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Статья посвящена проблеме постинсультной апатии, которая признается важным нейропсихиатрическим синдромом, что связано с ее воздействием на эффективность реабилитации, социальную адаптацию больного, возвращение к трудовой активности. В работе представлены литературные данные по распространенности, клиническим проявлениям, диагностическим критериям постинсультной апатии, ассоциация ее с возрастом, полом, депрессией, когнитивной дисфункцией. Рассмотрены вопросы патогенеза постинсультной апатии, взаимосвязи с локализацией очага поражения мозга, тяжестью инсульта, представлены направления лечения и прогноз. Ключевые слова: инсульт, постинсультная апатия. Для цитирования: Петрова Е.А., Поневежская Е.В., Савина М.А., Кольцова Е.А. Постинсультная апатия. Consilium Medicum. 2020; 22 (9): 33–37. DOI: 10.26442/20751753.2020.9.200274

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BACKGROUND. Inadequate coping strategies are associated with affective disorders and poor quality of life in stroke survivors. Although coping strategies are determined by several non-modifiable factors they have been shown to change over time. AIM. Longitudinal assessment of coping strategies and associated factors in patients with first-ever stroke. MATERIAL AND METHODS. This study was a part of prospective observational study of a cohort of patients with first-ever stroke. Patients underwent standard psychiatric, neurological and cognitive assessment and CT. Patients without aphasia, severe fatigue, eye problems fulfilled the coping strategies indicator (Amirkhan J.H., 1990): 87 patients in the first week after stroke, 45 patients in the second week, 20 patients in 3 months, 21 patients in 6 months, 33 patients in 1 year after stroke. Non-parametric statistics were used. RESULTS. Different coping strategies were not determined by age, gender and severity of neurological deficit; there were some correlations with educational level, work status, cognitive dysfunction, stroke volume and lesion location. There were differences in the use of coping strategies in the groups with different depression manifestations: in the group with depression manifestations in the early recovery period and later, coping strategies did not differ from the control group in the acute stroke period, but since the manifestation of depression the amount of avoidance strategies increased. In the group with pre-stroke depression, a significant increase in avoidance strategies was observed in the first week after the stroke. CONCLUSIONS. The longitudinal study of coping strategies revealed that the use of coping strategies is a dynamic process determined by several modifiable and non-modifiable factors in combination. Coping strategies were not predictors of depression; on the contrary, depression seems to influence the choice of coping strategies.

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