized controlled trials involving different pharmacological and non-pharmacological PSD treatment interventions. The primary outcome was reduction in the Hamilton depression scale (HAMD) score. This study is registered with PROSPERO (number, CRD42016049049). Of a total of 1,152 studies, 23 randomized trials comprising 1,542 participants were included. Nine PSD treatment interventions were considered. Noradrenaline reuptake inhibitor (NRI) was associated with the highest reduction in the HAMD score, followed by tricyclic antidepressant (TCA), psychotherapy plus antidepressant, and selective serotonin reuptake inhibitor (SSRI). This study indicated that NRIs, SSRIs, and TCAs are associated with a considerable higher HAMD score reduction compared with the control treatment. rTMS is a beneficial therapeutic approach for managing PSD to obtain good response to treatments compared with the control treatment.
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Affiliation(s)
- Linghui Deng
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuejun Sun
- Second Department of Psychiatry, Kangning Hospital, Anshan, Liaoning, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yao Xiong
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxiao Li
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deren Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Ming Liu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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He JR, Zhang Y, Lu WJ, Liang HB, Tu XQ, Ma FY, Yang GY, Zeng LL. Age-Related Frontal Periventricular White Matter Hyperintensities and miR-92a-3p Are Associated with Early-Onset Post-Stroke Depression. Front Aging Neurosci 2017; 9:328. [PMID: 29051732 PMCID: PMC5633610 DOI: 10.3389/fnagi.2017.00328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/22/2017] [Indexed: 01/13/2023] Open
Abstract
Objective: To explore the correlationship among white matter hyperintensities (WMHs), miR-92a-3p and early-onset post-stroke depression (PSD). Methods: We recruited consecutively 238 patients with acute cerebral infarction and MRI examination in the Department of neurology, Ruijin hospital, Shanghai Jiaotong University School of Medicine. The diagnosis of early-onset PSD was made in accordance with DSM-IV criteria for depression in 2 weeks after stroke. Clinical information and assessments of stroke severity were recorded on admission. The analysis of plasma miR-92a-3p was performed using quantitative PCR at the same time. WMHs were evaluated by the Fazekas and Scheltens visual rating scales. The relationship among WMHs, miR-92a-3p and PSD were analyzed by SPSS 22.0 software. Results: Logistic regression demonstrated that periventricular WMHs (PVWMHs) in frontal caps was an independent risk factor with early-onset PSD (OR = 1.579, 95% CI: 1.040-2.397, p = 0.032). The age and numbers of lacunes were related to frontal PVWMHs. Plasma miR-92a-3p in the PSD group was higher compared with the non-depressed group. Receiver operating curve analysis revealed that miR-92a-3p could predict early-onset PSD with 90% sensitivity and 90% specificity. The higher miR-92a-3p trended toward association with greater frontal PVWMHs. Conclusion: Acute ischemic stroke patients with frontal PVWMHs or a high plasma miR-92a-3p at baseline were more likely to develop early-onset PSD. MiR-92a-3p might be involved in the white matter impairment and post-stroke depression.
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Affiliation(s)
- Ji-Rong He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Jing Lu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huai-Bin Liang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan-Qiang Tu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei-Yue Ma
- Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Li Zeng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Paolucci S. Advances in antidepressants for treating post-stroke depression. Expert Opin Pharmacother 2017; 18:1011-1017. [PMID: 28535081 DOI: 10.1080/14656566.2017.1334765] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is a common and serious complication after stroke, occurring in nearly one third of stroke survivors, and affecting mortality rate, functional outcome, rehabilitation results and quality of life. However, in the common clinical practice only a minority of patients are properly treated. A relatively small number of scientific reports are available on clinical usefulness and safety of antidepressants (ADs) in PSD. Areas covered: This report provides an updated review about pharmacological state of art of PSD, including efficacy and safety of different drugs and their role on prevention, treatment and functional outcome. Expert opinion: Even if currently an antidepressant treatment can improve depressive symptoms, neither the optimal drug nor the optimal lengths of treatment, have been identified. Serotonergic drugs are preferable because of their better safety profile, but in the recent years there has been an important debate on possible association between selective serotonin reuptake inhibitor use and increased mortality. Another issue is the potential role of ADs for improving functional recovery. Newer ADs have interesting properties, in particular vortioxetine, due to its properties of enhancing cognitive functions, but further research is needed to clarify its/their role in treatment of PSD.
