Karris Bianca C, Capobianco Marc, Wei Xin, Ross Lesley
KARRIS: Department of Mental Health, United States Naval Hospital, Yokosuka, Japan CAPOBIANCO: Department of Mental Health, Naval Medical Center, San Diego, CA WEI: Department of Internal Medicine, Naval Hospital, Pensacola, FL ROSS: Department of Mental Health, Naval Medical Center, San Diego, CA.
J Psychiatr Pract. 2017 Mar;23(2):141-144. doi: 10.1097/PRA.0000000000000215.
High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far. DPD involves persistent or recurrent experiences of unreality and feelings of detachment causing distress or functional impairment while insight remains intact. The prevalence of DPD is approximately 1% to 2%. Studies of the pharmacological treatment of DPD are limited, and medications have proven to be of limited benefit. We present the case of a 30-year-old man with major depressive disorder and DPD who did not respond to pharmacotherapy. After the patient was treated with low frequency rTMS to the right DLPFC followed by high frequency rTMS to the left DLPFC, there was a significant reduction in his depersonalization symptoms. Given its effectiveness in our patient, the use of both low frequency rTMS to the right DLPFC and high frequency rTMS to the left DLPFC for treatment of DPD should be further explored.
高频重复经颅磁刺激（rTMS）于2008年获得美国食品药品监督管理局批准，用于治疗对至少1次抗抑郁药物试验无反应的重度抑郁症患者。先前的研究表明，对左侧背外侧前额叶皮质（DLPFC）进行高频rTMS以及对右侧DLPFC进行低频rTMS在难治性抑郁症中均具有抗抑郁疗效。尽管rTMS已广泛应用于抑郁症治疗，但迄今为止，关于rTMS治疗人格解体障碍（DPD）患者的研究报道极少。DPD表现为持续或反复出现的不真实感和脱离感，导致痛苦或功能受损，而自知力保持完整。DPD的患病率约为1%至2%。DPD的药物治疗研究有限，且已证明药物疗效有限。我们报告一例患有重度抑郁症和DPD的30岁男性患者，其对药物治疗无反应。在该患者接受右侧DLPFC低频rTMS治疗，随后接受左侧DLPFC高频rTMS治疗后，其人格解体症状显著减轻。鉴于其在我们患者中的有效性，应进一步探索使用右侧DLPFC低频rTMS和左侧DLPFC高频rTMS联合治疗DPD。
