劳拉西泮联合低频重复经颅磁刺激对慢性失眠障碍的效果

目的探讨劳拉西泮联合低频重复经颅磁刺激(rTMS)对慢性失眠障碍的临床疗效,为慢性失眠障碍的治疗提供参考。方法纳入符合《中国失眠障碍诊断和治疗指南》慢性失眠障碍诊断标准的患者120例,按照随机数字表法分为劳拉西泮联合低频rTMS治疗组(研究组)与劳拉西泮联合伪低频rTMS治疗组(对照组)各60例。于治疗前和治疗第4周末进行多导睡眠监测(PSG),于治疗前和治疗第1、2、4周末进行匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定。结果①治疗第4周末,研究组PSQI评分低于对照组(t=-3. 506,P=0. 001),研究组睡眠质量疗效的显效率和有效率均高于对照组(χ~2=4. 658、5. 926,P均0. 05);研究组实际睡眠总时间、睡眠效率均高于对照组(t=2. 333～3. 784,P均0. 05),睡眠潜伏期、觉醒时间、觉醒次数、快速眼球运动睡眠潜伏期均低于对照组(t=-2. 903～-2. 214,P均0. 05)。②治疗第4周末,研究组HAMA评分低于对照组(t=-2. 072,P0. 05);治疗第1、2、4周末,研究组HAMD-17评分均低于对照组(t=-2. 190～-1. 701,P均0. 05)。结论劳拉西泮联合低频rTMS可能有助于改善慢性失眠障碍患者的睡眠质量,并缓解其抑郁、焦虑等负性情绪。     

曲唑酮对酒依赖患者焦虑抑郁症的疗效观察

目的 探讨曲唑酮对酒依赖患者焦虑抑郁症状的有效性.方法 采用随机数字表法将70例符合酒依赖伴发抑郁障碍患者分为研究组和对照组各35例.对照组给予临床常规戒酒治疗,研究组合用曲唑酮治疗,疗程8周,分别于入组时、治疗后第2、4、6、8周末进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、饮酒问卷(ADS)和密西根酒精依赖调查表(MAST)评定.结果 自第2周末起两组HAMA、HAMD评分比较差异均有统计学意义(P＜0.05).自第4周末起两组ADS、MAST评分比较差异均有统计学意义(P＜0.05).结论 曲唑酮能有效治疗酒依赖伴发的焦虑抑郁症状,降低饮酒欲望,强化酒依赖治疗效果.     

低频重复经颅磁刺激治疗首发抑郁症的临床对照研究

目的探讨低频重复经颅磁刺激(rTMS)治疗首发抑郁症的疗效及安全性。方法采用随机数字表法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的65例首发抑郁症患者分为rTMS组33例和氟西汀组32例,观察期6周。用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)分别评定疗效及不良反应。结果 rTMS组有效率78.8%,氟西汀组有效率84.4%,两组疗效相当(P0.05);在第1周末rTMS组HAMD-17和HAMA评分较氟西汀组低,差异有统计学意义(P均0.05);rTMS组和氟西汀组不良反应发生率分别为12.1%和40.6%,差异有统计学意义(P0.01)。结论 rTMS治疗首发抑郁症的效果与氟西汀相当,但起效较氟西汀快、不良反应发生率低于氟西汀。     

高频rTMS联合度洛西汀对青年首发广泛性焦虑障碍的疗效及认知功能的影响

目的探讨高频重复经颅磁刺激(rTMS)联合度洛西汀对青年首发广泛性焦虑障碍(GAD)的临床疗效、安全性及对认知功能的影响。方法将符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的90例首发青年患者分为研究组和对照组,研究组接受高频rTMS(10 Hz)联合度洛西汀治疗,对照组接受伪经颅磁刺激联合度洛西汀治疗,观察期4周。于治疗前采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁状况,治疗前和治疗第1、2、4周末采用汉密尔顿焦虑量表(HAMA)评定疗效,治疗前和治疗第4周末使用MATRICS共识认知成套测验(MCCB)评定认知功能,治疗第4周末采用副反应量表(TESS)评定不良反应。结果治疗后各时点,两组HAMA评分均较同组治疗前低(P均0.01)。治疗4周末,研究组治疗总有效率高于对照组(88.89%vs.73.81%,χ~2=2.100,P=0.040),研究组推理及问题解决、社会认知领域评分均高于对照组(P均0.05)。治疗后,两组TESS评分比较差异无统计学意义[(2.48±0.86)分vs.(2.14±0.78)分,χ~2=0.640,P=0.420]。结论高频rTMS联合度洛西汀对GAD的疗效更好,且有助于改善推理及问题解决、社会认知等认知功能。     

