The Post-Stroke depression rating scale: A test specifically devised to investigate affective disorders of stroke patients

Abstract

Owing to the lack of instruments specifically constructed to study emotional and affective disorders of stroke patients, the nature of post-stroke depression (PSD) remains controversial. With this in mind, the authors constructed a new scale, the Post-Stroke Depression Scale (PSDS) which takes into account a series of symptoms and problems commonly observed in depressed stroke patients. The PSDS and the Hamilton Depression Rating Scale (HDS) were administered to a group of 124 patients, who had been classified, on the basis of DSM III-R diagnostic criteria, in the following categories: No depression (n = 32); Minor PSD (n = 47); Major PSD (n = 45). Scores obtained by these stroke patients on the PSDS and on the HDS were compared to those obtained on the same scales by 17 psychiatric patients also classified as major depression on the basis of DSM III-R diagnostic criteria. An analysis of the symptomatological profiles clearly showed that: (1) a continuum exists between the so-called "major" and "minor" forms of PSD; (2) in both groups of depressed stroke patients the depressive symptomatology seems due to the psychological reaction to the devastating consequences of stroke, since the motivated aspects of depression prevailed in depressed stroke patients, whereas the (biologically determined) unmotivated aspects prevailed in patients with a functional form of major depression; and (3) in stroke patients a DSM III-based diagnosis of major PSD could be in part inflated by symptoms (such as apathy and vegetative disorders) that are typical of major depression in a patient free from brain damage, but that could be due to the brain lesion per se in a stroke patient.

Post-Stroke Depression: Main Phenomenological Clusters and their Relationships with Clinical Measures

“…This limitation may have determined the lack of a systematic approach to its underlying psychopathological dimensions. In this study, we report the results of a factor analysis of the PS-DRS [15], an assessment scale specifically developed for PSD.…”

“…When a specific assessment scale (the Post-Stroke Depression Rating Scale, PSDRS) was used, clinical profile of "major" and "minor" PSD overlapped, and they were clearly distinguishable from the one of primary Major Depressive Disorder (MDD) [15]. Furthermore, several studies were not able to replicate the association between PSD and left frontal lesions [14,33] or identified different anatomical substrates [27].…”

“…All the enrolled patients underwent the Post-Stroke Depression Rating Scale [15], which was administered by a trained neurologist in the late morning or in the early afternoon.…”

Assessment of Depression After Stroke

“…7,8 Some authors support the use of the DSM criteria despite the nature or origin of the symptoms, and see both the psychological and somatic symptoms as associated with poststroke depression. 10 -12 Others stress differences in symptom profiles between poststroke and endogenous depression 13,14 or suggest that diagnosis should rely more heavily on nonsomatic symptoms 15 or consider different symptoms individually according to their diagnostic sensitivity. 9 More information on the responsiveness of the measures to change over time and appropriateness of cutoff values are needed.…”

How should depression be diagnosed in patients with stroke?

“…One research group, however, has proposed that the diagnostic criteria for poststroke major depression should be substantially altered by including apathy, anxiety, catastrophic reactions, hyperemotionalism and diurnal variations as new diagnostic criteria (12,13). Other research groups, however, have rarely adopted these modified criteria and almost all the published literature has utilized standard DSM criteria for diagnosis and the Hamilton Depression Scale (14) (based almost exclusively on the DSM symptom criterion) for symptom severity measurement.…”