低频重复经颅磁刺激联合氟伏沙明治疗儿童青少年首发强迫障碍的临床双盲随机对照研究

目的 探讨低频重复经颅磁刺激（rTMS）联合氟伏沙明治疗儿童青少年首发强迫障碍的临 床疗效。方法 选取2021年6月至2022年3月在青岛市精神卫生中心门诊和住院的58例首发强迫障碍 患儿为研究对象,采用随机数字表法分为试验组和对照组,每组 29 例。试验组采用低频 rTMS 联合氟伏 沙明治疗,对照组采取伪刺激联合氟伏沙明治疗,两组均观察治疗 8 周。采用耶鲁 - 布朗强迫障碍量表 （Y-BOCS）、汉密尔顿焦虑量表（HAMA）、不良反应症状量表（TESS）对两组患儿进行评估。采用重复测量 方差分析比较治疗前及治疗第 2、4、6、8 周末两组患儿的强迫症状严重程度、焦虑情况,并比较两组患 儿的治疗总有效率和不良反应发生率。结果 两组患儿治疗前的Y-BOCS、HAMA 评分比较,差异无统 计学意义（P＞ 0.05）。试验组患儿治疗第 2、4、6、8 周末的 Y-BOCS 评分与对照组比较［（26.10±5.11）分 比（30.24±3.79）分、（22.48±5.09）分比（25.76±4.60）分、（17.34±5.15）分比（20.31±5.65）分、（12.59±5.82）分比 （16.31±6.71）分］,差异均有统计学意义（均P＜ 0.05）;HAMA 评分与对照组比较［分别为（19.41±4.02）分 比（22.55±3.88）分、（15.62±4.53）分比（18.90±3.39）分、（11.66±3.11）分比（15.62±3.23）分、（8.31±2.19）分 比（12.55±2.68）分］,差异均有统计学意义（均P＜ 0.01）。重复测量方差分析结果显示,两组患儿的 Y-BOCS、HAMA 评分存在组间、时间和交互效应,差异均有统计学意义（均P＜ 0.05）。进一步分析显示, 试验组在治疗第 2 周末起效,而对照组在治疗第 4 周末起效。试验组的治疗总有效率为 93.11%（27/29）, 高于对照组的 72.41%（21/29）,差异有统计学意义（Z=1.980,P＜ 0.05）。两组患儿的不良反应发生率比较 ［37.93%（11/29）比 27.59%（8/29）］,差异无统计学意义（χ2 =0.704,P＞ 0.05）。结论 低频 rTMS 联合氟伏 沙明治疗儿童青少年首发强迫障碍能够改善患儿的强迫症状和焦虑症状,治疗2周可起效,有效率较高。     

重复经颅磁刺激治疗老年期认知功能障碍的新进展

简述重复经颅磁刺激对老年期认知功能障碍的改善作用及局限性.     

重复经颅磁刺激治疗焦虑障碍的研究进展

本文综述了重复经颅磁刺激（Repetitive Transcranial Magnetic Stimulation,rTMS）用于治疗焦虑障碍的文献,以期能更好的了解此领域的研究现状,探讨进一步研究的有效性及可行性,揭示此领域今后的研究方向。     

儿童青少年强迫障碍的临床特征与治疗进展

本文综述了儿童青少年强迫障碍的临床特征与治疗原则方面的研究进展。     

重复经颅磁刺激治疗认知功能障碍的研究进展

重复经颅磁刺激在精神科领域的使用已趋于成熟,其对认知功能的治疗作用也受到国内外学者的关注,本文就重复经颅磁刺激的基本原理、对认知功能治疗的有关研究结果及有关的作用机制、安全性等作一综述.     

儿童青少年强迫障碍临床特征和生物学研究进展

介绍儿童青少年强迫障碍的临床特征以及神经生物学和治疗方面的研究进展。     

重复经颅磁刺激对广泛性焦虑障碍患者认知功能影响的研究进展

本文目的是对重复经颅磁刺激（rTMS）对广泛性焦虑障碍（GAD）患者认知功能影响的研究进展进行综述,以期为临床应用提供参考。GAD作为一种常见的慢性精神疾病,影响患者的认知功能、生活质量及社会功能。一线治疗虽对大部分患者安全有效,但对认知功能的改善效果并不明确。rTMS作为一项无创安全的辅助物理治疗技术,有望能为GAD的临床治疗提供新思路。本综述从GAD的认知功能、一线治疗以及rTMS治疗方面进行阐述。     

