A comprehensive rehabilitation program for the management of anxiety and depressive disorders in post-stroke patients

Rassvet M.; Konovalova O.; Galushina E.

doi:10.14529/jpps250304

M. M. Rassvet 1) Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky (1 Partizan Zheleznyak St., Krasnoyarsk, Krasnoyarsk Territory, 660022, Russia); 2) Federal Siberian Scientific and Clinical Center of the FMBA of Russia (26 - 2, Kolomenskaya St., Krasnoyarsk, Krasnoyarsk Territory, 660037 Russia) https://orcid.org/0009-0008-3614-9436 baiguzhinpa@susu.ru
O. N. Konovalova Federal Siberian Scientific and Clinical Center of the Russian Academy of Medical Sciences (26 - 2, Kolomenskaya str., Krasnoyarsk, Krasnoyarsk Territory, 660037 Russia) https://orcid.org/0009-0008-8688-0569 tereshonokon@gmail.com
E. N. Galushina Krasnoyarsk State Medical University named after prof. V.F. Voino-Yasenetsky (1 Partizan Zheleznyak St., Krasnoyarsk, Krasnoyarsk Territory, 660022, Russia) https://orcid.org/0000-0002-5628-0078 e.n.galushina@gmail.com

DOI: https://doi.org/10.14529/jpps250304

Keywords: anxiety, art therapy, cognitive behavioral therapy, depression, emotional disorders, pharmacotherapy, psychotherapy, rehabilitation, stroke, SSRIs

Abstract

Background. Emotional disorders such as anxiety and depression are frequent consequences of stroke that significantly impair patients' quality of life and impede neurorehabilitation. The limited efficacy of conventional approaches necessitates the development and evaluation of integrated rehabilitation programs designed to address the emotional disturbances in this population. Aims. This study aimed to evaluate the efficacy of a comprehensive rehabilitation program, including psychopharmacotherapy, cognitive behavioral therapy, art therapy, and autogenic training, for the management of anxiety and depressive disorders in post-stroke patients. Materials and methods. The study involved 40 patients (28 women and 12 men) aged 48 to 75 years (mean age 61.5 ± 8.2 years) with a history of stroke (at least 3 months post-event) and diagnosed anxiety and depressive disorders. The Hospital Anxiety and Depression Scale (HADS) and the Beck Depression and Anxiety Inventories (BDI-II, BAI) were used to assess symptom severity. The comprehensive intervention comprised pharmacotherapy (SSRIs), cognitive behavioral therapy (SMEER technique), art therapy (drawing a picture of illness and health), and Schultz’s autogenic training. Statistical analysis was performed using Student's paired t-test. Results. Prior to the intervention, patients exhibited elevated levels of anxiety and depression on all scales. Upon completion of the program, a statistically significant reduction in scores was observed on all measures (p < 0.001), indicating a marked improvement in patients’ emotional states. The mean HADS-anxiety score decreased from 8.175 ± 4.56 to 3.65 ± 2.47, and the mean HADS-depression score decreased from 7.975 ± 3.17 to 3.475 ± 2.36. Conclusion. A comprehensive rehabilitation program integrating psychopharmacotherapy, cognitive behavioral therapy, art therapy, and autogenic training is an effective intervention for the management of anxiety and depressive disorders in post-stroke patients. These findings underscore the importance of timely diagnosis and a multimodal approach to treating emotional disorders within stroke rehabilitation protocols.

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Author Biographies

M. M. Rassvet , 1) Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky (1 Partizan Zheleznyak St., Krasnoyarsk, Krasnoyarsk Territory, 660022, Russia); 2) Federal Siberian Scientific and Clinical Center of the FMBA of Russia (26 - 2, Kolomenskaya St., Krasnoyarsk, Krasnoyarsk Territory, 660037 Russia)

1) clinical psychologist, lecturer at the Department of Clinical Psychology and Pedagogy with a course; 2) medical psychologis

O. N. Konovalova , Federal Siberian Scientific and Clinical Center of the Russian Academy of Medical Sciences (26 - 2, Kolomenskaya str., Krasnoyarsk, Krasnoyarsk Territory, 660037 Russia)

Neurologist and somnologist, Head of the Department of Medical Rehabilitation No. 1

E. N. Galushina , Krasnoyarsk State Medical University named after prof. V.F. Voino-Yasenetsky (1 Partizan Zheleznyak St., Krasnoyarsk, Krasnoyarsk Territory, 660022, Russia)