舍曲林联合小剂量奥氮平对抑郁焦虑共病患者的疗效

目的观察舍曲林联合小剂量奥氮平对抑郁焦虑共病的疗效、安全性及其对患者睡眠质量的影响,为抑郁焦虑共病的治疗提供参考。方法纳入2019年10月-2020年8月在甘肃省天水市第三人民医院和天水市复退军人精神病疗养院门诊就诊、符合《国际疾病分类(第10版)》(ICD-10)抑郁发作和广泛性焦虑障碍诊断标准的121例患者为研究对象,按照随机数字表法分为研究组(n=61)和对照组(n=60),研究组采用舍曲林联合小剂量奥氮平治疗,对照组采用舍曲林治疗,观察期8周。于治疗前和治疗后第1、2、4、6、8周采用汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定病情严重程度,采用匹兹堡睡眠质量指数量表(PSQI)评定睡眠质量,采用副反应量表(TESS)评定药物不良反应。结果治疗后,两组HAMD-17、HAMA和PSQI评分均低于治疗前,差异均有统计学意义(P均0.05);治疗后各时点,研究组HAMD-17、HAMA和PSQI评分均低于对照组,差异均有统计学意义(P均0.05)。结论舍曲林联合小剂量奥氮平与单一舍曲林对抑郁焦虑共病的治疗均有效,但联合用药在改善焦虑和失眠症状方面的效果更好、安全性更高。     

安非他酮缓释片治疗海洛因依赖者稽延性戒断症状的临床研究

目的对照观察安非他酮缓释片联合纳曲酮片治疗海洛因依赖者稽延性戒断症状疗效和安全性。方法将84例海洛因依赖患者随机分成两组,研究组采用安非他酮缓释片联合纳曲酮片治疗,对照组单纯使用纳曲酮片,观察疗程为8周。采用心理渴求量表(PCS)、稽延性戒断症状量表(PWSS)、和汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定疗效。治疗前、后分别对患者行心电图、肝功能、肾功能等检查以评价安全性。结果治疗8周末,两组PCS、PWSS、HAMA、HAMD评分均较治疗前有显著下降(P0.01),研究组PCS、PWSS、HAMA和HAMD评分较对照组下降更显著(P0.01)。研究组和对照组的血常规、心电图、肝功能、肾功能两组比较差异无统计学意义(P0.05)。结论安非他酮缓释片能有效的缓解海洛因依赖患者在预防复吸治疗过程中的焦虑、抑郁等情绪,对海洛因依赖患者脱毒后的稽延性戒断症状可以很好改善。安非他酮缓释片联合纳曲酮治疗海洛因依赖患者稽延性戒断症状是一种安全、有效的治疗方案。     

舍曲林联合乌灵胶囊对抑郁症的临床疗效观察

目的观察舍曲林联合乌灵胶囊对抑郁症的临床疗效。方法将2014年3月-2015年3月在天水市复退军人精神病疗养院住院和门诊就医的130例符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)中抑郁发作的患者按照随机数字表法分为研究组和对照组各65例,研究组以舍曲林联合乌灵胶囊治疗,对照组单用舍曲林治疗,均治疗6周。采用汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定疗效;采用副反应量表(TESS)评定不良反应,分别于治疗前及治疗后1、2、4、6周末各评定一次。结果研究组有效率为92.3%,对照组为80.0%,两组差异有统计学意义(P0.05)。从治疗第1周末开始,两组HAMD-17、HAMA评分均较治疗前低(P均0.01),两组同一治疗时点比较,研究组评分低于对照组(P0.05);研究组服用艾司唑仑的时间短于对照组(P0.05)。结论舍曲林联合乌灵胶囊治疗抑郁症较单用舍曲林效果好,且失眠、焦虑不安的发生率更低。     

