The Relationship between the Serum Cytokine and Clinical Improvement in Major Depressive Disorder

OBJECT: Currently, the alteration of cytokine system has been known to play an important role in regard to depressive symptom. We focused on the relationship between immunological parameters and clinical improvement in major depressive disorder. METHOD: Data were collected on 26 patients with major depressive disorder using a 8-week prospective follow-up design. After 8-week treatment period with fluoxetine, patients were classified into a response group and a non-response group according to their psychopathological outcome as evaluated by Hamilton Depression Rating Scale. The differences of the immunological parameters between pre-treatment phase and post-treatment phase were compared among patients. The difference of those was also compared within each phase among them. The relationship between socio-demographic variables, depression, cytokine, mononuclear cells was examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of clinical improvement of major depressive disorder. RESULT: Pre-treatment levels of IL-1beta in the response group were significantly higher than those in the non-response group. Pre-treatment levels of IL-1beta of all patients and in the response group were positively correlated with pre-treatment monocyte counts. Patients with subsequent remission showed significantly lower IL-6 values at baseline than those with non-response. Post-treatment values of IL-6 did not differ significantly among the patients. The correlation test showed more frequent relations among cytokines and mononuclear cells in the response group than in the non-responder group. Especially, serum level of IL-6 in pre-treatment phase was only significantly correlated with HAMD score after 8-week treatement phase, while other cytokines and mononuclear cells were not. Pretreatment level of IL-6 was of paramount importance in predicting clinical improvement of depressive symptom. CONCLUSION: The immune system of major depressive disorder patients might dichotomize the patients into subsequent responders and non-responders. Immune system might be of great influence on the clinical improvement of major depressive disorder. The mode of interaction between depression and cellular immune function and the mediators responsible for the cytokine production need to be studied further.

Correlates of Depression and Anxiety in Acute Stroke Patients

BACKGROUND: This study is aimed at the pathoanatomic correlates of depression and anxiety in acute stroke patients including subcortical lesion(periventricular hyperintensity, deep white matter hyperintensity, subcortical gray matter hyperintensity). METHODS: Sixty nine patients with acute stoke were recruited. Their brain lesions were measured using Brain MRI. Depressive or anxiety symptoms were rated by Beck depression inventory(BDI) or Beck anxiety inventory, respectively. RESULTS: There were significant correlation between depression and periventricular hyperintensity and deep white matter hyperintensity in acute stroke patients. There are no significant pathoanatomic correla- tions between anxiety and brain lesions on MRI. CONCLUSION: Our findings suggest that the white matter lesion may increase the risk of depression after stroke. Prevention of asymptomatic cerebrovascular lesion could decrease the risk of depression in acute stroke patients as well as the risk of stroke.

Correlates of Depression and Anxiety in Acute Stroke Patients

BACKGROUND: This study is aimed at the pathoanatomic correlates of depression and anxiety in acute stroke patients including subcortical lesion(periventricular hyperintensity, deep white matter hyperintensity, subcortical gray matter hyperintensity). METHODS: Sixty nine patients with acute stoke were recruited. Their brain lesions were measured using Brain MRI. Depressive or anxiety symptoms were rated by Beck depression inventory(BDI) or Beck anxiety inventory, respectively. RESULTS: There were significant correlation between depression and periventricular hyperintensity and deep white matter hyperintensity in acute stroke patients. There are no significant pathoanatomic correla- tions between anxiety and brain lesions on MRI. CONCLUSION: Our findings suggest that the white matter lesion may increase the risk of depression after stroke. Prevention of asymptomatic cerebrovascular lesion could decrease the risk of depression in acute stroke patients as well as the risk of stroke.

Influencing Factors on Quality of Life after Stroke

OBJECTIVES: The cerebrovascular diseases including stroke have become prevalent in Korea, ranking first as the cause of death in the aged. The quality of life (QOL) in stroke patients has been studied with growing interest since every aspect of life after stroke is influenced by the sequelae of this illness. This study aimed at 1) describing QOL of stroke patients and 2) identifying predictors of two month QOL after the event in stroke survivors. METHOD: WHO QOL scale was used to evaluate two month QOL after the stroke in 69 ischemic stroke patients. Data on age at the stroke event, sex, education level, brain MRI (magnetic resonance imaging) findings, symptoms of depression and anxiety, and neurologic disabilities were collected. Analyses were performed to explore the predictors of two month QOL. RESULTS: Stroke survivors with higher number and volume of frontal cortex lesions had lower two month QOL. Also, patients with more severe subcortical gray matter lesions had significantly lower two month QOL. Stroke patients with depression at the event had lower two month QOL than patients without depression. CONCLUSION: Lesions in frontal cortex and subcortical gray matter hyperintensities on MRI T2 images and depression in acute phase were of paramount importance in predicting two month QOL. Accurate and prompt neurologic and psychiatric interventions are required to improve QOL after stroke.

Quality of Life after Stroke: A Two-Month Follow-Up / 신경정신의학

OBJECTIVES: Currently, there is a growing interest of Quality of Life(QOL) in stroke patients. This study aimed at describing the temporal change of QOL in stroke patients and identifying factors that influence QOL of stroke survivors 2 month after the event. METHODS: Data were collected on 98 stroke patients using a two month prospective follow-up design, using WHO QOL scale. The difference of the QOL between in acute phase and 2 month after stroke was compared with by t-test. The relationships between sociodemographic variables, depression, anxiety, social support and neurological variables, and QOL were examined by correlation analysis. Multiple regression analyses were performed to explore the predictors of QOL. RESULTS: The overall QOL domains and total scores except the social support domain were left unchanged 2 month after stroke, even though mean anxiety scores had decreased and neurological disabilities had improved during the 2 month course. Depression, anxiety, social support and neurological disabilities were significantly correlated with total QOL and its sub-domains. Among these factors, Depression was of paramount importance in predicting QOL in acute phase and 2 month after stroke. CONCLUSION: Although the mean of QOL in stroke patients had not significantly changed 2 month after stroke, QOL and its sub-domains were significantly correlated with depression and neurological disability. This study suggests that psychiatric intervention and holistic approach would be required after stroke as well as neurological treatment.