Psychosocial/Behavioral Intervention in PSD

描述（由申请人提供）：2002年3月，本研究作为一项随机对照试验获得资助，以测试护士提供的简短心理社会行为干预对临床抑郁的卒中幸存者的抑郁症以及随后的活动和参与结局的疗效（1 R 01 NR 007755 - 01 A1）。本研究的第四个目的是探索最能预测这种干预反应的患者特征。纳入这一目标是因为关于卒中后抑郁预测因素的文献相互矛盾，并且几乎完全缺乏关于谁最有可能从PSD的药物或非药物治疗中获益的证据。关于SERT基因的遗传多态性在预测抑郁症和对SSRI的反应方面的价值的最新证据促使我们将该特征添加到已经提出的特征中（性别、重度或轻度抑郁症、中风的严重程度或社会支持水平，文献中与抑郁症相关的所有因素）。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研究人员与医学博士Ruth Kohen之间的持续合作。Kohen博士目前正在进行NIH资助，以研究抑郁症动物模型中的5-HT受体和SERT多态性。该补充研究的早期发现指出了SERT多态性在预测伴随慢性疾病的抑郁症以及该抑郁症对心理社会干预的反应中的价值。因此，这种补充将提供机会，增加一个新的标志物，最终可能有价值的预测反应的药物和非药物治疗的患者中风后抑郁症（可能抑郁症伴随其他慢性健康问题）。此外，这些数据将提供重要的描述性信息，可用于进一步探索，尽管是间接的，血清素在中风后抑郁症中的作用。

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.