摘要
目的 探讨重复经颅磁刺激(rTMS)并药物治疗难治性强迫症的效果.方法 难治性强迫症病人55例,随机分为研究组与对照组两组,研究组在药物治疗的基础上接受rTMS治疗,对照组接受伪刺激治疗,两组均连续治疗4周,应用耶鲁-布朗强迫症量表(Y-BOCS)、蒙特利尔认知评估量表(MoCA)(北京版)及治疗时出现的症状量表(TESS)评估病人治疗前后的强迫症状、认知功能及不良反应.结果 与治疗前比较,研究组治疗4周后Y-BOCS总分、Y-BOCS强迫思维总分、Y-BOCS强迫行为总分、Y-BOCS自知力分、MoCA总分、MoCA各分领域分差异均有显著性(t=2.121～16.027,P＜0.05).对照组治疗4周后Y-BOCS强迫行为总分、Y-BOCS总分、MoCA总分与治疗前比较差异有显著性(t=2.793～4.878,P＜0.05),其余Y-BOCS分及MoCA各分领域分差异均无显著性(P＞0.05).两组治疗前后Y-BOCS总分、Y-BOCS强迫思维总分、Y-BOCS强迫行为总分、Y-BOCS自知力分、MoCA总分、MoCA执行功能分、MoCA注意力分、MoCA抽象能力分、MoCA定向力分差值比较,差异有显著性(t=2.085～8.830,P＜0.05).两组临床疗效比较,差异有显著性(Z=-4.283,P＜0.05).两组治疗前后TESS分差值比较,差异无显著性(P＞0.05).结论 rTMS可改善难治性强迫症病人症状及认知功能,且不良反应小.
Abstract
Objective To investigate the clinical effect of repetitive transcranial magnetic stimulation (rTMS) combined with drugs in the treatment of refractory obsessive-compulsive disorder (OCD).Methods A total of 55 OCD patients were randomly divided into study group and control group.The patients in the study group were given rTMS in addition to drug therapy,and those in the control group were given sham stimulation.The course of treatment was 4 consecutive weeks.The Yale-Brown Obsessive Compulsive Scale (Y-BOCS),Montreal Cognitive Assessment (MoCA) scale (Beijing version),and Treatment Emer gent Symptom Scale (TESS) were used to assess obsessive compulsive symptoms,cognitive function,and adverse events.Results After 4 weeks of treatment,the study group had significant changes in Y-BOCS total score,Y BOCS obsession score,Y BOCS compulsion score,Y-BOCS insight score,MoCA total score,and score on each subscale of MoCA (t=2.121 16.027,P＜0.05);the control group had significant changes in Y-BOCS compulsion score,Y-BOCS total score,and MoCA total score (t =2.793-4.878,P ＜ 0.05),and there were no significant changes in the other Y-BOCS scores and the score on each subscale of MoCA (P＞0.05).There were significant differences between the two groups in Y-BOCS total score,Y-BOCS obsession score,Y-BOCS compulsion score,Y-BOCS insight score,MoCA total score,MoCA executive function score,MoCA attention score,MoCA abstraction score,and MoCA orientation score before and after treatment (t =2.085-8.830,P ＜ 0.05).There was a significant difference in clinical outcome between the two groups (Z=-4.283,P＜0.05),and there was no significant difference in the change in TESS score after treatment between the two groups (P＞0.05).Conclusion In patients with refractory OCD,rTMS can improve their obsessive-compulsive symptoms and cognitive function and has few adverse effects.
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NSTL
维普
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