Biaxial Diagnosis Of Affective Disorder Patients With Acute Stroke Clinical Research

Objective: To study the rate of incidence and relative factors of the acute-onset affective disorders in stroke through the methods of two-way diagnosis ( physical and mental diseases) and the changes in the hypothalamus-hypophysis-thyroid (HPT) axis by measuring thyroid hormones. Methods: 109 patients suffering from stroke were investigated, assessed and diagnosed with two criteria , correlative scales and self-designed questionnaire. According to the diagnosis they were divided into two groups: The first group was patients without affective disorders (n=55 ) and the second with affective disorders (n=54 ). Thyroid hormones ( FT3 FT4 TSH ) were tested by chemolumminescence method on second day and 14th day respectively after stroke. The relevant factors and the changes of thyroid hormones level were analyzed by using the different statistical methods. Results: The total incidence of the post-stroke affective disorder in acute phase was 49.54%. It included depression 39.45%; anxiety 17.43%; and mania 2.75%. The relative factors included depression history or family history, the degree of neurological deficit, accompanying disease, daily living activity, the family member relationship, personality and recent negative living events. The changes of thyroid function on second day: FT3 was significantly decreased in two groups compared to control ( p<0.001 ) and also was obviously decreased in the second group compared to the first group ( p<0.001 ); FT4 was obviously elevated in two groups compared to control( p<0.001.) and was significantly higher in the second group than in the first group ( p<0.05); TSH was greatly increased in the first group compared to control ( p<0.01 ), whereas in the second group had no significant difference from control (p>0.05). The changes of thyroid function on the 14th day: The level of thyroxin ( FTs FT4 TSH ) was almost within the normal range in the first group which had no difference from control (p>0.05); but FT3 and FT4 were still abnormal in the second group compared to control (p<0.01). FT3 and FT4 were obviously different between the group one and two (p<0.01). TSH was no significantly different in three groups. Conclusion: The high incidence of affective disorders in the acute phase of stroke is the result of multiple factors which mainly include biologic, psychological and social factors. The changes of FT3 FT4 are more significant in the patients with affective disorder following stroke than non-affective disorder, and recovered slowly.Furthermore the feedback action of TSH was reduced in the second group.Testing the thyroid function can help diagnose and predict the post-stroke affective disorder. The method of two-way diagnosis should be popularized.