Nghiên cứu đặc điểm lâm sàng và một số yếu tố liên quan đến trầm cảm ở bệnh nhân sau nhồi máu não (tt)

T N 

Nh    t trong nhng bnh ph bi   
  vong cao  n t cho ng i ng t sau
i u o.
Nhng xy ra mt ngng n. Nu
  n c     li nhiu di chng. Trong s
nhng ri lon sau nhm cu hin hay
gp. m m 
 u qu ca tc th ti t  n
ri lon chu qu ca phn c
mt bnh nng, nhiu di chi b i
i v i. Trm c xut
hin cp hoc  gn hi phc. u 
a trm cm t m m n nh c m m
n ng thi bnh ca trm c
xen hoc b che lp bi nhng ri loa
t ng vi chn
kinh cao c
y, vic u t c ng a m m sau
i u o p y c n n c m c u u a
m m, p u tr
        c hi ch   nh

Mu:
 a trm cm  bi

u mt s yu t n trm cm  nhng bnh
.
B cc ca lu
Na lum 133 trang vi 27 bng, 3 bi, 16

di u tham kho vi b cc nht v 2
trang, tu 
cu 13 trang, kt qu n 42 trang, kt lun
n ngh 3 trang.
Phu tham kho g ng
n phn m  l
Ph lc gu, trc nghim

Nh thc tin ca lu
a trm cm sau nh
  n th ngi Vit Nam, t l trm cm sau nhi  
nht gia trm cm sau nhm cm
chung, trm cnh c m
cho tha c 

Nhn dic mt s yu t i trm cm sau nh
i c  tr y thu
nhn bit mt s yu t nguy ca bi vi trm
cm.
CH
NG QUAN I U

NH
m:
Nhng m hp
hoc b tc, lng tum trm trng, ch
 ri lon.
Nh        vong cao ho  li nhiu di
chng k c v th chn. Trong nhng tt chng v n
thm ci lon rt hay gp.

1.2. RI LON TRM CM
1.2.1. Lch s i trm cm
Su ut ng 
hc thuyt th dch ca Hippocrate (460  377 tr g
 mt dng bn v
gm  su u Melancolicus
m cc ICD 10 p  c sau:
+ F06.32: Trm cm thc tn.
n trm cm trong ri lon CXLC
n trm cm
+ F33: Trm cn
+ F41.2: Ri lon hn h- trm cm
m cm trong ri lon s ng
+ F20.4: Trm ct
1.2.2. Ba trm cm
1.2.2.1. Trm c
1.2.2.2. Trm c        c t  i
lon hoc do s dc c ch n.
1.2.2.3. Trm cm ni sinh:
A. Di truyn
B. Bt thng trong dn truyn th
c tn
i lon trm cm (ICD10)
1.3. M M SAU I U O
1.3.1. Nhu v trm cm sau nh
u t 
m m u h

Hackett Anderson (2005) y ng 




1.3.2. nh sinh:
u t 
Nhn mt
tri nghit ln cho ngi b     t
bnh nng, nhiu di chi
b i v - 
hi, m c t nh c p vm t ng c ng.
1.3.2.2. Yu t 
 l
h n th i trm cm sau nhi
     u nhn thy m m sau NMN  ng
c u p 
               


1.3.3. c ng a m m sau i u o
nh ng a m m sau i u o t
m m n nh c  t m   n nh 




  
             

m m sau i u o t nh i sau:
1.3.3.1. Trm c
Bu ch c ch

duy c ch, vng c ch hou chn h
ca ICD10 gm 3 triu chng ch yu chng ph bin.
1.3.3.2. Trm c
-  nh bnh c       m cm
n hu hic trng than phin v
u ch, d b t, gim giao ti
nhiu, ng nhi

ng bm cn
nh   u chng ca nhi lon
n thc tn nh , suy gim nhn thc, ri lo
nh ng th bm cm sau nhi
ng ngi cao tui do vy trm cm sau nh 
ng sng vi trm cm ngi cao tui, trm c
m cm c
1.3.4 Mt s yu t n trm cm sau nh
Nhng bi cao tui do
vu t  n th 
ng yu t n s xut hin trm cm  la tui
ng din, suy gim nhn thc, tng kinh t

