背景:脑卒中后常常会出现明显的神经心理学改变,除认知功能受损外,抑郁、焦虑等症状亦十分突出.目的:运用神经心理学方法探讨与脑卒中后相关的神经心理学变化特点.设计:病例-对照实验.单位:大庆市第三医院心理科,哈尔滨医科大学附属第二医院神经内科.对象:选择2001-10/2002-06哈尔滨医科大学附属第二医院神经科住院治疗的脑卒中患者60例.男33例,女27例,年龄42～75岁,平均年龄(59.3±8.8)岁.脑梗死49例,脑出血11例.病灶为单灶31例,多灶(含2个病灶以上)29例.左半球病变20例,右半球病变21例,双侧病变19例.病变部位在颞叶6例、枕叶2例、额顶颞联合病变15例、内囊4例、基底核19例、侧脑室旁4例、丘脑4例、小脑1例、多部位5例.病灶大小＜15mm的患者33例,≥15mm27例.同期选择来自哈尔滨市社区和市郊居民60例为对照组,男33例,女27例,年龄42～75岁,平均年龄(58.7±7.9)岁,无脑器质性病变、无精神障碍及重大躯体疾病,无精神病家族史.方法:病情处于稳定恢复期患者使用症状自评量表(90个项目,9个症状因子,分为5级评分(从0～4级,0=从无,1=轻度,2=中度,3=相当重,4=严重),汉密顿抑郁量表(共24项.其中11个躯体症状按0～2级评分,13个精神症状按0～4级评分.总分超过＞24分严重抑郁、17～24分中等抑郁、7～16分轻度抑郁、＜7分没有抑郁),抑郁自评量表(共20项,按症状出现频度评定,分为4个等级.正向评分题,则依次评为1,2,3,4分;反向评分题,则评为4,3,2,1分.总分最高80分.抑郁严重程度=受试者各条目累积分/80×100,抑郁指数范围为25～100,规定指数在0.5以下为无抑郁,0.5～0.59为轻度抑郁,0.6～0.69为中度抑郁,0.7以上为重度抑郁),焦虑自评量表(含有20个项目,分为4级评分,主要评定项目所定义的症状出现的频度.正向计分评为1,2,3,4分;反向计分评为4,3,2,1分.总分乘以1.25取整数,即得标准分,分值越小越好,分界值为50.焦虑总分低于50分者为正常;50～60分为轻度焦虑,61～70分是中度焦虑,70以上者是重度焦虑)评定脑卒中后患者的精神状态.中度以上抑郁患者针对不同的病情特点给予适当的心理治疗及精神科药物治疗,共4周,1个疗程.主要观察指标:①两组对象4个量表总分比较.②脑卒中患者不同病变性质、病灶部位以及病灶大小时4个量表总分比较.③伴发抑郁患者治疗前后症状自评量表因子分比较.结果:60例脑卒中患者和60例对照组均进入结果分析.①脑卒中组和对照组症状自评量表、汉密顿抑郁量表、抑郁自评量表、焦虑自评量表总分比较:脑卒中组均高于对照组[(131.45±18.89),(94.25±9.08)分;(18.73±6.54),(8.60±2.39)分;(56.49±11.85),(41.63±9.91)分;(40.08±6.55),(28.72±1.84)分,t=7.45～13.75,P＜0.05].②脑卒中组病变性质、病灶部位以及病灶大小不同的患者4个量表总分比较:在脑卒中组,左半球病变、皮质病变、多发病灶、大病灶(≥15 mm)4个量表总分高于右半球病变、皮质下病变、单发病灶、小病灶(5～14mm),(t=1.92～4.31,P＜0.05);而脑梗死患者与脑出血患者评分基本一致(P＞0.05).③伴发抑郁患者治疗前后症状自评量表因子分比较:21例患者有中等程度以上的抑郁症状.症状自评量表、汉密顿抑郁量表、抑郁自评量表、焦虑自评量表总分明显高于对照组(t=7.45～13.75,9.83～21.20,P＜0.01).结论:脑卒中后的神经心理学改变比较明显,这种改变与脑卒中病变部位、病灶大小和病灶部位有关,与病变性质关系不密切.有明显抑郁症状患者经心理干预后抑郁情绪明显改善,说明脑卒中后患者需要心理干预.
