Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, New York, USA.
Int J Geriatr Psychiatry. 2012 Oct;27(10):1053-60. doi: 10.1002/gps.2822. Epub 2012 Jan 16.
Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy.
A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks.
Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability.
These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.
脑卒中后抑郁（PSD）发生在突然发生的灾难性残疾的背景下，使患者及其家属措手不及。我们开发了以生态系统为中心的治疗（EFT），这是一种系统干预措施，旨在提高 PSD 患者及其生态系统应对 PSD 的“心理社会风暴”的能力，并有效地利用现有治疗方法。这是其疗效的初步研究。
共有 24 名 PSD 患者被随机分配接受每周一次的 EFT 或由系统的中风和抑郁教育及其治疗组成的对照条件，持续 12 周。
与中风和抑郁教育相比，以生态系统为中心的治疗（EFT）可能更能有效减轻抑郁症状和体征，提高缓解率，并改善 PSD 患者的残疾状况。试验早期残疾的减少导致后期抑郁症状的改善。同样，早期抑郁症状和体征的减轻也导致后期残疾的改善。
这些令人鼓舞的发现需要复制。除了在 PSD 方面的潜在直接益处外，EFT 还可以为高效和及时地进行药物治疗以及物理、言语和职业治疗提供适当的环境，从而最大限度地提高其疗效。