CH
U

U
t c 

m
243 b
kinh, 44 b            

u nhng bu hin trm
c ca ICD10.
n chn bu
* Bc ch 
thn kinh vn:
* Trm cm:
c chn chm cm ca ICD-10
b      n. Gm 3 triu ch    
triu chng ph biu ch
nht 2 tun
n loi tr:
Ngi bnh ri lon c ni phc.
 nhu ln.
ng h m nng.
ng hp thn ch trong vi triu chng.
Lit hu hng, lit t chi nn ch giao ti
Ngi bn s ri lon t c khi b nh
nh nhp MRI s 
ủ thờứu.
2.2. PHU
2.2.1. C mu:
C t t l trong
qun thc phu ti thiu 38 bnh
m cm.
2.2.2. Thit k u:
S dng phu tin cc. Nhng
b     n chn l   n loi tr  
u.
Mi b t  i u
o m nh :

n n a i u o
n trm cm sau nh ng ch ng 
n n ng t 
u v trm cm sau nh
Mi bm cc tip t t ng
trm cn.
u trm cm sau nhng ph
c 
:
  m chung c   u nh i, gii,
u kin kinh t, ngh nghip, x
m la nh t
 
a trm cm
+ Nh u tr trm cm/nh

a s xut hin trm cu t
a bnh   ti
a nhnh hng ti biu hia trm
cng ca s xut hin trm c
tin trin ca nh
c ti
2.2.3.1. c chun b
 u nh
m cn ca Beck
Bu chi tip vi mu
2.2.3.2. Phn trm cm:
* Bu tr n
 m bo c: mi hi ch
 nh li chu tr.

*Bu tr ngo:
Trm cc:
Bc: Bu s dng
b t  n nhng b
du hiu trm cu g u tr
ci hi)
Bc chnh trm cmc, nhng bu
hiu trm cm s 
nh ch
n cha ICD10).
Tin trin ca trm cng nhng
bm cm/nhi tn sun.
2.2.4. X  LIU
  li   c thu thp s c x  ng phn mm
th
Tin sut cu hin,
so s  i



CH
T 




Bng 3.1: i trung nh a 
m
Tng s
i trung

nh
SD
i
p t
i
cao t
m m
167
64,29
11,775
35
90
m m
76
63,42
10,395
40
86
Chung cho m NC
243
64,02
11,347
35
90
u 35i i p t 
 

u 
+ m i u o u b
nht (78 bm cm  t (25 b

5 b



Tng s
% (n=243)

Nam
149
61,3


94
38,7
ng ng
243
100,0
Trong 


 

Tng s
% (n=243)

nh 
a

c
2

0,8
u c
37
15,2
Trung c c
129
53,1
Trung c 
75
30,9
ng 
243
100
m  nh  c n trung h     t    


ng 3.4: T l trm cm sau i u o


Gii
Nam
N
Tng
P
n=149
%
n=94
%
n=243
%

m trm cm
46
30,9
30
31,9
76
31,3
> 0,05
m cm
103
69,1
64
68,1
167
68,7
Tng cng
149
100,0
94
100,0
243
100,0

Trong 243 i u o, 76 m m, m .
m m 

Bi 3.2: Thm xut hin trm cm
Trm cm t n u t 

Bi 3.3:Th ca trm cm
Bng 3.5: c u 

Triu chng
n = 76
T l %
c m
66
86,8
t ch 
50
65,8
ng, t i m t ng.
46
60,5
86,8% c m. t ch , m 65,8%, ng- t
i m t t trong c u 

Bng 3.6 : c m c u 

Triu chng
Tng s
T l % (n = 76)
m 
52
68,4
m t nh 
44
57,9


19
25,0
n o t
42
55,3

2
2,6
nh vi 
1
1,3
RL c 
t , o c 
75
98,7

70
92,1
ng
49
64,5

Trong c u  



Bc m c a m m sau NMN khi 
Triu chng
Tng s
T l % (n = 76)

n n
72
94,7
m n ng
47
61,8
Lo ng, n n
61
80,3
c u 
76
100,0
Suy m n 
4
5,3
n n p 94,7% 
Bng 3.8: 
Triu chng
ng
Tng s
T l % (n = 76)
c m t t, nhanh ng
27
35,5
m n ng t ch c ng i
ng n ra 
34
44,7

30

39,5
ch n nh
36
47,4
nh ch thay i: u h
37
48,7
m u 
30
39,5
Ri long
13
17,1
     biu hin  c thay i t ch t t, nhanh
ng so i m ng.

