The 12-Month Effects of Early Motivational Interviewing After Acute Stroke

Abstract

Background and Purpose-The purpose of this study was to determine whether motivational interviewing (MI), a patient-centered counseling technique, can benefit patients' mood and mortality poststroke. Methods-This was a single-center, open, randomized, controlled trial. The setting was a hospital with a stroke unit. Four hundred eleven consecutive patients on the stroke register were Ͼ18 years old, not known to be moving out-of-area postdischarge, not receiving psychiatric or clinical psychology intervention, and were without severe cognitive or communication problems preventing participation in interviews. All patients received usual stroke care. Patients in the intervention group also received 4 individual, weekly sessions of MI. The primary outcome was the proportion of patients with normal mood measured by the 28-item General Health Questionnaire (normal Ͻ5; low Ն5) using a mailed questionnaire at 12 months poststroke. Results-At 12-month follow-up (including imputed data), 37.7% patients in the control group and 48.0% patients in the intervention group had normal mood. Twenty-five (12.8%) of 195 patients in the control group and 13 (6.5%) of 199 patients in the intervention group had died. A significant benefit of motivational interviewing over usual stroke care was found for mood (Pϭ0.020; OR, 1.66; 95% CI, 1.08 to 2.55) and mortality (Pϭ0.035; OR, 2.14; 95% CI, 1.06 to 4.38). Conclusions-Results

Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing

“…48 In this study, depression and anxiety were both reduced over time, but this did not differ between the groups. This may be because of the timing and intensity of the intervention, as we provided 3 MI sessions spaced over 9 months.…”

“…This may be because of the timing and intensity of the intervention, as we provided 3 MI sessions spaced over 9 months. An earlier study 48 provided weekly sessions for ≤4 weeks beginning within 4 weeks post stroke. Other studies post stroke have not examined talk-based therapies delivered so early poststroke nor found such benefits.…”

Post-stroke depression

“…Alkalmazott kezelés Vizsgálat típusa Vizsgálat 100 Mianserin vs. placebo Kettős vak, placebokontrollált, randomizált Palomäki [59] 48 Nortriptilin vagy fl uoxetin vs. placebo Kettős vak, placebokontrollált, randomizált Narushima és mtsai [62] 111 Sertralin vs. placebo Kettős vak, placebokontrollált, randomizált Almeida [60] 137 Sertralin vs. placebo Kettős vak, placebokontrollált, randomizált Rasmussen [61] 129 Escitalopram vs. placebo vs. problémamegoldó pszichoterápia Kettős vak, placebokontrollált, randomizált Robinson és mtsai [63] 411 Motivációs beszélgetés vs. szokásos stroke-ellátás Randomizált, kontrollált Watkins és mtsai [66] 104 Nortriptilin vagy fl uoxetin vs. placebo Kettős vak, placebokontrollált, randomizált Jorge és mtsai [67] 95 Duloxetin vs. placebo Nyílt egyes vak vizsgálat Zhang, L. S. [64] Jorge és munkatársai [58] a repetitív transcranialis mág-neses stimuláció (TMS) hatását vizsgálták olyan PSD-s betegek esetében, akiknél a gyógyszeres kezelés nem bizonyult hatékonynak. Tíz kezelés után szignifi káns javulás mutatkozott a depressziós tünetekben függetlenül a beteg korától, nemétől, a laesio lokalizációjától és méretétől.…”

“…Watkins [66] vizsgálatában a stroke-ot követően motivációs beszélgetéseket folytattak, amelyek után szignifikánsan ritkábban alakult ki depresszív hangulatzavar és kisebb volt a halálozási arány, mint a kontrollcsoportban. [67] nortriptilinnel, fl uoxetinnel vagy placebóval kezeltek stroke-ot követően betegeket.…”

CASE-REPORT Dysregulation of gene expression in a patient with depressive disorder after transient ischemic attack confirmed by a neurophysiological neuromarker

“…Recent studies reveals that patients with stroke or TIA, a "warning stroke" not usually associated with long-lasting functional deficit, have similar frequency of depression and newly identified depression between 3 and 12 months after hospitalization (House et al, 2001;Watkins et al, 2011;El Husseini et al, 2012;Tene et al, 2016).…”