| Stroke or cerebrovascular accident (CVA) is the most common diagnosis of patients in rehabilitation hospitals and the leading cause of disability among adults. Whereas various neurological deficits resulting from stroke are commonly known (e.g., hemiplegia, ataxia, somatosensory deficits, aphasia), stroke patients are also frequently debilitated in their social and psychological functioning. These patients may suffer permanent loss of mobility or a diminished capacity to verbally communicate, resulting in social isolation or diminished quality of life. Post-stroke depression (PSD) is the most salient and common psychoemotional sequela of stroke, occurring in an estimated 28% to 65% of patients.;Post-stroke depression leads to longer hospitalizations, diminished rehabilitation effectiveness, and ultimately increases mortality. Secondary depression is also observed in spouses or caregivers. Since stroke patients are initially treated in medical facilities, more research has been conducted for psychopharmacological interventions than psychological or cognitively based treatments. Medical personnel are generally not trained to diagnose PSD, and commonly underdiagnose the phenomenon or perceive it to be an intractable condition. When detected, drug therapy is usually the treatment of choice. Surprisingly, there are no controlled studies to date demonstrating the efficacy of traditional psychotherapy in the treatment of PSD.;This study evaluated the efficacy of brief cognitive-behavioral psychotherapy in five inpatient rehabilitation patients diagnosed with PSD. Capitalizing upon single-case methodology to avoid the pitfall of low statistical power, patients were empirically diagnosed and a variety of objective and subjective measures of mood and perceived rehabilitation effectiveness (e.g., Geriatric Depression Scale, nurse or caregiver collateral ratings) were administered continuously over the length of hospitalization. Other outcome measures utilized included multidisciplinary team ratings of functional independence. Examining temporal changes in mood, four patients were empirically reclassified as "Not Depressed" and one patient's diagnosis was downgraded from Major PSD to Mild PSD at treatment termination. Objective measures were more effective at demonstrating treatment effectiveness than subjective ratings, and results were maintained at follow-up. There was marginal support that cognitive-behavioral therapy enhanced physical rehabilitation. Despite certain inherent limitations of modified single-case designs, patients generally reported that treatment was worthwhile and nurtured adaptive coping skills. |
