Mood disorder as a specific complication of stroke.

Abstract

SUMMARY In an effort to discern whether cerebral vascular injuries provoke specific emotional disturbances, 20 consecutively admitted stroke patients were compared with 10 orthopaedic patients. Both groups were examined for functional disabilities (Activities of Daily Living) and for psychiatric symptoms. Reliable and valid instruments, the Hamilton Rating Scale, the Visual Analogue Mood Scale, the Present State Exam, and the Mini-Mental State Exam were employed to display the psychopathology. More of stroke patients than orthopaedic patients were depressed (45% versus 10%) even though the level of functional disability in both groups was the same. Patients with right hemisphere stroke seemed particularly vulnerable and displayed a syndrome of irritability, loss of interest, and difficulty in concentration, in addition to depression of mood (70% of right hemisphere stroke patients versus 0% left hemisphere stroke patients and 0% orthopaedic patients). We conclude that mood disorder is a more specific complication of stroke than simply a response to the motor disability. We suggest that a controlled trial of antidepressant medication is indicated for patients with this complication.Persistent and refractory depression of mood has often been reported to follow stroke (Bleuler, 1924;Post, 1961;Adams, 1963;Bell, 1966). This symptom is commonly explained as an expected psychological reaction of the patient to his disability or restrictions in activity. We began to doubt the adequacy of this explanation when we admitted to the Psychiatry Service for the elderly at the Westchester Division of the New York Hospital, a 72 year old physician who, after a stroke manifest by a left hemiparesis, had developed incapacitation, symptoms of irritability and depression persisting for two years. After treatment with antidepressant medication these distressing symptoms were relieved and his interest and enjoyment of life returned. From this experience we were prompted to study the emotional symptoms of a group of patients with stroke, comparing them with the emotional symptoms of patients with non-neurological but disabling conditions. Our purpose was to discover any specific emotional changes after stroke. Such a

Lesion location and poststroke depression

“…The second suggests that depression arises as a consequence of the specific brain lesion and presumably subsequent changes in neurotransmitters. Accordingly, Folstein et al 9 observed that stroke patients suffered more from depression than equally physically impaired orthopedic patients, thereby suggesting that the brain lesion itself could influence mood. Furthermore, differences in emotional reactions depending on hemisphere of the infarct suggested an organic basis of PSD.…”

Mental health: Ups and downs

“…In 1977, researchers at Johns Hop kins University in Baltimore, Maryland, compared the mental health of two groups of people who no longer had fully functional legs as a result of either stroke or orthopae dic injuries, such as hip fractures or arthritis. The researchers found that almost half of those who had had a stroke were depressed compared with just one fifth of those with orthopaedic injuries 5 . The study triggered a marked change in how neurolo gists viewed psychological complications after a brain injury 6 and research into depres sion following a stroke "went from an intel lectual backwater too dull for neurologists to even bother seeing", says Carson, to being a hot topic.…”

Depressão pós-AVC: aspectos psicológicos, neuropsicológicos, eixo HHA, correlato neuroanatômico e tratamento

“…Estudos iniciais já sugeriram que, além do aspecto psicológico, deveria existir uma contribuição da lesão neuronal na etiologia da DPAVC. Folstein et al 66 relataram uma maior prevalência da depressão em pacientes com AVC quando comparados com pacientes ortopédicos com limitação física semelhante. Robinson e Szetela 67 encontraram uma associação da depressão com a localização do AVC na região cerebral frontal anterior esquerda.…”