[Clinical study on depressive state following stroke]

Abstract

A clinical study was made on depressive state following stroke using stroke patients in the chronic stage. There were 118 stroke patients in the present study and 25 patients (21.2%) satisfied the diagnostic criteria for major depressive syndrome of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R). As for dispositional, social, and somatic factors, a tendency was observed for depressive state to develop at a high frequency among patients with a past history of mental disorder prior to development of stroke, patients residing in suburban area, patients engaged in domestic and agricultural work, and patients with a frequent history of physical disorders. A tendency was observed for depressive state to develop at a high frequency among patients showing B type in YG test and patients presenting laterality in electroencephalography. Among the 49 right stroke patients, depressive state was observed in 10 cases (20.4%), while among the 43 left stroke patients, depressive state was seen in 10 cases (23.2%) with the incidence of depressive state showing no difference by hemisphere stroke. Study of the clinical characteristics of depressive state by hemisphere stroke with the use of symptom items of Zung scale and Hamilton scale showed that patients in depressive state with right hemisphere stroke had high values in symptom items considered close to the essence of endogenous depression such as depressed mood, suicide, diurnal variation, loss of weight, and paranoid symptoms, while patients in depressive state with left hemisphere stroke had high values in symptom items having a nuance of so-called neurotic depression such as psychic anxiety, hypochondriasis, and fatigue. Comparison with endogenous depression patients indicated that right stroke patients rather than left stroke patients showed a clinical picture suggestive of endogenous depression. Antidepressant was effective in 71.4% of the cases, but no difference in effectiveness could be observed by hemisphere stroke. In stroke patients in the chronic stage the incidence of clinical depressive state was higher than 20%, and involved in its onset were not only brain organ lesions but also dispositional, social, and somatic factors and integration dysfunction in the emotional activity of the left and right hemisphere functions. As for the clinical picture, a picture considered close to endogenous depression was observed in right stroke patients, while that considered close to so-called neurotic depression was seen in left stroke patients. The therapeutic effect of antidepressant was almost equivalent to that for endogenous depression.