Medical School, Clinical Hospital, Institute of Psychiatry, Universidade de São Paulo, São Paulo, SP, Brazil.
Braz J Psychiatry. 2009 Sep;31(3):202-7. doi: 10.1590/s1516-44462009000300004.
Post-stroke major depressive episode is very frequent, but underdiagnosed. Researchers have investigated major depressive episode symptomatology, which may increase its detection. This study was developed to identify the depressive symptoms that better differentiate post-stroke patients with major depressive episode from those without major depressive episode.
We screened 260 consecutive ischemic stroke patients admitted to the neurology clinic of a university hospital. Seventy-three patients were eligible and prospectively evaluated. We assessed the diagnosis of major depressive episode using the Structured Clinical Interview for DSM-IV and the profile of depressive symptoms using the 31-item version of the Hamilton Depression Rating Scale. For data analysis we used cluster analyses and logistic regression equations.
Twenty-one (28.8%) patients had a major depressive episode. The odds ratio of being diagnosed with major depressive episode was 3.86; (95% CI, 1.23-12.04) for an increase of one unit in the cluster composed by the domains of fatigue/interest and retardation, and 2.39 (95% CI, 1.21-4.71) for an increase of one unit in the cluster composed by the domains of cognitive, accessory and anxiety symptoms. The domains of eating/weight and insomnia did not contribute for the major depressive episode diagnosis.
The domains of retardation and interest/fatigue are the most relevant for the diagnosis of major depressive episode after stroke.
脑卒中后发生重度抑郁发作十分常见，但常常被漏诊。研究人员对重度抑郁发作的症状学进行了研究，这可能有助于提高其检出率。本研究旨在确定能更好地区分脑卒中后伴发与不伴发重度抑郁发作患者的抑郁症状。
我们连续筛查了 260 例因脑卒中入住我院神经科病房的患者。共 73 例患者符合入组条件并进行了前瞻性评估。我们使用 DSM-IV 定式临床访谈和 Hamilton 抑郁评定量表 31 项版本评估了重度抑郁发作的诊断和抑郁症状的严重程度。数据分析采用聚类分析和逻辑回归方程。
21 例（28.8%）患者被诊断为重度抑郁发作。在疲劳/兴趣和迟缓这两个症状域的得分每增加一个单位，患重度抑郁发作的风险比为 3.86（95%可信区间，1.23-12.04）；在认知、附加和焦虑症状这三个症状域的得分每增加一个单位，患重度抑郁发作的风险比为 2.39（95%可信区间，1.21-4.71）。而在食欲/体重和失眠这两个症状域的得分与重度抑郁发作的诊断无关。
迟缓及疲劳/兴趣丧失这两个症状域对脑卒中后重度抑郁发作的诊断最具提示意义。