Candidate of Physico-Mathematical Sciences, Associate Professor of the Department of Medical Cybernetics and Computer Science

References

1. Liu L., Li X., Marshall I.J. et al. Trajectories of depressive symptoms 10 years after stroke and associated risk factors: a prospective cohort study. Lancet. 2023;402(1):S64. DOI: 10.1016/S0140-6736(23)02111-6.
2. Kutlubaev M.A., Akhmetova A.I., Ozerova A.I. Emotional disorders after stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(12-2):30–35. (in Russ.). DOI: 10.17116/jnevro202312312230
3. Shevchenko P.A. Psychoemotional disorders in stroke patients. Innovatsii. Nauka. Obrazovanie = Innovations. Science. Education. 2022;(49):1634–1644. (in Russ.)
4. Kutlubaev M.A., Akhmetova A.I. Poststroke Asthenic Disorder. Annaly klinicheskoi i eksperimentalnoi nevrologii = Annals of Clinical and Experimental Neurology. 2023;17(4):64–71. DOI: 10.54101/ ACEN.2023.4.8. (in Russ.).
5. Ponevezhskaya EV, Savina MA, Petrova EA. Organization of post-stroke apathy. Psikhicheskoe zdorovie = Mental Health. 2022;17(6):37–43. (in Russ.). DOI: 10.25557/2074-014X.2022.06.37-43
6. Privalova M.A., Karasaeva L.A., Alekseev G.A., Okhotnikova A.A. Problems of post-hospital rehabilitation of patients suffering from post-stroke depression. Vestnik nevrologii, psikhiatrii i neirokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery. 2020;(9):31–37. (in Russ.). DOI: 10.33920/med-01-2009-03.
7. Trofimova S.A., Balunov O.A., Dubinina E.E. Oxidative stress and post-stroke depression. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(7):44–49. (in Russ.). DOI: 10.17116/jnevro202012007144.
8. Badwaik D.G., Badwaik P. Influence of psychological disorders on the functional out-comes in survivors of ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2021;30(2):105486. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105486.
9. Khutieva L.S., Kodzoeva T.I., Evloev R.Yu. Psychoemotional disorders, clinical features and factors of their development in patients with ischemic stroke. Sovremennye problemy nauki i obrazovaniya = Modern problems of science and education. 2021;(3):125. (in Russ.). DOI: 10.17513/spno.30824.
10. Kotov S.V., Isakova E.V., Egorova Yu.V. Post-stroke depression and the abilities of anti-depressants to enhance the effectiveness of neurorehabilitation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):110–116. (in Russ.). DOI: 10.14412/2074-2711-2020-6-110-116
11. Strelnikova I.A., Svetkina A.A., Minina Y.D., Androfagina O.V. Experience with vortioxetine in the treatment of post-stroke depression. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(1):45–49. (In Russ.). DOI: 10.14412/2074-2711-2020-1-45-49
12. Khasanova D.R. Post-stroke depression, the role of a multidisciplinary team. Pharmacology and Pharmacotherapy. 2021;(2):28–29. (in Russ.).
13. Shtankov S.I., Arzhanykh Ya.V., Kharitonov E.V. The influence of risk factors and the degree of loss of employment on the development of post-stroke depression and anxiety in patients with CVA. Nauchno-meditsinskii vestnik Tsentralnogo Chernozemya = Medical Scientific Bulletin of Central Chernozemye. 2021;(84):38–44. (in Russ.)
14. Gureeva I.L. Cognitive and personality disorders in post-stroke patients. NauchnoeMnenie = Scientific Opinion. 2020;(11):93–97. (in Russ.). DOI: 10.25807/PBH.22224378.2020.11.93.97
15. Molchanova E.E., Prikhodko O.B., Kostrova I.V. Features of psychoemotional and cognitive functioning of patients in the acute period of ischemic stroke. Zametki Uchenogo = Scientists notes. 2021;(4-2):74–79. (in Russ.)
16. Chugunov A.V., Pyshkina L.I., Osmayeva Z.Kh. Correction of post-stroke cognitive and motor disorders. RMZh. Meditsinskoe obozrenie = Russian Medical Inquiry. 2020;4(9):584–589. (in Russ.). DOI: 10.32364/2587-6821-2020-4-9-584-589.
