| 1. |
- Engström, Christer, et al.
(författare)
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Relationship between prophylactic effect of lithium therapy and family history of affective disorders
- 1997
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Ingår i: Biological Psychiatry. - 0006-3223 .- 1873-2402. ; 42:6, s. 425-433
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Tidskriftsartikel (refereegranskat)abstract
- Lithium therapy response and age of onset (AOO) were studied in 98 patients with bipolar affective disorder (BPAD) who were divided into subgroups depending on type of family history of affective disorders. The highest (33.0 years) and lowest (25.5 years) age of onset were found in nonfamilial patients and in familial patients with a first-degree relative of BPAD, respectively. Nonfamilial patients showed the best response to lithium. There were 0.9 episodes/year off lithium compared to 0.3 episodes/year on lithium (an 88% decrease). A poorer response (a 71% decrease; a reduction from 1.39 episodes per year off lithium to 0.65 on lithium) was found in familial patients with a first-degree relative of BPAD. Differences in serum lithium values between the groups could not explain the observed differences. Thus, familial patients showed a more severe manifestation of the disease with an earlier AOO and a lower prophylactic effect of lithium.
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| 2. |
- Åström, Monica, 1941-
(författare)
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Depression after stroke
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.
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| 3. |
- Åström, Monica, 1941-, et al.
(författare)
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Life before and after Stroke : Living Conditions and Life Satisfaction in Relation to a General Elderly Population
- 1992
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Ingår i: Cerebrovascular Diseases. - : S. Karger. - 1015-9770 .- 1421-9786. ; 2:1, s. 28-34
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Tidskriftsartikel (refereegranskat)abstract
- Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.
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| 4. |
- Åström, Monica, 1941-, et al.
(författare)
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Major depression in stroke patients : A 3-year longitudinal study
- 1993
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Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 24:7, s. 976-982
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.
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