I. What is “post-stroke depression”?
Post-stroke depression, or PSD for short, is a syndrome that occurs after a stroke and is characterized by a series of depressive symptoms and corresponding physical symptoms.
Why do we need to recognize “post-stroke depression”?
According to the recent epidemiological data, the combined incidence of PSD within 5 years after stroke is 31%! In the acute (<1 month), mid-stroke (1-6 months) and recovery (>6 months) periods after stroke, the incidence is 33%, 33% and 34%, respectively.
Numerous studies have found that PSD is closely related to the poor prognosis of stroke, which can lead not only to prolonged hospitalization, impaired neurological recovery, greater loss of independent living ability, but even to increased mortality.
Unfortunately, not only is the general public unable to recognize “post-stroke depression”, but many clinicians are also unable to recognize and manage PSD in a timely and correct manner, which affects the neurological recovery of stroke patients and leads to high rates of disability, death and recurrence among PSD patients, and even leads to cognitive impairment and mental and behavioral abnormalities. It even leads to cognitive impairment and mental and behavioral abnormalities, which seriously reduces the quality of life of patients and causes prolongation of the disease.
What causes “post-stroke depression”?
The most likely pathogenesis: The sudden onset of stroke reduces the patient’s ability to perform daily activities, neurological deficits, and changes in the social and economic environment, resulting in psychological stress disorders and imbalance in psychological balance, which may induce the development of PSD.
In addition, some studies have shown that a personal and/or family history of depression may be a risk factor for PSD.
It has also been suggested that the damage to specific parts of the brain after a stroke leads to a decrease in the amount or biological activity of some bioactive substances in the brain, such as 5-HT (5hydroxytryptamine), NE (norepinephrine) and DA (dopamine), which finally leads to the development of depressive symptoms.
4. How to recognize “post-stroke depression”?
There are various clinical manifestations of PSD, generally divided into core symptoms and non-core symptoms.
1.The “core symptoms” of PSD include.
(1) Always feel unhappy, sullen and even painful most of the time.
(2) interest and sense of pleasure is reduced or lost, the usual hobby interested in the activities or things can not be as willing to do and get pleasure from.
(3) Easily fatigued, feel less energy, most of the time every day feel that life is boring and meaningless, feel like years; often think that there is no point in living in the world, or even life is better than death; serious cases have the tendency to commit suicide.
2.The “non-core symptoms” of PSD include
(1) physical symptoms, such as weight loss, difficulty sleeping, shallow sleep and dreaminess, easy to wake up and wake up early, unexplained pain, loss of appetite or hyperactivity, loss of sexual desire, etc.
(2) May be accompanied by nervousness, anxiety, and motor agitation, etc.
(3) Other symptoms, such as indecision, reduced self-evaluation, self-blame, self-guilt, feelings of worthlessness, suicide and self-injury, and decreased concentration.
3. Other manifest characteristics of PSD.
(1) Generally do not actively narrate or conceal their adverse emotional experiences, but mostly focus on somatic symptoms such as insomnia, pain, gastrointestinal symptoms, lacrimation, forgetfulness, etc.
(2) Some present with poor compliance, leading to worsening or prolonged stroke symptoms.
(3) Since patients with PSD are often accompanied by some cognitive impairment, they may manifest as executive function impairment, memory loss, and inattention.
(4) Depressive symptoms in patients with PSD are mostly mild to moderate depression, often accompanied by anxiety or somatization symptoms.