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Affiliation(s)
- Stefano Paolucci
- a Department of Neurorehabilitation , Fondazione I.R.C.C.S. Santa Lucia , Rome , Italy
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Theeke L, Lucke-Wold AN, Mallow J, Horstman P. Life after stroke in Appalachia. Int J Nurs Sci 2017; 4:105-111. [PMID: 31406728 PMCID: PMC6626097 DOI: 10.1016/j.ijnss.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/08/2016] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia. METHODS This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience. RESULTS Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one's life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present.
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Affiliation(s)
- Laurie Theeke
- West Virginia University School of Nursing, Health Sciences South, PO Box 9620, Morgantown, WV 26506-9620, United States
| | - A. Noelle Lucke-Wold
- West Virginia University School of Nursing, Health Sciences South, PO Box 9620, Morgantown, WV 26506-9620, United States
| | - Jennifer Mallow
- West Virginia University School of Nursing, Health Sciences South, PO Box 9620, Morgantown, WV 26506-9620, United States
| | - Patricia Horstman
- West Virginia University HealthCare, 1 Medical Center Drive, Morgantown, WV 26506, United States
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Knottnerus AM, Turner-Stokes T, van de Weg FB, Heijnen L, Lankhorst GJ, Turner-Stokes L. Diagnosis and treatment of depression following acquired brain injury: a comparison of practice in the UK and the Netherlands. Clin Rehabil 2016; 21:805-11. [PMID: 17875560 DOI: 10.1177/0269215507079129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe and compare current practice in diagnosis and treatment of depression following acquired brain injury in two countries (UK and the Netherlands) which have different sets of guidelines. Setting and design: A cross-sectional survey of reported practice among rehabilitation physician members of the British and Dutch specialist societies. Methods: A 12-item postal questionnaire was sent to 496 rehabilitation physicians with two reminders: N = 353 (71%) responded, 146 of whom did not manage people with acquired brain injury, leaving 207 questionnaires for analysis (Netherlands N = 121, UK N = 86). Descriptive summary statistics were compiled. Categorical and dichotomous data were compared between the groups using chi-squared tests. Results: Sixty-seven (78%) of British respondents served a predominantly younger adult (65 years) population, compared with only 27 (22%) of the Dutch, who mainly treated patients of all ages. In line with their respective guidelines, more British respondents reported that they screened all acquired brain injury patients for depression (68/86 (79%) British versus 71/121 (59%) Dutch, P < 0.01), and used formal measures (37/68 (54%) versus 14/69 (20%), P < 0.001). They also took a more active role in treatment of depression: only 1 (1%) never used antidepressants, compared with 22 (18%) of Dutch respondents (P < 0.001). On the other hand, where antidepressants were prescribed, the Dutch respondents were more likely than the British to follow-up their patients (93/98 (95%) versus 67/84 (80%), P < 0.01). Conclusions: The survey demonstrates a broadly similar approach, but highlights some significant variance in practice between the two countries which may stem from differences in population and service provision as well as their respective guidelines.
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de Man-van Ginkel JM, Hafsteinsdóttir TB, Lindeman E, Geerlings MI, Grobbee DE, Schuurmans MJ. Clinical Manifestation of Depression after Stroke: Is It Different from Depression in Other Patient Populations? PLoS One 2015; 10:e0144450. [PMID: 26637178 PMCID: PMC4670173 DOI: 10.1371/journal.pone.0144450] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/18/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite ample research on depression after stroke, the debate continues regarding whether symptoms such as sleep disturbances, loss of energy, changes in appetite and diminished concentration should be considered to be consequences of stroke or general symptoms of depression. By comparing symptoms in depressed and non-depressed stroke patients with patients in general practice and patients with symptomatic atherosclerotic diseases, we aim to further clarify similarities and distinctions of depression after stroke and depression in other patient populations. Based on this, it is possible to determine if somatic symptoms should be evaluated in stroke patients in diagnosing depression after stroke. METHODS An observational multicenter study is conducted in three hospitals and seven general practices including 382 stroke patients admitted to hospital with a clinical diagnosis of intracerebral hemorrhage or ischemic infarction, 1160 patients in general practice (PREDICT-NL), and 530 patients with symptomatic atherosclerotic diseases (SMART-Medea). RESULTS The prevalence of major depressive disorder according to DSM-IV criteria was 14.1% (95% CI 11.0%-18.0%) in the stroke cohort, 5.4% (95% CI 3.8%-7.9%) in the symptomatic atherosclerotic diseases cohort and 12.9% (95% CI 11.1%-15.0%) in the general practice cohorts. Comparing depressed patients of the three cohorts demonstrated broadly similar symptom profiles, as well as comparable levels of individual symptom prevalence. However, the stroke patients suffered more severely from these symptoms than patients in the other populations. CONCLUSIONS The findings suggest that depression after stroke is not a different type of depression. This finding indicates that all depressive symptoms should be evaluated in stroke patients, including somatic symptoms.