帕罗西汀联合重复经颅磁刺激治疗女性更年期抑郁症的对照研究

目的探讨帕罗西汀联合重复经颅磁刺激(r TMS)对女性更年期抑郁症的疗效。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的72例更年期女性患者分为研究组和对照组各36例,研究组采用帕罗西汀联合r TMS治疗,对照组单用帕罗西汀治疗,采用汉密尔顿抑郁量表17项版(HAMD-17)、汉密尔顿焦虑量表(HAMA)、流调用抑郁自评量表(CES-D)于治疗前及治疗后第2、4、6、8周评定疗效,采用副反应量表(TESS)评定不良反应。结果研究组与对照组有效率分别为94.4%和75.0%,差异有统计学意义(P0.01)。从治疗第1周末开始,研究组HAMD-17、HAMA及CES-D评分与治疗前比较,差异均有统计学意义(P均0.01),从治疗第2周末开始,对照组HAMD-17、HAMA及CES-D评分与治疗前比较,差异均有统计学意义(P均0.01)。治疗后两组同期比较差异有统计学意义(P0.01)。治疗结束时两组TESS评分差异无统计学意义(P0.05)。结论帕罗西汀联合r TMS对女性更年期抑郁症疗效优于单用帕罗西汀,起效较快。     

右侧低频rTMS联合艾司西酞普兰治疗综合医院首发抑郁症患者的随机对照研究

目的探讨右侧低频rTMS联合艾司西酞普兰治疗综合医院首发抑郁症患者临床疗效。方法选择符合ICD-10抑郁症诊断标准的首发患者。分为研究组和对照组,两组均服艾司西酞普兰(10mg/天)。研究组联用2周rTMS治疗,对照组联用伪刺激。采用HAMD-17、HAMA、TESS于治疗前、第2、4周末评价疗效和副反应。结果 1.治疗第4周,研究组有效率为94.7%,对照组为42.5%;2.研究组在治疗第2周末显示出明显疗效,与对照组比较有显著差异;3.治疗2周后研究组的HAMA低于对照组差异有显著性;4.仅有局部疼痛的反应。结论右侧低频经颅磁刺激联合艾司西酞普兰治疗综合医院首发抑郁症患者的疗效优予单一药物治疗,并能缩短治疗起效的时间。     

认知行为治疗对头颈部肿瘤患者焦虑抑郁情绪的对照研究

目的探讨认知行为疗法对头颈部肿瘤患者伴发情绪问题的治疗作用。方法将43例抑郁症患者用随机数字法分为研究组21例(认知行为治疗,CBT)和对照组22例(支持性咨询),疗程为8周,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评定疗效。结果治疗后第8周末,研究组HAMA和HAMD评分显著低于对照组(P<0.05),SAS标分、SDS指数、精神情感症状、躯体性障碍、精神运动性障碍和抑郁心理障碍评分均显著低于治疗前,差异有统计学意义(P<0.05)。结论 CBT可有效减少患者焦虑和抑郁症状,并通过早期干预治疗急性应激,防止癌症患者心理病理状态慢性化。     

出院准备度评估在首发精神分裂症患中的应用

目的探讨出院准备度评估对首发精神分裂症患者出院后康复情况的影响。方法选取2016年10月-2017年3月在四川省精神卫生中心住院、符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的首发精神分裂症患者60例,采用随机数字表法分为研究组和对照组各30例。两组患者均接受奥氮平治疗4周及以上,对照组由医生评估后下达医嘱办理出院,研究组由医生评估后下达出院医嘱,并接受出院准备度量表(RDQ)评定,评估达到标准后再办理出院。对两组患者在出院后1月、6月、12月通过电话或门诊随访的方式进行回访,采用自制出院回访调查表了解患者出院后康复情况。结果出院后研究组与对照组复发且再次入院、出现情绪问题、生活不能自理、自行停药情况、睡眠异常5个方面差异均有统计学意义(P均0. 05)。出院后1月,研究组满意度高于对照组,差异有统计学意义(P0. 05)。结论对于首发精神分裂症患者,通过出院准备度评估,可能有助于判断患者出院后进一步康复的能力。     

The long-term effect of repetitive transcranial magnetic stimulation in the treatment of intractable insomnia

ObjectiveTo explore the differences in clinical efficacy of different courses of repetitive transcranial magnetic stimulation (rTMS) in the treatment of intractable insomnia and the duration of clinical efficacy after cessation of treatment.Method70 patients with intractable insomnia were randomly divided into 1 treatment course group and 2 treatment courses group. The rTMS course consisted of daily sessions of 1200 stimuli for the r-DLPFC at a frequency of 1 Hz and 800 stimuli for parietal lobe (CPZ) at a frequency of 1 Hz. The pitchburg sleep index (PSQI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and cardiopulmonary coupled sleep (CPC) were assessed for 35 patients in each group at baseline, at 2 weeks, and at 1 and 3 months after treatment.ResultThe scores of PSQI, HAMD and HAMA in the 2 groups were significantly improved after 1 month of follow-up after rTMS treatment (p < 0.01). The long-term effect of different treatment courses is different. After 2 consecutive courses of treatment, there was still a significant difference between the 3-month follow-up and the pre-treatment period (p < 0.05). However, there was no statistical difference between the 3-month follow-up of one course of treatment and the pre-treatment period. The results of CPC test showed that the improvement of total sleep time (TST), and deep sleep time (DST) was basically consistent with the assessment of PSQI, HAMD and HAMA that the clinical efficacy of the 3-month follow-up was better than that of one course of treatment after 2 consecutive courses of treatment.ConclusionThe treatment of refractory insomnia by rTMS is effective, and the duration of the curative effect is related to the course of treatment. 2 consecutive courses of treatment still have a certain effect after 3 months, which is worthy of clinical promotion.     

