1
|
Li W, Ding Z, Rong L, Wei X, Sun C, Lowe S, Meng M, Xu C, Yin C, Liu H, Liu W, Zhou Q, Wang K. A one-year relapse prediction model for acute ischemic stroke (AIS) based on clinical big data. Heliyon 2024; 10:e32176. [PMID: 38882377 PMCID: PMC11176826 DOI: 10.1016/j.heliyon.2024.e32176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year. Method Patients with AIS treated at the second affiliated hospital of Xuzhou Medical University from August 2017 to July 2019 were enrolled. Clinical data such as demographic data, risk factors, laboratory tests, TOAST etiological types, MRI features, and treatment methods were collected. Cox regression analysis was done to determine the parameters for entering the nomogram model. The performance of the model was estimated by receiver operating characteristic curves, decision curve analysis, calibration curves, and C-index. Result A total of 645 patients were enrolled in this study. Side of hemisphere (SOH, Bilateral, HR = 0.35, 95 % CI = 0.15-0.84, p = 0.018), homocysteine (HCY, HR = 1.38, 95 % CI = 1.29-1.47, p < 0.001), c-reactive protein (CRP, HR = 1.04, 95 % CI = 1.01-1.07, p = 0.013) and stroke severity (SS, HR = 3.66, 95 % CI = 2.04-6.57, p < 0.001) were independent risk factors. The C-index of the nomogram model was 0.872 (se = 0.016). The area under the receiver operating characteristic (ROC)curve at one-year recurrence was 0.900. Calibration curve, decision curve analysis showed good performance of the nomogram. The cutoff value for low or high risk of recurrence score was 1.73. Conclusion The nomogram model for stroke recurrence within one year developed in this study performed well. This useful tool can be used in clinical practice to provide important guidance to healthcare professionals.
Collapse
Affiliation(s)
- Wenle Li
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
- .Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhendong Ding
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Liangqun Rong
- .Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiu'e Wei
- .Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chenyu Sun
- Department of Thyroid and Breast Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO 64106, USA
| | - Muzi Meng
- UK Program Site, American University of the Caribbean School of Medicine, Vernon Building Room 64, Sizer St, Preston PR1 1JQ, United Kingdom
- Bronxcare Health System, 1650 Grand Concourse, The Bronx, NY 10457, USA
| | - Chan Xu
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Haiyan Liu
- .Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wencai Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Qian Zhou
- Department of Respiratory and Critical Care Medicine, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Kai Wang
- .Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
2
|
Xu T, Dong F, Zhang M, Wang K, Xu T, Xia S, Feng C. Post-stroke arrhythmia could be a potential predictor for post-stroke depression. Sci Rep 2024; 14:9093. [PMID: 38643303 PMCID: PMC11032346 DOI: 10.1038/s41598-024-59789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
Post-stroke depression (PSD) is regarded as the consequence of multiple contributors involving the process of cognition, mood and autonomic system, with the specific mechanism unclear yet. As a common type of stroke-heart syndromes, post-stroke arrhythmia shared some common pathogenesis with PSD. We presumed that post-stroke arrhythmia might be an early distinguishable marker for the presence of PSD and aimed to verity their association in this study. Patients with first-ever ischemic stroke were enrolled. The presence of post-stroke ectopic arrhythmia and the symptoms of arrhythmia were recorded with anti-arrhythmia drugs prescribed when necessary. Patients were followed up 3 months later to identify their presence and severity of PSD using Hamilton Depression Scale (HAMD) and also presence and severity of arrhythmia. Characteristics including the prevalence of various types of arrhythmias were compared between PSD and non-PSD groups. The HAMD scores were compared between patients with and without arrhythmia in PSD group. Logistic regression was used to identify the independent predictor of PSD. Patients with PSD had higher prevalence of post-stroke arrhythmia especially newly-detected arrhythmia, symptomatic arrhythmia and poor-controlled arrhythmia. In PSD group, patients of post-stroke arrhythmia had higher scores of HAMD than those without arrhythmia. Presence of newly-detected, symptomatic and poor-controlled arrhythmias were independent predictor of PSD. post-stroke arrhythmia especially newly-detected arrhythmia and symptomatic arrhythmia could be an early predictor of PSD. Successful control of arrhythmia was associated with reduced prevalence and severity of PSD.
