脑卒中后抑郁的病因机制及相关治疗的研究进展
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摘要
脑卒中是一种常见的脑血管疾病,脑卒中后患者不仅出现肢体功能障碍,而且会伴发神经精神障碍,其中最常见的是脑卒中后抑郁(PSD)。关于PSD的发病机制学者们提出了很多假说,其中应用的最多的是神经递质假说,并由此提出选择性5-羟色胺再摄取抑制剂用于PSD治疗的可能性,研究证实其确实有治疗PSD的作用,但存在一定的不良反应。除药物治疗外,康复锻炼、中医药、经颅直流电刺激、高压氧以及心理疏导也可用于PSD的治疗,经临床研究证实疗效较佳。
Stroke is one of the most common cerebrovascular diseases,the patients of which not only have physical dysfunction,but also neurological disorders after stroke,and the most common is post-stroke depression( PSD). There are many hypotheses about pathogenesis of PSD,among which the most applied is the neurotransmitter,and the possibility of selective serotonin reuptake inhibitor for PSD treatment is proposed,and studies confirmed that it did have therapeutic effect on PSD,though there are certain adverse reactions. In addition to drug therapy,rehabilitation exercise,traditional Chinese medicine,transcranial direct current stimulation,hyperbaric oxygen and psychological counseling can also be used in the treatment of PSD,and clinical studies have proved the efficacy.
Stroke is one of the most common cerebrovascular diseases,the patients of which not only have physical dysfunction,but also neurological disorders after stroke,and the most common is post-stroke depression( PSD). There are many hypotheses about pathogenesis of PSD,among which the most applied is the neurotransmitter,and the possibility of selective serotonin reuptake inhibitor for PSD treatment is proposed,and studies confirmed that it did have therapeutic effect on PSD,though there are certain adverse reactions. In addition to drug therapy,rehabilitation exercise,traditional Chinese medicine,transcranial direct current stimulation,hyperbaric oxygen and psychological counseling can also be used in the treatment of PSD,and clinical studies have proved the efficacy.
引文
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[4]唐雪梅.卒中后抑郁的流行病学及病因机制的研究进展[J].国际神经病学神经外科学杂志,2011,38(3):280-284.
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[13]Zhang X,Ru B,Sha W,et al.Performance on the Wisconsin cardsorting test and serum levels of glial cell line-derived neurotrophic factor in patients with major depressive disorder[J].Asia Pac Psychiaty,2014,6(3):302-307.
[14]Zhang Y,Jiang H,Yue Y,et al.The protein and mRNA expression levels of glial cell line-derived neurotophic factor in past stroke depression and major depression disorder[J].Sci Rep,2017,7(1):8674.
[15]Nabavi SF,Dean OM,Turner A,et al.Oxidative stress and poststroke depression possible therapeutic role of polyphenols?[J].Curr Med Chem,2015,22:343-351.
[16]毕晓莹.神经内科疾病的精神心理障碍[M].上海:科学技术出版社,2015:2-3.
[17]Hackett ML,K9hler S,O'Brien JT,et al.Neuropsychiatric outcomes of stroke[J].Lancet Neurol,2014,13(5):525-534.
[18]Robinson RG,Jorge RE,Moser DJ,et al.Escitalopram and problem-solving therapy for prevention of poststroke depression:A randomized controlled trial[J].JAMA,2008,299(20):2391-2400.
[19]Ayerbe L,Ayis S,Crichton SL,et al.Explanatory factors for the increased morality of stroke patients with depression[J].Neurology,2014,83(22):2007-2012.
[20]Mortensen JK,Johnsen SP,Larsson H,et al.Early antidepressant and all-cause 30-day mortality in patients with ischemic stroke[J].Cerebrovasc Dis,2015,40(1/2):81-90.
[21]Karaiskos D,Tzavellas E,Spengos K,et al.Duloxetine versus citalopram and sertraline in the treatment of poststroke depression,anxiety,and fatigue[J].J Neuropsychiatry Clin Neurosic,2012,24(3):349-353.
[22]Zhang LS,Hu XY,Yao LY,et al.Prophylatic effects of duloxetine on post-stroke depression symptoms:An open single-blind trial[J].Eur Neurol,2013,69(6):336-343.
[23]Davis R,Wilde MI.Mirtazapine:A Review of its pharmacology and therapeutic potential in the management of major depres sion[J].CNS Drugs,1996,5(5):389-402.
[24]Rampello L,Chiechio S,Nicoletti G,et al.Prediction of the response to citalopram and reboxetine in post-stroke depressed patients[J].Psychopharmacology(Berl),2004,173(1/2):73-78.
[25]Eng JJ,Reime B.Exercise for depressive symptoms in stroke patients:A systematic review and meta-analysis[J].Clin Rehabil,2014,28(8):731-739.
