PSYCHOSOCIAL/BEHAVIORAL INTERVENTION IN PSD

PSD 的心理社会/行为干预

• 批准号: 7029729
• 负责人: PAMELA H MITCHELL
• 金额: $ 40.9万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-03-01 至 2008-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7029729
• 关键词: antidepressants; behavior therapy; behavioral /social science research tag; brain disorder chemotherapy; combination therapy; community health services; depression; emotions; functional ability; human subject; human therapy evaluation; medical rehabilitation related tag; mental disorder chemotherapy; nursing intervention; patient oriented research; psychosocial rehabilitation; stroke; stroke therapy

Depression is a sufficiently common sequela of a completed ischemic stroke to warrant intervention to improve social and functional outcome after stroke. PSD is associated with worse social and functional outcome as much as ten years post-stroke, poorer cognitive status, increased medical costs, impaired rehabilitation response, delayed return to work, and increased long-term mortality. The primary aim of this study is to determine the effect of a nurse-delivered psychosocial/behavioral intervention on reduction of depression in community dwelling post-stroke patients. We expect the combined behavioral and pharmacologic intervention to be more effective than pharmacotherapy alone in sustaining the improvement in depression for the experimental group. Secondary aims are to examine the effect of the psychosocial/behavioral intervention time course and sustainability of response to treatment, effect on limitations in ability, limitation in participation and overall stroke impact in community-dwelling post-stroke patients. 150 patients at three University of Washington affiliated hospitals that comprise the UW Stroke Assessment and Treatment center, who are found to be depressed within the first four months following ischemic stroke will be invited to join the study, and randomly assigned to a problem-solving/pleasant events intervention provided by an advanced practice nurse, or to regular clinic follow-up. Both groups will receive standard antidepressant treatment and written materials from the American Stroke Association, and will be assessed for up to two years following the study. The primary outcome is reduction in depression at 12 months following stroke. Secondary outcomes are reductions in limitations in activity (Barthel Index), reduction in limitation in participation (Stroke Impact Scale) and overall stroke impact (Stroke Impact Scale) at 6, 12, and 24 months post- stroke. We hypothesize that all patients will improve their mood and functional ability related to their post-stroke standard treatment, but that those who receive the psychosocial intervention will have significantly greater improvement in mood, functional ability, social participation, and less overall stroke impact at all follow-up measurement.

抑郁症是完整的缺血性中风的足够常见的后遗症，可保证干预以改善中风后的社会和功能结果。 PSD在中风后十年，认知状况较差，医疗费用增加，康复反应障碍，延迟工作返回以及长期死亡率增加。 这项研究的主要目的是确定护士分配的社会心理/行为干预对减少中风后社区住宅抑郁症的影响。 我们预计，在维持实验组抑郁症的改善方面，行为和药理学干预的综合比单独的药物疗法更有效。 次要目的是检查心理/行为干预时间课程的影响以及对治疗的反应的可持续性，对能力的限制，参与限制和中风后患者的总体中风影响的影响。华盛顿大学三家隶属医院的150名患者构成了UW中风评估和治疗中心，在缺血性中风后的头四个月内被发现抑郁症，将邀请参加研究，并随机分配给问题/宜人的事件干预措施，由高级实践护士提供，或进行正式诊所随访。 这两组将获得美国中风协会的标准抗抑郁治疗和书面材料，并将在研究后最多进行两年评估。 主要结果是中风后12个月的抑郁症减少。 次要结果是在6、12和24个月的中风后6、12和24个月的活动限制（Barthel指数）的限制（Barthel指数）减少（中风撞击量表）和整体中风撞击（Stroke Impact量表）。 我们假设所有患者都将提高与中风后标准治疗相关的情绪和功能能力，但是那些接受社会心理干预的人的情绪，功能能力，社交参与能力，社交参与和中风的整体影响都将在所有后续测量中都显着改善。