7 April 2005 Mood Disorders in Post Stroke Patients in Hong Kong
¡@¡@Post stroke depression (PSD) adversely affects the speed of recovery, length of stay in hospital, functional outcome, quality of life, suicide rate, and mortality. Oversea studies indicated the frequency of PSD in Chinese populations ranging from 33 to 55%. ¡@¡@The Chinese University of Hong Kong conducted a local study in 1999 and examined the frequency of PSD in 157 Chinese first time stroke patients, using vigorous assessment. All subjects were interviewed by a qualified psychiatrist. It was found that the frequency of all depressive disorders was 17.2%. Major depressive episodes, adjustment disorder with depressed mood and dysthymia were diagnosed in 7.6%, 8.2% and 1.3% of the subjects, respectively. The majority of depressed subjects were in remission at the follow-up assessment. ¡@¡@In 2002, another study was conducted to evaluate the psychosocial, clinical, and radiological predictors of PSD in Chinese patients. 189 patients participated in the study. Three months after the index stroke, a psychiatrist made a diagnosis of depression. Thirty-one (16.4%) of the subjects had a diagnosis of PSD that included major depression (n=11, 5.8%,), minor depression (n=16, 8.5%,), or dysthymia (n=4, 2.1%,). Risk factors for PSD included a female gender, a lower level of education, subcortical infarcts, more life events in the previous 12 months, and lesions in the anterior cerebral artery territory. A high level of social support was a protective factor. ¡@¡@Another common mood disorders inflicting post stroke patients is emotional incontinence. Emotional incontinence (EI) is a condition defined by virtually uncontrollable episodes of laughter, crying, or both. Post stroke EI is a distressing and socially disabling problem. It affects 16 to 29% of all stroke survivors. Antidepressant is an effective treatment of EI. Of the few studies published on post stroke EI, none has investigated a consecutive stroke cohort in a Chinese population. ¡@¡@In 2002, we examined the frequency and the clinical and radiological correlates of EI in Chinese stroke patients in Hong Kong. Three months after their admission, a psychiatrist interviewed 127 stroke patients who were consecutively admitted to the medical wards of a university-affiliated regional hospital. The frequency of EI was 17.9% according to Kim's criteria and 6.3% according to House's criteria. 40% of all patients with EI also had concurrent PSD. Risk factors for EI were a younger age, previous history of depression, a higher National Institutes of Health Stroke Scale total score and cortical infarcts. ¡@¡@Although mood disorders affect many post stroke patients, treatment to the problems has been effective, concluded researchers at the Chinese University. Patients and their carers should have a heightened awareness of the problem and seek for professional help. |