Assessing Post-Stroke Depression - #2
Take QuizLearn to assess post-stroke depression (PSD).
1. Clinical Assessment Tools
- Self-Administered Mood Scale: These assessments include the Beck Depression Inventory and PH-9 questionnaire. Patients answer a short series of questions assessing common depression symptomatology.
- Beck Depression Inventory http://www.fpnotebook.com/psych/exam/bckdprsninvntry.htm
- PHQ-9 Questionnaire
- Interviewer-Administered Questionnaires: These assessments include the Hamilton Depression Rating scale and Clinical Global Impression scale. The questionnaires are administered by a primary health care provider or psychiatrist at scheduled visits.
- Hamilton Depression Rating Scale http://healthnet.umassmed.edu/mhealth/HAMD.pdf
- Clinical Global Impression http://miksa.ils.unc.edu/unc-hit/media/CGI.pdf
- Other: The DSM-IV criteria has demonstrated acceptable sensitivity and specificity in diagnosing PSD5
- DSM-IV criteria http://www.mental-health-today.com/dep/dsm.htm
2. Common Symptoms of PSD
- Depressed mood: feeling apathetic, sad, helpless, hopeless
- Feelings of guilt: a common symptom of major depressive episodes that may not be present in PSD patients
- Suicide: thoughts or attempts, homicide
- Insomnia hypersomnia: difficulty falling sleep (early), difficulty staying sleep (middle), or waking early in the morning (late)
- Work & activities: loss of interest in daily activities, loss in ability to work, loss of enjoyment in activities (anhedonia)
- Psychomotor retardation: slowness of thought and speech, impaired ability to concentrate, decreased motor activity
- Agitation & Irritability: fidgeting, hand-wringing, nail-biting
- Anxiety: psychological (fears, worrying) and somatic (sweating, indigestion, stomach cramps, diarrhea, palpitations, hyperventilation, paresthesia, flushing, tremor, headache)
- Somatic symptoms: GI (loss of appetite, weight loss) or general (back aches, heaviness in limbs, headache, muscle aches)
- Sexual symptoms: loss of libido, impaired performance
3. Differential Diagnosis Assessment:
- It is important to consider apathy in the differential diagnosis of PSD. Apathy is common in PSD patients and may be mistaken for PSD. The apathy inventory (AI) is a valid & reliable assessment in diagnosing apathy6 /sites/default/files/editor/fastfacts/benoit%20robert%20IA%20Apathy%20Inventory.pdf
- Cognitive deficits
- Fatigue
- Anosognosia-lack of awareness, denial or underestimate of sensory, cognitive of affective impairment (60% in R-CVA, 24% L-CVA)
- Poststroke Anxiety Disorder (highly comorbid with PSD, up to 75%8)
- Pseudobulbar affect (affective disinhibition syndrome)
- Vascular Depression (associated with cerebrovascular disease (silent strokes)
Other:
- Mood disorder due to generalized condition
- Substance induced mood disorder
- Dysthymic disorder
- Unrecognized schizoaffective disorder
- Dementia
Geriatric Stroke Patient Follow-Up Visit
Assessment of post-stroke depression (PSD) is a complex task that does not lend itself to a single evaluation tool. Research has shown that a self-administered mood scale or interview-administered questionnaires can identify depressive symptoms.
The incidence of depressive symptoms within 6 months to 2 years post-stroke is estimated at over 33%. Patients who have suffered transient ischemic attacks (TIAs) may also be at an increased risk for depression. Abnormal mood may impede functional recovery by impairing physical and cognitive function3. Post-stroke depression (PSD) may also be associated with an increased risk of death, including death by suicide. Elderly post-stroke patients must be evaluated frequently at each scheduled visit as a preventative measure and to determine underlying etiology if changes.
Science Principles
Recognize and assess post-stroke depression in elderly patients.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Hackett, ML, Anderson, CS. (2005). Predictors of depression after stroke: A systematic review of observational studies Stroke. 36(10), 2296-2301. http://www.ncbi.nlm.nih.gov/pubmed/16179565
- Luijendijk HJ. Stricker BH. Wieberdink RG. Koudstaal PJ. Hofman A. Breteler MM. Tiemeier H. (2011). Transient ischemic attack and incident depression. Stroke. 42(7), 1857-61. http://www.ncbi.nlm.nih.gov/pubmed/21566240
- Mikami K. Jorge RE. Adams HP Jr. Davis PH. Leira EC. Jang M. Robinson RG.(2011) Effect of antidepressants on the course of disability following stroke. American Journal of Geriatric Psychiatry. 19(12):1007-15. http://www.ncbi.nlm.nih.gov/pubmed/21358384
- Andersen G, Vestergaard K Ingemann-Nielsen M, Lauritzen L.(1995). Risk factors for Post-Stroke Depression. Acta Psychiatry. Scand. 92(3), 193-8. http://www.ncbi.nlm.nih.gov/pubmed/7484197
- Berg, A, Lonnqvist J, Pahomaki H, Kaste M.(2009). Assessment of Depression After Stroke: A Comparison of Different Screening Instruments. Stroke. 40:523-529. http://www.ncbi.nlm.nih.gov/pubmed/19074478
- Robert PH, Clairet S, Benoit M, Koutaich J, Bertogliati C, Tible O, Caci H, Borg M, Brocker P, Bedoucha P.(2002) The Apathy Inventory: assessment of apathy and awareness in Alzheimer’s disease Parkinson’s disease and Mild cognitive impairment. International Journal of Geriatric Psychiatry, 17: 1099 – 1105. http://www.ncbi.nlm.nih.gov/pubmed/12461757
- Hackett ML, Anderson, CS, House A, Halteh C. (2008). Interventions for Preventing Depression After Stroke. Cochrane Database Syst. Rev. July 16 (3) CD003689. http://www.ncbi.nlm.nih.gov/pubmed/18646094
- Åström M. (1996) Generalized Anxiety Disorder in Stroke Patients: A 3-Year Longitudinal Study. Stroke. 27:270-275. http://www.ncbi.nlm.nih.gov/pubmed/8571422
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