揹景:腦卒中後常常會齣現明顯的神經心理學改變,除認知功能受損外,抑鬱、焦慮等癥狀亦十分突齣.目的:運用神經心理學方法探討與腦卒中後相關的神經心理學變化特點.設計:病例-對照實驗.單位:大慶市第三醫院心理科,哈爾濱醫科大學附屬第二醫院神經內科.對象:選擇2001-10/2002-06哈爾濱醫科大學附屬第二醫院神經科住院治療的腦卒中患者60例.男33例,女27例,年齡42～75歲,平均年齡(59.3±8.8)歲.腦梗死49例,腦齣血11例.病竈為單竈31例,多竈(含2箇病竈以上)29例.左半毬病變20例,右半毬病變21例,雙側病變19例.病變部位在顳葉6例、枕葉2例、額頂顳聯閤病變15例、內囊4例、基底覈19例、側腦室徬4例、丘腦4例、小腦1例、多部位5例.病竈大小＜15mm的患者33例,≥15mm27例.同期選擇來自哈爾濱市社區和市郊居民60例為對照組,男33例,女27例,年齡42～75歲,平均年齡(58.7±7.9)歲,無腦器質性病變、無精神障礙及重大軀體疾病,無精神病傢族史.方法:病情處于穩定恢複期患者使用癥狀自評量錶(90箇項目,9箇癥狀因子,分為5級評分(從0～4級,0=從無,1=輕度,2=中度,3=相噹重,4=嚴重),漢密頓抑鬱量錶(共24項.其中11箇軀體癥狀按0～2級評分,13箇精神癥狀按0～4級評分.總分超過＞24分嚴重抑鬱、17～24分中等抑鬱、7～16分輕度抑鬱、＜7分沒有抑鬱),抑鬱自評量錶(共20項,按癥狀齣現頻度評定,分為4箇等級.正嚮評分題,則依次評為1,2,3,4分;反嚮評分題,則評為4,3,2,1分.總分最高80分.抑鬱嚴重程度=受試者各條目纍積分/80×100,抑鬱指數範圍為25～100,規定指數在0.5以下為無抑鬱,0.5～0.59為輕度抑鬱,0.6～0.69為中度抑鬱,0.7以上為重度抑鬱),焦慮自評量錶(含有20箇項目,分為4級評分,主要評定項目所定義的癥狀齣現的頻度.正嚮計分評為1,2,3,4分;反嚮計分評為4,3,2,1分.總分乘以1.25取整數,即得標準分,分值越小越好,分界值為50.焦慮總分低于50分者為正常;50～60分為輕度焦慮,61～70分是中度焦慮,70以上者是重度焦慮)評定腦卒中後患者的精神狀態.中度以上抑鬱患者針對不同的病情特點給予適噹的心理治療及精神科藥物治療,共4週,1箇療程.主要觀察指標:①兩組對象4箇量錶總分比較.②腦卒中患者不同病變性質、病竈部位以及病竈大小時4箇量錶總分比較.③伴髮抑鬱患者治療前後癥狀自評量錶因子分比較.結果:60例腦卒中患者和60例對照組均進入結果分析.①腦卒中組和對照組癥狀自評量錶、漢密頓抑鬱量錶、抑鬱自評量錶、焦慮自評量錶總分比較:腦卒中組均高于對照組[(131.45±18.89),(94.25±9.08)分;(18.73±6.54),(8.60±2.39)分;(56.49±11.85),(41.63±9.91)分;(40.08±6.55),(28.72±1.84)分,t=7.45～13.75,P＜0.05].②腦卒中組病變性質、病竈部位以及病竈大小不同的患者4箇量錶總分比較:在腦卒中組,左半毬病變、皮質病變、多髮病竈、大病竈(≥15 mm)4箇量錶總分高于右半毬病變、皮質下病變、單髮病竈、小病竈(5～14mm),(t=1.92～4.31,P＜0.05);而腦梗死患者與腦齣血患者評分基本一緻(P＞0.05).③伴髮抑鬱患者治療前後癥狀自評量錶因子分比較:21例患者有中等程度以上的抑鬱癥狀.癥狀自評量錶、漢密頓抑鬱量錶、抑鬱自評量錶、焦慮自評量錶總分明顯高于對照組(t=7.45～13.75,9.83～21.20,P＜0.01).結論:腦卒中後的神經心理學改變比較明顯,這種改變與腦卒中病變部位、病竈大小和病竈部位有關,與病變性質關繫不密切.有明顯抑鬱癥狀患者經心理榦預後抑鬱情緒明顯改善,說明腦卒中後患者需要心理榦預.
