PSYCHOSOCIAL/BEHAVIORAL INTERVENTION IN PSD

抑郁是完全性缺血性卒中的常见后遗症，需要进行干预以改善卒中后的社会和功能结局。 PSD与卒中后10年的社会和功能结局差、认知状态差、医疗费用增加、康复反应受损、重返工作延迟和长期死亡率增加相关。 本研究的主要目的是确定护士提供的心理社会/行为干预对减少社区居住中风后患者抑郁的影响。 我们期望行为和药物相结合的干预比单独的药物治疗更有效地维持实验组抑郁症的改善。 次要目的是检查社会心理/行为干预时间进程的效果和对治疗反应的可持续性，对社区居住卒中后患者能力限制、参与限制和总体卒中影响的影响。将邀请华盛顿大学三家附属医院（包括华盛顿大学卒中评估和治疗中心）的150名患者参加本研究，这些患者在缺血性卒中后的前四个月内被发现患有抑郁症，并随机分配到由高级执业护士提供的解决问题/愉快事件干预组或定期门诊随访组。 两组患者都将接受标准的抗抑郁治疗和来自美国中风协会的书面材料，并将在研究结束后进行长达两年的评估。 主要结局是卒中后12个月抑郁症的减少。 次要结局是卒中后6、12和24个月时活动受限（Barthel指数）减少、参与受限（卒中影响量表）减少和总体卒中影响（卒中影响量表）减少。 我们假设，所有患者的情绪和功能能力都将得到改善，这与他们的卒中后标准治疗有关，但那些接受心理社会干预的患者在情绪、功能能力、社会参与方面的改善明显更大，在所有随访测量中，总体卒中影响较小。

Depression is a sufficiently common sequela of a completed ischemic stroke to warrant intervention to improve social and functional outcome after stroke. PSD is associated with worse social and functional outcome as much as ten years post-stroke, poorer cognitive status, increased medical costs, impaired rehabilitation response, delayed return to work, and increased long-term mortality. The primary aim of this study is to determine the effect of a nurse-delivered psychosocial/behavioral intervention on reduction of depression in community dwelling post-stroke patients. We expect the combined behavioral and pharmacologic intervention to be more effective than pharmacotherapy alone in sustaining the improvement in depression for the experimental group. Secondary aims are to examine the effect of the psychosocial/behavioral intervention time course and sustainability of response to treatment, effect on limitations in ability, limitation in participation and overall stroke impact in community-dwelling post-stroke patients. 150 patients at three University of Washington affiliated hospitals that comprise the UW Stroke Assessment and Treatment center, who are found to be depressed within the first four months following ischemic stroke will be invited to join the study, and randomly assigned to a problem-solving/pleasant events intervention provided by an advanced practice nurse, or to regular clinic follow-up. Both groups will receive standard antidepressant treatment and written materials from the American Stroke Association, and will be assessed for up to two years following the study. The primary outcome is reduction in depression at 12 months following stroke. Secondary outcomes are reductions in limitations in activity (Barthel Index), reduction in limitation in participation (Stroke Impact Scale) and overall stroke impact (Stroke Impact Scale) at 6, 12, and 24 months post- stroke. We hypothesize that all patients will improve their mood and functional ability related to their post-stroke standard treatment, but that those who receive the psychosocial intervention will have significantly greater improvement in mood, functional ability, social participation, and less overall stroke impact at all follow-up measurement.