摘要
目的探讨θ短阵快速脉冲刺激(theta burst stimulation,TBS)模式下重复经颅磁刺激(repeated transcranial magnetic stimulation,r-TMS)对老年慢性精神分裂症患者的阴性症状及认知功能影响。方法选取稳定期慢性老年精神分裂症患者48例(r-TMS治疗组24例,r-TMS伪刺激对照组24例)。治疗组予以TBS模式重复经颅磁刺激,刺激部位选择左侧前额叶背外侧皮质区,对照组予以同部位伪刺激。治疗前后采用精神病量表(the brief psychiatric rating scale,BPRS)、阳性症状和阴性症状量表(positive and negative syndrome scale,PANSS)、阴性症状量表(scale for assessment of negative symptoms,SANS)评估精神症状,Mattis痴呆评定量表-2(Mattis-dementia rating scale,MDRS-2)和社会适应性功能评价(social adaptation functioning evaluation,SAFE)分别评估认知功能和社会功能。采用SPSS 20.0进行统计分析,采用独立样本t检验、配对t检验比较组间和组内差异。结果(1)治疗组在治疗前后的PANSS量表[(60.17±3.73)分,(56.67±3.12)分]、阴性症状分量表[(20.88±2.94)分,(17.96±2.33)分]、一般病理症状分量表[(30.67±1.66)分,(30.25±1.45)分]及SANS量表[(59.33±4.00)分,(54.21±5.32)分]的评分差异有统计学意义(均P<0.05)。治疗组与对照组BPRS量表(t=3.513,P=0.001)、PANSS量表(t=6.048,P<0.01)及其阴性症状分量表(t=6.610,P<0.01)、SANS量表(t=8.239,P<0.01)治疗前后的评分差值,均差异有统计学意义。(2)治疗组在治疗前后的MDRS-2量表及其各分量表的评分差异均有统计学意义(均P<0.05)。治疗组与对照组MDRS-2量表(t=6.216,P<0.01)及其注意(t=4.596,P<0.01)、起始/保持(t=6.424,P<0.01)、概念形成(t=3.974,P<0.01)、结构(t=2.194,P=0.033)、记忆(t=3.162,P=0.003)分量表治疗前后的评分差值均差异有统计学意义。(3)治疗组与对照组SAFE量表评分治疗前后均差异无统计学意义(t=0.138,0.142,均P>0.05)。结论TBS模式rTMS治疗可以改善老年慢性精神分裂症患者的阴性症状及认知功能,改善社会功能效果不明确。
Objective To investigate the effects of theta burst stimulation(TBS)mode repeated transcranial magnetic stimulation(r-TMS)in the left prefrontal on negative symptoms and cognitive function in the elderly chronic schizophrenic patients.Methods Totally 48 patients with stable chronic senile schizophrenia(24 cases in r-TMS treatment group and 24 cases in r-TMS pseudo stimulation control group)were selected.The treatment group was given the TBS mode r-TMS performed in the left dorsolateral prefrontal cortex.The control group was given pseudo stimulation at the same site.Before and after treatment,the brief psychiatric rating scale(BPRS),scale for assessment of negative symptoms(SANS),and positive and negative syndrome scale(PANSS)were used to assess mental symptoms,while Mattis-dementia rating scale(MDRS-2)and social adaptation functioning evaluation(SAFE)were used to assess cognitive function and social function.SPSS 20.0 was used for statistical analysis.Comparisons of the differences between inter groups and intra groups were conducted by independent sample t test and paired t-test.Results(1)There were significant differences in the total score of PANSS scale((60.17±3.73),(56.67±3.12)),the negative symptom subscale score of PANSS((20.88±2.94),(17.96±2.33))and the score of SANS((30.67±1.66),(30.25±1.45))before and after treatment in the treatment group(all P<0.05).The D-value before and after treatment in the scores of BPRS(t=3.513,P=0.001),PANSS(t=6.048,P<0.01),negative symptom subscale(t=6.610,P<0.01)and SANS(t=8.239,P<0.01)were significantly different between the two groups.(2)There were significant differences in the scores of MDRS-2 and its sub scales before and after treatment in the treatment group(all P<0.05).The D-value before and after treatment in the scores of MDRS-2(t=6.216,P<0.01),attention(t=4.596,P<0.01),start/maintain(t=6.424,P<0.01),concept formation(t=3.974,P<0.01),construction(t=2.194,P=0.033)and memory(t=3.162,P=0.003)were significantly different between the two groups.(3)There was no significant difference in the SAFE score between the treatment group and the control group before and after treatment(t=0.138,0.142,both P>0.05).Conclusion TBS can improve the negative symptoms and cognitive function in patients with the elderly chronic schizophrenic,but the effect of social function is not clear.
作者
赵婧
郭银淼
李梦楠
高炬
方新宇
周超
陈玖
张付全
张向荣
Zhao Jing;Guo Yinmiao;Li Mengnan;Gao Ju;Fang Xinyu;Zhou Chao;Chen Jiu;Zhang Fuquan;Zhang Xiangrong(Geriatric Psychiatry Department,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 211166,China;Shanghai Minhang Mental Health Center,Shanghai 201112,China;Shanghai Fengxian Mental Health Center,Shanghai 201418,China;Institute of Neuropsychiatric Medicine,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 211166,China)
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2021年第7期577-583,共7页
Chinese Journal of Behavioral Medicine and Brain Science
基金
科技部重点研发计划(2018YFC1314300)
国家自然科学基金项目(81971255)
江苏省科技厅社会发展项目(BE2019610)
江苏省前沿引领技术基础研究专项(BK20192004D)
江苏省医学重点人才项目(ZDRCA2016075)。
关键词
重复经颅磁刺激
θ短阵快速脉冲刺激
慢性精神分裂症
老年
阴性症状
认知功能
Repeated transcranial magnetic stimulation
Theta burst stimulation
Chronic schizophrenia
Elderly
Negative symptoms
Cognitive function
作者简介
通信作者:张向荣,Email:drxrz@hotmail.com。
