Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China; Department of Neurology, Xinhua Hospital Chongming Branch, Shanghai, China.
Department of Neurology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, China.
J Stroke Cerebrovasc Dis. 2022 Feb;31(2):106225. doi: 10.1016/j.jstrokecerebrovasdis.2021.106225. Epub 2021 Nov 24.
Post-stroke depression (PSD) is a common psychiatric complication of stroke and is associated with the subsequent prognosis, yet still lacking of enough attention. PSD is preventable, and psychotherapy is an alternative prophylactic treatment which needs more solid evidences to confirm its efficacy. In this study, group Acceptance and Commitment Therapy (G-ACT) was performed in acute stroke patients to see if it can effectively relieve depressive symptoms and improve neurological function. The efficacy was also evaluated in stroke patients of different severity.
One hundred and four hospitalized patients with acute ischemic stroke were enrolled according to the inclusion criteria and exclusion criteria. After baseline evaluation, they were randomly allocated to the intervention (G-ACT) group and the control (usual care) group. Patients in the control group received routine stroke treatment, while those in the intervention group were given additional G-ACT treatment (5 sessions, 45-55 min/session). Both of the two groups were assessed with 24-item Hamilton Depression Scale (HAMD-24), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI) at baseline, 2 weeks, 1 month, and 3 months follow-up. Patients were further divided into the mild stroke group (NIHSS 0-3) and the moderate stroke group (NIHSS 4-9), HAMD scores at different time points were also assessed.
The HAMD score of G-ACT group was significantly lower than that of control group at 1 month (p = 0.018) and 3 months follow-up (p = 0.001). As to the NIHSS score, there was no significant difference between the two groups within the follow-up period (p > 0.05). The BI score of the two groups was statistically different at 2 weeks (p = 0.033) and 1 month (p = 0.019), while no difference was shown at 3 months (p = 0.191). In acute phase, the HAMD score of moderate stroke patients was significantly higher than that of mild ones (p < 0.001). After G-ACT treatment, both mild and moderate stroke patients showed lower HAMD score at 3 months follow-up (p = 0.004; p = 0.033).
G-ACT seems to be a viable and effective treatment for preventing PSD in the acute phase of stroke, while the efficacy of which on improving neurological deficits needs to be further evaluated.
脑卒中后抑郁（PSD）是脑卒中常见的精神并发症，与随后的预后相关，但仍未得到足够重视。PSD 是可预防的，心理治疗是一种替代的预防治疗方法，需要更多确凿的证据来证实其疗效。本研究对急性脑卒中患者进行团体接受与承诺疗法（G-ACT），观察其是否能有效缓解抑郁症状，改善神经功能。同时还评估了不同严重程度的脑卒中患者的疗效。
根据纳入和排除标准，共纳入 104 例住院急性缺血性脑卒中患者。基线评估后，将患者随机分配至干预组（G-ACT 组）和对照组（常规护理组）。对照组患者接受常规脑卒中治疗，而干预组患者则接受额外的 G-ACT 治疗（5 次，每次 45-55 分钟）。两组患者均在基线、2 周、1 个月和 3 个月随访时采用 24 项汉密尔顿抑郁量表（HAMD-24）、美国国立卫生研究院卒中量表（NIHSS）和巴氏指数（BI）进行评估。患者进一步分为轻度卒中组（NIHSS 0-3）和中度卒中组（NIHSS 4-9），评估不同时间点的 HAMD 评分。
1 个月（p=0.018）和 3 个月随访时（p=0.001），G-ACT 组的 HAMD 评分明显低于对照组。在随访期间，两组的 NIHSS 评分无显著差异（p＞0.05）。两组的 BI 评分在 2 周（p=0.033）和 1 个月（p=0.019）时存在统计学差异，而在 3 个月时无差异（p=0.191）。在急性期，中度卒中患者的 HAMD 评分明显高于轻度卒中患者（p＜0.001）。经过 G-ACT 治疗后，轻度和中度卒中患者在 3 个月随访时的 HAMD 评分均降低（p=0.004；p=0.033）。
G-ACT 似乎是一种可行且有效的脑卒中急性期 PSD 预防治疗方法，但其改善神经功能缺损的疗效尚需进一步评估。