Collapse
Affiliation(s)
- Tao Xu
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Fangying Dong
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
- The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Muhua Zhang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Kewu Wang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Tian Xu
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Shudong Xia
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Chao Feng
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China.
| |
Collapse
|
3
|
Elias S, Benevides ML, Pereira Martins AL, Martins GL, Sperb Wanderley Marcos AB, Nunes JC. In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke. Neurohospitalist 2023; 13:121-129. [PMID: 37064927 PMCID: PMC10091427 DOI: 10.1177/19418744221132675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD. Methods This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated. Results The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS - anxiety score 90 days after AIS was strongly associated with the HADS - depression value 90 days after stroke (R: .71; B: .56; P < .01). Conclusions The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.
Collapse
Affiliation(s)
- Stefany Elias
- University of Southern Santa
Catarina, Santa Catarina, Brazil
| | | | | | - Gladys Lentz Martins
- Department of Neurology, Hospital Governador Celso Ramos
(HGCR), Florianópolis, Brazil
| | - Ana Beatriz Sperb Wanderley Marcos
- Department of Medical Sciences,
Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
| | - Jean Costa Nunes
- Department of Pathology, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
- Neurodiagnostic Brasil – Diagnósticos
em Neuropatologia, Florianópolis, Brazil
| |
Collapse
|
4
|
Factors associated with post-stroke depression in the acute phase of ischemic stroke: A cross-sectional study. Clin Neurol Neurosurg 2022; 223:107505. [DOI: 10.1016/j.clineuro.2022.107505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
|
5
|
Lan Y, Pan C, Qiu X, Miao J, Sun W, Li G, Zhao X, Zhu Z, Zhu S. Nomogram for Persistent Post-Stroke Depression and Decision Curve Analysis. Clin Interv Aging 2022; 17:393-403. [PMID: 35411138 PMCID: PMC8994611 DOI: 10.2147/cia.s357639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
Collapse
Affiliation(s)
- Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Chensheng Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Zhou Zhu; Suiqiang Zhu, Tel +86-18171081029; +86-13035101141, Email ;
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| |
Collapse
|
6
|
Stokman-Meiland DCM, Groeneveld IF, Arwert HJ, van der Pas SL, Meesters JJL, Rambaran Mishre RD, Vliet Vlieland TPM, Goossens PH. The course of depressive symptoms in the first 12 months post-stroke and its association with unmet needs. Disabil Rehabil 2022; 44:428-435. [PMID: 35130113 DOI: 10.1080/09638288.2020.1769746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To describe the course of depressive symptoms during the first 12 months post-stroke and its association with unmet needs. METHODS A prospective cohort study among stroke patients admitted to inpatient rehabilitation. Depressive symptoms were assessed 3, 6, and 12 months post-stroke using the Hospital Anxiety and Depression Scale, and categorized into three trajectories: no (all times <8), non-consistent (one or two times ≥8), or persistent (all times ≥8) depressive symptoms. Unmet needs were assessed using the Longer-Term Unmet Needs questionnaire. Multivariable logistic regression analyses were used to investigate the association between depressive symptoms and unmet needs. RESULTS One hundred and fifty-one patients were included, of whom 95 (62.9%), 38 (25.2%), and 18 (11.9%) had no, non-consistent, or persistent depressive symptoms, respectively. Depressive symptoms three months post-stroke persisted in 43.9% and recurred in 19.5% of patients during the first 12 months post-stroke. Depressive symptoms were significantly associated with the occurrence and number of unmet needs (odds ratio 6.49; p = 0.003 and odds ratio 1.28; p = 0.005, respectively). CONCLUSIONS Depressive symptoms three months post-stroke were likely to persist or recur during the first 12 months post-stroke. Depressive symptoms are associated with unmet needs. These results suggest that routine monitoring of depressive symptoms and unmet needs should be considered post-stroke.Implications for rehabilitationPatients with depressive symptoms three months post-stroke have a high risk of developing persistent or recurrent depressive symptoms during the first 12 months post-stroke.Unmet needs are associated with both non-consistent and persistent depressive symptoms post-stroke.These results suggest that health professionals should routinely screen for depressive symptoms and health care needs around three months post-stroke.In patients with depressive symptoms at three months post-stroke early treatment of depressive symptoms and addressing unmet needs should be considered and depressive symptoms should be routinely monitored during the first 12 months post-stroke.
