rTMS合并舍曲林治疗难治性强迫症的临床观察
|
摘要
目的:探讨重复经颅磁刺激(rTMS)合并舍曲林治疗难治性强迫症的临床疗效。方法:随机选取2016年5月至2017年5月82例难治性强迫症患者作为研究对象,采用随机数字法分为观察组和对照组各41例,其中对照组患者单用舍曲林治疗,观察组患者在对照组的基础上联合rTMS治疗,连续治疗2个月,分别采用耶鲁-布朗强迫症状量表(Y-BOCS)中文版、汉密尔顿焦虑量表(HAMA)评价两组患者治疗前、治疗后2、4、6、8周的强迫症症状程度及焦虑情绪,比较两组临床治疗效果,采用副反应量表(TESS)评价不良反应情况。结果:观察组治疗后的Y-BOCS、HAMA评分均较治疗前明显下降(P<0.05),且对照组除第2周与治疗前差异不明显外,第4、6、8周均较治疗前差异明显(P<0.05);观察组治疗后第4、6、8周的Y-BOCS、HAMA评分与治疗后第2、4、6、8周HAMA评分均明显优于同期对照组(P<0.05)。治疗8周后,观察组临床总有效率95.1%明显优于对照组的70.7%,两组患者血、尿常规检查及肝、肾功能检查、心电图检查等均未发现异常,TESS评分差异不明显(P>0.05)。结论:临床中对于难治性强迫症患者,rTMS刺激联合舍曲林治疗能有效改善患者的强迫症状及焦虑情绪,临床疗效显著,不良反应小,安全性高,值得临床推广应用。
Objective: To investigate the clinical efficacy of repeated transcranial magnetic stimulation(rTMS) combined with sertraline in the treatment of refractory obsessive-compulsive disorder. Methods: A total of 82 patients with refractory obsessive-compulsive disorder from May 20 to May 2017 were enrolled in this study. All the patients were randomly divided into observation group and control group,41 cases in each group. The control group was treated with sertraline alone,while the observation group was treated with rTMS on the basis of the control group for 2 months. The Chinese version of Yale-Brown obsessive-compulsive symptoms scale(Y-BOCS) and Hamilton anxiety scale(HAMA) were used to evaluate the degree of obsessive-compulsive disorder symptoms and anxiety of the two groups before and after treatment for 2,4,6 and 8 weeks,respectively. The clinical therapeutic effects of the two groups were compared. The adverse reactions were assessed by the side effects scale(TESS). Results: The levels of Y-BOCS and HAMA in the observation group after treatment were significantly lower than those before treatment(P < 0. 05),and the control group except the first 2 weeks and before treatment was not obvious difference,but 4,6,8 weeks and before treatment was significantly obvious difference(P <0.05). The scores of Y-BOCS,HAMA and HAMA at the4 th,6 th and 8 th week after treatment were significantly better than those of the control group at the 2 nd,4 th,6 th and 8 th week after treatment(P <0.05). After 8 weeks of treatment,the total effective rate was 95.1% in the observation group was significantly better than the control group of 70.7%,the two groups of patients with blood and urine routine examination and liver and kidney function tests,ECG were not found abnormal,TESS score was not significant(P >0.05). Conclusion: For patients with refractory obsessive-compulsive disorder,rTMS stimulation combined with sertraline can effectively improve the obsessive-compulsive symptoms and anxiety of patients. The clinical efficacy is remarkable,the adverse reactions are small,and the safety is high.It is worthy of clinical application.
Objective: To investigate the clinical efficacy of repeated transcranial magnetic stimulation(rTMS) combined with sertraline in the treatment of refractory obsessive-compulsive disorder. Methods: A total of 82 patients with refractory obsessive-compulsive disorder from May 20 to May 2017 were enrolled in this study. All the patients were randomly divided into observation group and control group,41 cases in each group. The control group was treated with sertraline alone,while the observation group was treated with rTMS on the basis of the control group for 2 months. The Chinese version of Yale-Brown obsessive-compulsive symptoms scale(Y-BOCS) and Hamilton anxiety scale(HAMA) were used to evaluate the degree of obsessive-compulsive disorder symptoms and anxiety of the two groups before and after treatment for 2,4,6 and 8 weeks,respectively. The clinical therapeutic effects of the two groups were compared. The adverse reactions were assessed by the side effects scale(TESS). Results: The levels of Y-BOCS and HAMA in the observation group after treatment were significantly lower than those before treatment(P < 0. 05),and the control group except the first 2 weeks and before treatment was not obvious difference,but 4,6,8 weeks and before treatment was significantly obvious difference(P <0.05). The scores of Y-BOCS,HAMA and HAMA at the4 th,6 th and 8 th week after treatment were significantly better than those of the control group at the 2 nd,4 th,6 th and 8 th week after treatment(P <0.05). After 8 weeks of treatment,the total effective rate was 95.1% in the observation group was significantly better than the control group of 70.7%,the two groups of patients with blood and urine routine examination and liver and kidney function tests,ECG were not found abnormal,TESS score was not significant(P >0.05). Conclusion: For patients with refractory obsessive-compulsive disorder,rTMS stimulation combined with sertraline can effectively improve the obsessive-compulsive symptoms and anxiety of patients. The clinical efficacy is remarkable,the adverse reactions are small,and the safety is high.It is worthy of clinical application.
