Psychosocial/Behavioral Intervention in PSD

描述(申请人提供)：2002年3月，这项研究作为一项随机对照试验得到资助，目的是测试护士提供的短暂心理社会行为干预对临床抑郁的中风幸存者的抑郁以及随后的活动和参与结果的有效性(1R01NR007755-01A1)。这项研究的第四个目的是探索对这种干预反应最具预测性的患者特征。纳入这一目标是因为关于卒中后抑郁的预测因素的文献相互矛盾，而且几乎完全没有证据表明谁最有可能从PSD的药物或非药物治疗中受益。最近有证据表明，SERT基因的遗传多态在预测抑郁症和对SSRI的反应方面具有价值，这促使我们在已经提出的指标(性别、重度或轻度抑郁症、中风的严重程度或社会支持水平，所有文献中与抑郁症相关的因素)的基础上增加了这一特征。这个补充项目利用了生物行为护理与健康系统部门的生物行为调查人员与马里兰州鲁思科恩之间的持续合作。科恩博士目前正在进行一项美国国立卫生研究院的拨款，用于研究抑郁症动物模型中的5-羟色胺受体和SERT多态。这项补充研究的早期发现表明，SERT基因多态在预测伴随慢性病的抑郁症以及抑郁症对心理社会干预的反应方面具有价值。因此，这一补充将提供机会增加一种新的标记物，该标记物最终可能在预测中风后抑郁症(以及可能伴随其他慢性健康问题的抑郁症)患者的药物和非药物治疗的反应方面具有价值。此外，这些数据将提供重要的描述性信息，可用于进一步探讨5-羟色胺在中风后抑郁中的作用，尽管是间接的。

DESCRIPTION (provided by applicant): In March 2002, this study was funded as a randomized controlled trial to test the efficacy of a nurse- delivered brief psychosocial-behavioral intervention on depression and subsequent activity and participation outcomes in stroke survivors who are clinically depressed (1R01NR007755-01A1). The fourth aim of this study is to explore patient characteristics that are most predictive of response to this intervention. This aim was included because of the conflicting literature regarding predictors of post-stroke depression and the almost complete absence of evidence regarding who is most likely to benefit from either drug or nonpharmacologic therapies in PSD. Recent evidence regarding the value of genetic polymorphisms of the SERT gene in predicting both depression and response to SSRI has prompted us to add this characteristic to those already proposed (gender, major or minor depression, severity of stroke, or level of social support, all factors associated with depression in the literature). This supplemental project capitalizes on a continuing collaboration between biobehavioral investigators in the Department of Biobehavioral Nursing & Health Systems and Ruth Kohen, MD. Dr. Kohen is currently conducting an NIH grant to study 5-HT receptors and SERT polymorphisms in an animal model of depression. Early findings in that supplemental study point to the value of the SERT polymorphisms in predicting depression concomitant with a chronic condition and the response of that depression to psychosocial interventions. Thus, this supplement will provide the opportunity to add a new marker that may ultimately have value in terms of predicting responses to drug and non-drug therapies in patients with post-stroke depression (and possibly depression concomitant with other chronic health problems). In addition, the data will provide important descriptive information that could be used to further explore, albeit indirectly, the role of serotonin in post-stroke depression.