If our stroke medical 'professionals' would actually rub their two functioning neurons together the spark generated just might lead to the realization that depression treatment is totally unnecessary once 100% recovery protocols are available. Solve the primary problem of 100% recovery and you don't have to work on the secondary problem of depression. Do you blithering idiots ever think at all?
Evaluation and Treatment of Depression in Stroke Patients: A Systematic Review
Abstract
Those who received early diagnosis and treatment for poststroke depression had lower mortality rates, cognitive impairments, improved long-term disability, a higher quality of life, and lower rates of suicidal thoughts than those who did not. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were used to conduct this systematic review. Until May 1, 2022, a systematic search was conducted utilizing ScienceDirect, Cochrane, PubMed, Google Scholar, and PubMed central databases, which have been used during the previous 10 years. Randomized controlled trials (RCTs), observational studies, systematic reviews, review articles, case reports, clinical studies, and meta-analyses were included in the research, which covered post-stroke depression patients and how to identify and treat them.
There were 545 possibly related titles found in the database search. Finally, each publication was given a quality rating, and 10 studies with a score of higher than 70% were allowed into the review. Because of their brevity and ease of use, they employed the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 screening instruments in stroke patients. According to pooled studies, the risk of acquiring post-stroke depression (PSD) was lower in participants undergoing pharmacological therapy with selective serotonin reuptake inhibitors (SSRIs), especially after a year. Identifying further features of the PSD process, we believe, is the most pressing need for future study since it might lead to a more precise treatment strategy.
Introduction & Background
Among the leading causes of death worldwide and disability-adjusted life years, stroke ranks second [1]. Following that, in addition to physical disabilities, cognitive and psychological problems may also be present [1]. Stroke rates range from 10 to 20 per 10,000 people in the 50 to 64 age group, to 200 per 10,000 people in the over 85 age group [2]. As well as being a significant public health problem, stroke continues to be a major financial hardship for patients and their families, despite advances in prevention and therapy [1].
The most prevalent psychological condition following a stroke is poststroke depression (PSD) [3]. Poststroke depression affects approximately 85% of strokes and is linked to more severe functional dysfunction, poor rehabilitation outcomes, and social isolation after stroke [4]. Depressed mood apathy, weight loss or increase, sleep disturbances, exhaustion, worthlessness, and anhedonia are the primary clinical signs of poststroke depression, with the first two being the most prominent [5]. The pooled frequency of poststroke depression was 31% in a meta-analysis of 61 studies with 25,488 stroke patients, although it dropped to 25% one to five years after the stroke [6].
Stroke survivors with poststroke depression had a higher chance of poor functional recovery, recurrent episodes of cerebrovascular events, diminishing quality of life, and death than stroke survivors without depression [3]. When compared to post-stroke patients without depression, people with poststroke depression death rates are higher, cognitive deficits are more evident, long-term disability is more prevalent, quality of life is lower, and suicidal ideation is more prevalent, implying that early detection and treatment of depression are critical after a stroke [1]. Patient's quality of life after a stroke is greatly reduced when they have depression and a stroke together [7]. Mood depression, in particular, is thought to be the main determinant of quality of life in stroke survivors [8]. However, anxiety, irritability, agitation, emotional incontinence, modification of the emotional experience, sleep disturbances, behavioral disturbances such as disinhibition, apathy, fatigue, and psychotic symptoms such as delusions and hallucinations are just some of the neuropsychiatric symptoms that can appear after a stroke [9]. Some studies imply that stroke and depression have a bidirectional link. Although stroke increases the risk of depression following a stroke, depression is an independent risk factor for stroke and stroke-related death as well [1].
The Center for Epidemiological Studies Depression Scale (CESD) and the Hamilton Depression Rating Scale have both been used to assess the severity of poststroke depression [6]. Poststroke depression is diagnosed using five criteria: (a) symptoms are pathophysiologically connected to the stroke; (b) symptoms are not better explained by other psychiatric diseases; (d) disruption does not occur just in the context of delirium; (e) symptoms produce severe suffering or impairment [1]. A number of observational studies have indicated that poststroke depression could increase the risk of stroke outcomes [10]. A network approach to studying depression allows researchers to look at possible causal routes among distinct symptoms, as well as how these symptoms may reinforce one another and build feedback loops (e.g., insomnia → fatigue→ not feeling good → insomnia) [6].
This systematic review will look at how to recognize poststroke depression, as well as its prevalence, and links to physical, cognitive, and mortality impairments. We will also talk about how to treat poststroke depression, how to avoid it, what causes it, and what research we should do next.
Fist bump x's 100 on your opening comment, Dean. Definitely misdirected focus by the "Professionals"
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