Department of Psychiatry, Carver College of Medicine, University of Iowa, IA; Department of Psychiatry, Tokai University School of Medicine, Kanagawa, Japan.
Am J Geriatr Psychiatry. 2013 Sep;21(9):855-62. doi: 10.1016/j.jagp.2012.07.003. Epub 2013 Feb 6.
Apathy occurs frequently following stroke and prior studies have demonstrated the negative effect of apathy on recovery from stroke. This study was a secondary analysis examining the efficacy of escitalopram, problem-solving therapy (PST), or placebo administered for 1 year to prevent the onset of apathy among patients with recent stroke.
Patients within 3 months of an index stroke who did not meet DSM-IV diagnostic criteria for major or minor depression and who did not have a serious comorbid physical illness were enrolled. Patients were recruited from three sites: University of Iowa, University of Chicago, and Burke Rehabilitation Hospital. One hundred fifty-four patients without evidence of apathy at initial evaluation were included in the randomized controlled trial using escitalopram (10 mg patients ≤65 years; 5 mg patients >65 years) (N = 51) or placebo (N = 47) or non-blinded PST (12 total sessions) (N = 56) over 1 year. At 3, 6, 9, and 12 months, patients were assessed for diagnosis and severity of apathy using the Apathy Scale.
Using a Cox proportional hazards model of time to onset of apathy, participants given placebo were 3.47 times more likely to develop apathy than patients given escitalopram and 1.84 times more likely to develop apathy than patients given PST after controlling for age, sex, cognitive impairment, and diabetes mellitus status (adjusted hazard ratio: 3.47, 95% CI: 1.79-6.73 [escitalopram group]; adjusted hazard ratio: 1.84, 95% CI: 1.21-2.80 [PST group]).
Escitalopram or PST was significantly more effective in preventing new onset of apathy following stroke compared with placebo.
卒中后常发生淡漠，先前的研究表明淡漠对卒中后恢复有负面影响。本研究为二次分析，旨在评估艾司西酞普兰、问题解决疗法（PST）或安慰剂治疗 1 年对预防近期卒中患者发生淡漠的疗效。
纳入无 DSM-IV 重性或轻性抑郁诊断标准、无严重合并躯体疾病的索引性卒中后 3 个月内的患者。患者来自三个地点：爱荷华大学、芝加哥大学和伯克康复医院。154 名初始评估无淡漠证据的患者纳入随机对照试验，随机分为艾司西酞普兰（≤65 岁者 10mg；＞65 岁者 5mg）组（N=51）、安慰剂组（N=47）或非盲 PST 组（共 12 次）（N=56），治疗 1 年。在 3、6、9 和 12 个月时，使用淡漠量表评估患者的淡漠诊断和严重程度。
采用淡漠发生时间的 Cox 比例风险模型，与给予艾司西酞普兰的患者相比，给予安慰剂的患者发生淡漠的可能性高 3.47 倍，与给予 PST 的患者相比，发生淡漠的可能性高 1.84 倍，调整年龄、性别、认知障碍和糖尿病状态后（调整后的风险比：3.47，95%CI：1.79-6.73[艾司西酞普兰组]；调整后的风险比：1.84，95%CI：1.21-2.80[PST 组]）。
与安慰剂相比，艾司西酞普兰或 PST 治疗在预防卒中后新发淡漠方面更有效。
