上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2011年
4期
200-206
,共7页
陈海莹%张志娟%王继军%陈月敏%项志清%施慎逊%盛建华
陳海瑩%張誌娟%王繼軍%陳月敏%項誌清%施慎遜%盛建華
진해형%장지연%왕계군%진월민%항지청%시신손%성건화
探索性眼球运动%重复经颅磁刺激%精神分裂症
探索性眼毬運動%重複經顱磁刺激%精神分裂癥
탐색성안구운동%중복경로자자격%정신분렬증
Exploratory eye movement%Repetitive transcranial magnetic stimulation%Schizophrenia
背景左侧前额叶背外侧区(dorsolateral prefrontal cortex,DLPFC)是调控眼球运动的关键区域,很可能与精神分裂症的异常探索性眼球运动(exploratory eye movement,EEM)有关.重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)刺激大脑的这个区域有可能辅助治疗精神分裂症阴性症状.目的评估rTMS干预对精神分裂症者EEM异常的影响,以及EEM变化与精神分裂症阳性和阴性症状变化之间关系.方法 在上海市精神卫生中心住院的46位精神分裂症患者于2009年6月至2010年2月参加本研究.患者被随机分为rTMS真刺激组(研究组,24例)和rTMS伪刺激组(对照组,22例).两组均接受标准抗精神病药治疗.rTMS真刺激组每周接受5次rTMS干预,持续4周,应用θ短阵快速脉冲刺激(intermittent theta burst stimulation,iTBS)模式刺激左侧DLPFC.于治疗前及治疗4周末应用阳性与阴性症状量表(Positive and Negative Syndrome Scale,PANSS)盲法评定患者的精神症状和进行EEM检查,EEM检查指标包含凝视点数(number of eye fixations score,NEF)、反应探索分(the responsive search score,RSS)和判别值(differentiation score,D).结果 研究组23例和对照组19例完成研究.经rTMS干预4周后,两组的症状均有明显减轻,但是,接受rTMS辅助治疗患者组的PANSS总分及PANSS阴性症状因子分明显低于对照组.4周后,rTMS真刺激组的NEF分较治疗前有明显升高(改善),而rTMS伪刺激组的NEF分未见明显升高;两组治疗前后RSS及D值的变化均不明显.但是,rTMS真刺激组的NEF中位数变化的百分数 (+10%),并没有显著性高于rTMS伪刺激组的NEF中位数变化的百分数(-19%).结论 与标准药物治疗相比,接受4周rTMS刺激左侧前额叶背外侧区辅助治疗的精神分裂症患者的阴性症状更轻,异常探索性眼球运动EEM有一成份也有提高.EEM指标对于治疗的反应方面存在高度个体化变异,这表明需要相对较大的样本来判断特殊治疗是否有效.
揹景左側前額葉揹外側區(dorsolateral prefrontal cortex,DLPFC)是調控眼毬運動的關鍵區域,很可能與精神分裂癥的異常探索性眼毬運動(exploratory eye movement,EEM)有關.重複經顱磁刺激(repetitive transcranial magnetic stimulation,rTMS)刺激大腦的這箇區域有可能輔助治療精神分裂癥陰性癥狀.目的評估rTMS榦預對精神分裂癥者EEM異常的影響,以及EEM變化與精神分裂癥暘性和陰性癥狀變化之間關繫.方法 在上海市精神衛生中心住院的46位精神分裂癥患者于2009年6月至2010年2月參加本研究.患者被隨機分為rTMS真刺激組(研究組,24例)和rTMS偽刺激組(對照組,22例).兩組均接受標準抗精神病藥治療.rTMS真刺激組每週接受5次rTMS榦預,持續4週,應用θ短陣快速脈遲刺激(intermittent theta burst stimulation,iTBS)模式刺激左側DLPFC.于治療前及治療4週末應用暘性與陰性癥狀量錶(Positive and Negative Syndrome Scale,PANSS)盲法評定患者的精神癥狀和進行EEM檢查,EEM檢查指標包含凝視點數(number of eye fixations score,NEF)、反應探索分(the responsive search score,RSS)和判彆值(differentiation score,D).結果 研究組23例和對照組19例完成研究.經rTMS榦預4週後,兩組的癥狀均有明顯減輕,但是,接受rTMS輔助治療患者組的PANSS總分及PANSS陰性癥狀因子分明顯低于對照組.4週後,rTMS真刺激組的NEF分較治療前有明顯升高(改善),而rTMS偽刺激組的NEF分未見明顯升高;兩組治療前後RSS及D值的變化均不明顯.但是,rTMS真刺激組的NEF中位數變化的百分數 (+10%),併沒有顯著性高于rTMS偽刺激組的NEF中位數變化的百分數(-19%).結論 與標準藥物治療相比,接受4週rTMS刺激左側前額葉揹外側區輔助治療的精神分裂癥患者的陰性癥狀更輕,異常探索性眼毬運動EEM有一成份也有提高.EEM指標對于治療的反應方麵存在高度箇體化變異,這錶明需要相對較大的樣本來判斷特殊治療是否有效.