17. Ferro J.M., Santos A.C. Emotions after stroke: A narrative update. International Journal of Stroke. 2020;15(3):256–267. DOI: 10.1177/1747493019879662.
18. Facucho-Oliveira J., Esteves-Sousa D., Espada-Santos P. et al. Depression after stroke. Practical Neurology. 2021;21(5):384–391. DOI: 10.1136/practneurol-2020-002622.
19. Tang W.K., Wang L., Tsoi K.K.F. et al. Post-traumatic stress disorder after stroke: A systematic review. Neurology India. 2022;70(5):1887–1895. DOI: 10.4103/0028-3886.359285.
20. Khomyachuk A.A., Verbakh T.E., Doyan Yu.I. Modern methods of treatment of post-stroke anxietydepressive disorder. Deviantologiya = Deviant Behavior (Russia). 2023;7(2):24–30. (in Russ). DOI: 10.32878/devi.23-7-02(13)-24-30
21. Guo J., Wang J., Sun W., Liu X. The advances of post-stroke depression: 2021 update. Journal of Neurology. 2022;269(3):1236–1249. DOI:10.1007/s00415-021-10597-4.
22. Popkova E.V., Verbakh T.E., Kicherova K.P., Ostapchuk E.S. Pathophysiological aspects of post-stroke depression. Universitetskaya meditsina Urala = Ural University Medicine. 2024;10(2):75–78. (in Russ.)
23. Khomyachuk A.A., Verbakh T.E., Ostapchuk E.S., Belova E.V. Risk factors and charac-teristics of depressive disorders in patients with cerebral stroke. Akademicheskii zhurnal Zapadnoi Sibiri = Academic Journal of West Siberia. 2023;19(3):29-35. (in Russ). DOI: 10.32878/sibir.23-19-03(100)-29-35
24. Zhang X., Huang L., Zhang J. et al. Association between post-stroke depression and post-stroke sleep disorders: A systematic review and meta-analysis. Sleep and Breathing. 2024;29(1):5. DOI: 10.1007/s11325-024-03200-3.
25. Arzhanykh Ya.V., Zolotukhin V.O. Somatic extrusion and risk factors as formoforming components of post-stroke depression and anxiety in patients with CMV. Molodezhnyi innovatsionnyi vestnik = Youth Innovation Bulletin. 2021;10(S1):250–253. (in Russ.)
26. Allida S., House A., Hackett M.L. Pharmaceutical interventions for emotionalism after stroke. Cochrane Database of Systematic Reviews. 2022;11(11):CD003690. DOI: 10.1002/14651858.CD003690.pub5.
27. Yan N., Hu S. The safety and efficacy of escitalopram and sertraline in post-stroke depression: a randomized controlled trial. BMC Psychiatry. 2024;24(1):365. DOI: 10.1186/s12888-024-05833-w.
28. Tkach V.V., Almasud R., Tkach A.V. Post-stroke depression. Modern Science. 2021;(5-4):85–89. (in Russ.)
29. Chopaleva A.G., ShugaevaK.Ya., Ramazanova K.G., Ilyasova U.S. Effectiveness of escitalopram in the prevention and treatment of post-stroke depression. International Journal of Medicine and Psychology. 2023;6(1):157–159. (in Russ.)
30. Molchanova E.E., Goncharova O.M., Reshetnikova L.K. Experience of application of nondrug technologies in the correction of post-stroke psychoemotional disorders. Sovremennaya nauka: Aktualnye problemy teorii i praktiki. Seriya: Estestvennye i tekhnicheskie nauki = Modern Science: actual problems of theory and practice. Series Natural and Technical Sciences. 2023;(8):196–200. (in Russ.). DOI: 10.37882/2223-2982.2023.08.24.
31. Pizov N.A., Pizov A.V., Skachkova O.A., Pizova N.V. Depression, apathy, and anxiety in stroke patients. Pharmateka. 2021;28(3):25–31. DOI: 10.18565/pharmateca.2021.3.25-30. (in Russ.)
32. Rassvet M.M., Konovalova O.N., Galushina E.N. The use of transcranial magnetic stimu-lation for the treatment of anxiety and depressive disorders. Psikhologiya. Psikhofiziologiya = Psychology. Psychophysiology. 2024;17(3):57–65. DOI: 10.14529/jpps240305. (in Russ.)
33. Robinson R.G., Jorge R.E., Starkstein S.E. Poststroke depression: An update. Journal of Neuropsychiatry and Clinical Neurosciences. 2024;36(1):22–35. DOI: 10.1176/appi.neuropsych.21090231.

References on translit

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