Department of Psychiatry, Telemark Hospital, 3710 Skien, Norway.
Faculty of Medicine, Department of Behavioral institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
J Psychosom Res. 2022 Nov;162:111016. doi: 10.1016/j.jpsychores.2022.111016. Epub 2022 Aug 24.
Estimate the prevalence of anxiety disorders, depressive disorders and apathy two years after stroke, examine their longitudinal course, describe the course of psychological distress through two years after stroke, and evaluate Hospital Anxiety and Depression Scale HADS-A and HADS-D cut-off scores of ≥4 and ≥ 8 for detection of anxiety and depressive disorders two years after stroke.
In a longitudinal cohort study of 150 consecutive stroke patients in a stroke unit, 103 were assessed four months and 75 two years after stroke. Anxiety and depression disorders and symptoms were assessed by the Structured Clinical Interview for DSM-IV and HADS, apathy by the Apathy Evaluation Scale.
Prevalence of at least one anxiety disorder or one depressive disorder decreased from four months to two years (23% vs 9%, P = 0.026, 19% vs 10%, P = 0.17). Apathy remained stable at 48% vs 50%. After two years, 80%, 79% and 19% of those with anxiety, depression or apathy at four months had recovered. Recovery-rates among patients with anxiety were 83% for panic disorder, 60% for generalized anxiety disorder (GAD), and 50% for social phobia.
In contrast to apathy, recovery from anxiety and depression was high. About half of the patients with GAD, social phobia or agoraphobia did not recover. Co-morbid depression and apathy at four months implied a high risk for not recovering at two years. HADS-A and HADS-D cut-off scores of ≥8 were feasible for detection of anxiety and depression disorders two years after stroke.
评估卒中后 2 年焦虑障碍、抑郁障碍和淡漠的患病率，观察其纵向病程，描述卒中后 2 年内心理困扰的病程，并评估 HADS-A 和 HADS-D 分界值≥4 和≥8 对卒中后 2 年焦虑和抑郁障碍的检测效果。
在一项对卒中单元 150 例连续卒中患者的纵向队列研究中，103 例患者在卒中后 4 个月和 75 例患者在卒中后 2 年进行评估。采用 DSM-IV 定式临床访谈和 HADS 评估焦虑和抑郁障碍及症状，采用淡漠评估量表评估淡漠。
至少有一种焦虑障碍或抑郁障碍的患病率从 4 个月到 2 年下降（23%比 9%，P=0.026，19%比 10%，P=0.17）。淡漠在 4 个月和 2 年时分别为 48%和 50%，保持稳定。在 2 年后，4 个月时有焦虑、抑郁或淡漠的患者中，80%、79%和 19%已经恢复。在有焦虑的患者中，惊恐障碍的恢复率为 83%，广泛性焦虑障碍为 60%，社交恐怖症为 50%。
与淡漠相比，焦虑和抑郁障碍的恢复率较高。大约一半的广泛性焦虑障碍、社交恐怖症或广场恐怖症患者未恢复。4 个月时伴发抑郁和淡漠提示 2 年时不恢复的风险较高。HADS-A 和 HADS-D 分界值≥8 对卒中后 2 年焦虑和抑郁障碍的检测是可行的。
