Are depressive symptoms nonspecific in patients with acute stroke?
Are depressive symptoms nonspecific in patients with acute stroke?
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急性中风患者的抑郁症状是否具有非特异性？
DOI：
10.1176/ajp.148.9.1172
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Robinson,RG
中科院分区：
文献类型：
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作者：
Fedoroff,JP;Starkstein,SE;Parikh,RM;Price,TR;Robinson,RG
目的一些研究者认为，脑卒中患者的重度抑郁症可能被过度诊断，因为他们的医学疾病导致了食欲、睡眠或性兴趣的改变；另一些人则认为，由于病感失认、忽视或抑郁而否认抑郁症状的中风患者可能未被充分诊断出抑郁症。作者的目的是确定伴有和不伴有抑郁情绪的急性中风患者出现抑郁症状的频率，以估计纳入或排除诊断错误的频率。方法对205例连续住院的急性脑卒中患者进行自主神经和心理抑郁症状的调查。85例（41%）患者有抑郁情绪，120例（59%）患者无情绪障碍。85名抑郁情绪患者中的46名（54%）（占所有患者的22%）被分配到DSM-III重度抑郁症诊断。结果120例无情绪障碍患者平均有1个自主神经症状，85例情绪抑郁患者平均有近4个自主神经症状。收紧诊断标准，多考虑一种非特异性自主神经症状，只减少了3例重度抑郁症患者；再增加两个标准只减少了五个。因此，DSM-III重度抑郁症的发生率比附加一项非特异性自主神经症状的发生率高1%，比附加两项标准的发生率高2%。相反，放松诊断标准来解释抑郁症的否认，只会使重度抑郁症的发病率增加5%。结论自主神经和心理抑郁症状与急性脑卒中患者抑郁情绪密切相关。
ObjectiveSome investigators have suggested that major depression might be overdiagnosed in stroke patients because of changes in appetite, sleep, or sexual interest caused by their medical illness; others have suggested that depression may be underdiagnosed in stroke patients who deny symptoms of depression because of anosognosia, neglect, or aprosody. The authors' goal was to determine how frequently depressive symptoms occur in acute stroke patients with and without depressed mood to estimate how often diagnostic errors of inclusion or exclusion may be made.MethodThey examined the rate of autonomic and psychological symptoms of depression in 205 patients who were consecutively hospitalized for acute stroke. Eighty-five (41%) of these patients had depressed mood, and 120 (59%) had no mood disturbance. Forty-six (54%) of the 85 patients with depressed mood (22% of all patients) were assigned the DSM-III diagnosis of major depression.ResultsThe 120 patients without mood disturbance had a mean of one autonomic symptom, but the 85 patients with depressed mood had a mean of almost four. Tightening the diagnostic criteria to account for one more nonspecific autonomic symptom decreased the number of patients with major depression by only three; adding two more criteria decreased the number by only five. Thus, the rate of DSM-III major depression was 1% higher than the rate with one extra nonspecific autonomic symptom and 2% higher than the rate with two extra criteria. Conversely, loosening diagnostic criteria to account for denial of depressive illness increased the rate of major depression by only 5%.ConclusionsBoth autonomic and psychological depressive symptoms are strongly associated with depressed mood in acute stroke patients.