引文
[1]黄英民.难治性强迫症的临床治疗研究进展[J].当代医学,2016,22(27):12~13.
[2] Atmaca M. Treatment-refractory obsessive compulsive disorder[J]. Prog Neuropsychopharmacol Biol Psychiatry,2016,70(3):127~133.
[3] D'Urso G,Brunoni A R,Anastasia A,et al. Polarity-dependent effects of transcranial direct current stimulation in obsessive-compulsive disorder[J]. Neurocase,2016,22(1):60~64.
[4]中华医学会精神医学分会《中国强迫症防治指南》编写组.中国强迫症防治指南2016(精编版)[J].中华精神科杂志,2016,49(6):353~366.
[5]李小平,张宗凤,王垚,等.中重度强迫症患者强迫信念与强迫症状相关分析[J].中华精神科杂志,2016,49(5):307~311.
[6]吴慧玲,胡茂荣,余斌,等.重复经颅磁刺激联合文拉法辛及劳拉西泮治疗广泛性焦虑[J].上海精神医学,2016,28(4):212~217.
[7]舒忙巧,赵芳霞,张婷.重复经颅磁刺激治疗难治性强迫症效果观察[J].武警后勤学院学报(医学版),2016(8):622~624.
[8] Riesel A,Endrass T,Auerbach L A,et al. Overactive Performance Monitoring as an Endophenotype for ObsessiveCompulsive Disorder:Evidence From a Treatment Study[J].American Journal of Psychiatry,2015,172(7):665~73.
[9] Lizano P,Popat-Jain A,Scharf J M,et al. Challenges in Managing Treatment-Refractory Obsessive-Compulsive Disorder and Tourette's Syndrome[J]. Harvard Review of Psychiatry,2016,24(4):294~301.
[10]潘爱祖,潘隽峰.舍曲林合并利培酮治疗难治性强迫症的临床疗效评价[J].海峡药学,2016,28(11):141~142.
[11]赵永明.24例舍曲林合并重复经颅磁刺激治疗难治性强迫症患者临床观察[J].中国卫生标准管理,2016,7(9):110~111.
[12]彭成国,肖寒.舍曲林合并重复经颅磁刺激治疗难治性强迫症的临床研究[J].现代诊断与治疗,2015,26(2):378~379.
[13]罗秀芳,黄美莲,叶秀娟.舍曲林单用与合并重复经颅磁刺激治疗难治性强迫症患者临床对照研究[J].临床精神医学杂志,2015(4):238~240.
[14]郭丽.重复经颅磁刺激用于精神分裂症中安全性及可行性[J].中国实用神经疾病杂志,2016,19(2):20~21.
[2] Atmaca M. Treatment-refractory obsessive compulsive disorder[J]. Prog Neuropsychopharmacol Biol Psychiatry,2016,70(3):127~133.
[3] D'Urso G,Brunoni A R,Anastasia A,et al. Polarity-dependent effects of transcranial direct current stimulation in obsessive-compulsive disorder[J]. Neurocase,2016,22(1):60~64.
[4]中华医学会精神医学分会《中国强迫症防治指南》编写组.中国强迫症防治指南2016(精编版)[J].中华精神科杂志,2016,49(6):353~366.
[5]李小平,张宗凤,王垚,等.中重度强迫症患者强迫信念与强迫症状相关分析[J].中华精神科杂志,2016,49(5):307~311.
[6]吴慧玲,胡茂荣,余斌,等.重复经颅磁刺激联合文拉法辛及劳拉西泮治疗广泛性焦虑[J].上海精神医学,2016,28(4):212~217.
[7]舒忙巧,赵芳霞,张婷.重复经颅磁刺激治疗难治性强迫症效果观察[J].武警后勤学院学报(医学版),2016(8):622~624.
[8] Riesel A,Endrass T,Auerbach L A,et al. Overactive Performance Monitoring as an Endophenotype for ObsessiveCompulsive Disorder:Evidence From a Treatment Study[J].American Journal of Psychiatry,2015,172(7):665~73.
[9] Lizano P,Popat-Jain A,Scharf J M,et al. Challenges in Managing Treatment-Refractory Obsessive-Compulsive Disorder and Tourette's Syndrome[J]. Harvard Review of Psychiatry,2016,24(4):294~301.
[10]潘爱祖,潘隽峰.舍曲林合并利培酮治疗难治性强迫症的临床疗效评价[J].海峡药学,2016,28(11):141~142.
[11]赵永明.24例舍曲林合并重复经颅磁刺激治疗难治性强迫症患者临床观察[J].中国卫生标准管理,2016,7(9):110~111.
[12]彭成国,肖寒.舍曲林合并重复经颅磁刺激治疗难治性强迫症的临床研究[J].现代诊断与治疗,2015,26(2):378~379.
[13]罗秀芳,黄美莲,叶秀娟.舍曲林单用与合并重复经颅磁刺激治疗难治性强迫症患者临床对照研究[J].临床精神医学杂志,2015(4):238~240.
[14]郭丽.重复经颅磁刺激用于精神分裂症中安全性及可行性[J].中国实用神经疾病杂志,2016,19(2):20~21.