双频加速重复经颅磁刺激治疗精神分裂症阴性症状的随机双盲对照研究  

Dual frequency accelerated repetitive transcranial magnetic stimulation for negative symptoms of schizophrenia:a randomized double-blind,sham-controlled study

作　　者：陈天意 介勇[1] 汪作为[1] 肖春兰[1] 朱光[1] 王玮 郭向晴 姜雅琴[1] 陆峥[2] CHEN Tian-yi;JIE Yong;WANG Zuo-wei;XIAO Chun-lan;ZHU Guang;WANG Wei;GUO Xiang-qing;JIANG Ya-qin;LU Zheng(Shanghai Hongkou District Mental Health Center,Shanghai 200083,China)

机构地区：[1]上海市虹口区精神卫生中心,200083 [2]上海市同济医院

出　　处：《临床精神医学杂志》2023年第2期137-141,共5页Journal of Clinical Psychiatry

摘　　要：目的:探讨重复经颅磁刺激(rTMS)对精神分裂症阴性症状的疗效。方法:入组41例存在明显阴性症状的精神分裂症患者,随机进入真刺激组(n=25)和伪刺激组(n=16),分别对其进行加速双频模式(iTBS)rTMS干预24组,每组4次,治疗12周。以阳性与阴性症状量表(PANSS)及临床总体印象量表(CGI)评估患者的精神症状和疾病严重程度,以功能大体评定量表(GAF)评价患者的社会功能情况。结果:两组治疗前各量表评分差异无统计学意义(P均>0.05)。两组治疗后阳性症状分差异无统计学意义(P>0.05)。阴性症状分治疗4周后,真刺激组较伪刺激组明显降低(P<0.05)。一般症状分均随时间降低,两组差异无统计学意义。PANSS总分治疗4周后两组无差异,刺激组持续减分到8周,伪刺激组4周后不再有变化。真刺激组CGI分随时间降低,第8周到第12周之间趋于稳定,伪刺激组前4周降低,之后无变化。治疗后GAF评分升高,两组差异无统计学意义。结论:有明显阴性症状的精神分裂症患者在药物治疗稳定后予以iTBS rTMS,可快速有效改善阴性症状,对阳性症状无影响,对社会功能损害有一定改善作用。Objective:To investigate the efficacy of accelerated dual frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of negative symptoms of schizophrenia.Method:41 schizophrenic patients with obvious negative symptoms were randomly divided into true stimulation group(n=25)and false stimulation group(n=16).24 blocks were intervened with intermittent theta-burst stimulation(iTBS)rTMS,four times in each block for 12 weeks of treatment.The patients'mental symptoms and disease severity were evaluated with Positive and Negative Syndrome Scale(PANSS)and Clinical Gglobal Impression Scale(CGI),and their social functions were evaluated with Global Assessment Function(GAF).Results:There were no significant differences between the two groups before treatment(all P>0.05).The positive symptom score of the two groups was not significantly different after treatment(P>0.05).After 4 weeks of treatment,negative symptoms of the true stimulation group was significantly decreased compared with the pseudo stimulation(P<0.05).The general symptom scores decreased with time,and the differences between the two groups was not statistically significant.The total score of PANSS reduced equally in the two groups after 4 weeks of treatment,and continued to decrease to 8 weeks in the true stimulation group and there was no change in the pseudo stimulation group after 4 weeks.The CGI scores in the true stimulation group continued to decrease over time and became stable from the 8th week to the 12th week,and the CGI scores in the pseudo stimulation group decreased in the first 4 weeks and remained unchanged thereafter.After treatment,GAF scores of the true stimulation group increased with no significant differences between the two groups.Conclusion:ITBS rTMS can rapidly and effectively improve the negative symptoms of schizophrenic patients with obvious negative symptoms after stable drug treatment,which has no effect on the positive symptoms,and has a certain improvement effect on social function damage.

关 键 词：精神分裂症 双频加速重复经颅磁刺激 阴性症状 

分 类 号：R749.3[医药卫生—神经病学与精神病学]