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Affiliation(s)
- Janneke M. de Man-van Ginkel
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Thóra B. Hafsteinsdóttir
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- University of Professional Education Utrecht, Department of Healthcare, Utrecht, The Netherlands
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Eline Lindeman
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, Rehabilitation Center ‘De Hoogstraat’, The Netherlands
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J. Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science, program in Clinical Health Sciences University Medical Center Utrecht, Utrecht, The Netherlands
- University of Professional Education Utrecht, Department of Healthcare, Utrecht, The Netherlands
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Gourab K, Schmit BD, Hornby TG. Increased Lower Limb Spasticity but Not Strength or Function Following a Single-Dose Serotonin Reuptake Inhibitor in Chronic Stroke. Arch Phys Med Rehabil 2015; 96:2112-9. [PMID: 26376447 DOI: 10.1016/j.apmr.2015.08.431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke. DESIGN Double-blind, randomized, placebo-controlled crossover trial. SETTING Outpatient research setting. PARTICIPANTS Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of >1 year duration who completed all assessments. INTERVENTIONS Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions. MAIN OUTCOME MEASURES Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s-120°/s) plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion. RESULTS SSRI administration significantly increased stretch reflex torques at higher stretch velocities (eg, 90°/s; P=.03), with reflexes at lower velocities enhanced by superimposed voluntary drive (P=.02). No significant improvements were seen in volitional peak torques or in clinical measures of lower limb function (lowest P=.10). CONCLUSIONS Increases in spasticity but not strength or lower limb function were observed with single-dose SSRI administration in individuals with chronic stroke. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on lower limb function poststroke.
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Affiliation(s)
- Krishnaj Gourab
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL
| | - T George Hornby
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL.
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Vallury KDB, Jones M, Gray R. Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice. Top Stroke Rehabil 2015; 22:453-9. [PMID: 25816867 DOI: 10.1179/1074935715z.00000000061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions. METHODS A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention; and (3) were available in English. RESULTS Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke. CONCLUSION Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.
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Affiliation(s)
- Kari D B Vallury
- University Department of Rural Health (UDRH), University of South Australia , Whyalla, Australia
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van het Hoofd MGV, Roelse H, Kwakkel G, Schepers VPM, van de Port IGL. Does exercise therapy affect depression or depressive symptoms after stroke? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fleminger S, Oliver DL, Williams WH, Evans J. The neuropsychiatry of depression after brain injury. Neuropsychol Rehabil 2012; 13:65-87. [PMID: 21854328 DOI: 10.1080/09602010244000354] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Biological aspects of depression after brain injury, in particular traumatic brain injury (TBI) and stroke, are reviewed. Symptoms of depression after brain injury are found to be rather non-specific with no good evidence of a clear pattern distinguishing it from depression in those without brain injury. Nevertheless symptoms of disturbances of interest and concentration are particularly prevalent, and guilt is less evident. Variabilitiy of mood is characteristic. The prevalence of depression is similar after both stroke and TBI with the order of 20-40% affected at any point in time in the first year, and about 50% of people experience depression at some stage. There is no good evidence for areas of specific vulnerability in terms of lesion location, and early suggestions of a specific association with injury to the left hemisphere have not been confirmed. Insight appears to be related to depressed mood with studies of TBI indicating that greater insight over time post-injury may be associated with greater depression. We consider that this relationship may be due to depression appearing as people gain more awareness of their disability, but also suggest that changes in mood may result in altered awareness. The risk of suicide after TBI is reviewed. There appears to be about a three to fourfold increased risk of suicide after TBI, although much of this increased risk may be due to pre-injury factors in terms of the characteristics of people who suffer TBI. About 1% of people who have suffered TBI will commit suicide over a 15-year follow-up. Drug management of depression is reviewed. There is little specific evidence to guide the choice of antidepressant medication and most psychiatrists would start with a selective serotonin reuptake inhibitor (SSRI). It is important that the drug management of depression after brain injury is part of a full package of care that can address biological as well as psychosocial factors in management.