高频重复经颅磁刺激对酒精使用障碍患者饮酒行为和认知功能的疗效

目的:探讨重复经颅磁刺激(rTMS)对酒精使用障碍(AUD)患者认知功能、饮酒行为和冲动水平的干预效果。方法:84例男性AUD患者,分为实验组(rTMS联合药物治疗组)42例和对照组(药物治疗组)42例。采用饮酒问卷(ADS)与临床酒精戒断状态评估量表(CIWA-Ar)评估患者治疗前酒精依赖水平与是否存在戒断症状;治疗前后分别采用蒙特利尔认知量表(MoCA)评估患者整体认知水平;冲动行为量表(BIS-11)评估患者行为冲动水平;强制饮酒量表(OCDS)评估患者饮酒渴求程度。结果:治疗两周后,实验组的MoCA总分高于对照组,BIS-11总分、认知冲动与无计划冲动水平得分较对照组低(P均<0.01)。实验组OCDS得分低于对照组,差异有统计学意义(P=0.034)。在治疗后,实验组与对照组的MoCA量表总分均有提高(P<0.05)。两组BIS得分、OCDS得分均有下降(P<0.01)。结论:rTMS辅助药物治疗可较好地改善AUD患者认知功能,亦可抑制冲动与降低饮酒渴求。     

rTMS及CBT-I对慢性失眠障碍患者治疗效果的随机对照研究

背景 目前,药物疗法是失眠障碍的一线治疗手段,但仍然存在着一定的不良反应。与药物治疗相比,重复经颅磁刺激（rTMS）和失眠的认知行为治疗（CBT-I）的不良反应较少、患者耐受性较好。目的 探讨rTMS与CBT-I治疗慢性失眠障碍的效果,以期为慢性失眠障碍患者提供更优的治疗方案。方法 选取2020年9月21日—2021年12月16日在内蒙古自治区精神卫生中心门诊或社区医院就诊的、符合《国际睡眠障碍分类第三版》（ICSD-3）诊断标准的慢性失眠障碍患者（n=50）,同期在社区招募与患者组年龄和性别相匹配的健康人作为对照组（n=16）。采用随机数字表法将慢性失眠障碍患者分为rTMS组与CBT-I组各25例,分别接受为期6周的rTMS或CBT-I干预。于干预前和干预后,慢性失眠障碍患者接受多导睡眠监测（PSG）以及匹兹堡睡眠质量指数量表（PSQI）、失眠严重程度指数量表（ISI）、重复性成套神经心理状态测验（RBANS）评定。对患者组和对照组进行静息态磁共振成像（rs-fMRI）扫描,并进行静息态低频振幅（ALFF）分析。将患者组和对照组ALFF值差异有统计学意义的脑区作为感兴趣区域（ROI）,将其作为种子点与患者全脑进行功能连接分析。结果 rTMS组和CBT-I组的PSQI评分、ISI评分以及RBANS中的即刻记忆、言语功能、延时记忆维度评分的时间效应均有统计学意义（F=41.160、69.615、47.923、12.090、28.193,P均<0.05）;两组总睡眠时间的时间效应、睡眠效率的时间效应和组别效应以及N1%的时间效应均有统计学意义（F=8.995、12.414、4.342、7.806,P均<0.05）。干预后,CBT-I组睡眠效率高于干预前（t=-2.785,P<0.05）。rTMS组眶部额上回与左侧豆状壳核（t=4.991,P<0.05）、右内侧和旁扣带回（t=4.471,P<0.05）和右侧中央后回（t=4.922,P<0.05）之间的功能连接增强,CBT-I组眶部额上回与左侧额中回之间的功能连接增强（t=6.586,P<0.05）。结论 rTMS及CBT-I可能有助于改善慢性失眠障碍患者的失眠情况和认知功能。     

Long-term sertraline treatment of children and adolescents with obsessive-compulsive disorder

OBJECTIVE: To evaluate the safety and effectiveness of sertraline in the long-term treatment of pediatric obsessive-compulsive disorder (OCD). METHOD: Children (6-12 years; n= 72) and adolescents (13-18 years; n = 65) with DSM-III-R-defined OCD who had completed a 12-week, double-blind, placebo-controlled sertraline study were given open-label sertraline 50 to 200 mg/day in this 52-week extension study. Concomitant psychotherapy was allowed during the extension study Outcome was evaluated by the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), National Institute of Mental Health Global Obsessive-Compulsive Scale, and Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I) scores. RESULTS: Significant improvement (p < .0001) was demonstrated on all four outcome parameters on an intent-to-treat analysis for the overall study population (n = 132), as well as the child and the adolescent samples. At endpoint, 72% of children and 61% of adolescents met response criteria (>25% decrease in CY-BOCS and a CGI-I score of 1 or 2). Significant (p < .05) improvements were also demonstrated from the extension study baseline to endpoint on all outcome parameters in those patients who received sertraline during the 12-week, double-blind acute study. Long-term sertraline treatment was well tolerated, and there were no discontinuations due to changes in vital signs, laboratory values, or electrocardiograms. CONCLUSION: Sertraline (50-200 mg/day) was effective and generally well tolerated in the treatment of childhood and adolescent OCD for up to 52 weeks. Improvement was seen with continued treatment.     

