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Randomized Controlled Trial
. 2012 Oct;27(10):1053-60.
doi: 10.1002/gps.2822. Epub 2012 Jan 16.

Ecosystem focused therapy in poststroke depression: a preliminary study

George S Alexopoulos  1 , Victoria M Wilkins, Patricia Marino, Dora Kanellopoulos, Michael Reding, Jo Anne Sirey, Patrick J Raue, Samiran Ghosh, Michael W O'Dell, Dimitris N Kiosses
Affiliations
Randomized Controlled Trial

Ecosystem focused therapy in poststroke depression: a preliminary study

George S Alexopoulos et al. Int J Geriatr Psychiatry. 2012 Oct.

Abstract

Objective: Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy.

Design: A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks.

Results: Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability.

Conclusion: These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.

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Figures

Figure 1
Figure 1
Trajectory of Depressive Symptoms in Subjects with Post-Stroke Major Depression Receiving Ecosystem Focused Therapy (EFT; N=12) or Education on Stroke and Depression (ESD; N=12) HAM-D: Hamilton Depression Rating Scale
Figure 2
Figure 2
Trajectory of Disability in Subjects with Post-Stroke Major Depression Receiving Ecosystem Focused Therapy (EFT; N=12) or Education on Stroke and Depression (ESD; N=12) WHODAS-II: World Health Organization Disability Assessment Schedule-II
See this image and copyright information in PMC

References

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