Gan Jingli, Duan Huifeng, Chen Zhengxiang, Shi Zhenjuan, Gao Cunyou, Zhu Xiquan, Liang Xuejun
Zhonghua Yi Xue Za Zhi. 2015 Dec 15;95(47):3808-12.
To evaluate the efficacy and safety of high dose transcranial magnetic stimulation (rTMS) in patients with schizophrenia with refractory negative symptoms.
From January 2013 to April 2014 at our institute, 70 hospitalized patients of schizophrenia, according to the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV), aged from 18 to 45 were randomly divided into study group (n = 33) and control group (n = 37). Both kinds and dosages of antipsychotics were preserved as before. All patients were treated with 10 Hz rTMS. rTMS was delivered to the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight solid core coil at 100% motor threshold, 2 times daily for 10 days within 2 weeks. Sham stimulation was used in control group. In both groups, Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate the efficacy and safety before treatment, at week 1 and week 2, and subjective visual analogue scale (VAS) score was checked after each rTMS session. PANSS was performed 3 times at followup visits of week 4, week 8 and week 12.
Compared with before treatment the total score of PANSS and the score of negative symptoms at week 2 declined in study group (q = 3.780, 4.258, P < 0.05), especially the factors of blunted affect, emotional withdrawal and passive/apathetic social withdrawal (q = 3.829, 4.089, 4.072, P < 0.05). At the follow-up of week 4, week 8 and week 12 after treatment, none of the above factors got significant changes in study group (P > 0.05). After 2 weeks' treatment, the effective rates were 43.75% and 11.43% in study group and control group, respectively, and there was a significant difference between two groups (X2 = 8.888, P =0.003). The incidence of headache in study group was higher than that in control group(37.50% vs 8.57%, χ2 = 8.051, P = 0.005). The highest score of pain was (49 ± 14) in study group, which occurred after the first rTMS treatment. Along with the treatment, the score gradually become lower, and the lowest was (11 ± 5) after 20th treatment.
Among schizophrenia patients with refractory negative symptoms, 10 Hz rTMS applied 2 times daily within 2 weeks is effective and safe, especially, may improve blunted affect, emotional withdrawal and passive/apathetic social withdrawal.
评估高剂量重复经颅磁刺激（rTMS）治疗难治性精神分裂症阴性症状患者的疗效和安全性。
2013年1月至2014年4月在我院，70例住院精神分裂症患者，根据《精神障碍诊断与统计手册》第4版（DSM-IV）诊断标准，年龄18至45岁，随机分为研究组（n = 33）和对照组（n = 37）。抗精神病药物的种类和剂量均保持不变。所有患者均接受10 Hz的rTMS治疗。采用八字形实心线圈将rTMS施加于左侧背外侧前额叶皮质（DLPFC），强度为100%运动阈值，每天2次，2周内共治疗10天。对照组采用假刺激。两组在治疗前、第1周和第2周使用阳性和阴性症状量表（PANSS）和治疗中出现的症状量表（TESS）评估疗效和安全性，每次rTMS治疗后检查主观视觉模拟量表（VAS）评分。在第4周、第8周和第12周的随访中进行3次PANSS评估。
与治疗前相比，研究组在第2周时PANSS总分和阴性症状评分下降（q = 3.780，4.258，P < 0.05），尤其是情感迟钝、情感退缩和被动/淡漠社交退缩因子（q = 3.829，4.089，4.072，P < 0.05）。在治疗后第4周、第8周和第12周的随访中，研究组上述因子均无显著变化（P > 0.05）。治疗2周后，研究组和对照组的有效率分别为43.75%和11.43%，两组间差异有统计学意义（X2 = 8.888，P = 0.003）。研究组头痛发生率高于对照组（37.50% vs 8.57%，χ2 = 8.051，P = 0.005）。研究组疼痛最高评分为（49 ± 14）分，出现在首次rTMS治疗后。随着治疗进行，评分逐渐降低，第20次治疗后最低为（11 ± 5）分。
在难治性精神分裂症阴性症状患者中，2周内每天2次应用10 Hz的rTMS是有效且安全的，尤其可能改善情感迟钝、情感退缩和被动/淡漠社交退缩。
