Cognitive-behavioural intervention for depression after stroke: five single case studies on effects and feasibility.

The purpose of the study was to investigate whether or not a cognitive-behavioural intervention for depression after stroke has an effect and is feasible. A single-subject quasi experimental design (SSED) was used with an AB design and follow-up. The participants were five first episode stroke patients attending outpatient rehabilitation in a rehabilitation centre in The Netherlands. Mood and quality of life were measured on four occasions over four weeks (baseline phase A). During the eight week intervention phase (B) a visual analogue measure of mood was administered three times a week. Immediately after the intervention, and one and three months later, the baseline measures were repeated. The intervention (phase B) was based on cognitive-behavioural principles: recognising negative thoughts and challenging them, learning principles of relaxation, and planning of pleasurable activities. Following intervention three patients reported they had improved, three patients reported a minor improvement in quality of life, and four patients reported a more positive mood. Three months later three patients reported fewer depressive symptoms. Both patients and therapist were positive about the intervention and three months later, in daily life, all patients still applied the strategies. It was concluded that despite some ambiguous results, it seems that the cognitive-behavioural intervention has an effect on patients' mood. The intervention was rated as feasible by both patients and therapists.

Early increase in vegetative symptoms predicts IFN-alpha-induced cognitive-depressive changes.

BACKGROUND: The vegetative symptoms of depression resemble the symptoms of malaise associated with activation of the inflammatory response system (IRS), and can be regarded as an expression of a central motivational state that resets the organism's priorities to promote recovery from infection. Early vegetative symptoms, however, may also contribute to the high rates of depression seen later in the course of immune activation. We hypothesized that the onset of vegetative-depressive symptoms early in the treatment with the pro-inflammatory cytokine IFN-alpha in chronic hepatitis C patients would increase the risk for subsequent depressive cognitions. METHOD: Sixteen patients eligible for IFN-alpha treatment and free of psychiatric disorders were recruited. The DSM-IV, the Multidimensional Fatigue Inventory, and the Montgomery-Asberg Depression Rating Scale (MADRS) were administered at baseline and 1, 2, 4, 8, 12 and 24 weeks after treatment was initiated. Cognitive-depressive and vegetative-depressive symptom clusters were constructed. RESULTS: Fatigue and depression scores increased significantly during IFN-alpha treatment. Depression scores were highest at week 8 of treatment. First week increase in vegetative-depressive symptom score predicted cognitive-depressive symptom score at week 8 and at week 24. CONCLUSIONS: During IFN-alpha treatment, vegetative symptoms of depression appear earlier than, and are predictive of, their cognitive counterparts. This finding suggests that low mood state may in part be driven by the increase in early vegetative-depressive symptoms in the course of IFN-alpha-induced immune activation.