Comparison of the effectiveness of duloxetine in depressed patients with and without a family history of affective disorders in first-degree relatives

Background

It remains unclear whether or not a positive family history of affective disorders predicts the effectiveness of antidepressant treatment of depression.

Aims

Assess the relationship of a family history of affective disorders to the efficacy of duloxetine in the treatment of depressive disorder.

Methods

Seventy-seven patients with depressive disorder (as defined by the 10th edition of the International Classification of Diseases, ICD-10) were enrolled in the study and treated with standard doses of duloxetine for 12 weeks. Among these patients 37 had a family history of affective disorder in first-degree relatives and 40 did not. The Hamilton Depression rating scale (HAMD-17), Hamilton Anxiety rating scale (HAMA), Side Effects Rating Scale (SERS), Snaith-Hamilton Pleasure Scale (SHAPS), and Beck Depression Inventory (BDI) were assessed at baseline and at the end of the 2^nd, 4^th, 6^th, 8^th, and 12^th week after enrollment. Repeated measures analysis of variance and logistic regression were used to analyze the association between a family history of affective disorders and the efficacy of duloxetine.

Results

Patients with a positive family history of affective disorders had an earlier age of onset, a longer duration of illness, a higher level of psychic anxiety, and more prominent anhedonia. Repeated measures analysis of variance showed a significant improvement in the severity of depression over the 12 weeks but no differences in the magnitude or speed of improvement between the two groups. Treatment was considered effective (i.e., drop in baseline HAMD-17 total score of ≥50%) in 75.7% of those with a family history of affective disorders and in 77.5% of those without a family history (X²=0.04, p=0.850).

Conclusions

Family history of affective disorders is not associated with the effectiveness of duloxetine in the acute treatment of depressive disorder.     

重复经颅磁刺激治疗帕金森病2年随访

目的随访观察重复经颅磁刺激(r TMS)治疗帕金森病(PD)患者的疗效。方法应用统一PD评分量表第Ⅲ部分(UPDRSⅢ)、Hoehn-Yahr(H-Y)分级、PD非运动症状(NMS)筛查问卷(NMSQ)、PD睡眠量表(PDSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和简易智能量表(MMSE)对37例应用药物和r TMS治疗的PD患者(r TMS+药物组)及45例单纯药物治疗的PD患者(药物组)在基线和2年随访末的运动症状(MS)和非运动症状(NMS)进行评估,对比分析两组患者病情进展。结果 r TMS+药物组2年随访末H-Y分级较基线显著升高(P 0.05);药物组2年随访末UPDRSⅢ、H-Y分级、HAMD、HAMA评分及左旋多巴等效剂量(LED)较基线均显著升高(P 0.05);对两组2年随访末的症状进行比较,药物组的UPDRSⅢ、H-Y分级、HAMD评分及LED较r TMS+药物组升高显著(P 0.05)。结论规律的r TMS辅助常规抗PD药物治疗可减缓PD进展,优于单纯抗PD药物治疗。     