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Abstract
OBJECTIVE To systematically evaluate the curative effect of acupuncture on post-stroke depression (PSD). METHODS The internet was used to retrieve the Wanfang Medical Data System, Chinese Periodical Net, the Weipu Information Resources System, PubMed and the Cochrane Library Database. Relevant articles, up to September 2010, were manually retrieved. These papers included studies that had performed random and semi-random control trials for the use of acupuncture to treat PSD. Fifteen random control tests involving 1096 patients were included in this study and individual cases, interventional measures and curative effects were extracted from this research. Grade methodological quality evaluation and meta-analysis were performed on these studies. RESULTS Comparison between the acupuncture group and the Western medicine group for the curative rate on PSD revealed an OR of 1.48, 95% CI = [1.11 1.97] and P = 0.008. Comparison of obviously effective rate shows that OR = 1.39, 95% CI = [1.08 1.80] and P = 0.01. Comparison of effective rate shows that OR = 0.83, 95% CI = [0.631.09] and P = 0.18. CONCLUSION Comparison between the acupuncture group and Western medicine group in treating PSD revealed that there is a statistical difference in curative rate and remarkably effective rate, but no difference in effective rate.
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Affiliation(s)
- Birgit Gurr
- Poole Stroke Unit Poole Hospital and Neuropsychology Service Poole Community Clinic
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Capaldi VF, Wynn GH. Emerging strategies in the treatment of poststroke depression and psychiatric distress in patients. Psychol Res Behav Manag 2010; 3:109-18. [PMID: 22110334 PMCID: PMC3218762 DOI: 10.2147/prbm.s10035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Poststroke depression (PSD) is a common sequela of stroke associated with increased morbidity and mortality among stroke survivors. PSD has been associated with poorer rehabilitative outcomes, longer inpatient stays, inefficient use of medical resources, worsened cognitive decline, and increased suicidality. This article reviews the definition and proposed etiology of PSD as well as current and emerging evidence-based prevention, screening, and treatment modalities. The timely use of prevention and treatment techniques including pharmacologic and nonpharmacologic methods may improve treatment outcomes and enhance the quality of life in stroke patients.
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Affiliation(s)
- Vincent F Capaldi
- Department of Psychiatry, Walter Reed Army Medical Center, Washington, DC, USA
| | - Gary H Wynn
- Department of Military Psychiatry, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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de Man-van Ginkel JM, Gooskens F, Schuurmans MJ, Lindeman E, Hafsteinsdottir TB. A systematic review of therapeutic interventions for poststroke depression and the role of nurses. J Clin Nurs 2010; 19:3274-90. [PMID: 21083778 DOI: 10.1111/j.1365-2702.2010.03402.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Janneke M de Man-van Ginkel
- Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
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Abstract
Depression is common after stroke. Post-stroke depression (PSD) is an independent predictor of poor long-term functional outcome following stroke. PSD has been associated with poor social and rehabilitation outcomes, cognitive impairment and increased mortality. Prevalence varies widely between studies because of differences in patient selection, time, evaluation methods and diagnostic criteria. Approximately a third of stroke survivors may suffer from PSD. Potential confounders include anosognosia, apathy and emotional lability. The identification of risk factors is important to prevent and detect PSD early, and provide appropriate interventions. PSD may be associated with restriction in social activities and dependence in activities of daily living in the chronic phase of stroke. Pharmacologic and rehabilitation strategies are needed to treat PSD. More evidence is required before recommendations can be made about the routine use of antidepressants to prevent PSD.