배경좌측전액협배외측구(dorsolateral prefrontal cortex,DLPFC)시조공안구운동적관건구역,흔가능여정신분렬증적이상탐색성안구운동(exploratory eye movement,EEM)유관.중복경로자자격(repetitive transcranial magnetic stimulation,rTMS)자격대뇌적저개구역유가능보조치료정신분렬증음성증상.목적평고rTMS간예대정신분렬증자EEM이상적영향,이급EEM변화여정신분렬증양성화음성증상변화지간관계.방법 재상해시정신위생중심주원적46위정신분렬증환자우2009년6월지2010년2월삼가본연구.환자피수궤분위rTMS진자격조(연구조,24례)화rTMS위자격조(대조조,22례).량조균접수표준항정신병약치료.rTMS진자격조매주접수5차rTMS간예,지속4주,응용θ단진쾌속맥충자격(intermittent theta burst stimulation,iTBS)모식자격좌측DLPFC.우치료전급치료4주말응용양성여음성증상량표(Positive and Negative Syndrome Scale,PANSS)맹법평정환자적정신증상화진행EEM검사,EEM검사지표포함응시점수(number of eye fixations score,NEF)、반응탐색분(the responsive search score,RSS)화판별치(differentiation score,D).결과 연구조23례화대조조19례완성연구.경rTMS간예4주후,량조적증상균유명현감경,단시,접수rTMS보조치료환자조적PANSS총분급PANSS음성증상인자분명현저우대조조.4주후,rTMS진자격조적NEF분교치료전유명현승고(개선),이rTMS위자격조적NEF분미견명현승고;량조치료전후RSS급D치적변화균불명현.단시,rTMS진자격조적NEF중위수변화적백분수 (+10%),병몰유현저성고우rTMS위자격조적NEF중위수변화적백분수(-19%).결론 여표준약물치료상비,접수4주rTMS자격좌측전액협배외측구보조치료적정신분렬증환자적음성증상경경,이상탐색성안구운동EEM유일성빈야유제고.EEM지표대우치료적반응방면존재고도개체화변이,저표명수요상대교대적양본래판단특수치료시부유효.
Background:The left dorsolateral prefrontal cortex (DLPFC) is one of the crucial areas in ocular control that may be involved in the abnormal Exploratory Eye Movements (EEM) seen in schizophrenia.Repetitive Transcranial Magnetic Stimulation (rTMS) to this same region of the brain is a promising adjunctive therapy for the negative symptoms of schizophrenia.Objective: Assess the effects of rTMS stimulation on EEM abnormalities in schizophrenia and the relationship of changes in EEM to changes in the positive and negative symptoms of schizophrenia.Methods: 46 inpatients with schizophrenia at the Shanghai Mental Health Center between June 2009 and February 2010 were randomly divided into an rTMS group (n=24) and a sham rTMS group (n=22).Both groups received standard antipsychotic medication.The rTMS group received five adjunctive rTMS treatments per week for four weeks using intermittent theta burst stimulation to the left dorsolateral prefrontal cortex.Patients were evaluated using blinded assessments of the Positive and Negative Syndrome Scale (PANSS) and tests of EEM [including number of eye fixations score (NEF),responsive search score (RSS),and the differentiation score (D)] before and after the course of treatment.Results:23 patients in the intervention group and 19 patients in the control group finished the study.Both groups had significant decreases in symptoms after four weeks of treatment but at the end of the treatment period both the total PANSS score and the PANSS negative symptom score were significantly lower in the group that received adjunctive rTMS.The NEF score increased significantly (i.e.,improved) in the real rTMS group after four weeks of treatment but not in the sham rTMS group;neither group had significant changes in the RSS or D scores.However,the median percent change in the NEF score for the real rTMS group ( +10%) was not significantly greater than the median percent change in the sham rTMS group ( -19%).Conclusion: Compared to standard antipsychotic therapy,a four-week course of antipsychotic medication with adjunctive rTMS was more effective in improving both the negative symptoms of schizophrenia and one component of the abnormal EEM seen in schizophrenia.High individual variability in responsiveness of EEM measures to treatment will necessitate relatively large samples to determine whether or not particular treatments are effective.
