Activity Dates: 04/20/2009 - 04/20/2012
This course is closed. Please look for other available products in CPNP University.
If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric and/or neurological patients, we invite you to participate in this online course.
Although the prevalence of PSD depends upon whether the patients are examined in community settings or acute hospitals, the mean prevalence of major depressive disorder based on pooled data from the world’s literature is 20% during acute poststroke period for major depression and 19% for minor depression. The diagnosis of depression is based on DSM-IV criteria for major or minor depression. There is relatively little effect of physical illness on the manifestations of depressive symptoms. The major risk factors for developing poststroke depression include severity of impairment in activities of daily living, in cognitive function and in social support.
In addition, previous personal history, gender, personality, and negative life events, have also been demonstrated to be associated with the development of poststroke depression. The most controversial risk factor has been lesion location, but a meta analysis of studies examining patients within the first 2 months following stroke have demonstrated a relative risk ratio of 2.3 for patients with left anterior compared with right anterior lesions. Poststroke depression has been demonstrated to effect recovery in activities of daily living, cognitive function and survival. After controlling for other risk factors, patients with acute poststroke depression were 3.7 times more likely to die as early as 12 months and as long as 7 years following stroke compared to nondepressed patients. There have been 8 double blind placebo controlled trials of antidepressants following stroke.
Nortriptyline, citalopram and reboxetine have all been shown to be significantly more effective than placebo in the treatment of poststroke depression. In addition, escitalopram has been demonstrated in a double blind randomized treatment trial to prevent the occurrence of poststroke depression. Patients receiving placebo were 4.5 times more likely to develop depression than patients receiving escitalopram. Antidepressants have also been shown in both depressed and nondepressed patients to improve recovery in cognitive function, activities of daily living and decrease the probability of death.
You will proceed through the following steps to satisfactorily complete this course:
This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.
Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.
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Robert Robinson, MDView biographical information and disclosures
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This self-study course provides 1.0 contact hours (0.1 CEUs) of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0000-09-005-H01-P (1.0 contact hours).
ACPE approved contact hours are accepted for ANCC Certification Renewal (see pages 5 and 6): At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information and disclosures). The opinions expressed in the educational activity do not necessarily represent the views of CPNP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: Escitalopram-off-label use as preventive of depression. Fluoxetine-to augment recovery from stroke-off-label.
This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, and Shire.