不同频率rTMS联合帕罗西汀治疗广泛性焦虑障碍临床研究

目的探讨高、低频率重复经颅磁刺激联合帕罗西汀治疗广泛性焦虑障碍患者的疗效.方法将90例广泛性焦虑障碍患者按照治疗方法不同分为低频组、高频组与对照组,每组30例,均常规口服帕罗西汀治疗,在此基础上低频组重复经颅磁刺激频率为1 Hz、高频组重复经颅磁刺激频率为10 Hz,对照组患者置于相同的环境,线圈不通电,既无电流脉冲,只施予同样次数的声音刺激,观察4周.治疗前后采月汉密顿焦虑量表、焦虑自评量表评定焦虑症状改善状况.结果治疗前3组汉密顿焦虑量表、焦虑自评量表评分比较差异均无统计学意义(P>0.05);治疗后3组汉密顿焦虑量表及焦虑自评量表评分均较治疗前显著下降(P<0.01).治疗第1周末高频组、低频组汉密顿焦虑量表评分减分率显著低于对照组(P<0.05),焦虑自评量表评分减分率3组差异无统计学意义(P>0.05);第2周末高频组汉密顿焦虑量表评分显著低于对照组、减分率显著高于低频组及对照组(P<0.05或0.01);治疗第4周末高频组、低频组汉密顿焦虑量表及焦虑自评量表评分均显著低于对照组(P<0.01)、减分率均显著高于对照组(P<0.01).结论低频及高频重复经颅磁刺激联合帕罗西汀治疗广泛性焦虑障碍患者具有协同增效作用,疗效显著,高频治疗起效更快,有利于提高患者的治疗依从性,优于单用抗抑郁剂治疗.

Clinical study of rTMS with different frequencies and paroxetine in the treatment of generalized anxiety disorder

Objective To investigate the efficacy of high and low frequency rTMS combined with paroxetine in the treatment of patients with generalized anxiety disorder.Methods 90 patients with GAD were divided into low frequency group,high frequency group and control group according to different treatment methods,30 cases in each group.All were treated with paroxetine orally.On this basis,the rTMS frequency of the low frequency group was 1 Hz,and the rTMS frequency of the high frequency group was 10 Hz.The patients in the control group were placed in the same environment,the coil was not energized.No current pulse was given,and only the same number of sound stimuli were applied,and observed for 4 weeks.Before and after treatment,HAMA and SAS were used to evaluate the improvement of anxiety symptoms.Results There was no significant difference in HAMA and SAS scores among the three groups before treatment(P>0.05).After treatment,the HAMA and SAS scores in the three groups were significantly lower than those before treatment(P<0.01).At the end of the first week of treatment,the reduction rate of Hamilton anxiety scale score in the high-frequency group and the low-frequency group was significantly lower than that in the control group(P<0.05),There was no statistically significant difference of SAS(P>0.05).After 2 weeks of treatment,the HAMA score of the high frequency group was significantly lower than the control group,and the reduction rate was significantly higher than that of the low frequency group and the control group(P<0.05 or 0.01).After 4 weeks of treatment,the HAMA and SAS scores in the high-frequency group and the low-frequency group were significantly lower than those in the control group(P<0.01),and the reduction rates were significantly higher than those in the control group(P<0.01).Conclusions Low-frequency and high-frequency rTMS combined with paroxetine has a synergistic effect on patients with generalized anxiety disorder,and the effect is significant.High-frequency treatment has a faster onset of treatment,which is beneficial to improve the patient's treatment compliance.It is better than antidepressant alone.