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Am J Psychiatry 1991; 148:1172-1176
Copyright © 1991 by American Psychiatric Association
Are depressive symptoms nonspecific in patients with acute stroke?
JP Fedoroff, SE Starkstein, RM Parikh, TR Price and RG Robinson
Department of Psychiatry and Neuroscience, Johns Hopkins University School of Medicine, Baltimore.
OBJECTIVE: Some investigators have suggested that major depression might be
overdiagnosed in stroke patients because of changes in appetite, sleep, or
sexual interest caused by their medical illness; others have suggested that
depression may be underdiagnosed in stroke patients who deny symptoms of
depression because of anosognosia, neglect, or aprosody. The authors' goal
was to determine how frequently depressive symptoms occur in acute stroke
patients with and without depressed mood to estimate how often diagnostic
errors of inclusion or exclusion may be made. METHOD: They examined the
rate of autonomic and psychological symptoms of depression in 205 patients
who were consecutively hospitalized for acute stroke. Eighty-five (41%) of
these patients had depressed mood, and 120 (59%) had no mood disturbance.
Forty-six (54%) of the 85 patients with depressed mood (22% of all
patients) were assigned the DSM-III diagnosis of major depression. RESULTS:
The 120 patients without mood disturbance had a mean of one autonomic
symptom, but the 85 patients with depressed mood had a mean of almost four.
Tightening the diagnostic criteria to account for one more nonspecific
autonomic symptom decreased the number of patients with major depression by
only three; adding two more criteria decreased the number by only five.
Thus, the rate of DSM-III major depression was 1% higher than the rate with
one extra nonspecific autonomic symptom and 2% higher than the rate with
two extra criteria. Conversely, loosening diagnostic criteria to account
for denial of depressive illness increased the rate of major depression by
only 5%. CONCLUSIONS: Both autonomic and psychological depressive symptoms
are strongly associated with depressed mood in acute stroke patients.
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