Assessment and Treatment of Post-Stroke Depression.ppt

Assessment and Treatment of Post-Stroke Depression Michael A. Schmitz, Psy.D, LP Clinical Psychologist Neuroscience Institute Abbott Northwestern Hospital Minneapolis, MN Michael.schmitz@ Goals of presentation Describe etiology and incidence of post-stroke depression (PSD). Outline assessment and screening tools for PSD. Outline treatment options and strategies for PSD. Incidence of PSD. Approximately 1/3 of persons will experience clinically significant depression at some point following a stroke. Hacket, et al., 2005 Robinson found that 19.3% and 18.5% of stroke survivors had major depression or minor depression, respectively, in acute care rehabilitation settings. Robinson, RB, 2003 No significant difference in incidence between hemorrhagic and infarct strokes PSD associated with: Poor functional recovery – may delay recovery by 2 years. Poor social outcomes Reduced quality of life Reduced rehabilitation treatment efficiency Increased cognitive impairment Increased mortality Morris, et al., 1993 A biopsychosocial model of PSD Biological factors Location of stroke – left cortical and subcortical lesions risk is controversial Exact neuroanatomical mechanism unknown Presumed disruption in amine pathways A biopsychosocial model of PSD Psychosocial factors Pre-stroke history of depression Personality and coping style Inadequate social support, particularly significant other. Level of disability Early Predictors of PSDCarota, et al. (2005) Low Barthel Index score /trials/scales/barthel.pdf Age 68 years Crying in first few days Pathological crying (not associated with PSD) Emotionalism (41% developed PSD) Catastrophic reaction (63% developed PSD) Distinguishing types of crying: Pathological crying linked to infarct in basis of pontis and corticobulbar pathways and occurs in response to mood incongruent cues. Emotionalism is crying that is congruent with mood (sadness) but patient is unable to control