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[非侵入性脑刺激治疗精神分裂症性精神病]

[Non-invasive brain stimulation for treatment of schizophrenic psychoses].

作者信息

Hasan A, Wobrock T, Palm U, Strube W, Padberg F, Falkai P, Fallgatter A, Plewnia C

机构信息

Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland.

Zentrum für seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Darmstadt-Dieburg, Deutschland.

出版信息

Nervenarzt. 2015 Dec;86(12):1481-91. doi: 10.1007/s00115-015-4323-8.

Abstract

Despite many different available pharmacological and psychosocial treatment options, an optimal control of symptoms is only partly possible for most schizophrenia patients. Especially, persistent auditory hallucinations, negative symptoms and cognitive impairment are difficult to treat symptoms. Several non-invasive brain stimulation techniques are increasingly being considered as new therapeutic add on options for the management of schizophrenia, targeting these symptom domains. The technique which has been available for the longest time and that is best established in clinical care is electroconvulsive therapy (ECT). New stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) allow a more pathophysiological-based approach. This review article introduces various non-invasive brain stimulation techniques and discusses recent treatment studies on schizophrenia. In total, the novel brain stimulation techniques discussed here can be considered relevant add on therapeutic approaches for schizophrenia. In this context, the best evidence is available for the application of rTMS for the treatment of negative symptoms and persistent auditory hallucinations; however, negative studies have also been published for both indications. Studies using other non-invasive brain stimulation techniques showed promising results but further research is needed to establish the clinical efficacy. Based on a growing pathophysiological knowledge, non-invasive brain stimulation techniques provide new treatment perspectives for patients with schizophrenia.

摘要

尽管有许多不同的药理学和心理社会治疗选择,但对于大多数精神分裂症患者来说,症状的最佳控制只能部分实现。特别是,持续性幻听、阴性症状和认知障碍是难以治疗的症状。几种非侵入性脑刺激技术越来越被视为精神分裂症管理的新治疗附加选项,针对这些症状领域。临床护理中使用时间最长且最成熟的技术是电休克疗法(ECT)。新的刺激技术,如重复经颅磁刺激(rTMS)和经颅直流电刺激(tDCS),允许采用更基于病理生理学的方法。这篇综述文章介绍了各种非侵入性脑刺激技术,并讨论了最近关于精神分裂症的治疗研究。总的来说,这里讨论的新型脑刺激技术可被视为精神分裂症相关的附加治疗方法。在这种情况下,rTMS用于治疗阴性症状和持续性幻听的应用有最佳证据;然而,针对这两种适应症也发表了阴性研究。使用其他非侵入性脑刺激技术的研究显示出有希望的结果,但需要进一步研究以确定临床疗效。基于不断增长的病理生理学知识,非侵入性脑刺激技术为精神分裂症患者提供了新的治疗前景。

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