Treatment of obsessive-compulsive disorder in children and adolescents

The literature on treatment of childhood and adolescent obsessive-compulsive disorder is reviewed. Most studies concerning treatment of obsessive-compulsive disorder has been based on experience from adult patients. Only a few controlled trials using medication with obsessive-compulsive children have been produced. No controlled study has as yet documented the effect of behavioural therapy alone. The most effective treatment seems to be a combination of behavioural therapy and medication with a serotonin reuptake inhibitor. In the treatment of children with OCD, it is important to consider the child's personality and comorbid disorders.     

A review of obsessive-compulsive disorder in children and adolescents

This article is a review of recent literature on obsessive-compulsive disorder in the pediatric population. Areas covered include: a brief historical perspective, clinical presentation in relation to symptoms found in different age groups, epidemiology, psychiatric comorbidity, etiology (with regards to genetics, neuroimaging, and familial factors), clinical course and prognosis, and treatment, with special emphasis on individual and family-based cognitive-behavioral therapy and psychopharmacology.     

Changes in cognitive dysfunction in children and adolescents with obsessive-compulsive disorder after treatment

The majority of follow-up studies show stability of deficits after treatment in adults with obsessive-compulsive disorder (OCD), regardless of improvement in symptomatology, and this suggests a possibly chronic dysfunction of the dorsolateral-striatal circuit. To our knowledge, this is the first study to explore the evolution of cognitive dysfunction in children and adolescents with OCD after treatment. A neuropsychological battery designed for this study was administered to 29 OCD patients aged between 7 and 18 years before and after 6 months of naturalistic treatment, and to 22 healthy subjects of similar age, sex and intellectual level. In the first assessment, the OCD group performed worse on some tests of memory, speed of information processing and executive functions, this being similar to the cognitive dysfunction described in adult patients. After treatment the cognitive profile of the OCD group was normalized, and many of the significant differences present in the first assessment disappeared. Children and adolescents did not show the stability in cognitive dysfunction described in studies with adults. Six months of effective treatment normalized cognitive performance in young patients, who showed an important response to treatment.     

Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents

Obsessive-compulsive disorder (OCD) is a common, chronic, and impairing condition in youth. Cognitive-behavioral therapy (CBT), now widely recognized as the gold standard intervention for childhood OCD, relies on exposure and response prevention, and also includes psychoeducation, creation of a symptom hierarchy, imaginal exposures, cognitive interventions, and a contingency management system. This article reviews the theoretical underpinnings of current CBT approaches, key components of treatment, developmental considerations specific to childhood OCD, and evidence supporting the use of this psychosocial intervention. The current state of knowledge will be aided by further study of predictors and mechanisms of CBT treatment response.     

Impulse-control disorders in children and adolescents with obsessive-compulsive disorder

The aim of this study was to examine current prevalences, clinical correlates and patterns of co-occurrence of impulse-control disorders (ICDs) in children and adolescents with obsessive-compulsive disorder (OCD). We examined rates and clinical correlates of comorbid ICDs in 70 consecutive child and adolescent subjects with lifetime DSM-IV OCD (32.9% females; mean age = 13.8 ± 2.9 years). Comorbidity data were obtained with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Child Yale-Brown Obsessive-Compulsive Scale. All variables were compared in OCD subjects with and without current ICDs. 12 (17.1%) subjects met criteria for a current ICD. Pathological skin picking and compulsive nail biting were the most common ICDs with current rates of 12.8% and 10.0%, respectively. OCD subjects with current ICDs were significantly more likely to have a co-occurring tic disorder (66.7% vs. 20.7%). Although having an ICD was associated with greater numerical scores of OCD symptomatology, these differences were not statistically significant. There were no sex-specific patterns of ICD occurrence in children and adolescents with OCD. Certain ICDs are common among children and adolescents with OCD. Better identification of ICDs in children and adolescents with OCD is needed, as are empirically validated treatments for youth with co-occurring ICDs.     

Indication and therapy of obsessive-compulsive disorder in children and adolescents

Based on normal developmental phenomena we describe characteristics of obsessive-compulsive disorder in childhood. The functionalities of OCD symptoms are crucial for the treatment planning. According to the functions of symptoms a treatment of OCD symptoms or a treatment of their underlying problems or even a treatment with the family members of the child with OCD is indicated. Finally the peculiarities of OCD treatment with children and adolescents are described.     

Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder

Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral therapy, pharmacotherapy, combined treatment, and other interventions.     

Psychotherapeutic methods in the treatment of obsessive-compulsive disorder (OCD) in children and adolescents

The psychiatric and psychological literature was systematically reviewed for studies applying psychotherapeutic principles to young persons with obsessive-compulsive disorder. Abundant clinical and empirical evidence suggest that cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. Thirty-two investigations, most of them single case reports, showed some benefit for such kind of interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and specific family interventions may play an adjunctive role.