PSYCHOSOCIAL/BEHAVIORAL INTERVENTION IN PSD

抑郁症是完全性缺血性脑卒中的常见后遗症，需要干预以改善脑卒中后的社会和功能结果。PSD与中风后长达10年的社会和功能结果恶化、认知状况恶化、医疗费用增加、康复反应受损、延迟重返工作岗位和长期死亡率增加有关。本研究的主要目的是确定护士提供的社会心理/行为干预对减少社区卒中后患者抑郁的影响。我们期望行为和药物联合干预在维持实验组抑郁改善方面比单独药物治疗更有效。次要目的是检查社会心理/行为干预的时间过程和治疗反应的可持续性，对社区居住的中风后患者的能力限制，参与限制和总体卒中影响的影响。由华盛顿大学中风评估和治疗中心组成的三所华盛顿大学附属医院的150名患者将被邀请加入研究，这些患者在缺血性中风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，或定期临床随访。两组患者都将接受标准的抗抑郁治疗和美国中风协会提供的书面材料，并在研究结束后的两年内接受评估。主要结果是中风后12个月抑郁症的减少。次要结果是中风后6、12和24个月的活动限制（Barthel指数）、参与限制（中风影响量表）和整体中风影响（中风影响量表）的减少。我们假设所有患者的情绪和功能能力都会在卒中后的标准治疗中得到改善，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更大，并且在所有随访测量中总体卒中影响更小。

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.