MossRehab has implemented a team-based, multifaceted care model that evaluates and addresses depression and other psychological issues in stroke patients. MossRehab neuropsychologists with doctorates in clinical psychology work closely on a daily basis with physicians, nurses and therapists to manage depression and anxiety by:

•comprehensively evaluating the patient’s psychological profile upon intake, then tracking mood through the time of discharge

•determining whether symptoms like lability, flat affect or changes in energy level are physical manifestations of the stroke or true depression

•diagnosing depression in individuals who are unable to communicate their depressive state due to aphasia

•evaluating whether depressive symptoms emanate from neurological conditions, metabolic causes or medication

•choosing appropriate treatment for depression

Separating Emotional From Cognitive Deficits

MossRehab neuropsychologists conduct assessments that help separate emotional from cognitive deficits, then communicate their findings to therapists in order to improve rehabilitation sessions. As part of this effort, MossRehab neuropsychologist Agnieszka Kleczek, PhD, and other neuropsych team members evaluate stroke patients to determine which behaviors are pre-morbid versus new, a particular concern when treating patients with multiple pre-existing comorbidities. In addition, MossRehab neuropsychologists host “behavior rounds” in which all therapists working with a particular patient meet to discuss therapeutic challenges and develop strategies to optimize therapy.

Neuropsych team members are also actively involved in managing behavioral difficulties that can occur during a patient’s unstructured time, e.g., the time between therapy sessions. Utilizing a sleep/behavior chart on which a patient’s level of arousal and behavior are recorded in 15-minute increments, team members can closely match medications such as stimulants and antipsychotics to a patient’s needs.

Support Groups to Prevent and Manage Depression

Several support groups led by MossRehab neuropsychologists also contribute to preventing and managing depression among stroke survivors. According to Julie Pickholtz, PhD, MossRehab neuropsychologist and coordinator of the support groups, leaders facilitate social interaction, discuss topics such as independence and dignity loss, explain what happens to the brain during a stroke, dispel the misconception that strokes happen only to those who are old and frail, and implement cognitive behavioral techniques to help patients change negativistic thinking and disabuse them of cognitive distortions such as believing themselves to be completely dependent. Recognizing that psychological stress can decrease a family’s ability to care for and support a stroke survivor, MossRehab provides monthly support groups for patients’ families, as well.

Stroke and Depression Links

MossRehab Stroke Center: http://www.einstein.edu/yourhealth/physicalrehab/stroke/article8859.html
Harrington C, Salloway S: The diagnosis and treatment of post-stroke depression. Med Health R I. 1997 Jun;80(6):181-7. Full text available at: http://www.brown.edu/Departments/Clinical_Neurosciences/articles/ch18197.html
Anderson CS, Hackett ML, House AO: Interventions for preventing depression after stroke (review). The Cochrane Library. 2005. Full text available at: http://wdh.state.wy.us/Media.aspx?mediaId=1007
Scholarly Articles: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=17519996&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum