Depression associated with stroke.pptVIP

Leeds Institute of Health Sciences Depression associated with stroke Allan House Professor of liaison psychiatry Academic Unit of Psychiatry and Behavioural Sciences The emotional impact of stroke: three approaches Distress as symptom burden Emotional disorders as specific syndromes The role of individual cognitions or behaviours Some common measures of symptom burden Hospital Anxiety and Depression Scale: HAD 14 items General Health Questionnaire: GHQ 12, 28, 30, 60 items Beck Depression Inventory: BDI 21 items Center for Epidemiological Studies: CES-D 20 items Major depression: depressed mood or loss of interest or pleasure and during the same 2 week period 3 from: Weight loss or weight gain, or marked change in appetite Insomnia or hypersomnia Agitation or retardation Fatigue or loss of energy Worthlessness or guilt Poor concentration or indecisiveness Thoughts of death or suicidal thinking Negative cognitions in stroke In two cohort studies ARCOS / SOS2 at 6 months: Of those reporting no depressed mood 112/1262 (9%) reported wishing they were dead Of those reporting no depressed mood, and scoring under threshold on a self-report mood rating scale 72/1262 (5%) reported wishing they were dead Depressive symptoms after stroke: their relation to outcomes Possible mechanisms for an association: endocrine stress response (HPA axis overactivity) platelet stickiness autonomic instability physical inactivity non-adherence to treatment Smoking and diet poorer quality of medical care Two main components of the earlyexperience of stroke Perceptions of disease and disability: Controllability Locus of control Sense of coherence Helplessness/hopelessness Perceptions of healthcare: Quality Co-ordination Continuity Information received Satisfaction with care Lessons for assessment You need to know about both burden and specific symptoms, so: - routine use of a symptom measure - follow up with an interview You need to know about persistence of sym