Collapse
Affiliation(s)
| | | | - Henk J Arwert
- Basalt, The Hague, The Netherlands.,Department of Rehabilitation, Haaglanden Medical Center, The Hague, The Netherlands
| | - Stéphanie L van der Pas
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt, The Hague, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Radha D Rambaran Mishre
- Basalt, The Hague, The Netherlands.,Department of Rehabilitation, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt, The Hague, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
7
|
Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
8
|
Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:282-293. [PMID: 34690594 DOI: 10.1176/appi.focus.20210006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Late life depression (LLD), a familiar syndrome, is not differentiated in the DSM-5. LLD can resemble depressive syndromes in younger adults but it differs in demographic characteristics, phenomenology, prognosis, treatment, suicide risk, relationship to other disorders, and etiology. Older depressed adults often present with fewer major depressive symptoms, less emphasis on mood disturbance, greater preoccupation with somatic or psychotic symptoms, and misleading cognitive deficits. LLD's relationships with medical and neurocognitive symptoms and with inflammatory and immune factors are complex. Formal screening tools and biopsychosocial assessment informs diagnosis and treatment. Evidence supports the effectiveness of lifestyle interventions, several psychotherapies, and a variety of somatic treatment approaches. Comorbid medical disorders must be taken into account when planning treatment. In this article, the authors describe the characteristics of LLD, present an approach to assessment and management, and recommend that future DSM editions include a new specifier to differentiate LLD from other depressive syndromes.
Collapse
Affiliation(s)
- Sehba Husain-Krautter
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
| | - James M Ellison
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
| |
Collapse
|
9
|
Isuru A, Hapangama A, Ediriweera D, Samarasinghe L, Fonseka M, Ranawaka U. Prevalence and predictors of new onset depression in the acute phase of stroke. Asian J Psychiatr 2021; 59:102636. [PMID: 33848806 DOI: 10.1016/j.ajp.2021.102636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is known to be associated with poor functional outcome and high mortality. There is limited data on the prevalence and associated factors of depression in the acute phase after stroke. OBJECTIVES To determine the prevalence of PSD in the acute phase and its correlates among patients with stroke in a tertiary care hospital in Sri Lanka. METHOD A cross sectional descriptive study was conducted among patients with stroke admitted to the stroke unit of a tertiary care hospital in Sri Lanka over a 3-year period. Demographic and clinical information was obtained using an interviewer administered questionnaire. Depression was diagnosed using the ICD-10 criteria. Group comparisons were performed using Pearson's Chi-square test and Mann-Whitney U test Multiple logistic regression was used to identify factors associated with PSD. RESULTS Of 374 patients, 106 patients experienced moderate to severe PSD, with a prevalence of 28.3 % (95 % CI: 23.8 %-32.9 %). Of them, 54.7 % were females, 49 % were above the age of 60 years, and 79.9 % had ischemic strokes. Female gender (OR-2.77, 95 % CI: 1.46-5.07, P = 0.002), a longer duration of hypertension (OR-1.31, 95 % CI: 1.01-1.721, P = 0.004), strokes involving the temporal lobe (OR-7.25, 95 % CI: 2.81-20.25, P < 0.001) and post-stroke functional disability (OR- O.98, 95 % CI:0.97-0.99, P = 0.001) were associated with PSD on multivariate analysis. CONCLUSION More than one fourth of the patients suffered from PSD in the acute phase of stroke. Female gender, longer history of hypertension, physical dependence and temporal lobe strokes were predictive of PSD.
