健康与遗传心理学研究室知识库

脑卒中后抑郁(Post-stroke depression, PSD)是脑卒中后患者常见的并发症之一，直接影响脑卒中患者的生活质量、躯体功能和认知功能等方面的康复，甚能改善和生活质量的提高有着重要意义。本研究采用经颅直流电刺激(transcranial direct current stimulation, tDCS)技术和社会工作者介入的心理干预至可引起脑卒中再发。因此加强对脑卒后抑郁症的干预，对脑卒中患者的愈后功方法，对脑卒中后抑郁症加以干预治疗，考察其治疗效果为今后脑卒中抑郁的治疗应用提供依据。研究分为两个部分:研究一重点考察tDCS 放置大脑不同位置对脑卒中后抑郁的干预效果，鉴于左侧背外侧前额叶(left dorsolateral prefrontal cortex, 1DLPFC )和右侧背外侧前额叶((right dorsolateral prefrontal cortex, rDLPFC)在抑郁症发病机制中的不同作用，结合tDCS阳极刺激使皮层的兴奋性提高，阴极刺激降则低皮层的兴奋性的特点，把不同极性的电极分别放置于左右侧的背外侧前额叶，将被试分为4组(控制组\1DLPFC \ rDLPFC \ 1DLPFC+rDLPFC )。此实验遵从双盲随机控制实验设计，采用汉密尔顿焦虑和抑郁量表评估脑卒中患者治疗后的心理情绪状态。结果发现对DLPFC进行tDCS治疗对于缓解脑卒中后的抑郁症状是有明显效果的;刺激1DLPFC要好于刺激rDLPFC，而同时刺激双侧的DLPFC和刺激1DLPFC之间的效果没有明显差异。研究二通过社会工作者介入运用认知行为治疗的方法帮助出院后仍然有抑郁症的脑卒中患者认识到自己思维和行为上的消极态度，学会控制情绪，适应环境，进而改善抑郁症状。实验设计为随机双盲控制实验，患者随机分为两组，实验组和对照组。对于实验组，社会工作者每周上门一次，连续4周，对患者进行面对面的家庭服务，提供心理咨询和意见咨询以及提供物质帮助和劳务服务等。结果发现实验组汉密尔顿抑郁和焦虑量表的评分明显降低，而对照组却发现患者的抑郁症评分增加。表明出院后脑卒中后抑郁的患者随时间推移日常功能有所改善，但没有干预个体一个月后的抑郁症状加重。

总的来说，当前研究发现，将tDCS不同极性电极分别放置于PSD患者大脑皮层的不同区域对于改善抑郁症患者的症状是有效的:通过阳极刺激增强1DLPFC神经元的兴奋性，阴极刺激rDLPFC降低神经元的兴奋性可引起抑郁症状的缓解。而且在跟踪治疗时发现，社会工作师通过心理干预和生活指导的介入对改善出院后脑卒中患者的抑郁状态是有效的。因此，住院期间加强对PSD患者tDCS的积极干预，出院后社会工作者介入，都将更好地提高脑卒中病人的生活质量和心理状况。

Post-stroke depression (PSD) is one of common complications after stroke patients, directly affects the quality of life of patients with cerebral apoplexy, physical function and cognitive function of rehabilitation, and even leads to stroke recurrence. So it is very important to intervent the depression symptom of stroke patients. The current study used transcranial direct current stimulation (tDCS) technology and social workers psychological intervention methods to intervene the post-stoke depression patients and investigated the therapeutic effects.

This study has been divided into two parts. In the first experiment, the main aim is to investigate the effects of different tDCS electrodes placed at different locations of the brain on PSD. In view of the important roles of left dorsolateral prefrontal cortex (1DLPFC) and right dorsolateral prefrontal cortex (rDLPFC) role in the onset of depression, the PSD patients were randomly distributed into four groups (control group\IDLPFC\rDLPFC\1DLPFC+rDLPFC), based on the electrodes of tDCS placing in different positions. The following randomized double blind control design was adopted and Hamilton depression (HAMD) and Hamilton anxiety (HAMA) scales were used to assess psychological emotional state after treatment. The results found that use tDCS to alleviate symptoms of depression after stroke is have obvious effect; Left DLPFC rather than stimulate the right DLPFC, while at the same time stimulate bilateral DLPFC and stimulation effect was no significant difference between the left DLPFC..In the second Experiment, we involved the social workers intervention to help the discharged patients. It was also randomized double blind control design. The patients were randomly divided into two groups, experimental group and control group. For the experimental group, social workers were involved once a week, lasting four weeks. The social workers provided face-to-face family services to patients, psychological counseling and consultation, and material assistance and personal services, etc. The results showed that the Hamilton anxiety and depression scale scores significantly decreased, while the control group was found in patients with depression score increased after month. The results also show that the patient with depression after stroke who's daily function has improved over time, but no individual intervention after a month of depressive symptoms.

In summury, the current study found that transcranial direct current stimulation in the early years of the depression after stroke using different electrode polarity effect in different regions of the cerebral cortex is effective to improve the symptoms of depression patients; By anode stimulus the left dorsolateral prefrontal neuronal excitability, cathode stimulus right dorsolateral prefrontal reduce the excitability of neurons can cause depression symptom relief And found during the follow-up, division of social work through the psychological intervention and life coaching intervention to improve the discharge patients with depression in effective. Therefore, to strengthen the patients of depression after stroke positive transcranial direct current stimulation intervention, psychological guidance after discharge, will better improve the quality of life in patients with cerebral apoplexy and psychological conditions.