배경:뇌졸중후상상회출현명현적신경심이학개변,제인지공능수손외,억욱、초필등증상역십분돌출.목적:운용신경심이학방법탐토여뇌졸중후상관적신경심이학변화특점.설계:병례-대조실험.단위:대경시제삼의원심이과,합이빈의과대학부속제이의원신경내과.대상:선택2001-10/2002-06합이빈의과대학부속제이의원신경과주원치료적뇌졸중환자60례.남33례,녀27례,년령42～75세,평균년령(59.3±8.8)세.뇌경사49례,뇌출혈11례.병조위단조31례,다조(함2개병조이상)29례.좌반구병변20례,우반구병변21례,쌍측병변19례.병변부위재섭협6례、침협2례、액정섭연합병변15례、내낭4례、기저핵19례、측뇌실방4례、구뇌4례、소뇌1례、다부위5례.병조대소＜15mm적환자33례,≥15mm27례.동기선택래자합이빈시사구화시교거민60례위대조조,남33례,녀27례,년령42～75세,평균년령(58.7±7.9)세,무뇌기질성병변、무정신장애급중대구체질병,무정신병가족사.방법:병정처우은정회복기환자사용증상자평량표(90개항목,9개증상인자,분위5급평분(종0～4급,0=종무,1=경도,2=중도,3=상당중,4=엄중),한밀돈억욱량표(공24항.기중11개구체증상안0～2급평분,13개정신증상안0～4급평분.총분초과＞24분엄중억욱、17～24분중등억욱、7～16분경도억욱、＜7분몰유억욱),억욱자평량표(공20항,안증상출현빈도평정,분위4개등급.정향평분제,칙의차평위1,2,3,4분;반향평분제,칙평위4,3,2,1분.총분최고80분.억욱엄중정도=수시자각조목루적분/80×100,억욱지수범위위25～100,규정지수재0.5이하위무억욱,0.5～0.59위경도억욱,0.6～0.69위중도억욱,0.7이상위중도억욱),초필자평량표(함유20개항목,분위4급평분,주요평정항목소정의적증상출현적빈도.정향계분평위1,2,3,4분;반향계분평위4,3,2,1분.총분승이1.25취정수,즉득표준분,분치월소월호,분계치위50.초필총분저우50분자위정상;50～60분위경도초필,61～70분시중도초필,70이상자시중도초필)평정뇌졸중후환자적정신상태.중도이상억욱환자침대불동적병정특점급여괄당적심리치료급정신과약물치료,공4주,1개료정.주요관찰지표:①량조대상4개량표총분비교.②뇌졸중환자불동병변성질、병조부위이급병조대소시4개량표총분비교.③반발억욱환자치료전후증상자평량표인자분비교.결과:60례뇌졸중환자화60례대조조균진입결과분석.①뇌졸중조화대조조증상자평량표、한밀돈억욱량표、억욱자평량표、초필자평량표총분비교:뇌졸중조균고우대조조[(131.45±18.89),(94.25±9.08)분;(18.73±6.54),(8.60±2.39)분;(56.49±11.85),(41.63±9.91)분;(40.08±6.55),(28.72±1.84)분,t=7.45～13.75,P＜0.05].②뇌졸중조병변성질、병조부위이급병조대소불동적환자4개량표총분비교:재뇌졸중조,좌반구병변、피질병변、다발병조、대병조(≥15 mm)4개량표총분고우우반구병변、피질하병변、단발병조、소병조(5～14mm),(t=1.92～4.31,P＜0.05);이뇌경사환자여뇌출혈환자평분기본일치(P＞0.05).③반발억욱환자치료전후증상자평량표인자분비교:21례환자유중등정도이상적억욱증상.증상자평량표、한밀돈억욱량표、억욱자평량표、초필자평량표총분명현고우대조조(t=7.45～13.75,9.83～21.20,P＜0.01).결론:뇌졸중후적신경심이학개변비교명현,저충개변여뇌졸중병변부위、병조대소화병조부위유관,여병변성질관계불밀절.유명현억욱증상환자경심리간예후억욱정서명현개선,설명뇌졸중후환자수요심리간예.