阿戈美拉汀治疗首发抑郁障碍效果和安全性的Meta分析

目的系统评价阿戈美拉汀治疗首发抑郁障碍患者的效果和安全性,以期为抑郁障碍的药物治疗提供参考。方法检索PubMed、Web of Science、中国学术期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库中关于阿戈美拉汀治疗首发抑郁障碍患者的临床随机对照研究,提取阿戈美拉汀与SSRIs/SNRIs类抗抑郁药物在治疗首发抑郁障碍的效果和安全性的数据,采用RevMan 5. 3进行Meta分析。结果共纳入12篇文章,其中中文10篇,英文2篇。Meta分析结果显示,治疗后阿戈美拉汀组与对照组HAMD-17评分差异有统计学意义(SMD=-1. 31,95%CI:-1. 55～-1. 07,Z=10. 77,P0. 01)。由于研究间异质性较大(I2=83%,P0. 01),根据对照组所采用抗抑郁药种类进行亚组分析,分别以氟西汀(SMD=-1. 22,95%CI:-1. 66～-0. 77,Z=5. 30,P0. 01)、度洛西汀(SMD=-0. 88,95%CI:-1. 26～-0. 50,Z=4. 49,P0. 01)为对照的研究治疗后HAMD-17评分与阿戈美拉汀组差异均有统计学意义。关于副作用的Meta分析显示,阿戈美拉汀组与对照组之间差异有统计学意义(RR=0. 63,95%CI:0. 49～0. 80,Z=3. 73,P0. 01)。结论阿戈美拉汀治疗首发抑郁障碍的疗效优于SSRIs/SNRIs类抗抑郁药物或与其疗效相当,副作用小于SSRIs/SNRIs类抗抑郁药物。     

低频重复经颅磁刺激联合草酸艾司西酞普兰治疗广泛性焦虑障碍的临床对照研究

目的探讨低频重复经颅磁刺激(r TMS)联合草酸艾司西酞普兰对广泛性焦虑障碍(GAD)的临床疗效及安全性。方法采用随机数字表法将符合《国际疾病分类(第10版)》(ICD-10)广泛性焦虑障碍诊断标准的60例患者分为研究组和对照组各30例,研究组采用低频r TMS(1Hz)刺激右侧前额叶背外侧部联合草酸艾司西酞普兰治疗,对照组单用草酸艾司西酞普兰治疗,观察期6周。分别在治疗前和治疗后1、2、4、6周采用汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)评定疗效,于治疗后第1、2、4、6周采用副反应量表(TESS)评定不良反应。结果治疗后各时点两组HAMA、SAS评分均较治疗前低(P均0.01),从第1周末开始,研究组HAMA、SAS评分均低于对照组,差异均有统计学意义(P均0.05)。治疗6周后,研究组有效率高于对照组(86.67%vs.63.33%,χ~2=4.356,P0.05),且两组TESS评分比较差异无统计学意义[(2.33±0.96)分vs.(2.13±0.90)分,P0.05]。结论低频r TMS联合草酸艾司西酞普兰对GAD疗效可能优于单用草酸艾司西酞普兰。     

Targeting location relates to treatment response in active but not sham rTMS stimulation

BackgroundPrecise targeting of brain functional networks is believed critical for treatment efficacy of rTMS (repetitive pulse transcranial magnetic stimulation) in treatment resistant major depression.ObjectiveTo use imaging data from a “failed” clinical trial of rTMS in Veterans to test whether treatment response was associated with rTMS coil location in active but not sham stimulation, and compare fMRI functional connectivity between those stimulation locations.MethodsAn imaging substudy of 49 Veterans (mean age, 56 years; range, 27–78 years; 39 male) from a randomized, sham-controlled, double-blinded clinical trial of rTMS treatment, grouping participants by clinical response, followed by group comparisons of treatment locations identified by individualized fiducial markers on structural MRI and resting state fMRI derived networks.ResultsThe average stimulation location for responders versus nonresponders differed in the active but not in the sham condition (P = .02). The average responder location derived from the active condition showed significant negative functional connectivity with the subgenual cingulate (P < .001) while the nonresponder location did not (P = .17), a finding replicated in independent cohorts of 84 depressed and 35 neurotypical participants. The responder and nonresponder stimulation locations evoked different seed based networks (FDR corrected clusters, all P < .03), revealing additional brain regions related to rTMS treatment outcome.ConclusionThese results provide evidence from a randomized controlled trial that clinical response to rTMS is related to accuracy in targeting the region within DLPFC that is negatively correlated with subgenual cingulate. These results support the validity of a neuro-functionally informed rTMS therapy target in Veterans.     