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Rochette A, Korner-Bitensky N, Bishop D, Teasell R, White C, Bravo G, Côté R, Lachaine J, Green T, Lebrun LH, Lanthier S, Kapral M, Wood-Dauphinee S. Study protocol of the YOU CALL--WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke. BMC Neurol 2010; 10:3. [PMID: 20053273 PMCID: PMC2818655 DOI: 10.1186/1471-2377-10-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/06/2010] [Indexed: 11/26/2022] Open
Abstract
Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable. Trial Registration ISRCTN95662526
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Abstract
Stroke is the major cause of disability in the Western world and is the third greatest cause of death, but there are no widely effective treatments to prevent the devastating effects of stroke. Extensive and growing evidence implicates inflammatory and immune processes in the occurrence of stroke and particularly in the subsequent injury. Several inflammatory mediators have been identified in the pathogenesis of stroke including specific cytokines, adhesion molecules, matrix metalloproteinases, and eicosanoids. An early clinical trial suggests that inhibiting interleukin-1 may be of benefit in the treatment of acute stroke.
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Ashman TA, Cantor JB, Gordon WA, Spielman L, Flanagan S, Ginsberg A, Engmann C, Egan M, Ambrose F, Greenwald B. A randomized controlled trial of sertraline for the treatment of depression in persons with traumatic brain injury. Arch Phys Med Rehabil 2009; 90:733-40. [PMID: 19406291 DOI: 10.1016/j.apmr.2008.11.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/11/2008] [Accepted: 11/11/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the efficacy of sertraline in the treatment of depression after traumatic brain injury (TBI). DESIGN Double-blind, randomized controlled trial. SETTING Research center at a major urban medical center. PARTICIPANTS Subjects were a referred and volunteer sample of 52 participants with TBI, a diagnosis of major depression disorder (MDD), and a score on the Hamilton Rating Scale for Depression (HAM-D) of 18 or greater. The majority of the sample was male (58%), had less than 14 years of education (73%), had incomes below $20,000 (82%), and were from minority backgrounds (75%). Approximately one third of the sample had mild brain injuries, and two thirds had moderate to severe brain injuries. The mean age was 47+/-11, and the mean time since injury was 17+/-14 years. One participant withdrew from the study because of side effects. INTERVENTION Daily oral sertraline in doses starting at 25mg and increasing to therapeutic levels (up to 200mg) or placebo for 10 weeks. MAIN OUTCOME MEASURES The HAM-D, the Beck Anxiety Inventory, and the Life-3 quality of life (QOL). RESULTS No statistically significant differences were found at baseline between drug and placebo groups on baseline measures of depression (24.8+/-7.3 vs 27.7+/-7.0), anxiety (16.4+/-12.3 vs 24.0+/-14.9), or QOL (2.96+/-1.0 vs 2.9+/-0.9). The income level of those receiving placebo was significantly lower than those participants receiving medication. Analyses of covariance revealed significant changes from preintervention to posttreatment for all 3 outcome measures (P<.001) but no group effects. Random-effects modeling did not find any significant difference in patterns of scores of the outcome measures between the placebo and medication groups. CONCLUSIONS Both groups showed improvements in mood, anxiety, and QOL, with 59% of the experimental group and 32% of the placebo group responding to the treatment, defined as a reduction of a person's HAM-D score by 50%.
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Affiliation(s)
- Teresa A Ashman
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Abstract
OBJECTIVE This self-directed learning module highlights common poststroke medical complaints encountered on an inpatient rehabilitation unit. It is part of the study guide on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on the differential diagnosis, evaluation and management of chest pain, mental status changes, weight loss and poor motivation in stroke patients. The goal of this article is to expand the learner's knowledge of how to diagnose and manage common medical complications of stroke patients in rehabilitation.
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Abstract
Mood depression is a common and serious complication after stroke. According to epidemiological studies, nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke. Although depression may affect functional recovery and quality of life after stroke, such condition is often ignored. In fact, only a minority of patients is diagnosed and even fewer are treated in the common clinical practice. Moreover, the real benefits of antidepressant (AD) therapy in post-stroke depression have not been fully clarified. In fact, controlled studies on the effectiveness of ADs in post stroke depression (PSD) are relatively few. Today, data available suggest that ADs may be generally effective in improving mood, but guidelines for the optimal treatment and its length are still lacking.