Collapse
Affiliation(s)
- Amila Isuru
- Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka and University Psychiatry Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - Aruni Hapangama
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Dileepa Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - Madhavi Fonseka
- University Psychiatry Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, University of Sri Lanka, Sri Lanka
| |
Collapse
|
10
|
Abstract
Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
Collapse
Affiliation(s)
- Katlyn Nemani
- Departments of Neurology and Psychiatry, NYU Langone Health, New York, New York
| | - Lindsey Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York
| |
Collapse
|
11
|
Astuti P, Kusnanto K, Dwi Novitasari F. Depression and functional disability in stroke patients. J Public Health Res 2020; 9:1835. [PMID: 32728574 PMCID: PMC7376455 DOI: 10.4081/jphr.2020.1835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Stroke patients often suffer from depression, a mental disorder that worsens their condition and slows down the recovery process. Depression is the leading cause of functional disability due to inability to cope with daily stressors and to function independently in their activities. The purpose of this study is to analyze the relationship between depression and functional disability levels in post-stroke patients. Design and Methods: This is an analytic observational research with a cross-sectional approach. The population in exam consisted of all 4-12 week post-stroke patient in the hospital (about 139 patients). The study focused on 104 respondents, who were selected using simple random sampling techniques. Results: The results show that 62.5% stroke patients suffered mild depressive episodes after the stroke while 58.7% experienced mild disabilities. Analysis results using the Pearson Product Moment Test obtained P=0,000. This shows there is a relationship between the level of depression and the degree of functional disability in post-stroke patients. Conclusions: It can be concluded that there is a significant relationship between the levels of post-stroke depression and the functional disability. Families are expected to provide a safe, supportive, and comfortable environment to lessen the level of depression.
Collapse
Affiliation(s)
- Puji Astuti
- Doctoral Program of Public Health, Faculty of Public Health.,Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Kusnanto Kusnanto
- Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Ferra Dwi Novitasari
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya
| |
Collapse
|
12
|
Assessment of the Progression of Poststroke Depression in Ischemic Stroke Patients Using the Patient Health Questionnaire-9. J Stroke Cerebrovasc Dis 2020; 29:104561. [PMID: 31941579 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/28/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poststroke depression (PSD) affects one-third of stroke patients and is linked with higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct when to screen for PSD, and predictors of PSD are not well understood. We sought to understand progression of PSD symptoms early after ischemic stroke, identify predictors of PSD, and describe the use of antidepressants in PSD. METHODS We collected demographic, clinical, and PSD (Patient Health Questionnaire-9; PHQ-9) data from ischemic stroke patients hospitalized at our Comprehensive Stroke Center and followed up in our clinic. PHQ-9 was obtained during hospitalization and again in clinic within 180 days of discharge. We performed univariate analysis and logistic regression to detect variables associated with PSD. RESULTS Among 201 patients, PSD symptoms (PHQ-9 > 4) were identified in 30% of patients during hospitalization and 46% during follow-up (54% of which had no symptoms during hospitalization). At follow-up, 36% were worse by PHQ-9 category. In univariate analysis, follow-up modified Rankin Scale (mRS) greater than or equal to 2 (P = .03) and antidepressant prescription (P < .001) were associated with worsening PHQ-9 category. In logistic regression analysis, follow-up mRS greater than or equal to 2 (P = .02), posterior circulation stroke (P = .03), and antidepressant prescription (P < .01) were associated with worsening PHQ-9 category. CONCLUSIONS Almost half of ischemic stroke patients develop PSD symptoms and more than one-third worsen between hospitalization and follow-up. Poststroke disability (mRS ≥ 2) and posterior circulation stroke were associated with worsening PSD. Worsening PSD symptoms prompted treatment change in 29% of patients. Screening for PSD during hospitalization should be repeated during early follow-up.
Collapse
|
13
|
Huang J, Zhou FC, Guan B, Zhang N, Wang A, Yu P, Zhou L, Wang CY, Wang C. Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up. Front Psychiatry 2019; 9:738. [PMID: 30670990 PMCID: PMC6331416 DOI: 10.3389/fpsyt.2018.00738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023] Open
Abstract
Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035-1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111-27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190-4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019-2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F (1, 532) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.
Collapse
Affiliation(s)
- Jing Huang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Fu-Chun Zhou
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Boyuan Guan
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Anxin Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ping Yu
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Lei Zhou
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chuan-Yue Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
14
|
Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data. Psychosom Med 2018; 80:754-763. [PMID: 30113911 DOI: 10.1097/psy.0000000000000632] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions. METHODS Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates. RESULTS Fifty-five studies reported 32 stroke cohorts (n = 8938; pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%-38%) and 17 MI cohorts (n = 10,767; pooled frequency of depression = 24%, 95% CI = 20%-28%). In 29 stroke cohorts, 24% (95% CI = 20%-27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%-19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated. CONCLUSIONS Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.
