A 68-year-old man is admitted to a rehabilitation unit following a stroke that resulted in right-sided weakness and facial droop. He has a history of hypertension, coronary artery disease, osteoarthritis, and prostate cancer in remission. Prior to the stroke, the patient had retired to care for his wife, who has early-onset dementia. The physical therapist informs the physician that the patient has shown little effort over the past 3 weeks and has recently refused rehabilitation services, saying, "What's the point?" The physician speaks with the patient's family members, who say, "Ever since last month's stroke, he seems so resigned and barely talks when we visit. He seems uninterested in hearing about the grandchildren he adores and has asked his friends not to visit." When interviewed by the physician, the patient says he has had low energy, decreased concentration, and difficulty sleeping since the stroke. He says, "Of course I'm depressed, with all my medical problems and my wife's condition. Wouldn't anyone in my situation be depressed?" He has no suicidal ideation. Which of the following is the most appropriate response to the patient by the physician?

Question

A 68-year-old man is admitted to a rehabilitation unit following a stroke that resulted in right-sided weakness and facial droop.  He has a history of hypertension, coronary artery disease, osteoarthritis, and prostate cancer in remission.  Prior to the stroke, the patient had retired to care for his wife, who has early-onset dementia.  The physical therapist informs the physician that the patient has shown little effort over the past 3 weeks and has recently refused rehabilitation services, saying, "What's the point?"  The physician speaks with the patient's family members, who say, "Ever since last month's stroke, he seems so resigned and barely talks when we visit.  He seems uninterested in hearing about the grandchildren he adores and has asked his friends not to visit."  When interviewed by the physician, the patient says he has had low energy, decreased concentration, and difficulty sleeping since the stroke.  He says, "Of course I'm depressed, with all my medical problems and my wife's condition.  Wouldn't anyone in my situation be depressed?"  He has no suicidal ideation.  Which of the following is the most appropriate response to the patient by the physician?

Quizplus · Accepted Answer

This patient's depressed mood, loss of interest (eg, disinterest in family and friends), low energy, sleep difficulty, and impaired concentration meet the criteria for major depressive disorder. Poststroke depression is common and underdiagnosed, and untreated depression is associated with reduced quality of life, decreased adherence to treatment, poor functional outcomes, and increased mortality in patients recovering from stroke. Possible etiologic factors for poststroke depression include inflammation, cerebrovascular dysregulation, altered neuroplasticity, and altered glutamate neurotransmission. major depressive disorder Research supports the early treatment of poststroke depression with antidepressants and/or psychotherapy, which results in improved physical and cognitive recovery. This patient should be educated about depression and advised that treatment can help in overall recovery. Selective serotonin reuptake inhibitors are the pharmacotherapy of choice. (Choices B and F) Untreated poststroke depression can have a profound negative impact on stroke recovery, future functioning, and quality of life. Providing reassurance that the depression will improve on its own or attributing this patient's condition to a normal grief reaction underestimates the severity of the patient's condition. This patient meets criteria for poststroke major depressive disorder and requires appropriate antidepressant pharmacotherapy and/or psychotherapy. (Choices C, D, and E) Attending a support group, participating in physical rehabilitation, and spending more time with friends and family are useful adjuncts to antidepressant treatment. However, this patient, who is in an acutely depressed state, would likely have difficulty initiating and pursuing these activities, which are not sufficient substitutes for aggressive treatment. Educational objective: Poststroke depression is common, underdiagnosed, and associated with increased morbidity and mortality. Patients can benefit from early treatment with selective serotonin reuptake inhibitor antidepressants. References: Post-stroke depression: a review. (http://www.ncbi.nlm.nih.gov/pubmed/26684921) Post-stroke depression: an update. (http://www.ncbi.nlm.nih.gov/pubmed/22901370)

A 68-Year-Old Man Is Admitted to a Rehabilitation Unit Following