Abstract W P384: De-Depress: Detection of Post Stroke Depression in the Outpatient Setting; the Interim Analysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Daniel Ackerman ◽  
Diana L Tzeng ◽  
Maria C Pineda
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Screening Program ◽  
Historical Control ◽  
Screening Tools ◽  
Depression Screening ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Stroke is a major contributor to death and disability. For those who survive the initial incident, post stroke depression (PSD) represents a significant modifiable contributor to morbidity and mortality. The incidence of PSD is estimated between 9-50%, and may be higher as some prior studies have excluded those with communicative or cognitive impairments. We hypothesize that a depression screening program will significantly increase the rate of PSD detection and treatment, and can be implemented at a minimum of cost. Our primary objective is to evaluate the effectiveness and feasibility of initiating a depression screening program in the outpatient clinic of a comprehensive stroke center. Methods: This study is designed as a cross-sectional interventional prospective study with a historical control; divided into two phases. Phase I served as the control, wherein data was derived from a retrospective chart review of all patients newly presenting during 2013 with a diagnosis of ischemic stroke. Those already taking antidepressants or with a known mood disorder were excluded. Phase II began in 3/2014 with the initiation of a depression screen (via two validated screening tools, the Patient Health Questionaire-9 (PHQ-9), and the Aphasia Depression Rating Scale (ADRS)), and is ongoing at this time. Odds ratio, relative risk and absolute risk of a diagnosis of PSD will be calculated using a 2x2 table and the CHI-Squared method and compared with the historical control established in Phase I as well as expected norms. Interim Results: During Phase I, 591 new patient charts were reviewed with 268 qualifying for analysis. A diagnosis of PSD occurred in 13 patients (4.9%). The mean time from stroke to follow up was 5.75 months (1.85 in those diagnosed with PSD and 5.95 in those not diagnosed). Conclusion: Phase I of the De-Depress trial confirms a prevalence of PSD of 4.9% in the outpatient population of the cerebrovascular clinic at a comprehensive stroke center. We hypothesize that this is a result of under-recognition of this common condition, and will evaluate in phase II the effect of a simple depression screening program, implemented at a minimum of cost in time and resources.

Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening

2016 ◽  
Vol 11 (5) ◽  
pp. 509-518 ◽  
Author(s):  
Richard H Swartz ◽  
Mark Bayley ◽  
Krista L Lanctôt ◽  
Brian J Murray ◽  
Megan L Cayley ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cognitive Impairment ◽  
Sleep Apnea ◽  
Routine Screening ◽  
Screening Tools ◽  
Stroke Recurrence ◽  
Post Stroke ◽  
Obstructive Sleep ◽  
Post Stroke Depression ◽  
The Impact

Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment (“DOC”). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA.

Abstract T P279: Recognizing Depression in the Stroke Patient

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Rose M Donnelly ◽  
Jo-Ann Burns
Keyword(s):  
Stroke Patient ◽  
Screening Tool ◽  
Gap Analysis ◽  
Stroke Recovery ◽  
Depression Screening ◽  
Depression Symptoms ◽  
Post Stroke ◽  
Patient Health ◽  
Patients At Risk ◽  
Comprehensive Stroke Center

Depression is a frequent sequela of stroke that has been associated with poor recovery and rehabilitation response. Clinical depression may occur within 3 months post stroke and can last for several years if left untreated. Utilization of a depression screen helps identify patients at risk for post-stroke depression. It is important to recognize and treat depression symptoms early to improve patient outcomes. In performing a gap analysis in preparation for our survey for Comprehensive Stroke Center Certification, it became apparent this psychological aspect of patients was not being met. A systemic literature review was performed in search of a depression screening tool that was easy to use and addressed the needs of the patient. The tool chosen is the validated 2-item Patient Health Questionnaire depression module (PHQ-2). This depression screen is also utilized in our rehabilitation center which enhances the communication between our facilities. After educating all the neuroscience nursing staff and stroke physicians, the tool became part of the patient assessment. The nurse screens each stroke patient on admission to the division or transfer from the intensive care unit. If the patient scores 3 or greater, the physician is notified so appropriate follow-up and treatment can occur. If a patient is unable to be assessed, the physician is notified so other depression assessment measures can be considered. The utilization of a depression screening tool along with staff education has increased our staff’s awareness of the potential devastating effects depression can have on stroke recovery.

Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1-year prospective follow-up study

2006 ◽  
Vol 18 (1) ◽  
pp. 19-35 ◽  
Author(s):  
I. Aben ◽  
J. Lodder ◽  
A. Honig ◽  
R. Lousberg ◽  
A. Boreas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Damage ◽  
Rating Scales ◽  
Screening Tools ◽  
Vascular Depression ◽  
Lesion Location ◽  
Post Stroke ◽  
Negative Results ◽  
Post Stroke Depression ◽  
One Year

Background: Both the lesion location hypothesis and the vascular depression hypothesis have been proposed to explain the high incidence of depression in stroke patients. However, research studying both hypotheses in a single cohort is, at present, scarce.Objective: To test the independent effects of lesion location (left hemisphere, anterior region) and of co-occurring generalized vascular damage on the development of depression in the first year after ischemic stroke, while other risk factors for depression are controlled for.Methods: One hundred and ninety consecutive patients with a first-ever, supratentorial infarct were followed up for one year. CT was performed in the acute phase of stroke, while in 75 patients an additional MRI scan was also available. Depression was assessed at 1, 3, 6, 9, and 12 months after stroke using self-rating scales as screening tools and the SCID-I to diagnose depression according to DSM-IV criteria.Results: Separate analyses of the lesion location hypothesis and the vascular depression hypothesis failed to reveal significant support for either of these biological models of post-stroke depression. Similar negative results appeared from one overall, multivariate analysis including variables of both focal and generalized vascular brain damage, as well as other non-cerebral risk factors. In addition, level of handicap and neuroticism were independent predictors of depression in this cohort, as has been reported previously.Conclusion: This study supports neither the lesion location nor the vascular depression hypothesis of post-stroke depression. A biopsychosocial model including both premorbid (prior to stroke) vulnerability factors, such as neuroticism and (family) history of depression, as well as post-stroke stressors, such as level of handicap, may be more appropriate and deserves further study.

scholarly journals Correction: Acute post stroke depression at a Primary Stroke Center in the Middle East

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0212919 ◽  
Author(s):  
Stacy Schantz Wilkins ◽  
Naveed Akhtar ◽  
Abdul Salam ◽  
Paula Bourke ◽  
Sujatha Joseph ◽  
...  
Keyword(s):  
Middle East ◽  
Post Stroke ◽  
Primary Stroke Center ◽  
Post Stroke Depression ◽  
Stroke Center

Abstract WP401: What Goes Around Comes Around: The Impact of Adding the Stroke Coordinator to Daily Rounds

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Suzanne Stone ◽  
Amanda Dirickson
Keyword(s):  
Quality Care ◽  
Depression Screening ◽  
Advanced Practice ◽  
Prospective Data ◽  
Program Manager ◽  
Multidisciplinary Rounds ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact

Background: Multidisciplinary rounds have classically consisted of the attending, advanced practice providers, residents and fellows. For most large comprehensive stroke centers (CSC), the stroke coordinator role is not intimately engaged in these teaching rounds thus disconnected from the team during focused discussions on care management. In order to advance the quality and comprehensiveness of patient care the stroke coordinator was added to clinical rounds. Purpose: We propose allocating dedicated time to the stroke coordinator role for daily morning rounds with the stroke neurologist and team to increase compliance with quality care measures. Method: Following the core and care team measures required for certification of a comprehensive Stroke Center, the stroke program manager selected three targets for improvement from the provider team and collected retrospective and prospective data for comparison once implementing the role change. Baseline patient data (collected the year prior to initiation of the stroke coordinator at rounds, was compared to patient safety and quality variables after initiation of rounds. Results: The action of provider intervention triggered by scoring threshold in depression screening improved a yearly mean of 52% to 82%. The documentation of rTPA compliance went from a mean of 0% to 94%, The timely documentation of NIHSS as a severity score in acute ischemic stroke rose from a mean of 90% to 93% Conclusions: Each of the metrics reflect Improvement over time. During rounds the coordinator would actively discuss gaps in care including documentation of eligibility for TPA, team action on patients with high scores on depression screening and timely documentation of NIHSS. In addition, the stroke coordinator reflected feeling more like a team member and not an "outsider looking in". It can further be hypothesized that the team remained very receptive to suggestions in the care of stroke patients, as the stroke coordinator was well known to them and available for questions and discussion each day. The closer role of stroke coordinator is still ongoing due to its success.

Abstract TP151: Box Checking for Comprehensive Stroke Care Metrics of Depression Screening: Does It Actually Equate to Better Treatment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Parneet Grewal ◽  
Ray Mirembo ◽  
William Mathias ◽  
Jessica D Lee
Keyword(s):  
Depressive Symptoms ◽  
Parietal Lobe ◽  
Antidepressant Treatment ◽  
Retrospective Chart Review ◽  
Screening Tools ◽  
Appointment Adherence ◽  
Post Stroke ◽  
Common Location ◽  
Post Stroke Depression

