Anxiety After Stroke: The Importance of Subtyping.
Anxiety After Stroke: The Importance of Subtyping.
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DOI：
10.1161/strokeaha.117.020078
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发表时间：
2018-03
期刊：
影响因子：
8.3
通讯作者：
Carson AJ
中科院分区：
文献类型：
--
作者：
Chun HY;Whiteley WN;Dennis MS;Mead GE;Carson AJ
补充数字内容可在文本中找到。中风后的焦虑是常见的和致残的。中风试验者将焦虑视为一种同质性疾病，干预研究也随之而来，忽视了恐惧症和广泛性焦虑症的不同治疗方法。通过诊断性精神病学访谈，我们旨在报告卒中/短暂性脑缺血发作后3个月时恐怖和广泛性焦虑的频率、恐怖回避、焦虑的预测因素和患者结局。我们前瞻性随访了一组新诊断为卒中/短暂性脑缺血发作的患者，随访3个月时进行了电话半结构化精神病学访谈、恐惧问卷、改良兰金量表、EuroQol-5D 5L和工作与社会适应量表。焦虑症很常见（任何焦虑症，175例中有38例[22%]）。恐怖症是主要的焦虑亚型：仅恐怖症，18/175（10%）;恐怖症和广泛性焦虑症，13/175（7%）;和广泛性焦虑症，7/175（4%）。焦虑症的参与者在恐惧问卷的所有情况下都报告了更高水平的恐惧回避。年轻（每十年增加的比值比为0.64; 95%可信区间为0.45-0.91）和既往有焦虑/抑郁（比值比为4.38; 95%可信区间为1.94-9.89）是卒中后/短暂性脑缺血发作焦虑的预测因素。焦虑障碍受试者的依赖性更强（改良兰金量表评分3-5分，[焦虑] 55% vs [无焦虑] 29%; P<0.0005），EQ-5D 5 L生活质量较差，参与受限（工作和社会适应量表：中位数，四分位距，[焦虑] 19.5，10-27 vs [无焦虑] 0，0-5; P<0.001）。卒中/短暂性脑缺血发作后的焦虑主要是恐惧，与患者预后较差相关。卒中患者的焦虑干预试验应考虑恐惧和广泛性焦虑所需的不同治疗方法。
Supplemental Digital Content is available in the text. Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45–0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94–9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3–5, [anxiety] 55% versus [no anxiety] 29%; P<0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10–27 versus [no anxiety] 0, 0–5; P<0.001). Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety.