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Symptom Profile of DSM-IV Major and Minor Depressive Disorders in First-Ever Stroke Patients

Received May 6, 2004; revised August 6, October 20, 2004; accepted October 29, 2004. From the I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy (GS,AR,CC) and the Department of Neuroscience, University of Tor Vergata, Rome, Italy (GS,CC). Send correspondence and reprint requests to Dr. Gianfranco Spalletta, IRCCS Santa Lucia, Laboratorio di Neurologia Clinica e Comportamentale, Via Ardeatina, 306, 00179 Roma, Italy. e-mail: g.spalletta{at}hsantalucia.it
© 2005 American Association for Geriatric Psychiatry

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.

Key Words: Depression • Stroke • Physical Comorbidity • Neuropathology

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