BACKGROUND: There are obvious neuropsychological changes after stroke besides the damage of cognitive function, and the symptoms of depression and anxiety which are also very conspicuous.OBJECTIVE: To investigate the related characteristics of neuropsychological changes after stroke by means of neuropsychological methods.DESIGN: A case-control study.SETTING: Department of Psychology, the Third Hospital of Daqing; Department of Neurology, the Second Affiliated Hospital of Harbin Medical University.PARTICIPANTS: Sixty stroke inpatients (33 males and 27 female)aged from 42 to 75 years old with an average of (59.3±8.8) years old were selected from the Department of Neurology, the Second Affiliated Hospital of Harbin Medical University between October 2001 and June 2002. Totally 49 cases had cerebral infarction and 11 cases had cerebral hemorrhage; 31 cases had single focus and 29 cases had multiple focuses (including 2 focuses or more); 20 cases had lesion in left hemisphere,21 cases had lesion in right hemisphere and 19 cases had bilateral lesions. The lesion was at temporal lobe in 6 cases, at occipital lobe in 2 cases, at frontoparietal temporal lobe in 15 cases, at internal capsule in 4 cases, at basal nuclei in 19 cases, at lateral ventricle in 4 cases, at thalam us in 4 cases, at cerebellum in 1 case and at multiple sites in 5 cases. The focal size was ＜ 15 mm in 33 cases and ≥ 15 mm in 27 cases. Sixty residents (33 males and 27 females) aged 42to 75 years with an average of (58.7±7.9) years old were selected simultaneously from the communities and suburbs of Harbin city as the controls and they all had no cerebral and organic lesion, mental disorder, severe somatic diseases and family history of mental disease.INTERVENTIONS: The poststroke mental status of the patients at stable recovery period was assessed with symptom checklist-90 (SCL-90, consisted of 90 items and 9 symptoms, scored by 5 grades of 0 to 4, including 0 as never, 1 as mild, 2 as moderate, 3 as a little severe and 4 as severe;Hamilton depression scale (HAMD, consisted of 24 items, including 11 somatic symptoms scored by 0 to 2 grades and 13 mental symptoms scored by 0 to 4 grades; the total score ＞ 24 points was taken as severe depression, 17 to 24 as moderate depression, 7 to 16 as mild depression, ＜ 7 as no depression), self-rating depressive scale (SDS, consists of 20 items, evaluated according to the occurrence frequency of the symptom, and classified into 4 grades; the score was 1, 2, 3 and 4 points for the forward scored questions, but 4, 3, 2 and 1 point for the backward scored questions; the highest total score was 80 points; the depressive severity=accumulative scores of each item/80×100, the depressive index ranged 25 to 100, the index ＜ 0.5 was taken as no depression, 0.5 to 0.59 as mild depression,0.6 to 0.69 as moderate depression, ＞ 0.7 as severe depression) and selfrating anxiety scale (SAS, consisted of 20 items, scored by 4 grades, mainly evaluated according to the occurrencefrequency of the symptoms. The forward scores were 1, 2, 3 and 4 points, and the backward scores were 4,3, 2 and 1 point; the total score multiplied by 1.25, and then the integer was taken as the standard score, the lower the better, and the delimitative value was 50. The total score of anxiety ＜ 50 points was taken as normal,50 to 60 as mild anxiety, 61 to 70 as moderate anxiety, ＞ 70 as severe anxiety). According to the different characters of disease, the patients with moderate depression and above were given suitable psychotherapy and psychiatric drugs for 4 weeks as a course.of the 4 scales between stroke patients with different lesion natures, foin the patients accompanied by depression. RESULTS: All the 60 stroke patients and 60 eases in the control group were involved in the analysis and SAS between the stroke group and control group: All the total scores were higher in the stroke group than in the control group [(131.45 ±18.89), (94.25 ±9.08) points; (18.73 ±6.54), (8.60 ±2.39)points; (56.49±11.85), (41.63±9.91) points: (40.08±6.55), (28.72±1.84)the 4 scales between stroke patients with different lesion natures, focal sites and focal sizes: In the stroke group, the total scores were higher in the patients with lesion in left hemisphere, cortical lesion, multiple focuses and large focal size (≥ 15 mm) than in those with lesion in right hemisphere, subcortical lesion, single focus and small focal size (＜ 15 mm)(t=1.92 to 4.31, P ＜ 0.05), but the scores were almost the same between the patients with cerebral infarction and those with cerebral hemorrhage accompanied by depression before and after treatment: 21 patients had moderate depressive symptoms and above, and their total scores of SCL90, HAMD, SDS and SAS were obviously higher than those in the control group (t=7.45 to 13.75, 9.83 to 21.20, P ＜ 0.01).CONCLUSION: The poststroke neuropsychological changes are more obvious, and the changes are associated with the lesion location, focal size and focal site, but have no close correlation with the lesion nature.After psychological interventions, the depressive emotion is markedly ameliorated in the patients with obvious depressive symptoms and it is then indicated that poststroke patients should be given psychological interventions.