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Kapfhammer HP. Depressive und Angststörungen bei somatischen Krankheiten. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122024 DOI: 10.1007/978-3-540-33129-2_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
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Johnston M, Bonetti D, Joice S, Pollard B, Morrison V, Francis JJ, Macwalter R. Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial. Disabil Rehabil 2007; 29:1117-27. [PMID: 17612998 DOI: 10.1080/03323310600950411] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Disability following stroke is highly prevalent and is predicted by psychological variables such as control cognitions and emotions, in addition to clinical variables. This study evaluated the effectiveness of a workbook-based intervention, designed to change cognitions about control, in improving outcomes for patients and their carers. METHOD At discharge, stroke patients were randomly allocated (with their carers) to a 5-week intervention (n = 103) or control (normal care: n = 100). The main outcome (at 6 months) was recovery from disability using a performance measure, with distress and satisfaction as additional outcomes. RESULTS The intervention group showed significantly better disability recovery, allowing for initial levels of disability, than those in the control group, F(1,201) = 5.61, p = 0.019. Groups did not differ in distress or satisfaction with care for patients or carers. The only psychological process variable improved by the intervention was Confidence in Recovery but this did not mediate the effects on recovery. CONCLUSIONS A large proportion of intervention participants did not complete the workbook tasks. This was perhaps associated with the fairly low level of personal contact with workbook providers. The modest success of this intervention suggests that it may be possible to develop effective behavioural interventions to enhance recovery from disability in stroke patients.
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Sas K, Csete K, Vezekényi Z, Sztriha L, Vécseil L, Papp JG. Effects of citalopram and fluoxetine on the corticocerebral blood flow in conscious rabbits. ACTA ACUST UNITED AC 2007; 94:167-77. [PMID: 17853768 DOI: 10.1556/aphysiol.94.2007.3.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Depression, which is associated with an increased incidence of vascular events, frequently occurs following stroke. Selective serotonin reuptake inhibitory drugs (SSRIs) as antidepressants, are well tolerated, and also seem to be effective in post-stroke depression. The aim of this study was to investigate the effects of the SSRIs citalopram and fluoxetine, on the corticocerebral blood flow (cCBF) in rabbits with unilateral carotid occlusion induced cerebral ischemia. The cCBF was measured by the hydrogen clearance technique. After determination of the mean baseline cCBF, the effects of individual doses (0.1, 0.3 and I mg/kg) of citalopram or fluoxetine on the cCBF were investigated. Following the induction of an impaired cCBF, the changes in cCBF after drug treatments in this condition were likewise measured. The mean arterial blood pressure (MABP) and the heart rate (HR) from the electrocardiogram (ECG) were also determined. Neither citalopram nor fluoxetine influenced the cCBF in the control group. Fluoxetine improved the cCBF only very slightly in the ischemic animals. In contrast, all the doses of citalopram exerted pronounced and dose-dependent cCBF-increasing effects in the animals with unilateral carotid occlusion (maximal mean ACBF: 10, 16 and 27 ml/min/100 g tissue). The HR was decreased in both groups. Only citalopram treatment led to a slight MABP-decreasing effect. Besides enhancement of the serotonergic transmission in the brain, the cCBF-increasing effect of citalopram under ischemic conditions may be of benefit in post-stroke and vascular depression.
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Affiliation(s)
- K Sas
- Department of Neurology, University of Szeged, P O Box 427, H-6701 Szeged, Semmelweis u 6, H-6725 Szeged, Hungary.
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Nyein K, Thu A, Turner-Stokes L. Complex Specialized Rehabilitation Following Severe Brain Injury. J Head Trauma Rehabil 2007; 22:239-47. [PMID: 17667067 DOI: 10.1097/01.htr.0000281840.85096.1f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes the setup of brain injury rehabilitation services in the United Kingdom within the context of the National Health Service. The rehabilitation services are broadly divided into local general rehabilitation services, specialist district rehabilitation services, and complex specialized rehabilitation services. The Department of Health published the National Service Framework for Long-Term Neurological Conditions in 2005, setting out the 11 quality requirements to ensure provision of lifelong patient-centered care. A network of rehabilitation services, cited as a model of good practice by the Department of Health, including specialist inpatient and community outreach services for patients with complex brain injury, with research embedded within the clinical program and close collaboration between the clinicians and researchers are described.