Di 3.1: c m n n a u u n n
n ng 



Di
93,4 m m u u c m.
Sau mt ng 36,8% u 
Sau 3 ng u 
70/71 i n n n t c sau 6 ng

Di 3.3: c m n n a u ch 
Sau ng    


Di 3.4: c m n n a u 

Khi kh   u ch       
ng 



Di 3.5: c m n n a u 





Di 3.6: c m n n a u 

u u bi quan, n t

Di 3.7: c m n n a u 
         
u 


Di 3.8: c m n n 
30,3% 
c u 


Di 3.9: c m n n a u 
i n c p 100% 

Sau 4 ng, i n n n c 
Sau 6 ng n n 2 

Di 3.10: c m n n a u 
Ngay 
triu chu.

Di 3.11: c m n n a u 

39,5% 

u 

Di 3.12: c m n n u 
 34,2%         
u chn trin nhanh,
 bi thin triu chu nht.

Di 3.13: c ch ch, m n 
47,4% u m c


Di 3.14: c m n n a u 
 Trong 


ng 3.9: c m n n a trm cm biu hin bng t (n=4)
u 
t 
Sau

1 ng
Sau
2 ng
Sau
3 ng
Sau
4 ng
Sau
5 ng
Sau
6 ng

i
c

i
c

i
c

i
c

i
c


i


c
Suy m n 
3
1
0
4

4

4

4

4
c m
3
1
0
4

4

4

4

4
  p trung 
m t t, t
2

2
0
4

4

4

4

4
m n ng ng
3
1
0
4

4

4

4

4
ng i ng ng

2
1
0
4

4

4

4

4
 4    u n ng c u      


ng 3.10: t thang m Beck t n a m m m





c t
n TC
Sau
1 ng
Sau
2 ng
Sau
3 ng
Sau
4 ng
Sau
5 ng
Sau

6 ng
n=76
%
n=7
6
%
n=76
%
n=76
%
n=76
%
n=7
6
%
n=76
%

TC
10
13,2
15
19,7
15
19,7
19
25,0
36
47,4
49

64,4
75
98,7
TC 
23
30,3
13
17,1
24
31,6
39
51,3
32
42,1
27
35,5
1
1,3
TC 
30
39,5
33
43,4
28
36,8
16
21,1
7
9,2
0

0,0
0
0,0
TC ng
13
17,1
15
19,7
9
11,8
2
2,6
1
1,3
0
0,0
0
0,0
ng
76
100
76
100
76
100
76
100
76
100
76

100
76
100,0

m m 
10 



U T 
ng 3.11: 

Nam

ng
CI 95%
m m
46
30
76
OR = 0,953
(0,547 <OR< 1,661)
m m
103
64
167
ng
149
94
243

Gii s hm cm vi OR = 0,953.
B
n th
n kinh 
m m
ng 
P


Tng
s
T l %
(n = 76)
Tng
s
T l %
(n = 167)
Tng
s
T l %
(n = 243)
Ct
49
64,5
112
67,06
161
66,25
P> 0,05
OR=0,89(0,5-1,58)

t
27
35,5
55
32,94
82
33,75
ng
76
100
167
100
243
100

66,25% i 
      trm c   t. 35,5% s i trm cm
t.
Lit ch u t m cm vi OR = 0,89.


t 
m m
ng 
P
CI 95%


n
%

n
%
n
%

34
44,7
80
47,9
114
46,9
P=0,65
OR= 0,88(0,51-1,52)

25
32,9
67
40,1
92
37,9
P = 0,28
OR = 0,73 (0,41  1,29)
t
17
22,4
20
12,0
37
15,2
P = 0,04

OR = 2,12(1,04  4,32)
ng
76
100
167
100
243
100

m tm m 77,6% m m 88% lit na ngi.




m c sau NMN
m m
m

m m
ng ng

P
n=76
%
n=167
%
n=243
%
Lo ng


34
44,7
85
50,9
119
49,0
P0,05
OR=0,78 (0,45-1,35)

42
55,3
82
48,1
124
51,0
i m

1
1,3
2
1,2
3
1,2
P>0,05
OR=1,1(0,1-12,32)

75
98,7
165
98,8

240
98,8



31
40,8
59
35,3
90
37,0
P>0,05
OR=1,26(0,72-2,2)

