Objective
To explore the impact of early psychological intervention in the treatment of stroke complicating mood disorders.
Methods
From December 2008 to December 2010, 66 patients with first-time stroke with anxiety disorder were selected and randomly divided into 33 patients in the intervention group and 33 patients in the control group using the Hamilton Anxiety Inventory.
The intervention group was given early psychological interventions, including family psychological education, behavioral interventions, supportive psychotherapy, relaxation training and, if necessary, adjunctive medication. Results: When the patients in both groups were discharged from the hospital with systematic treatment, there were statistically significant differences in HAMA, NAF, ADL scores compared with those before treatment (P0, 05), and the differences in HAMA, NAF, ADL, scores and ALOS after intervention were statistically significant compared with those in the control group (P0, 05).
Conclusion
Early psychological intervention can reduce the negative psychological state of stroke patients, and can promote the reconstruction of patients’ self-confidence and improve their ability to take care of themselves. It can shorten the length of hospitalization and promote the rehabilitation of limb function.
Cerebrovascular disease is a major cause of high morbidity, disability and death worldwide, and there are 2 million stroke patients in China every year. The incidence rate is as high as 120 per 100,000. There are now 7 million surviving stroke patients, 4.5 million of whom have varying degrees of labor loss and are unable to care for themselves. The disability rate is as high as 75% (2). Because patients generally have a sudden onset, most are accompanied by varying degrees of functional impairment, which prolongs the number of days in the hospital as they recover from the disease. This poses a great danger to the life and quality of life of patients.
Clinical treatment observation revealed that patients had up to 41, 56% of concurrent mood disorders after the first onset, in order to further observe the effect of early psychological intervention on the treatment of patients with concurrent mood disorders. We selected patients with anxiety disorders, which have a high prevalence in mood disorders, as the study subjects. We made a race selection of patients according to the Hamilton Anxiety Inventory, randomized the group and then carried out early psychological intervention and systematic follow-up study. To understand the impact of early psychological intervention in the recovery of the disease and on the prognosis, so that the patients can obtain the maximum recovery physically and mentally.
Materials and methods.
Subjects: Inpatients in our department were screened for first occurrence of stroke disease, and all patients met the diagnostic criteria established by the National Cerebrovascular Conference. Those with a Hamilton Anxiety Inventory (HAMA) score greater than 10 or more were used. All the enrolled patients were first-onset, conscious, and had a relevant lesion confirmed by cranial CT or MRI and corresponding clinical signs. Exclusion criteria: patients with previous history of hypertension, coronary artery disease, diabetes mellitus and mood disorders.
A total of 66 patients were enrolled and divided into control and intervention groups using a regional group randomization method. There were 33 cases in the intervention group, including 18 males and 15 females, aged 36-76 years, with a mean age of 60, 75 ± 10, 85 years. There were 33 cases in the control group: 13 males and 20 females, 38-77 years old, with a mean age of 61, 38±9, 72 years. The gender, age, and disease type of the two groups were not statistically significant (P0, 05), and they were not comparable.
Methods
Conventional treatment of cerebrovascular disease was given to all participating patients, and the intervention group was given early psycho-behavioral intervention on the basis of conventional treatment including:
1, establishing a good doctor-patient relationship, obtaining the trust of patients and their families, and increasing the dependence of patients.
2. Provide good guidance on disease knowledge. The onset of stroke is sudden, and patients and their families are usually not psychologically prepared to accept the reality. The patient and family are usually unprepared and have difficulty in accepting the reality. According to the patient’s condition, explain to the family the development and prognosis of the disease, eliminate the family’s nervousness, and obtain the cooperation of the family. The patient’s initial onset, the patient’s psychological changes are relatively strong, combined with the patient’s personality characteristics, help the patient to understand the disease early and change roles. Overcome bad mood, cultivate and maintain an optimistic and positive attitude.
3, patients in hospital according to the patient’s own characteristics, combined with the patient’s relevant background. Appropriate selection of psychological counselling, listening to the patient’s confession, behavioral intervention, psychological support and relaxation training. Auxiliary anti-anxiety drugs and other professional treatment when necessary. Also provide strong family and social support to the patient to promote recovery.
Measurement methods
The HAMA, NAF, ADL, scores of patients at the time of admission and at the time of discharge were measured by dedicated personnel, before and after treatment, and the intervention group was compared with the observation group. ALOS of the intervention group and the observation group were also compared.
Statistical analysis
All statistical data were analyzed by SPSS system, and data were expressed as mean ± standard deviation (x-±s). The t-test was used before and after treatment and between groups, and the difference was considered statistically significant at P0 and 05.
Discussion
The mechanism of stroke complicating anxiety may be related to abnormalities in central neurotransmitters and abnormalities in norepinephrine and 5-hydroxytryptamine (5-HT) metabolism due to oxygen radical damage during stroke (4), and is inextricably linked to psychological and social factors. Somatic changes in patients after stroke onset lead to psychological imbalance and difficulty in accepting reality. Neglect of psychological changes in treatment and poor family and social support make patients feel frustrated and helpless, which can lead to anxiety symptoms.
Post-stroke anxiety not only causes great mental pain to patients, but also seriously affects patients’ neurological impairment and quality of life, and even increases patients’ mortality. It prolongs patients’ hospitalization time, wastes medical resources and increases the burden on families. Early psychological interventions for patients are particularly important. The practice of this group shows that early psychological interventions can effectively alleviate or reduce post-stroke anxiety. It effectively improves the recovery of neurological function and the quality of life of patients, and shortens their hospitalization time. It is worth to draw clinical attention.