高频重复经颅磁刺激治疗以阴性症状为主的慢性精神分裂症对照研究  

A control study of high-frequency repetitive transcranial magnetic stimulation in chronic schizophrenia characterized by negative symptoms

作　　者：李哲[1] 杜向东[1] 张兰兰[1] 杨建功[1] 杨力[2] 殷铭[1] 潘能荣 黄自勇 顾震[1] 谢年秀[2] 杨忠[2] 

机构地区：[1]苏州市广济医院,江苏·苏州215008 [2]常熟市第三人民医院,江苏·常熟215500

出　　处：《临床心身疾病杂志》2016年第5期28-31,共4页Journal of Clinical Psychosomatic Diseases

基　　金：苏州市科技计划项目（编号SYS201261）;苏州市精神疾病临床医学中心（编号Szzx201509）

摘　　要：目的探讨高频重复经颅磁刺激治疗以阴性症状为主的慢性精神分裂症患者的临床疗效和安全性。方法将47例以阴性症状为主的慢性精神分裂症患者按随机数字表法分为两组，均维持原用抗精神病药物治疗剂量不变，在此基础上研究组联合高频重复经颅磁刺激治疗4周，对照组予以高频重复经颅磁刺激伪刺激治疗4周，观察8周。治疗前后采用阳性与阴性症状量表、阴性症状量表评定临床疗效，副反应量表评定不良反应。结果治疗4周末起两组阳性与阴性症状量表总分及阴性症状、一般精神病理均较治疗前显著下降（P〈0．05或0．01），同期两组间评分比较差异均无显著性（P〉0．05）。治疗后研究组阴性症状量表总分及各因子分均较治疗前显著下降（P〈0．01），对照组仅情感平淡、注意障碍因子分较治疗前显著下降（P〈0．05），治疗第8周末研究组阴性症状量表总分及意志缺乏、兴趣／社交缺乏和注意障碍因子分均显著低于对照组（P〈0．05）。两组不良反应较轻微，主要表现为一过性头痛、头昏头晕、活动减少等。结论高频重复经颅磁刺激治疗能够有效改善慢性精神分裂症患者的阴性症状，安全性高，但起效较慢，效应延迟出现。Objective To explore the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation （HF-rTMS） in chronic schizophrenia characterized by negative symptoms. Methods Fortyseven chronic schizophrenics characterized by negative symptoms were randomly assigned to two groups, both groups maintained original dosage, on this basis research was plus HF-rTMS for 4 weeks, control group plus high-frequency repetitive transeranial magnetic pseudo-stimulation, and observed for 8 weeks. Efficacies were assessed with the Positive and Negative Syndrome Scale （PANSS） and Scale for the Assessment of Negative Symptoms （SANS） before and after treatment and adverse reactions with the Treatment Emergent Symptom Scale （TESS）. Results Since the end of 4＇h week the total, negative symptom and general psychopathological symptom scores of oth groups lowered more significantly compared with pretreatment （P〈0.05 or 0.01）, there were no significant group differences （P〉0.05）. After treatment the total and each factor of the SANS lowered more significantly compared with pretreatment in research group （P〈0.01）, so did apathy and disturbance of attention in control group （P〈0.05）, and at the end of the 8^th week the total, abulia, interest/social intercourse absence and disturbance of attention score of the SANA were significantly lower in research than control group （P〈0.05）. Adverse reactions of both groups were mild and mainly transient headache, dizziness, less activity and so on. Conclusion HF-rTMS could effectively improve nega tive symptoms of chronic schizophrenia and has higher safety, but takes effect slowly and effects delay.

关 键 词：慢性精神分裂症 重复经颅磁刺激 抗精神病药物 阴性症状 阳性与阴性症状量表 阴性症状量表 副反应量表 

分 类 号：R749.3[医药卫生—神经病学与精神病学]