Farmakoterapi untuk gangguan mood dan emosional pasca stroke penting dipahami oleh dokter karena sekitar 6-35% pasien pasca stroke mengalami gangguan mood dan emosional. Gangguan dapat berupa depresi pasca stroke, inkontinensia emosi pasca stroke, dan kemarahan pasca stroke.[1,2]
Prevalensi depresi pasca stroke (post-stroke depression atau PSD) mencapai sepertiga dari total kasus selama 5 tahun pertama setelah stroke. Sementara itu, prevalensi inkontinensia emosi pasca stroke (post-stroke emotional incontinence atau PSEI) berkisar antara 6–34% dan prevalensi kemarahan pasca stroke (post-stroke anger atau PSA) berkisar antara 15–35%.[2-5]
Gejala PSEI meliputi ketakutan (terutama takut mengalami serangan stroke berulang dan takut terjatuh), penumpulan emosi, penurunan kemampuan pengenalan emosi, penurunan empati emosi, dan penurunan kontrol ekspresi emosi. Disfungsi serotonik yang berkaitan dengan lesi stroke diduga berhubungan dengan terjadinya PSEI, PSA dan PSD. Selain itu, PSD juga berkaitan dengan faktor genetik dan psikososial.[2,6]
(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)
Referensi
1. Hill K, House A, Knapp P, et al. Prevention of mood disorder after stroke: a randomised controlled trial of problem solving therapy versus volunteer support. BMC Neurol. 2019 Jun 14;19(1):128.
2. Kwon B, Lee EJ, Park S, et al. Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger. J Stroke. 2021 May 31;23(2):263–72.
3. Woranush W, Moskopp ML, Sedghi A, et al. Preventive Approaches for Post-Stroke Depression: Where Do We Stand? A Systematic Review. Neuropsychiatr Dis Treat. 2021 Dec 31;17:3359–77.
4. Castilla-Guerra L, et al. Pharmacological management of post-stroke depression. Expert Rev Neurother. 2020 Feb 1;20(2):157–66.
5. Mortensen JK, Andersen G. Pharmacological management of post-stroke depression: an update of the evidence and clinical guidance. Expert Opin Pharmacother. 2021 Jun 13;22(9):1157–66.
6. Ferro JM, Santos AC. Emotions after stroke: A narrative update. Int J Stroke. 2020 Apr 1;15(3):256–67.
7. Allida S, House A, Hackett ML. Pharmaceutical interventions for emotionalism after stroke. Cochrane Database of Systematic Reviews 2022, Issue 11. Art. No.: CD003690. DOI: 10.1002/14651858.CD003690.pub5
8. Zorowitz RD, et al. Dextromethorphan/Quinidine for Pseudobulbar Affect Following Stroke: Safety and Effectiveness in the PRISM II Trial. Wiley Online Library. 2019. doi:10.1016/j.pmrj.2018.06.003.
9. Lanctôt KL, Lindsay MP, Smith EE, et al. Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue following Stroke, 6th edition update 2019. International Journal of Stroke. 2020;15(6):668-688. doi:10.1177/1747493019847334
10. Li X, Zhang C. Comparative efficacy of nine antidepressants in treating Chinese patients with post-stroke depression: A network meta-analysis. J Affect Disord. 2020 Apr 1;266:540–8.
11. Reviews of Current Literature in Neuroplasticity and Functional Recovery. J Neurol Phys Ther. 2020 Apr;44(2):173.
12. Allida S, et al. Pharmacological, psychological, and non‐invasive brain stimulation interventions for treating depression after stroke. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD003437. DOI: 10.1002/14651858.CD003437.pub4.
13. Cao JX, et al. Effects of the prophylactic use of escitalopram on the prognosis and the plasma copeptin level in patients with acute cerebral infarction. Braz J Med Biol Res. 2020 Oct 7;53:e8930.
14. Hankey GJ, et al. Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2020 Aug 1;19(8):651–60.
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