[26]Garber CE,Blissmer B,Deschenes MR,et al.American college of sports medicine.American college of sports medicine position stand.Quantity and quality of exercise for developing and maintaining cardiorespiratory,musculoskeletal,and neuromotor fitness in apparently healthy adults:Guidance for prescribing exercise[J].Med Sci Sports Exerc,2011,43(7):1334-1359.
[27]Chen Y,Guo JJ.Meta-analysis of antidepressant treatment for patients with post stroke depression[J].Stroke,2006,37(6):1365-1366.
[28]Paolucci S.Role,indications,and controversies of antidepressant therapy in chronic stroke patients[J].Eur J Phys Rehabil Med,2013,49(2):233-241.
[29]Valiengo LC,Goulart AC,de Oliveira JF,et al.Transcranial direct current stimulation for the treatment of post-stroke depression:Results from a randomised,sham-controlled,double-blinded trial[J].J Neurol Neurosurg Psychiatry,2017,88(2):170-175.
[30]Ramasubbu R.Therapy for prevention of post-stroke depression[J].Expert Opin Pharmacother,2011,12(14):2177-2187.
[31]Kneebone II,Dunmore E.Psychological management of poststroke depression[J].Br J Clin Psychol,2000,39(Pt 1):53-65.
[32]姜博,赵永辰.加味半夏厚朴汤治疗脑卒中后轻中度抑郁症的临床疗效观察[J].四川中医,2014,32(9):101-106.
[33]张宸豪,李文贵,顾芳,等.乌灵胶囊治疗脑卒中后抑郁的疗效观察[J].临床神经病学杂志,2014,27(1):61-63.
[34]贾军丽.醒脑开窍针法治疗卒中后抑郁症临床疗效[J].中医临床研究,2015,7(21):90-91.
[35]杨继鹏,赵红,刘璟莹,等.醒脑开窍针法治疗中风后抑郁35例[J].河南中医,2015,35(2):270-272.
[36]关东升,李迎霞,孟毅,等.针药干预卒中后抑郁症伴躯体形式障碍临床研究[J].中医学报,2013,28(5):763-764.
[37]王金枝.高压氧在治疗脑卒中后抑郁症患者神经缺损及抑郁症状的临床疗效[J].山西医药杂志,2017,46(11):1321-1324.
[38]林妙君,邵艳霞,唐润东,等.针刺配合高压氧治疗脑卒中后抑郁症临床观察[J].上海针灸杂志,2017,36(10):1173-1176.
[2]Robinson RG,Jorge RE.Post-stroke depression:A review[J].Am J Psychiatry,2016,173(3):221-231.
[3]Fang J,Cheng Q.Etiological mechanisms of post-stroke depression:A review[J].Neurol Res,2009,31(9):904-909.
[4]唐雪梅.卒中后抑郁的流行病学及病因机制的研究进展[J].国际神经病学神经外科学杂志,2011,38(3):280-284.
[5]Nys GM,van Zandvoort MJ,van der Worp HB,et al.Early depressive symptoms after stroke:Neuropsychological correlates and lesion characteristics[J].J Neurol Sci,2005,228(1):27-33.
[6]Sch9ttke H,Giabbiconi CM.Post-stroke depression and poststroke anxiety:Prevalence and predictors[J].Int Psychogeriatr,2015,27(11):1805-1812.
[7]孙凯,马涤辉.卒中后抑郁的发病机制[J].吉林医学,2009,30(1):83-85.
[8]Herrmann N,Black SE,Lawrence J,et al.The sunnybrook stroke study:A prospective study of depressive symptoms and functional outcome[J].Stroke,1998,29(3):618-624.
[9]De Ryck A,Brouns R,Geurden M,et al.Risk factors for poststroke depression:Identification of inconsistencies based on a systematic review[J].J Geriatr Psychiatry Neurol,2014,27(3):147-158.
[10]Verdelho A,Hénon H,Lebert F,et al.Depression symptoms after stroke and relationship with dementia:A three-year follow-up study[J].Neurology,2016,62(6):905-911.
[11]Poynter B,Shuman M,Diaz-Granados N,et al.Sex differences in the prevalence of post-stroke depression:A systematic review[J].Psychosomatics,2009,50(6):563-569.
[12]Hisaoka-Nakashima K,Miyano K,Matsumoto C,et al.Tricyclic antidepressant amitriptyline-induced glial cell line-derived neurotrophic factor production involves pertussis toxin-sensitive Gai/o activation in astroglial cells[J].J Biol Chem,2015,290(22):13678-13691.
[13]Zhang X,Ru B,Sha W,et al.Performance on the Wisconsin cardsorting test and serum levels of glial cell line-derived neurotrophic factor in patients with major depressive disorder[J].Asia Pac Psychiaty,2014,6(3):302-307.
