Black K J
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
South Med J. 1995 Jul;88(7):699-708. doi: 10.1097/00007611-199507000-00001.
Neurobehavioral sequelae of strokes can limit a patient's ability to describe or express emotion, can cause him to give "yes" answers to the clinician who expects them, or can directly cause apathy or crying spells. Also, anosognosia for depressive signs can cause the patient to deny depressive signs that are objectively observable. These diagnostic confounders have not been adequately assessed in previous research on poststroke depression; thus many studies are of doubtful validity, as shown by studies of the dexamethasone suppression test for melancholia in stroke patients. Future studies on depression after stroke must prospectively rule out fluent aphasia, motor aprosody, and amnesia before relying on diagnostic information from the psychiatric interview, and the interview should always be supplemented by direct observation of vegetative signs and other behavior. With this extended information, major depression can and should be diagnosed using accepted symptom and duration criteria.
中风的神经行为后遗症会限制患者描述或表达情感的能力，可能导致其对预期得到肯定回答的临床医生给予“肯定”答复，或者直接导致冷漠或哭泣发作。此外，对抑郁症状的失认症可能导致患者否认客观上可观察到的抑郁症状。在先前关于中风后抑郁症的研究中，这些诊断混杂因素尚未得到充分评估；因此，许多研究的有效性存疑，中风患者忧郁症的地塞米松抑制试验研究就表明了这一点。未来关于中风后抑郁症的研究必须在依赖精神科访谈的诊断信息之前，前瞻性地排除流利性失语症、运动性韵律障碍和失忆症，并且访谈应始终辅以对植物神经体征和其他行为的直接观察。有了这些扩展信息，就可以且应该使用公认的症状和持续时间标准来诊断重度抑郁症。
