But who the hell is going to do the same research for stroke patients?
I was anxious since my doctor told me nothing, no diagnosis of what damage I had, no explanation of what stroke protocol I would be using, nothing on what recovery would look like. Anybody who gets such little to no information after a stroke has a perfect right to be anxious, angry and depressed. And I lay it all on the feet of the stroke medical world. Don't start blaming stroke patients for feeling anxious/depressed, we have every right.
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/39845?
AHA guidelines recommend screening heart patients for depression, but
it may be time to also screen for anxiety, researchers reported.
Of the 210 patients who received a diagnosis, generalized anxiety
disorder (GAD) was nearly as prevalent as depression (129 versus 143),
according to Christopher M. Celano, MD, of Massachusetts General
Hospital in Boston, and colleagues.
Investigators added that the GAD-2 scale was a robust and effective
screening tool for cardiac patients, they wrote in the study published
online in
Circulation: Cardiovascular Quality and Outcomes.
Panic disorder was rare in this group of patients, with only 30 receiving a diagnosis.
The mean age of screened patients was 66 and two-thirds were men.
In 2008, the American Heart Association (AHA) published
recommendations suggesting that all cardiac patients undergo a two-step
screening process for depression (
Circulation 2008; 118: 1768-1775).
The AHA recommended starting with the Patient Health Questionnaire-2
(PHQ-2), and if the test was positive, follow up with the nine-item
PHQ-9.
The study "confirms and expands on the current screening literature in several ways," Celano and colleagues said.
The multi-step study is consistent with other studies that evaluated the AHA-recommended screening process.
But the current paper is the first to "describe systematic
three-stage screening for anxiety disorders and depression in
hospitalized patients with cardiac disease."
The first step was the Coping Screen, a series of four yes/no
questions that helped to identify the presence or absence of fear,
depression, anxiety, and irritability.
But this technique was much less robust than the other tests, and
researchers said as a means to streamline the screening process, they
would no longer use the Coping Screen.
The positive predictive value (PPV) of the Coping Screen was 6% for depression, 7% for GAD, and 1% for panic disorder.
In contrast, the five-item screen (PHQ-2, PHQ-9, and PRIME-MD) had an
overall PPV of 20% for depression, 18% for GAD, and 4% for panic
disorder.
Researchers noted an improved PPV when evaluating the individual components of the five-item screen:
- PHQ-2 (32% for depression)
- GAD-2 (20% for GAD)
- PRIME-MD (27% for panic disorder)
The Coping Screen was associated with a diagnosis of depression in
the multivariate logistic regression, but none of the other items were
associated with a diagnosis of a psychiatric disorder.
On the other hand, all items on the five-item screen were associated with a diagnosis of a psychiatric disorder.
Celano and colleagues noted that the association of PHQ-2 with
depression and the subsequent diagnosis of depression made with the
PHQ-9 "seems to confirm the use of the two-stage screening for
depression recommended by the AHA."
They cautioned, however, that a systematic depression management
protocol should be in place for facilities that implement a two-stage
screening program.
Researchers lamented the "abysmal" low number of patients that
actually finished all three stages of the evaluation -- only 581
patients out of 6,210 completed portions of all three evaluation steps.
One of the problems with the low rate of return was that patients
would be discharged before they could complete the entire evaluation.
Nevertheless, the screening tools are well validated and brief, ideal for a busy inpatient cardiac unit, they said.
Limitations of the study include the inability to determine the true
prevalence rates of clinical depression, GAD, and panic disorder; the
potential for overestimating the power of the five-item screen;
potential variability in the administration of the Coping Screen; and a
fairly homogeneous patient population from one center.
And if more stroke patients
get anti-depressants, all the better because those who get them have better recoveries.
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