卒中后抑郁预防和治疗的行为干预

Behavioral intervention in the prevention and treatment of post stroke depression

卒中后抑郁对脑卒中患者的康复和再发有着巨大影响。具体发病机制不明，认为可能与单胺递质、炎性细胞因子、下丘脑一垂体一肾上腺轴功能和神经可塑性有关。由于药物治疗的不确定性和副作用，非药物治疗，尤其是行为干预治疗越来越引起广大临床医生的重视。目前临床常用的行为干预治疗手段包括：认知行为治疗、动机访谈、运动、音乐等。尽管大量的临床研究显示行为干预治疗对卒中后抑郁有明确的治疗效果，但由于缺乏大样本、高质量的多中心随机对照研究，行为干预在卒中后抑郁的预防和治疗中仍然没有得到高级别的推荐。

Post stroke depression has a huge impact on the rehabilitation and recurrence of patients with stroke.lts specific pathogenesis is unknown.Monoamine transmitters, inflammatory cytokines, hypothalamic pituitary adrenal axis function and neural plasticity are involved.Because of the uncertainty and side effects of drug therapy, non-drug therapy, especially behavioral intervention, is attracting more and more attention from clinicians. At present, behavioral intervention methods commonly used in clinical practice include：cognitive behavioral therapy, motivational interviewing, sports, music, and so on.Although a large number of clinical studies have shown that behavioral intervention has a clear therapeutic effect on post stroke depression, there is still no high level of recommendation for the prevention and treatment of post-stroke depression due to the lack of large sample and high quality multicenter randomized controlled studies.