PSYCHOSOCIAL/BEHAVIORAL INTERVENTION IN PSD

抑郁症是完全性缺血性中风的一种非常常见的后遗症，需要进行干预以改善中风后的社会和功能结局。PSD与中风后长达十年的社会和功能预后不良、认知状况较差、医疗费用增加、康复反应受损、工作延迟和长期死亡率增加有关。这项研究的主要目的是确定护士提供的心理社会/行为干预对社区居住的中风后患者减少抑郁的效果。我们期望联合的行为和药物干预在维持试验组抑郁症的改善方面比单纯药物治疗更有效。第二个目的是检查心理社会/行为干预的时间进程和对治疗反应的可持续性的影响，对社区居住的中风后患者能力限制、参与限制和整体中风影响的影响。华盛顿大学附属三家医院的150名患者将被邀请参加这项研究，他们被发现在缺血性中风后的前四个月内患有抑郁症，并被随机分配到由高级执业护士提供的问题解决/愉快事件干预组，或定期进行临床随访。这两组人都将接受标准的抗抑郁药物治疗和美国中风协会的书面材料，并将在研究结束后接受长达两年的评估。主要结果是中风后12个月抑郁减轻。次要结果是卒中后6个月、12个月和24个月的活动限制减少(Barthel指数)、参与限制减少(卒中影响量表)和总体卒中影响(卒中影响量表)。我们假设所有患者都会改善与卒中后标准治疗相关的情绪和功能能力，但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将显著更大，而在所有后续测量中对整体中风的影响较小。

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.