New opinion on the subtypes of poststroke depression in Chinese stroke survivors

Abstract

AimPoststroke depression (PSD) is the most common complication of stroke. However, some stroke survivors with depression cannot meet the diagnostic criteria of PSD. The aim of this study was to propose the new conception of stroke patients with depression and then make them to receive reasonable diagnosis and treatment.MethodsWe first put forward the opinion that the general PSD should consist of PSD disorder (PSDD) and PSD symptoms (PSDS) according to the Diagnostic and Statistical Manual of Mental Disorder – Fifth Edition (DSM-5) and ZhongDa diagnostic criteria – first edition (ZD-1), respectively. The ZD-1 was established based on the suggestions of 65 Chinese chief doctors considering that the symptoms of PSDS might be different from those of PSDD and the duration of DSM-5 was too strict. Then, 166 stroke inpatients were recruited, and the study was conducted using the diagnosis and classification of PSD to verify the new concept.ResultsA total of 24 (14.46%) and 80 (48.19%) stroke patients were diagnosed with PSDD and PSDS, respectively, according to individual diagnosis criteria. Moreover, patients meeting the diagnostic criteria of PSDD should satisfy the criteria of PSDS first. The distribution frequencies of depressive symptoms were different, which suggested that there might be discrepant depressive symptoms between PSDS and PSDD.ConclusionThe present study proposes new opinion about the classification and diagnosis of depression in stroke survivors. The definition and criteria of PSDS are beneficial to explore phenomenological consistency and provide useful information for early recognition and appropriate interventions.

Mild to Severe Depressive Symptoms in Elderly Stroke Survivors and Its Associated Factors: Evidence From a Cross-Sectional Study in Zhejiang Province, China

“…One study saw a prevalence of 41% even at 3 months after a stroke, using a Chinese version of the Self-rating Depression Scale (SDS) ( 28 ). Another one diagnosed 48% of stroke patients in acute stage with PSD symptoms, using a new assessment called ZhongDa diagnostic criteria—first edition (ZD-1) suggested by 65 Chinese chief doctors ( 29 ). The gap in the percentage of depressive symptoms might mainly be attributed to different assessments and stages after stroke.…”

“…In the current study, prevalence of mild to severe depressive symptoms was 22% among elderly stroke survivors in an economically developed province in China. Among previous evidence in the Chinese population, the prevalence was observed mainly between 10 and 30% (5,7,11,(23)(24)(25)(26), some even high up to 40% (27)(28)(29). Many of them assessed depression at an early stage after stroke and ranged between 2 weeks and 3 months following a stroke.…”

Common susceptibility variants ofKDRandIGF-1Rare associated with poststroke depression in the Chinese population

“…The stroke diagnosis for patients was verified by computed tomography (CT) or magnetic resonance imaging (MRI) reports, along with some persistent poststroke somatic impairments. The eligibility criteria for patients with PSD were as follows: (1) willingness to participate in the study, (2) history of stroke or stroke sequela as determined by CT or MRI, followed by depressive symptoms, (3) fulfilled PSD diagnostic criteria proposed by Yuan et al 20 who put forward the idea that general PSD should include PSD symptom disorder and PSD disorder according to ZhongDa Diagnostic Criteria, First Edition (ZD-1) (see box 1) and also fulfilled the DSM-5 criteria for depression; (4) aged 35-85 years; (5) no other major psychiatric disorders or psychiatric history. The eligibility criteria for patients with non-PSD were as follows: (1) General Psychiatry willingness to participate in the study, (2) history of ischaemic stroke as determined by CT or MRI, (3) aged 35-85 years, (4) did not fulfil PSD diagnostic criteria and (5) no other major psychiatric disorders or psychiatric history (figure 1).…”

Clinical practice guidelines for post-stroke depression in China

“…Yue et al79 further proposed a set of diagnostic criteria for PSDS (Table 1), which can be used for diagnosis one week post-stroke. Meanwhile, PSDD is considered post-stroke MDD, and should first fulfill the PSDS criteria and then the DSM-5’s MDD criteria 82. To confirm this diagnosis, clinicians should discriminate PSD from post-stroke apathy, post-stroke anxiety (PSA), post-stroke fatigue (PSF) and post-stroke psychotic disorder (PSPD).…”