Collapse
|
15
|
A Study of the Brain Abnormalities of Post-Stroke Depression in Frontal Lobe Lesion. Sci Rep 2017; 7:13203. [PMID: 29038494 PMCID: PMC5643375 DOI: 10.1038/s41598-017-13681-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/27/2017] [Indexed: 12/16/2022] Open
Abstract
Post stroke depression (PSD) is a serious complication of stroke. Brain imaging is an important method of studying the mechanism of PSD. However, few studies have focused on the single lesion location. The aim of this study was to investigate the brain mechanism of frontal lobe PSD using combined voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI). In total, 30 first-time ischemic frontal lobe stroke patients underwent T1 weighted MRI and resting-state fMRI scans. Clinical assessments included the 24-item Hamilton Rating Scale for Depression, the National Institutes of Health Stroke Scale, and the Mini-Mental State Examination. In our result, decreased gray matter (GM) volume in patients was observed in the prefrontal cortex, limbic system and motor cortex. The anterior cingulate cortex, selected as a seed to perform connectivity analyses, showed a greatly decreased functional connectivity with the prefrontal cortex, cingulate cortex, and motor cortex, but had an increased functional connectivity with the hippocampus gyrus, parahippocampa gyrus, insular, and amygdala. Stroke lesion location reduces excitability of brain areas in the ipsilateral brain. PSD affects mood through the brain network of the prefrontal-limbic circuit. Some brain networks, including motor cortex and the default mode network, show other characteristics of PSD brain network.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Nickel A, Thomalla G. Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations-A Topical Review. Front Neurol 2017; 8:498. [PMID: 28983281 PMCID: PMC5613107 DOI: 10.3389/fneur.2017.00498] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/05/2017] [Indexed: 01/30/2023] Open
Abstract
Post-stroke depression (PSD) affects approximately one-third of all stroke patients. It hinders rehabilitation and is associated with worse functional outcome and increased mortality. Since the identification of PSD is a significant clinical problem, clinicians and researchers have tried to identify predictors that indicate patients at risk of developing PSD. This also includes the research question whether there is an association between PSD and stroke lesion characteristics, e.g., lesion size and lesion location. Early studies addressing this question are largely limited by technical constraints and, thus, focused on simple lesion characteristics such as lesion side or proximity of the lesion to the frontal pole of the brain. More recent studies have addressed the impact of involvement of specific neuronal circuits in the stroke lesion. State-of-the-art methods of lesion symptom mapping to study PSD have only been applied to small patient samples. Overall, results are controversial and no clear pattern of stroke lesions associated with PSD has emerged, though there are findings suggesting that more frontal stroke lesions are associated with higher incidence of PSD. Available studies are hampered by methodological limitations, including drawbacks of lesion analysis methods, small sample size, and the issue of patient selection. These limitations together with differences in approaches to assess PSD and in methods of image analysis limit the comparability of results from different studies. To summarize, as of today no definite association between lesion location and PSD can be ascertained and the understanding of PSD rests incomplete. Further insights are expected from the use of modern lesion inference analysis methods in larger patient samples taking into account standardized assessment of possible confounding parameters, such as stroke treatment and reperfusion status.
Collapse
Affiliation(s)
- Alina Nickel
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
18
|
Douven E, Köhler S, Rodriguez MMF, Staals J, Verhey FRJ, Aalten P. Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2017; 27:202-219. [PMID: 28831649 PMCID: PMC5613051 DOI: 10.1007/s11065-017-9356-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
Abstract
Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34–2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33–3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18–5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06–0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.
Collapse
Affiliation(s)
- Elles Douven
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Maria M F Rodriguez
- Hospital Alvaro Cunqueiro, Department of Psychiatry, Complexo Universitario de Vigo, Vigo, Spain
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
19
|
Adelborg K, Sundbøll J, Videbech P, Grove EL. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:351-361. [DOI: 10.1007/5584_2016_125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|