Nursey Jane, Sbisa Alyssa, Knight Holly, Ralph Naomi, Cowlishaw Sean, Forbes David, O'Donnell Meaghan, Hinton Mark, Cooper John, Hopwood Malcolm, McFarlane Alexander, Herring Sally, Fitzgerald Paul
Phoenix Australia - Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia.
University of Melbourne Professorial Psychiatry Unit, Albert Road Clinic, 31 Albert Road, Melbourne, Victoria 3004, Australia.
Mil Med. 2020 Sep 18;185(9-10):e1770-e1778. doi: 10.1093/milmed/usaa149.
Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans.
This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pretreatment, post-treatment, and a 3-month follow-up.
Treatment was generally welltolerated, with reported side-effects including mild to moderate site-specific cranial pain and headaches during stimulation, which were relieved with the use of low dose analgesics. No serious side effects or adverse events were reported. Participants exhibited reductions in both PTSD and depression symptom severity (the repeated-measures effect size [dRM] for the CAPS-5 was -1.78, and the HAM-D was -1.16 post-treatment), as well as improvements in working memory and processing speed. Although significance cannot be inferred, these preliminary estimates of effect size indicate change over time.
Bilateral iTBS appears to be welltolerated by Australian veterans. Within this repeated-measures case series, iTBS treatment shows promise in reducing both PTSD and mood symptoms, as well as improving cognitive difficulties associated with these disorders. Large-scale randomized controlled trials of this promising treatment are warranted.
创伤后应激障碍（PTSD）是一种严重且使人衰弱的病症，影响着相当一部分退伍军人群体。大量患有创伤后应激障碍的退伍军人无法从以创伤为重点的心理治疗或药物治疗中获益，或者仍有残留症状，因此，需要研究新的创新治疗方法。theta 爆发刺激（TBS）是重复经颅磁刺激的一种新形式，已被证明可改善抑郁症状及相关认知缺陷。当前的试点研究旨在探讨间歇性 theta 爆发刺激（iTBS）作为澳大利亚退伍军人创伤后应激障碍治疗方法的可接受性、安全性和耐受性。
本研究采用病例系列重复测量设计。八名患有创伤后应激障碍的澳大利亚国防军退伍军人接受了20次双侧 iTBS 治疗（每天1次，每周5天，为期4周），并在治疗前、治疗后及3个月随访时接受一系列心理健康和神经心理学测量评估，包括《精神疾病诊断与统计手册》第5版临床医生管理的创伤后应激障碍量表（CAPS - 5）和汉密尔顿抑郁量表（HAM - D）。
治疗总体耐受性良好；报告的副作用包括刺激期间轻度至中度的特定部位颅骨疼痛和头痛，但使用低剂量镇痛药后症状缓解。未报告严重副作用或不良事件。参与者的创伤后应激障碍和抑郁症状严重程度均有所降低（治疗后 CAPS - 5的重复测量效应量[dRM]为 - 1.78，HAM - D为 - 1.16），工作记忆和处理速度也有所改善。尽管无法推断其显著性，但这些效应量的初步估计表明随时间有变化。
双侧 iTBS 似乎为澳大利亚退伍军人所耐受。在这个重复测量病例系列中，iTBS 治疗在减轻创伤后应激障碍和情绪症状以及改善与这些病症相关的认知困难方面显示出前景。有必要对这种有前景的治疗方法进行大规模随机对照试验。