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Affiliation(s)
- Kyaw Nyein
- Regional Rehab Unit, Northwick Park Hospital, Harrow, Middlesex, and King's College London Medical School, UK.
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Abstract
Vascular dementia (VaD) is the second most common cause of dementia, accounting for about 20% of all cases. Psychiatric and behavioral problems are at least as common in VaD as in Alzheimer's disease but are very different qualitatively. Patients with VaD, and especially those with small vessel disease, typically manifest symptoms related to damage to the frontal-subcortical system of the brain, including loss of executive function (which is not generally detected with most conventional tests of cognitive function), loss of drive, and disinhibited behaviors. Patients with VaD also commonly develop treatable mood disorders, most commonly depression. Once the symptoms are recognized, the clinician is in an ideal position to manage them and to educate caregivers about their nature.
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Affiliation(s)
- Jonathan T Stewart
- Department of Psychiatry, University of South Florida College of Medicine, Bay Pines VA Medical Center, Bay Pines, FL 33744, USA.
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Abstract
There is now considerable evidence from both experimental and clinical studies that immune and inflammatory processes can contribute to the onset of stroke and the neurologic and psychologic outcomes. Several specific therapeutic targets have been identified that may significantly improve the devastating impact of stroke.
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Affiliation(s)
- Robert Skinner
- Faculty of Life Sciences, Michael Smith Building (C2210), University of Manchester, Acker Street, Manchester M13 9PT, UK.
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Kotzailias N, Andonovski T, Dukic A, Serebruany VL, Jilma B. Antiplatelet activity during coadministration of the selective serotonin reuptake inhibitor paroxetine and aspirin in male smokers: a randomized, placebo-controlled, double-blind trial. J Clin Pharmacol 2006; 46:468-75. [PMID: 16554456 DOI: 10.1177/0091270006286432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression is associated with an increased incidence of vascular events and develops after stroke and myocardial infarction. Beside potential clinical outcome benefits of selective serotonin reuptake inhibitors for vascular diseases, bleeding events were reported. We investigated whether paroxetine and aspirin synergistically inhibit platelet function. Paroxetine (20 mg/d) was administered over 18 days to 20 men in a randomized, placebo-controlled, crossover design. Aspirin (100 mg/d) was coadministered within the last 4 study days. Platelet function was assessed by the platelet function analyzer and by flow cytometry. Paroxetine prolonged epinephrine-dependent predictive index within 14 days (P<.02). Aspirin enhanced the predictive index (P<.004 vs baseline and P>.05 between periods). A trend toward decreased thrombin receptor-activating peptide-induced CD62P expression after paroxetine was further enhanced by aspirin treatment (P>.05 between periods). The combination of paroxetine and aspirin did not further inhibit platelet plug formation under high shear stress in male smokers.
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Affiliation(s)
- Nicole Kotzailias
- Department of Clinical Pharmacology, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Roberts TL, Pasquina PF, Nelson VS, Flood KM, Bryant PR, Huang ME. Limb deficiency and prosthetic management. 4. Comorbidities associated with limb loss. Arch Phys Med Rehabil 2006; 87:S21-7. [PMID: 16500190 DOI: 10.1016/j.apmr.2005.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed. OVERALL ARTICLE OBJECTIVE To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome.
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Affiliation(s)
- Toni L Roberts
- Physical Medicine and Rehabilitation Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA.
