Aktuelle Neurologie 2013; 40(10): 553-556
DOI: 10.1055/s-0033-1354353
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Schlaganfall und Psyche

Stroke and Depression
G. Kronenberg
1   Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin
,
M. Endres
2   Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
10 December 2013 (online)

Zusammenfassung

Schlaganfall und Psyche haben eine komplexe und bidirektionale Beziehung. So ist es einerseits gut bekannt, dass psychische und soziale Faktoren, „Stress“ oder auch eine Depression einen unabhängigen Risikofaktor für das Auftreten von Schlaganfällen darstellen. Umgekehrt ist es aber auch so, dass der Schlaganfall selbst zu tiefgreifenden psychischen Folgen führen kann. Insbesondere die Post-Schlaganfall-Depression spielt hier eine wichtige Rolle. Sie tritt in mindestens 1/3 aller Schlaganfall-Patienten auf und ist mit einem schlechten „Outcome“ sowie einer erhöhten Sterblichkeit assoziiert. Klinische wie experimentelle Untersuchungen aus den letzten Jahren haben zum Verständnis der vielfältigen Beziehungen zwischen Schlaganfall und Psyche beigetragen. Insbesondere die vielversprechenden Ergebnisse der FLAME-Studie, welche eine verbesserte neurologische Erholung bei der frühen Gabe von Antidepressiva bei Schlaganfall-Pa­tienten zeigte, eröffnet nun die klinische Frage, ob Schlaganfall-Patienten generell bereits zu einem frühen Zeitpunkt mit Antidepressiva behandelt werden sollten.

Abstract

The relation between mental health and stroke is complex and bidirectional. It is well established that psychosocial factors, stress and major depression constitute independent risk factors for stroke. Conversely, stroke may lead to profound psychological consequences. Post-stroke depression, in particular, plays an important role. At least one third of stroke survivors develop depression, which confers a poorer clinical outcome and increased mortality. Both clinical and experimental studies have contributed to a better understanding of the interplay between stroke and psychological factors in recent years. The promising results of the FLAME-study showed improved neurological recovery through early treatment of stroke patients with a serotonergic antidepressant. These results lead to the question, whether stroke patients in general should be treated with antidepressants at an early stage.

 
  • Literatur

  • 1 Wilbert-Lampen U, Leistner D, Greven S et al. Cardiovascular events during World Cup soccer. N Engl J Med 2008; 358: 475-483
  • 2 Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-952
  • 3 O’Donnell MJ, Xavier D, Liu L et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112-123
  • 4 Salaycik KJ, Kelly-Hayes M, Beiser A et al. Depressive symptoms and risk of stroke: the Framingham Study. Stroke 2007; 38: 16-21
  • 5 Whooley MA, de Jonge P, Vittinghoff E et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300: 2379-2388
  • 6 Custodis F, Gertz K, Balkaya M et al. Heart rate contributes to the vascular effects of chronic mental stress: effects on endothelial function and ischemic brain injury in mice. Stroke 2011; 42: 1742-1749
  • 7 Strekalova T, Spanagel R, Bartsch D et al. Stress-induced anhedonia in mice is associated with deficits in forced swimming and exploration. Neuropsychopharmacology 2004; 29: 2007-2017
  • 8 Balkaya M, Prinz V, Custodis F et al. Stress worsens endothelial function and ischemic stroke via glucocorticoids. Stroke 2011; 42: 3258-3264
  • 9 Böhm M, Cotton D, Foster L et al. Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke. Eur Heart J 2012; 33: 2804-2812
  • 10 Hackett ML, Yapa C, Parag V et al. Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005; 36: 1330-1340
  • 11 Williams LS. Depression and stroke: cause or consequence?. Semin Neurol 2005; 25: 396-409
  • 12 Carota A, Berney A, Aybek S et al. A prospective study of predictors of poststroke depression. Neurology 2005; 64: 428-433
  • 13 Kim JM, Stewart R, Bae KY et al. Serotonergic and BDNF genes and risk of depression after stroke. J Affect Disord 2012; 136: 833-840
  • 14 Folstein MF, Maiberger R, McHugh PR. Mood disorder as a specific complication of stroke. J Neurol Neurosurg Psychiatry 1977; 40: 1018-1020
  • 15 Ghika-Schmid F, van Melle G, Guex P et al. Subjective experience and behavior in acute stroke: the Lausanne Emotion in Acute Stroke Study. Neurology 1999; 52: 22-28
  • 16 Biran I, Chatterjee A. Depression with anosognosia following a left subcortical stroke. Clin Neurol Neurosurg 2003; 105: 99-101
  • 17 Narushima K, Kosier JT, Robinson RG. A reappraisal of poststroke depression, intra- and inter-hemispheric lesion location using meta-analysis. J Neuropsychiatry Clin Neurosci 2003; 15: 422-430
  • 18 Shimoda K, Robinson RG. The relationship between poststroke depression and lesion location in long-term follow-up. Biol Psychiatry 1999; 45: 187-192
  • 19 Carson AJ, MacHale S, Allen K et al. Depression after stroke and lesion location: a systematic review. Lancet 2000; 356: 122-126
  • 20 Kronenberg G, Balkaya M, Prinz V et al. Exofocal dopaminergic degeneration as antidepressant target in mouse model of poststroke depression. Biol Psychiatry 2012; 72: 273-281
  • 21 Jorge RE, Robinson RG, Arndt S et al. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Am J Psychiatry 2003; 160: 1823-1829
  • 22 Chollet F, Tardy J, Albucher JF et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol 2011; 10: 123-130
  • 23 Mead GE, Hsieh CF, Lee R et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev 2012; 11 CD009286 DOI: 10.1002/14651858.CD009286.pub2.
  • 24 Ostwald SK, Davis S, Hersch G et al. Evidence-based educational guidelines for stroke survivors after discharge home. J Neurosci Nurs 2008; 40: 173-179 191