45
59,2
108
64,7
153
63,0


21
27,6
22
13,2
43
17,7
P=0,007



55
82,4
145
86,8
200
82,3
OR=2,52(1,28-4,94)
17,7% s bp, gn mt na s b
 trm cm. vm cm vi OR=2,52

B

u t i 
m m

m m
ng ng
P
n = 76
%
n=167
%
n=243
%
u, p n 
15
19,7
36
21,6

51
21,0
P >0,05
OR=0,89(0,46-1,76)
p n
44
57,9
72
43,1
116
47,3
P=0,036
OR=1,74(1,009-3,005)
u t NMN cho
ng nh 
3
4,0
26
15,6
29
11,9
P=0,017
OR=0,22(0,07-0,76)
n nhu
chm ht cho t
12
15,8
7
2,6
19

7,8
P=0,004
OR=4,29(1,6-11,4)
n n NMN nh ng
n hy ng
2
2,6
25
15,1
27
11,0
P=0,01
OR=0,15(0,04-0,67)
ng 
76
100
167
100
243
100


Bni vai tra BN khi NMN m m.


Nguy c
m m
m

m m

ng ng

P
CI 95%
n = 76
%
n = 167
%
n = 243
%
i
39
51,3
85
50,9
124
51,0
P = 0,95
OR=1,02(0,59-1,75)
Mt v i
1
1,3
3
1,8
4
1,6
P = 0,79
OR=0,73(0,07-7,12)
Nguy ci
vai tr


26
34,2
69
41,3
95
39,1
P = 0,29
OR=0,74(0,42-1,3)
Thay i vai 
i gia nh
10
13,2
10
6,0
20
8,3
P = 0,04
OR=2,37(1,95-6,0)
ng ng
76
100
167
100
243
100

13,2% thay i vai i gia nh, cao n so i 

  trm cm do thay i vai tr a ngi bnh sau nh   i

OR=2,37(1,95-6,0).3.3.1. Ma v n thm cm
ng 3.17: c ng n th
V n th
 n u o
i
n u o
i

P
n = 243
%
n =
24
3

%
y n
11
4,5
13
5,3


y i d
33
13,6
49
20,2
y m
8

3,3
8
3,3


>0,05
Bao trong
15
6,2
15
6,2
i 
4
1,6
15
6,2
o 
20
7,9
22
9,0
o
25
10,3
20
8,2
 o
10
4,1
8

3,3
u o
6
2,5
0
0,0
n th
46
18,9

i u o y i d
m i u u o t p t, 6 
ng 3.18: n 
Trm cm
i u y n i
ng


m m
162
5
167
m m
69
7
76
ng 
231
12
243


P=0,048 OR = 3,287 (1,008 <OR< 10,715)
n th
3.3.2. Trm cng din
ng 3.19: 
m m
t p
ng


m m
48
28
76
m m
83
84
167
ng 
131
112
243

CI 95%
OR = 1,735 (0,995 < OR< 3.025)
m cm sau nhi OR =
1,735
ng 3.20: 
m m
i o ng

ng


m m
21
55
76
m m
21
146
167
ng 
42
201
243

CI 95%
OR = 2,655 (1,345<OR<5,238)
i o ng a m m sau i u o. i P=0,007,
OR=2,655 (1,345-5,238). a nh t 

CH
N N
u n 
t s nh
4.1. C M CHUNG A 
4.1.1. i a 
m 

c Hinh, i u o ng n 

i. t 

4.1.2. nh


(bng 3.2). Nam gii b t qu 
h gii, 68% s t qu i. Brown C, Hasson H , V
u 105 b l gi

4.2. C NG A M M SAU I U O
4.2.1. n t m m sau i u o.
 Bp n 
m c

 u bu n
i 1/3 s bu hin trm cm.
Trong           
 

4.2.2. m m .
t 



Brittany Poynter (2009) tng 

 t lun rt
ph bin  c hai gi bin  ph n 
gii.
4.2.3. 

t 






4.2.4. ng a m m sau i u o:
 Cy 60 
 3). Sau 2-
ng bu hin bng trm cn h
ng tin trin h t i
 l trm c
triu chng trm cm dc ci thin dng
cu tr nh ci thin rt.
t 
              
m cn hm cn
  14%. Wongwandee M  CS (2012) y trm c  n
hm c.
4.2.5. u 
 






 i n c ng t trong hai u n 



ng 3.6).
 4.2.6. c m c u 
4.2.6.1. c u 
 Qua t 








4.2.6.2. c u 
 Gim tu chng ph bin ca trm cm,
u c 68,7% s bm
cm (b trm cu chi
 3.5).
 t 

