Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients.
OBJECTIVE
Depressive disorders are very common in stroke patients. However, vegetative and cognitive symptoms primarily derived from brain damage could hypothetically be indistinguishable from those directly derived from neuropsychiatric disorders, and this could invalidate the diagnostic assessment. Thus, authors aimed to detect the frequency of clinically-rated DSM-IV depressive symptoms and the diagnostic validity of depressive disorders in stroke patients suffering from major depressive disorder (MDD), minor depressive disorder (MIND), and those free of any neuropsychiatric disorders (NODEP).


METHODS
First-ever stroke patients (N=200) were approached within 3 months of the acute stroke and were interviewed with the SCID-P and administered the Hamilton Rating Scale for Depression (Ham-D), the Beck Depression Inventory (BDI), the Barthel Index, and the Mini-Mental State Exam.


RESULTS
Fifty patients (25%) had MDD, 62 (31%) had MIND, and 88 (44%) had NODEP. Global cognitive level, functional impairment, total scores, and psychic and somatic subscores of the Ham-D and the BDI were different among the three groups. The only symptom that did not differ among patients with MDD, MIND, and NODEP was Feelings of Guilt; all the other eight DSM-IV symptoms were significantly different. In particular, the frequency of Depressed Mood, Diminished Interest or Pleasure, Fatigue or Loss of Energy, Insomnia, and Psychomotor Agitation/Retardation was higher in MIND patients than in NODEP patients.


CONCLUSIONS
During the diagnostic procedure for depressive disorders in stroke patients, clinicians should consider equally important vegetative, cognitive, and psychological depressive symptoms, despite their nature.
Spalletta
Gianfranco
G
IRCCS Santa Lucia, Laboratorio di Neurologia Clinica e Comportamentale, Via Ardeatina 306, 00179 Rome, Italy. g.spalletta@hsantalucia.it
Ripa
Alessandra
A
Caltagirone
Carlo
C
D000368:Aged; D001037:Aphasia / Q000209:etiology; D001921:Brain / Q000473:pathology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000473:pathology / Q000523:psychology*