| Objective: Post-Stroke Depression is a common mental complication after stroke, which is characterized by low mood, poor initiative, loss of interest and sleep disorders. PSD patients cannot be more proactive on speech and physical rehabilitation exercise, is not conducive to the recovery of neural function defect, and daily life ability is relatively poor, cognitive, executive function recovery are also affected, and increased mortality after stroke and the risk of recurrent stroke. The early identification, prevention and treatment of PSD is very important. This topic for post-stroke depression patients treated with integration psychotherapy,escitalopram oxalate and functional exercise, before and after treatment were evaluated in patients with functional exercise compliance, depression, neurological deficits, activities of daily living(ADL) situation, and observed the changes of serum cytokines IL-6 and TNF-α, expectations for future clinical for the treatment of patients with PSD to seek more safe, reasonable and effective treatment method, and is expected to be in stroke after the diagnosis, treatment and prevention of depression to provide a new target.Methods: 60 cases were chosen with PSD of patients who were outpatient and inpatient in Neurology and Rehabilitation Department of the Affiliated Hospital of Hebei University from November 2014 to July 2015. All patients were strictly implemented into groups and exclusion criteria and were with depression after first stroke. All patients were randomly divided into treatment group and control group, 30 cases in each group,the actual compliance with the doctor’s order to complete the treatment of 57 cases, the treatment group of 28 cases, the control group of 29 cases.The diagnosis of stroke accord with the standard of academic meeting of the fourth national Conference on Cerebrovascular Disease of CMA in 1995. The imaging data of MRI or CT can explain the nerve function defect symptoms. PSD diagnosis reference to the Chinese Classification Of Mental Disorders and Diagnostic Criteria( CCMD-3),which is consistent with the symptom criteria, standard course and in the exclusion standard and according to Hamilton Depression table 17 scores were used to evaluate the degree of depression. The patients’ HAMD scores≥8 as the selected objects.Two groups were given conventional treatment on stroke.The control group treated with escitalopram oxalate tablets combined with functional exercise, morning oral 10 mg QD, after 1 week, according to the patient’s condition and tolerance, the dose was adjusted to 10~20 mg, QD for 12 weeks. The treatment group: in the control group based on the integration of psychotherapy,mainly based on cognitive behavior therapy, combined with daily communication, group communication, self education and family pleasure treatment methods for patients of integrated psychological intervention. The treatment lasted for 12 weeks. Respectively before treatment and 4 weeks, 8 weeks and 12 weeks after treatment were compared between the two groups functional exercise compliance score, HAMD score, scores of NIHSS and Barthel Index(BI).Through the comparison between the two groups of compliance, depression, neurological impairment and daily living ability score changes to observe the treatment difference. To compare the changes of serum cytokine IL-6 and TNF-αin the patients before and after treatment for 8 weeks, and to analyze the effect of integrated psychotherapy on the immune function of patients.Results: 1. Compliance score comparison before and after treatment. After treatment, The compliance scores of two groups were higher than those before treatment(F=3 61.420, P=0.000; F=412.425, P=0.000), two groups of treatment can effectively improve the functional exercise compliance of patients.After 4 weeks of treatment, the scores of functional exercise compliance in treatment group were significantly higher than that in the control group, scores of two groups were 12.00±3.81, 9.45±3.13, the difference is statistically significant(t=2.765, P=0.008). After 8 weeks and 12 weeks treatment group compliance was significantly higher than the control group(t=4.700, P=0.000; t=4.901, P=0.000), the treatment group in improving the compliance of patients with rapid onset, the improvement effect was significantly better than the control group.2. Comparison of HAMD scores before and after treatment. After treatment, the HAMD scores of the two groups were lower than before treatment(F=170.100, P=0.000; F=84.141, P=0.000), two groups of treatment can reduce the HAMD score, can effectively improve the depression.After 8 weeks of treatment,the HAMD score of two groups were 11.18 ±3.40, 13.21 ±3.06, HAMD score of treatment group was lower than that of the control group, the difference is statistically significant(t=2.368, P= 0.021). After 12 weeks of treatment group HAMD score was significantly lower than that of the control group(t=2.846, P=0.006), the treatment group improve the depressive effect is obviously superior to the control group.3. Comparison of NIHSS scores before and after treatment. NIHSS scores of two groups after treatment were lower than before treatment(F=764.845, P=0.000; F=513.065, P=0.000), two groups of treatment can reduce the NIHSS score, and effectively improve the neurological function defect. After 12 weeks of treatment, the scores of the two groups were 5.79±2.33, 8.10±2.51, treatment group was significantly lower than that of the control group, significant statistical difference(t=3.608, P=0.001), the treatment group improve the degree of neural function defect is obviously better than that of the control group.4. Comparison of BI scores before and after treatment. Two groups of BI score after treatment was higher than that before treatment(F=240.517, P=0.000; F=127.284, P=0.000), two groups of treatment can improve BI score, improve the ability of daily life in patients with PSD.After 12 weeks of treatment, the treatment group activities of daily living(ADL) improved significantly than that of the control group and BI scores of the two groups respectively71.61±8.06, 64.66±8.34, the treatment group was significantly higher than that of the control group(t=3.199, P= 0.002). Patients in the treatment group were better than the control group in improving the ability of daily life.5. Comparison of the serum levels of IL-6 before and after treatment. After 8 weeks treatment, the serum IL-6 levels in the two groups were decreased, and the treatment group was significantly lower than that of the control group. After treatment, the serum IL-6 concentrations in the two groups were 5.93±1.65pg/ml, 6.87 ±1.50pg/ml, and the difference was statistically significant between the two groups(t=2.250, P=0.028).6. Comparison of the serum levels of TNF-α before and after treatment. After 8 weeks of treatment, the serum levels of TNF-αwere decreased in the two groups, the treatment group was significantly lower than the control group. The serum levels of TNF-αin the two groups were 22.36±5.18pg/ml, 26.09±7.71pg/ml, and the difference was statistically significant between the two groups(t=2.137, P=0.037).Conclusion: Integrative psychotherapy combined with antidepressant drugs and functional exercise effective in the treatment of post-stroke depression can improve the patient’s functional exercise compliance, so that patients grasp the best recovery time, better reduce the degree of neural function defect and improve the ability of daily life; due to improved significantly after stroke depression levels and immune function, so that patients’ serum IL-6 and TNF-α content decreased significantly in clinic to provide a new starting point of post-stroke depression diagnosis, treatment and prevention. |
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