无抽搐电痉挛治疗合并氯氮平治疗难治性精神分裂症及其对记忆力的影响

Effects of modified electroconvulsive therapy combined with clozapine in patients with treatment-refractory schizophrenia

目的:探讨无抽搐电痉挛治疗(modified electroconvulsive therapy,MECT)合并氯氮平治疗难治性精神分裂症(treatment-refractory schizophrenia,TRS)的疗效及其对记忆力的影响。方法:本研究采用单纯随机对照研究设计,将云南省精神病医院246例符合中国精神障碍分类与诊断标准,并符合难治性精神分裂症条件的住院患者随机分为研究组和对照组,每组123名。研究组为无抽搐电痉挛治疗合并氯氮平治疗,最大剂量为350mg/d;对照组仅单一使用氯氮平治疗,最大剂量为450mg/d,治疗期为8周。分别于治疗前及治疗后第1、4、8周末使用简明精神病量表(Brief Psychiatric Rating Scale,BPRS)和副反应量表(Treatment Emergent Symptom Scale,TESS)分别评定两组患者的精神症状及不良反应。分别于治疗前、治疗1天后、治疗1周后及治疗结束后2周用韦氏记忆量表(Wechsler Memory Scale,WMS)评定两组患者的记忆水平。结果:治疗8周后,研究组BPRS评分低于对照组[(22.34±5.79)vs.(33.97±6.73);P<0.001]。研究组显效率高于对照组[(37.40%)vs.(23.77%);P=0.030]。研究组TESS评分低于对照组[(3.12±1.83)vs.(3.68±2.14);P=0.028]。无抽搐电痉挛治疗1天后,研究组记忆商(memory quo-tient,MQ)低于对照组[(76.49±14.16)vs.(82.12±16.53);P=0.004];研究组无抽搐电痉挛治疗1周后MQ与治疗前比较差异无统计学意义[(82.13±14.65)vs.(85.36±16.74);P=0.107]。结论:无抽搐电痉挛治疗合并氯氮平治疗对难治性精神分裂症有效,不良反应少,对患者记忆力影响短暂,随后可恢复。

Objective： To investigate the efficacy and effect on memory of modified electroconvulsive therapy （MECT） combined with clozapine in the treatment of treatment refractory schizophrenia { TRS ） . Method： This study adopted simple randomized controlled design. Totally 246 inpatients met the diagnostic criteria of mental disorders of China, and conformed to the term of TRS were randomly assigned to MECT combined with clozapine group and clozapine group. Each group had 123 inpatients for 8 week treatment. The max dosage of clozapine was 350 mg/ d in MECT combined with clozapine group, and 450 mg/d in clozapine group. The Brief Psychiatric Rating Scale { BPRS } and the Treatment Emergent Symptom Scale { TESS ） were used to evaluate the treatment effects and the side effects in the 2 groups before the treatment and after 1, 4, and 8 weeks of treatment. The Wechsler Memory Scale { WMS } was used to evaluate the memory lever of the two groups before the treatment, after 1 d and 1 week of treatment, and 2 weeks after the treatment. Result： After 8 weeks of treatment, the BPRS scores in combined with clozapine group were decreased significantly [ （ 22. 34 ±5.79 ） vs. （33.97 ±6. 73 ） ; P = 0. 000 ] . The apparent efficiency in MECT combined with clozapine was higher than that in clozapine group [ （ 37.40% } vs. （ 23.77% ） ; P =0. 030 ] . The TESS scores in MECT combined with clozapine group were lower than that in clozapine group [ （3.12± 1.83 } vs. { 3.68 ± 2. 14 ） ; P = 0. 028 ] . After 1 day of treatment, the memory quotient（MQ） in MECT combined with clozapine group were lower than that in clozapine group [ （76. 49 ±14. 16） vs. { 82. 12 ± 16. 53 } ; P =0. 004 ] . After 1 week of treatment, there was no significant change of MQ in MECT combined with clozapine group, compared with that before the treatment [ （82. 13 ±14. 65） vs. （85.36 ± 16.74} ; P =0. 107] . Conclusion： Modified electroconvulsive therapy combined with clozapine is effective and safe in the treatment of treatment refractory schizophrenia It may temporarily effect patients memory.