Aims and objectives

Methods

Results

Discussion

Conclusion

References

Abstract

Background: Mood disorder after stroke is common but drug and psychosocial treatments have been assessed with disappointing results. Preventing mood disorder from developing in the first place could be a better approach and might reduce the need for pharmacotherapy in this predominantly older patient group. We used a brief problem-solving therapy and evaluated its effect in reducing mood disorder in the 12 months after stroke.
Methods: A 3-group, parallel, randomised controlled trial. Four hundred fifty patients with stroke were randomised within 1 month of hospital admission to problem-solving therapy from a psychiatric nurse, non-specific support given by volunteers or treatment-as-usual. Follow up took place at 6 and 12 months after stroke. Standardised measures of mood (Present State Examination, GHQ-28), cognitive state (mini-mental state examination) and function (Barthel ADL index, Frenchay Activities Index) were taken at baseline, 6 and 12 months after randomisation. Satisfaction with care was recorded at follow up.
Results: At 6 months, all psychological and activity measures favoured problem-solving therapy. At 12 months, patients in the problem-solving therapy group had significantly lower GHQ-28 scores and lower median Present State Examination symptom scores. There were no statistically significant differences in activity. The problem-solving therapy group were more satisfied with some aspects of care.
Conclusions: The results are encouraging and suggest it is possible to prevent mood disorder in stroke patients using a psychological intervention. The differences between the groups at 12 months may indicate a sustained impact of psychological therapies, by comparison with non-specific support.

Background

Stroke patients are a predominantly older group and around 50% of acute stroke survivors have residual major physical or cognitive deficits. Given the need for patients to cope with the complex physical and social sequelae of stroke, the demands of recovery and rehabilitation, and the risk of recurrent stroke, it is not surprising that mood disorder, usually manifesting as anxiety or depression after stroke, is common. The consequences of unreconciled emotional distress can be reduced quality of life and impaired progress in physical and social rehabilitation. A number of drug and psychosocial treatments have been assessed in clinical trials but the results have been disappointing. Drug trials have suggested a role for antidepressants in both treatment and prevention, but the trials are generally of poor quality and do not provide sufficient information to judge their true costs and benefits [1, 2] Psychosocial interventions have similar methodological problems [3]. The latter are popular with patients but there is conflicting evidence for their effectiveness in either treating or preventing anxiety and depression [4, 5].