 Trong m m m sau i u o y 
68,4%   m p trung .  64,5% nh
  i   ng,  u  m    
ng. t t 

 yi, bn c yu t 
lu t thc ta loi trm cm
sau nhtrong 



4.2.6.3. c u 
 Hu nh

             


u hin triu chng c   bin
bao g l 64,5%), ri lon gic ng u gic,
b     c ng, chim t l    c ng
  p chn, thc dy s    ng l c chim
92,1% (Bu v ri lon trm c
chng cuc sng ca b nh ni khoa mn,
tim my t l ri loi lon gic ng 
 c ng   c ng  liu
chng c ca trm cu c
c c  cho thy rm ri
lon gic ng t trong nhng triu cha trm cm
u t l 
quan vi trm c bnh thn mu tr bo
tn  y t l i lon gic ng 
t l u chim 1/3 s m cm
(32,26%) vi ch s BMI rt thp. S  chim t l thp
c s .
 4.2.6.4. Tru   

 t 
 


 - c m t ch nhanh ng, t t:

 u n c nhanh ng thay n 
hai n n n m m a ICD 10 
c a i nh thay i t ch ng, c ng
u u c. t 

c git ng


 - m n ng t ch c ng
           








            


 - nh ch ch, nh ch thay i m 
 48,7% m m sau i u u
hin nh, nh ch u, n 


 Nh




            



 t 



 bm cm sau nh
u c l bt
qu u cp vi kt qu cu ca Kootker
m ct ri lon ph bin trong
n mt qun kh 
t lng cuc sng ci bnh.
Lassalle - Lagadec S , Sibon I , Dilharreguy B, Allard M. (2012) thy


 4.3. T U N M M SAU
NMN

 T l trm cm sau nh  
cu c bit (30,9%  nam so vi 31,9% 
n gii - ng 3.4).
 u v a gim
ct qu, rt nhiu thy n gi
trm c
    a nh ng 

 4.3.3. t khu m n ng sau NMN
 a 

m cm
 U T 
TRM CM SAU NH

sau NMN.
- Ngay sau i u o, 

n ng ci
u t a trm cm v







17,7% s bp, gn
mt na s b trm cm. S 
thi P= 0,007, vi nguy c trm cp 2,52 ln so vi
 phn ng c-4,94)).
H

u t



Theo Simon (2005), u vai quan n
m m sau i u o. t t n t 

              


t bu di ch
lc ti ngi bnh mng din. S 
ca nh n tr
a ngi bnh.












-y bu bit v
tng sc khe nhp nhc t  trm
cn. Nhnhn v m
n trm cm sau nh u c
b  n n NMN t ch bi quan (7,8%),  cho ng i
u o u m t cho t
 t
        -   
nhng ngn thc v nh trm
cp 4,29 ln.
4.3.5.3. 
i 



   
n
s v  ci trm cm. t t 


m th




4.3.6. MA TRM C N
TH
  l trm cm gi nhu
u cy
trm cm do tn thm cm  
tu ni (46,75% so vi 30,63%), vi CI 95%
nhu t i OR = 1,052 (0,61
 1,81).
 Theo 



u c cn vn  
s a v n thm cm.

 OR = 1,890 (0,558 < OR <6,396

 nh i nguy c CI 95%, OR = 1,236 (0,577 <
OR < 2,649)


 t cho y v     
   




 nh i nguy c
OR < 1,712

OR = 0,38 (0,12 < OR < 1,134, P=0,14
Kt qu u v ma v n tha nhi
m cm cho thy tn th
quan vi mn th 
i trm cm.
NG DIN
 t cho y, 



2,884).

