低频重复经颅磁刺激治疗精神分裂症患者的顽固性幻听

目的:探讨左背外侧前额叶低频重复经颅磁刺激(rTMS)治疗精神分裂症患者顽固性幻听的临床疗效。方法:本研究为随机双盲对照研究。根据美国精神障碍诊断统计手册第4版(DSM-Ⅳ)的诊断标准,选取122例伴顽固性幻听的精神分裂症患者按2∶1随机分为治疗组(n=88)和对照组(n=34)。治疗组共接受6周的rTMS治疗,对照组接受伪刺激治疗。采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、临床疗效总印象量表(CGI)评定临床症状,采用UKU副作用量表评估不良反应。对治疗组于治疗结束后在1、3、6个月进行随访。结果:共有108例(88.5%)患者完成治疗。两组间治疗6周末PANSS、AHRS、CGI量表得分差异无统计学意义(均P0.05)。但治疗组病程≤10年、病程10～20年的患者AHRS评分低于同病程的对照组(均P0.05),病程在20年以上的治疗组和对照组间差异无统计学意义(P=0.929,F=0.008)。治疗组除4例患者治疗时出现头痛外,余无不适主诉。结论:1Hz左背外侧前额叶低频rTMS治疗能减轻病程20年内的精神分裂症患者的顽固性幻听,可作为一种有效的安全性好的治疗手段。

Effects of low frequency repetitive transcrinail magnetic stimulation on auditory hallucination in patients with schizophrenia

Objective: To investigate the effects and safety of low frequency repetitive transcrinail magnetic stimulation(rTMS) on obstinate auditory hallucination in schizophrenia patients.Methods: Totally 122 schizophrenia patients with obstinate hallucination who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV) from outpatient and inpatient department.They were randomly allocated to receive 1Hz(n=88,80%MT) or sham(n=34) rTMS on left dorsolateral prefrontal cortex for 20 sessions(5 session per week and two weeks’ break after 10 sessions).The Positive and Negative Syndrome Scale(PANSS),Auditory Hallucination Rating Scale(AHRS) and Clinical Global Impressions Scale(CGI) were used to assess the effect of rTMS on clinical features.Subjects in 1Hz group were followed up in time point of 3rd,6th and 9th month after treatment.Results:Totally 108 patients finished 20 treatment sessions.There were no significant differences between two groups in scores of PANSS,AHRS,CGI at any time point of treatment(Ps>0.05).Meanwhile,in patients with course of disease less than 10 years (16.2±4.9 vs.20.3±4.0)] and 10-20 years (19.2±5.5 vs.23.1±6.5],the AHRS scores were significantly lower in 1Hz group than in the sham group(Ps<0.05).There was no other side effect complaints,except that 4 patients reported headache in treatment.Conclusion: It suggests that 1Hz repetitive transcrinail magnetic stimulation is a safe approach showing efficacy on obstinate auditory hallucination in schizophrenic patients whose course of disease are less than 20 years.