Objective: One in three stroke patients develop depression following the event. The exact cause of post stroke depression has been debated but may be due to brain injury resulting from stroke and psychological factors. We aimed to 1) Discover frequency of patients suffering from depressive symptoms post-stroke 2) Ascertain whether occurrence of post-stroke depression plays a role in adherence to follow up appointment 3) Determine the frequency of antidepressant treatment post-stroke and 4) Identify location of stroke most commonly associated with depression. Methods: We conducted a single institution, retrospective chart review of patients ≥18 years, discharged with ischemic stroke from October2017 - March2018. Variables such as age, sex, location of stroke, discharge PHQ9 score, depression treatment and follow up appointment adherence were determined. Results: In our cohort of 200 patients (48.5% M, 51.5% F), 28 (14.0%) had pre-existing diagnosis of depression. The mean PHQ9 on discharge was 5.32±5.16 (n=145, deficits too severe to obtain PHQ9 in 55 subjects), with 66 (45.5%) of patients having PHQ9 ≥5 at discharge, indicating at least mild depressive symptoms. While there was no difference in discharge NIHSS or modified Rankin scores, females were twice as likely to experience at least mild depressive symptoms post-stroke as compared to males (66.7% vs 33.3%, p=0.002). Only 19 patients with PHQ9≥5 at discharge were started or continued on antidepressants. On subgroup analysis of patients with PHQ9 ≥5 (n=66), the three most common locations of stroke, in descending order were right parietal (20, 30.3%), left subcortical (14, 21.2%) and right frontal (13, 19.6%). No association was found between discharge PHQ9 score and follow up appointment adherence. Conclusion: Discharge PHQ9 scores irrespective of treatment do not play a predictive role in follow up appointment adherence. Females were more likely than males to experience post stroke depression; and while depressive symptoms are common, patients were unlikely to be prescribed antidepressant therapy. The most common location of stroke associated with depression was right parietal lobe. Such patients should be assessed closely for symptoms of depression with standardized screening tools.

scholarly journals Acute post stroke depression at a Primary Stroke Center in the Middle East

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0208708 ◽  
Author(s):  
Stacy Schantz Wilkins ◽  
Naveed Akhtar ◽  
Abdul Salam ◽  
Paula Bourke ◽  
Sujatha Joseph ◽  
...  
Keyword(s):  
Middle East ◽  
Post Stroke ◽  
Primary Stroke Center ◽  
Post Stroke Depression ◽  
Stroke Center

Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program

2017 ◽  
Vol 30 (9) ◽  
Author(s):  
Majid Valizadeh ◽  
Farzaneh Moezzi ◽  
Zohreh Khavassi ◽  
Mohammad Movahedinia ◽  
Seideh Mazloomzadeh ◽  
...  
Keyword(s):  
Phase I ◽  
Congenital Hypothyroidism ◽  
Phase Ii ◽  
Screening Program ◽  
Recall Rate ◽  
Local Hospital ◽  
Screening Programs ◽  
Blood Specimens ◽  
Heel Prick ◽  
Tsh Levels

AbstractBackground:The proportion of newborns recalled during neonatal screening programs for congenital hypothyroidism (CH) varies substantially by country and may be higher in settings where povodine iodine (PVP-I) is used during delivery. We assessed this hypothesis by substituting PVP-I for chlorhexidine (CHL) and evaluated the reduction in the recall rate of the Irainian newborn screening program.Methods:This study investigated 2282 neonates of mothers admitted to a local hospital for delivery between December 2012 and October 2013. We measured thyorid stimulating hormone (TSH) levels in heel-prick blood specimens of infants, aged between 3 and 5 days, born to mothers who received PVP-I (phase I) and those who received CHL after withdrawal of PVP-I from obstetric procedures (phase II). Then we compared the median TSH levels and the recall rate based on a TSH level ≥5 mU/L.Results:Of 2282 cases, 1094 infants were born to mothers exposed to PVP-I during phase I (PVP-I group) and 1188 ones were born to mothers exposed to chlorhexidine in phase II (CHL group); 6.56% of the PVP-I group and 1.91% of the CHL group were recalled later during screening (p<0.001). The median TSH level was significantly higher in the PVP-I group compared to the CHL group (1.35 vs. 1.00, p<0.001).Conclusions:Replacement of iodine-containing antiseptics by iodine-free ones, during delivery resulted in a significant reduction in the recall rate of the Iranian screening program for CH.

Post-stroke depression screening using the depression intensity scales circles in the UAE

2019 ◽  
Vol 405 ◽  
pp. 92
Author(s):  
S. Al Jarrah ◽  
S. AlQaydi ◽  
F.T. Thajudeen ◽  
R. Radhakrishnan
Keyword(s):  
Depression Screening ◽  
Post Stroke ◽  
Post Stroke Depression

Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Alyssa J Herzig ◽  
Nancy Mayo ◽  
Syd Miller
Keyword(s):  
Length Of Hospital Stay ◽  
Critical Factor ◽  
Self Report ◽  
Screening Tools ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
C Statistic ◽  
Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

Sign in / Sign up

Export Citation Format

Share Document