Two weeks of image-guided left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation improves smoking cessation: A double-blind,sham-controlled,randomized clinical trial

BackgroundPrevious studies have found that repetitive transcranial magnetic stimulation (rTMS) to the left dorsal lateral prefrontal cortex (LDLPFC) transiently reduces smoking craving, decreases cigarette consumption, and increases abstinence rates.ObjectiveWe investigated whether 10 daily MRI-guided rTMS sessions over two weeks to the LDLPFC paired with craving cues could reduce cigarette consumption and induce smoking cessation.MethodsWe enrolled 42 treatment-seeking nicotine-dependent smokers (≥10 cigarettes per day) in a randomized, double-blind, sham-controlled trial. Participants received 10 daily sessions over 2 weeks of either active or sham MRI-guided rTMS (10Hz, 3000 pulses each session) to the LDLPFC concurrently with video smoking cues. The primary outcome was a reduction in biochemically confirmed cigarette consumption with a secondary outcome of abstinence on the target quit date. We also recorded cue-induced craving and withdrawal symptoms.ResultsCompared to sham (n = 17), participants receiving active rTMS (n = 21) smoked significantly fewer cigarettes per day during the 2-week treatment (mean [SD], 13.73[9.18] vs. 11.06[9.29], P < .005) and at 1-month follow-up (12.78[9.53] vs. 7.93[7.24], P < .001). Active rTMS participants were also more likely to quit by their target quit rate (23.81%vs. 0%, OR 11.67, 90% CL, 0.96–141.32, x² = 4.66, P = .031). Furthermore, rTMS significantly reduced mean craving throughout the treatments and at follow-up (29.93[13.12] vs. 25.01[14.45], P < .001). Interestingly across the active treatment sample, more lateral coil location was associated with more success in quitting (−43.43[0.40] vs. −41.79[2.24], P < .013).ConclusionsDaily MRI-guided rTMS to the LDLPFC for 10 days reduces cigarette consumption and cued craving for up to one month and also increases the likelihood of smoking cessation.Trial registrationClinicalTrials.gov identifier: NCT02401672.     

重复经颅磁刺激治疗广泛性焦虑的对照研究

目的探讨重复经颅磁刺激(rTMS)对广泛性焦虑(GAD)的治疗效果。方法选取确诊的42例广泛焦虑患者,随机分为真刺激组和假刺激组。22例患者采用真刺激线圈即风冷线圈刺激右侧顶叶,20名患者采用假刺激线圈,真刺激组和假刺激组采用的刺激参数相同(1Hz,500个刺激/串,每天共刺激三串,连续治疗10天)。在治疗前、治疗结束时、治疗结束后两周和治疗结束后一个月共四次评定汉密尔顿焦虑评分(HAMA)及汉密尔顿抑郁评分(HAMD)、匹兹堡质量指数评分(PSQI)的评分变化。结果与治疗前相比,真刺激组在治疗结束时、治疗结束后两周和治疗结束后一个月HAMA、HAMD及PSQI评分均有显著降低;假刺激组HAMA、HAMD及PSQI评分无显著改变。结论用重复经颅磁刺激低频刺激广泛性焦虑患者的右顶叶,有显著的治疗作用,同时能改善抑郁症状和失眠症状。     

Efficacy and safety of simultaneous rTMS–tDCS over bilateral angular gyrus on neuropsychiatric symptoms in patients with moderate Alzheimer's disease: A prospective,randomized, sham-controlled pilot study

BackgroundTreating neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) remains highly challenging. Noninvasive brain stimulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) is of considerable interest in this context.ObjectiveTo investigate the efficacy and safety of a novel technique involving simultaneous application of rTMS and tDCS (rTMS–tDCS) over bilateral angular gyrus (AG, P5/P6 electrode site) for AD-related NPS.MethodsEighty-four AD patients were randomized to receive rTMS–tDCS, single-rTMS, single-tDCS, or sham stimulation for 4 weeks, with evaluation at week-4 (W4, immediately after treatment) and week-12 (W12, follow-up period) after initial examination. Primary outcome comprising Neuropsychiatric Inventory (NPI) score and secondary outcomes comprising mini-mental state examination (MMSE), AD assessment scale-cognitive subscale (ADAS-cog), and Pittsburgh sleep quality index (PSQI) scores were collected and analyzed by a two-factor (time and treatment), mixed-design ANOVA.ResultsrTMS–tDCS produced greater improvement in NPI scores than single-tDCS and sham at W4 and W12 (both P < 0.017) and trended better than single-rTMS (W4: P = 0.058, W12: P = 0.034). rTMS–tDCS improved MMSE scores compared with single-tDCS at W4 (P = 0.011) and sham at W4 and W12 (both P < 0.017). rTMS–tDCS also significantly improved PSQI compared with single-rTMS and sham (both P < 0.017). Interestingly, rTMS–tDCS-induced NPI/PSQI improvement was significantly associated with MMSE/ADAS-cog improvement. tDCS- and/or rTMS-related adverse events appeared slightly and briefly.ConclusionsrTMS–tDCS application to bilateral AG can effectively improve AD-related NPS, cognitive function, and sleep quality with considerable safety.