[14]Zhang Y,Jiang H,Yue Y,et al.The protein and mRNA expression levels of glial cell line-derived neurotophic factor in past stroke depression and major depression disorder[J].Sci Rep,2017,7(1):8674.
[15]Nabavi SF,Dean OM,Turner A,et al.Oxidative stress and poststroke depression possible therapeutic role of polyphenols?[J].Curr Med Chem,2015,22:343-351.
[16]毕晓莹.神经内科疾病的精神心理障碍[M].上海:科学技术出版社,2015:2-3.
[17]Hackett ML,K9hler S,O'Brien JT,et al.Neuropsychiatric outcomes of stroke[J].Lancet Neurol,2014,13(5):525-534.
[18]Robinson RG,Jorge RE,Moser DJ,et al.Escitalopram and problem-solving therapy for prevention of poststroke depression:A randomized controlled trial[J].JAMA,2008,299(20):2391-2400.
[19]Ayerbe L,Ayis S,Crichton SL,et al.Explanatory factors for the increased morality of stroke patients with depression[J].Neurology,2014,83(22):2007-2012.
[20]Mortensen JK,Johnsen SP,Larsson H,et al.Early antidepressant and all-cause 30-day mortality in patients with ischemic stroke[J].Cerebrovasc Dis,2015,40(1/2):81-90.
[21]Karaiskos D,Tzavellas E,Spengos K,et al.Duloxetine versus citalopram and sertraline in the treatment of poststroke depression,anxiety,and fatigue[J].J Neuropsychiatry Clin Neurosic,2012,24(3):349-353.
[22]Zhang LS,Hu XY,Yao LY,et al.Prophylatic effects of duloxetine on post-stroke depression symptoms:An open single-blind trial[J].Eur Neurol,2013,69(6):336-343.
[23]Davis R,Wilde MI.Mirtazapine:A Review of its pharmacology and therapeutic potential in the management of major depres sion[J].CNS Drugs,1996,5(5):389-402.
[24]Rampello L,Chiechio S,Nicoletti G,et al.Prediction of the response to citalopram and reboxetine in post-stroke depressed patients[J].Psychopharmacology(Berl),2004,173(1/2):73-78.
[25]Eng JJ,Reime B.Exercise for depressive symptoms in stroke patients:A systematic review and meta-analysis[J].Clin Rehabil,2014,28(8):731-739.
[26]Garber CE,Blissmer B,Deschenes MR,et al.American college of sports medicine.American college of sports medicine position stand.Quantity and quality of exercise for developing and maintaining cardiorespiratory,musculoskeletal,and neuromotor fitness in apparently healthy adults:Guidance for prescribing exercise[J].Med Sci Sports Exerc,2011,43(7):1334-1359.
[27]Chen Y,Guo JJ.Meta-analysis of antidepressant treatment for patients with post stroke depression[J].Stroke,2006,37(6):1365-1366.
[28]Paolucci S.Role,indications,and controversies of antidepressant therapy in chronic stroke patients[J].Eur J Phys Rehabil Med,2013,49(2):233-241.
[29]Valiengo LC,Goulart AC,de Oliveira JF,et al.Transcranial direct current stimulation for the treatment of post-stroke depression:Results from a randomised,sham-controlled,double-blinded trial[J].J Neurol Neurosurg Psychiatry,2017,88(2):170-175.
[30]Ramasubbu R.Therapy for prevention of post-stroke depression[J].Expert Opin Pharmacother,2011,12(14):2177-2187.
[31]Kneebone II,Dunmore E.Psychological management of poststroke depression[J].Br J Clin Psychol,2000,39(Pt 1):53-65.
[32]姜博,赵永辰.加味半夏厚朴汤治疗脑卒中后轻中度抑郁症的临床疗效观察[J].四川中医,2014,32(9):101-106.
[33]张宸豪,李文贵,顾芳,等.乌灵胶囊治疗脑卒中后抑郁的疗效观察[J].临床神经病学杂志,2014,27(1):61-63.
[34]贾军丽.醒脑开窍针法治疗卒中后抑郁症临床疗效[J].中医临床研究,2015,7(21):90-91.
[35]杨继鹏,赵红,刘璟莹,等.醒脑开窍针法治疗中风后抑郁35例[J].河南中医,2015,35(2):270-272.
[36]关东升,李迎霞,孟毅,等.针药干预卒中后抑郁症伴躯体形式障碍临床研究[J].中医学报,2013,28(5):763-764.
[37]王金枝.高压氧在治疗脑卒中后抑郁症患者神经缺损及抑郁症状的临床疗效[J].山西医药杂志,2017,46(11):1321-1324.
[38]林妙君,邵艳霞,唐润东,等.针刺配合高压氧治疗脑卒中后抑郁症临床观察[J].上海针灸杂志,2017,36(10):1173-1176.