"Ecosystem Focused Therapy" in Post Stroke Depression

Summary

Principal Investigator: George S Alexopoulos
Abstract: DESCRIPTION (provided by applicant): We propose to study the efficacy of "Ecosystem Focused Therapy" (EFT) in post-stroke depression (PSD), a disorder that afflicts a large number of stroke victims and increases mortality, cognitive impairment, and disability for years after stroke. EFT is a new, home-delivered intervention based on our integrative model of PSD, which originated from our clinical biology and treatment studies in late-life depression. It postulates two main paths to PSD. First, stroke and stroke-repair mechanisms contribute to metabolic changes mediating PSD. Second, a "psychosocial storm" stemming both from the patient's sudden disability and the change in the patient's needs and family life add a biological burden to this cascade of depressogenic events. EFT targets the "psychosocial storm" of PSD and focuses on the reciprocal interaction between the patient's abilities and the challenges of his/her "ecosystem" (family, specialized therapists). EFT follows a structured personalization approach based on the "model of adaptive functioning", in which behavior is a function of the person's competence and the demands of the environment. Thus, EFT continuously "calibrates the environment" to the PSD patient's competence level and targets the PSD "psychosocial storm" through five integrated components: 1) It offers an action-oriented, "new perspective" about the patient's recovery. 2) It provides an "adherence enhancement structure". 3) It offers a "problem solving structure" to the patient focusing on problems, valued by the patient, and pertinent to daily function. 4) It helps the family "reengineer its goals, involvement, and plans" o accommodate the patient's disability. 5) It "coordinates care with specialized therapists" with the goal to increase patient participation in rehabilitation and social activities. We will recruit 160 PSD patients within 3 months after stroke and randomly assign them to 10 weekly sessions and 4 "booster" sessions (over 1 year) of EFT or a comparison condition (Education on Stroke and Depression;ESD) both administered by trained social workers (MSW). Our Primary Hypotheses state that: Over a period of 12 weeks, EFT will lead to greater reduction than ESD in: H1) severity of depression;and H2) disability. Our Secondary Hypotheses postulate that: SH1) EFT will lead to higher remission (HAM-Dd10) rates than ESD by 12 weeks;and SH2) EFT participants will have lower scores of depression and disability and higher scores in quality of life than ESD at 26 and 52 weeks. Exploratory Analyses will examine whether disability and depression mediate the effect of each other and whether "self-efficacy", "behavioral activation", and adherence to rehabilitation recommendations and/or antidepressants mediate change in depression and disability. We will also explore whether clinical features of PSD and serotonin transporter genotypes moderate the efficacy of ESD.
Funding Period: 2012-07-03 - 2017-03-31
more information: NIH RePORT

Top Publications

  1. pmc Ecosystem focused therapy in poststroke depression: a preliminary study
    George S Alexopoulos
    Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, New York, USA
    Int J Geriatr Psychiatry 27:1053-60. 2012
  2. pmc Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment
    Sarah Shizuko Morimoto
    Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA Electronic address
    Psychiatr Clin North Am 36:517-31. 2013

Detail Information

Publications2

  1. pmc Ecosystem focused therapy in poststroke depression: a preliminary study
    George S Alexopoulos
    Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, New York, USA
    Int J Geriatr Psychiatry 27:1053-60. 2012
    ..This is a preliminary study of its efficacy...
  2. pmc Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment
    Sarah Shizuko Morimoto
    Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA Electronic address
    Psychiatr Clin North Am 36:517-31. 2013
    ..Evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation is presented. ..

Research Grants30

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  2. Identifying cognitive markers of late-life suicide
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    ..The research project will be conducted at the University of Pittsburgh, in collaboration with the Experimental Psychology Department, University of Cambridge. ..
  3. BIOLOGY OF NEUROENDOCRINE PEPTIDES
    Marc R Montminy; Fiscal Year: 2013
    ..Specifying the contributions of the CRF family of ligands and receptors to the maintenance of homeostasis and to stress-linked allostasis may improve our ability to manage diseases, including mood and metabolic disorders ..
  4. Comprehensive NeuroAIDS Core Center
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  5. Brain aging and treatment response in geriatric depression
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    ..Our study will provide unique information on the use of memantine in geriatric depression, and will investigate the underlying mechanism of treatment response, and subgroups with preferential treatment to memantine. ..
  6. 1/2-Personalized Antidepressant Adherence Strategies for Depressed Elders
    Jo Anne Sirey; Fiscal Year: 2013
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  9. SRC on Primary Tumors of the CNS
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    ..Cores A and C are currently funded;Core B is a continuation from earlier grant periods. ..
  10. COBRE Center for Central Nervous System Function
    Jerome N Sanes; Fiscal Year: 2013
    ..The COBRE Center will leverage the administrative resources available through the Brown Institute for Brain Science to ensure efficient operation and coordinate with other brain science research activities at Brown. ..
  11. Center on Antisocial Drug Dependence: The Genetics of HIV Risk Behaviors
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    ..This new knowledge will contribute to the development of intervention strategies to reduce the risk of drug abuse, STDs, and HIV/AIDS. CENTER CHARACTERISTICS ..
  12. Early Experience, Stress and Neurobehavioral Development Center
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  13. Shared Decision-Making for Elderly Depressed Primary Care Patients
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  14. Puberty and Threat/Reward Processing in the Trajectory from Anxiety to Depression
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  15. Hopkins Center for Eliminate Cardiovascular Health Disparities
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  16. Early Phase Psychosis: Informing Treatment Decisions
    John M Kane; Fiscal Year: 2013
    ..Our ability to intervene appropriately, effectively and consistently in this population can have profound long-term public health consequences. ..
  17. ACISR for Late-Life Depression Prevention
    Charles F Reynolds; Fiscal Year: 2013
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  18. Cornell ACISR in Late Life Depression
    George S Alexopoulos; Fiscal Year: 2013
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  19. 2/2-Personalized Antidepressant Adherence Strategies for Depressed Elders
    Helen C Kales; Fiscal Year: 2013
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