Department of Psychiatry and Mental Health, Setúbal Hospital Center, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal.
J Neural Transm (Vienna). 2021 May;128(5):711-716. doi: 10.1007/s00702-021-02334-y. Epub 2021 Apr 7.
Post-stroke depression is a frequent complication of cerebrovascular lesions and mainly occurs within the first 6 months after stroke. Stroke patients who develop depression have slower recovery, greater disability, and higher mortality rates. The pathophysiology of post-stroke depression is not yet clearly defined, but studies suggest contributions from both psychosocial factors and stroke-related factors, such as lesions affecting the frontal-subcortical circuits. Early treatment has a positive impact on post-stroke rehabilitation outcome and survival. We present the case of an 82-year-old man with no psychiatric history who was brought to the psychiatric emergency department after two suicide attempts in the span of 7 days. He was severely depressed, with feelings of hopelessness, insomnia, and suicidal ideation. He had suffered a stroke the week before, affecting the anterior portion of the left cingulate gyrus, causing right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event. He was admitted to the psychiatry ward, treated with sertraline 100 mg/day and quetiapine 50 mg/day and discharged within 28 days, after full remission of symptoms. Our case strengthens the association between lesions located to the frontal-subcortical circuits and post-stroke depression. Physicians should be vigilant regarding the occurrence of depression in stroke patients, especially those who suffer lesions affecting the frontal-subcortical circuits and related regions.
卒中后抑郁是脑血管病变的常见并发症，主要发生在卒中后 6 个月内。发生抑郁的卒中患者康复较慢，残疾程度更高，死亡率也更高。卒中后抑郁的病理生理学尚未明确界定，但研究表明，心理社会因素和与卒中相关的因素都有贡献，如影响额皮质下回路的病变。早期治疗对卒中后康复结局和生存有积极影响。我们报告了一例 82 岁男性的病例，他没有精神病史，在 7 天内两次试图自杀后来到精神科急诊。他严重抑郁，感到绝望、失眠和自杀意念。他在一周前卒中，影响了左扣带回前部，导致右侧偏瘫和感觉异常。精神症状在卒中后立即出现，在事件发生前不存在。他被收入精神科病房，接受舍曲林 100mg/天和喹硫平 50mg/天治疗，28 天内症状完全缓解后出院。我们的病例加强了位于额皮质下回路的病变与卒中后抑郁之间的关联。医生应该警惕卒中患者发生抑郁，尤其是那些患有影响额皮质下回路和相关区域的病变的患者。