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Conroy B, Zorowitz R, Horn SD, Ryser DK, Teraoka J, Smout RJ. An Exploration of Central Nervous System Medication Use and Outcomes in Stroke Rehabilitation. Arch Phys Med Rehabil 2005; 86:S73-S81. [PMID: 16373142 DOI: 10.1016/j.apmr.2005.08.129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 08/24/2005] [Accepted: 08/31/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Conroy B, Zorowitz R, Horn SD, Ryser DK, Teraoka J, Smout RJ. An exploration of central nervous system medication use and outcomes in stroke rehabilitation. OBJECTIVE To study associations between neurobehavioral impairments, use of neurotropic medications, and outcomes for inpatient stroke rehabilitation, controlling for a variety of confounding variables. DESIGN Observational cohort study of post-stroke rehabilitation. SETTING Six inpatient rehabilitation hospitals in the United States. PARTICIPANTS Patients with moderate or severe strokes (N=919). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Discharge disposition, FIM score change, and rehabilitation length of stay (LOS). RESULTS Neurobehavioral impairments and use of many medications, including first-generation selective serotonin reuptake inhibitors, older traditional antipsychotic medications, and anti-Parkinsonian neuro-stimulants, have a statistical association with poorer outcomes, whereas use of the atypical antipsychotic medications has a positive association with improvement in motor FIM scores. Counter-intuitively, use of opioid analgesics is associated with a larger motor FIM score change but not an increase in LOS or reduced percentage of discharge to community. There was significant variation in use of neurotropic medications among the 6 study sites during inpatient stroke rehabilitation. CONCLUSIONS There are many opportunities to enhance a stroke survivor's ability to benefit from acute inpatient stroke rehabilitation through improved understanding of associations of neurotropic medications with outcomes for different patient groups.
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Affiliation(s)
- Brendan Conroy
- Stroke Recovery Program, National Rehabilitation Hospital, Washington, DC, USA
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Hassan N, Turner-Stokes L, Pierce K, Clegg F. A completed audit cycle and integrated care pathway for the management of depression following brain injury in a rehabilitation setting. Clin Rehabil 2002; 16:534-40. [PMID: 12194624 DOI: 10.1191/0269215502cr523oa] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop an evidence-based multidisciplinary integrated care pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of care and documentation. SETTING A regional rehabilitation unit providing inpatient rehabilitation for young patients (16-65) with complex disabilities mainly resulting from brain injury. METHODS AND DESIGN A completed cycle of audit including: standards set for documentation, assessment, management and review; an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records); ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature; re-audit from the ICP documentation (48 patient records) over a period of 15 months. RESULTS The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54-61%), but poor documentation of review (29%) and subsequent treatment (27%). Introduction of the ICP improved all standards of documentation to 94-100%, except for assessment using a validated measure (84%) and follow-up assessment (76%). CONCLUSIONS This ICP raised staff awareness of depression, leading to improved documentation and possibly also standards of care.
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Affiliation(s)
- Nibras Hassan
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK
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Turner-Stokes L, Hassan N, Pierce K, Clegg F. Managing depression in brain injury rehabilitation: the use of an integrated care pathway and preliminary report of response to sertraline. Clin Rehabil 2002; 16:261-8. [PMID: 12017513 DOI: 10.1191/0269215502cr489oa] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To use data generated from an integrated care pathway (ICP) to describe the characteristics of patients presenting with depression in a brain injury rehabilitation programme and to assess their response to treatment with sertraline. SETTING A regional rehabilitation unit providing inpatient rehabilitation for young patients (16-65) with severe complex disabilities. DESIGN Prospective cohort study of 82 patients admitted to the unit during the 15-month period between between 1 September 1999 and 1 December 2000. Response to sertraline was assessed in an open-label, before-and-after study design. METHODS AND DESIGN All admissions were screened and included in the ICP if there was clinical suspicion of depression, past or present. Antidepressant medication was prescribed, where appropriate, according to the ICP protocol. Depression was diagnosed on clinical grounds against DSM-IV criteria, and measured where feasible using the Beck Depression Inventory (BDI-II) administered by interview, pretreatment and at 6-8 weeks. RESULTS Of 82 admissions 41 (50%) were managed using the ICP and 27 (64%) were either started on or changed to sertraline--21 for depression +/- lability and six for emotional lability only. All of the depressed patients improved clinically at some level and no significant side-effects were observed. The BDI-II was assessable in 17/21 who showed a mean improvement of 14.5 +/- 9.7 (confidence interval (CI) 9.3-19.7, p < 0.001). Eleven patients (52%) had previously failed to respond with a different selective serotonin re-uptake inhibitor (SSRI) agent but still made a significant response when changed to sertraline with a mean reduction in BDI-II of 16.3 +/- 10.9 (CI 8.4-24.11, p < 0.001). CONCLUSIONS The ICP was practical to use and provided systematic data on assessment of depression and response to treatment in 'real-life' clinical practice in a brain injury rehabilitation setting. Sertraline appears to be useful and well-tolerated in this context. A full placebo-controlled study is now required.
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Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
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