Evaluation and Treatment of Depression in Stroke Patients: A Systematic Review

Lavu, Vamsi Krishna; Mohamed, Rana Abdelwahab; Huang, Ruimin; Potla, Shanthi; Bhalla, Sushen; Qabandi, Yousif Al; Nandula, Savitri Aninditha; Boddepalli, Chinmayi Sree; Gutlapalli, Sai Dheeraj; Mohammed, Lubna

doi:10.7759/cureus.28137

Cited by 7 publications

(7 citation statements)

References 48 publications

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“…PSD is associated with several factors that may be responsive to interventions, including the management of memory and executive difficulties with cognitive rehabilitation and speech pathology therapy, interventions for fatigue including exercise regimens and medications, interventions for sleep difficulties, and interventions for anxiety disorders such as group support or medication that specifically targets the particular anxiety disorder [ 36 , 37 ]. There is evidence that the treatment of PSD early on after stroke may lead to improved cognition and physical recovery, as well as increased longevity [ 8 , 38 ]. Managing these different factors will likely only help alleviate the burden of depression after stroke.…”

Section: Discussionmentioning

confidence: 99%

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

Dulay

Criswell

Hodics

2023

IJERPH

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Background: Depression is the most common psychiatric condition that occurs after cerebrovascular accident, especially within the first year after stroke. Poststroke depression (PSD) may occur due to environmental factors such as functional limitations in daily activities, lower quality of life, or biological factors such as damage to areas in the brain involved in emotion regulation. Although many factors are hypothesized to increase the risk of PSD, the relative contribution of these factors is not well understood. Purpose: We evaluated which cross-sectional variables were associated with increased odds of PSD in our adult outpatient stroke neuropsychology clinic population. Methods: The sample included 325 patients (49.2% female; mean age of 59-years old) evaluated at an average of 8.1 months after an ischemic or hemorrhagic stroke. Variables included in logistic regression were stroke characteristics, demographics, psychosocial factors, comorbid medical problems, comorbid psychiatric conditions, and cognitive status. The Mini International Neuropsychiatric Inventory was used to determine DSM-defined PSD and anxiety disorders. A standard neuropsychological test battery was administered. Results: PSD occurred in 30.8% of the sample. Logistic regression indicated that increased odds of PSD were associated with a comorbid anxiety disorder (5.9 times more likely to suffer from PSD, p < 0.001). Further, increased odds of PSD were associated with a history of depression treatment before stroke (3.0 times more likely to suffer from PSD), fatigue (2.8 times more likely), memory impairment (2.4 times more likely), and younger age at stroke (all p values < 0.006). Discussion: Results suggest that PSD is likely multifactorial and extends the literature by demonstrating that a comorbid anxiety disorder correlated strongest with PSD. Poststroke screening and treatment plans should address not only depression but comorbid anxiety.

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Section: Discussionmentioning

confidence: 99%

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

Dulay

Criswell

Hodics

2023

IJERPH

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“…25 A recent systematic review summarized findings of randomized controlled trials of desmopressin also including evidence from patients without VWD undergoing rhinoplasty, functional endoscopic sinus surgery, or gastrointestinal surgery. 26 As far as acquired von Willebrand syndrome is concerned, a double-blind, randomized, placebo-controlled trial demonstrated the efficacy of desmopressin in patients undergoing aortic valve replacement. Patients with aortic stenosis and impaired primary hemostasis measured by prolonged collagen adenosine diphosphate closure time using the platelet function analyzer (PFA-100), had an increase in VWF and FVIII and less postoperative blood loss, when they received desmopressin compared with the placebo group.…”

Section: Desmopressinmentioning

confidence: 99%

Progress in von Willebrand Disease Treatment: Evolution towards Newer Therapies

Moser,

Schoergenhofer,

Jilma

2024

Semin Thromb Hemost

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Abstractvon Willebrand disease (VWD) is a very heterogenous disease, resulting in different phenotypes and different degrees of bleeding severity. Established therapies (i.e., desmopressin, antifibrinolytic agents, hormone therapy for heavy menstrual bleeding, and von Willebrand factor [VWF] concentrates) may work in some subtypes, but not in all patients. In recent years, progress has been made in improving the diagnosis of VWD subtypes, allowing for more specific therapy. The impact of VWD on women's daily lives has also come to the fore in recent years, with hormone therapy, tranexamic acid, or recombinant VWF as treatment options. New treatment approaches, including the replacement of lacking factor VIII (FVIII) function, may work in those subgroups affected by severe FVIII deficiency. Reducing the clearance of VWF is an alternative treatment pathway; for example, rondaptivon pegol is a VWFA1 domain-binding aptamer which not only improves plasma VWF/FVIII levels, but also corrects platelet counts in thrombocytopenic type 2B VWD patients. These approaches are currently in clinical development, which will be the focus of this review. In addition, half-life extension methods are also important for the improvement of patients' quality of life. Targeting specific mutations may further lead to personalized treatments in the future. Finally, a few randomized controlled trials, although relatively small, have been published in recent years, aiming to achieve a higher level of evidence in future guidelines.

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“…It is well documented that if left untreated, mental health issues can have a range of detrimental effects on long-term outcomes poststroke, 3,5,7 but appropriate treatment may mitigate these effects. 6,20 Altogether, this underscores the importance of providing information to the patient, family, and health care providers about mental health poststroke not only during early rehabilitation but at every stage of the recovery trajectory to improve symptom recognition and treatment. Although not all stroke survivors develop mental health issues or pathology, mental health should be a focus of practice for all stroke survivors.…”

Section: See Related Article P 1519mentioning

confidence: 99%