 Nhi u cho ng m m u n 





 u c
 ng cao gp 2,655 ln so

v ng OR = 2,655 (1,345
<OR < 5,238).
T N

 t
khi trm ct s kt lun sau:
a trm cm  b
 T l trm cm trong s bi m
78,9% m m n nh, 5,3% u n ng 
t do m m.
 Triu chng khp vi t l 

 u chng  thi k  u ch
bin ca trm c     bin nh  m cm ni
sinh:
 c trm 86,8%, mt m
ng 60,5%
 Gim t tr tin 57,9%, bi
quan v tng b ti 25%
u chm m sau i u
o : c thay i t ch t t (35,5%). m n ng
t ch c ng (44,7%). ch ch, nh n nh
(48,7%)
 c t 

             

 u chng c



 Triu chm t l cao (80,3%)
 u t 
 Nhng phn ng ca ngi bnh sau khi b nh
n s xut hin trm cc ch 
 trm cm 2,43 ln (1,26 < OR = 2,43 < 4,67, P = 0,008), cm 
 trm cm sau nh
2,52 ln (1,28 < OR =2,52 < 4,94)
  u bit ca ngi bnh v tng nh
  n s xut hin trm cm sau nh ng bnh
u bit v nhp nhc
thc trng bnh l trm cp 1,74 ln
i nhm trng cho rng nhi
nh ti tu chm ht cho t
mc trm c    c li, nh    n
bnh nhnh nng nhu hy vu tr
th trm cm (OR=0,15).
 Tn thi trm cm sau
nhng b nh
b trm cm gp 3,287 ln so v     t  
a n
 Bng din: i o ng nh ng n 
m m sau i u n.
N 
 m m sau i u o t ri lo

y, rt c
ng d n kinh,
Phc hi ch          n ph
bin kin thc v bn truy bnh
u bi b

hin bnh sm, can thiu tr p thi.
INTRODUCTION

Ischemic stroke is one of the most common diseases and causes of mortality or
disability caused to the survivors after recovering from a ischemic stroke. Worldwide,
the rate of ischemic stroke is approximate1.3% (Bamford, Le Duc Hinh), the number
of new patients is 22/100.000 persons/year. Vietnam is a developing country with the
increasingly-high population of elderly people and the number of people with
ischemic stroke is also increased continuously.
Ischemic stroke usually occurs suddenly and heavily with focal neurological
symptoms, disorders of consciousness and is the cause resulting in high mortality rate.
If the patient can recover after the acute episode, it is usually resulted in many
physical, mental sequelae and the lower quality of life as well as the working ability
of the patients. Among the mental disorders after ischemic stroke, depression is one of
the common manifestations. The rate of depression is commonly occurred to one third
of people after ischemic stroke. This is not only a result of brain injury and
dysfunction, but also as a result of psychological responses again a serious illness,
many squeals, and patients are at risk of having the personnel position changed in
their job, family and society. Depression can occur even in the acute stage or in the
recovery episode. The clinical symptoms of depression may be a major depression or
minor depression, and clinical symptoms of the depression are overlapped or obscured
by the mental disorder with the anonymous damage to brain function area. According
to Linda's. William (2004), if depression after ischemic stroke is not detected and
treated promptly, it will not only affect the ability to restore function and quality of
work and quality of life but also increase the risk of death for these patients [3].
Therefore, understanding the clinical symptoms of the depression ischemic
stroke will help the doctors to identify early signs of depression, help the patients to
have early interventions to be treated properly and promptly. It has important meaning
in care and rehabilitation for the patients after suffering from a ischemic stroke.
1. Objectives of the study

1.1 Description of the clinical symptoms of depression in the patients after ischemic
stroke.
1.2 Study some factors relating to depression in the patients after ischemic stroke
2. Layout of the thesis
 The main contents of the thesis include 133 pages with 27 tables, 3 diagrams, 16
maps and 117 references which are presented as follows: 02 pages of
Introduction, 42 page of Overview, 13 page of Subjects and Methodology of the
study, 33 pages of the result, 42 pages of discussions, 3 pages of conclusions and
recommendations.
 References include 117 documents in which the majorities are new publications
in the last 10 years.
 Appendices include: the list of patients, clinical records, psychological tests
3. Scientific contributions and practical values of the thesis
The research on the clinical symptoms of the depression after ischemic stroke
in the Vietnamese population, the rate of depression after ischemic stroke, the
different features between depression after ischemic stroke and other depression,
depression in other chronic diseases is the new contribution to the clinical practice of
the mental health and other specialist.
Identify some factors relating to the depression after ischemic stroke as well as
new contributions of the thesis, support the doctors to identity the risks factors of
depression in ischemic stroke patients.
HAPTER 1
OVERVIEW
1.1 ISCHEMIC STROKE
Definition