MECT联合rTMS治疗对偏执型精神分裂症患者认知功能的影响

The effect of modified electroconvulsive therapy combined repetitive transcranial magnetic stimulation on cognitive function in patients with paranoid schizophrenia

目的探讨改良电休克治疗(MECT)联合重复经颅磁刺激(rTMS)治疗对偏执型精神分裂症患者认知功能的影响。方法将100例偏执型精神分裂症患者按随机数字表法分成联合治疗组和单纯MECT治疗组,联合治疗组中对患者实施MECT联合rTMS治疗,单纯MECT组中对患者实施MECT结合rTMS伪刺激治疗,每组各50例。偏执型精神分裂症的治疗疗效测定采用阳性与阴性症状量表(PANSS),采用修订韦氏记忆测验(WMS-RC)评定记忆功能,认知执行功能的评定采用威斯康星卡片分类测验(WCST),分别在第1次MECT治疗开始前(治疗前)和第24次rTMS或伪刺激结束后(治疗终点)运用上述3个量表对两组进行评定。结果与治疗前相比,3个量表的评分在治疗终点显示:与治疗前相比,两组PANSS量表评分在治疗终点时显著下降;联合治疗组的修订韦氏记忆测验(WMS-RC)量表评分结果显示在治疗终点,图片、再认、理解和联想评分均高于单纯MECT组;威斯康星卡片分类测验结果显示总错误数、持续反应数、持续错误数评分,联合治疗组在治疗终点均低于单纯MECT组,联合治疗组在治疗终点的完成分类数评分高于单纯MECT组。结论 MECT联合rTMS治疗与单纯MECT对偏执型精神分裂症的治疗疗效相当,但MECT联合rTMS治疗比单纯MECT对偏执型精神分裂症患者认知功能影响更小。

Objective To explore the effect of Modified Electroconvulsive Therapy（MECT） combined Repetitive Transcrani- al Magnetic Stimulation（rTMS） on cognitive function in patients with paranoid schizophrenia. Methods A total of 100 patients with paranoid schizophrenia were divided into combined treatment group and simple MECT treatment group,according to random number table method. The combined treatment group therapy for patients with MECT therapy combined rTMS treatment,the sim- ple MECT group therapy for patients with MECT therapy combined with rTMS pseudo stimulation,＇50 cases in each group. Every patient was assessed by Positive and Negative Syndrome Scale（PANSS） to evaluate curative effect,the revised Wechsler Memory Scale（WMS-RC） to evaluate the memory function and Wisconsin Card Sorting Test （WCST） to evaluate the cognitive function be- fore the start of the first MECT therapy （pre-treatment） and after the 24th rTMS or pseudo stimulation （post-treatment）. Results Three scale score in the treatment of end point showed that compared pre-treatment,two groups of PANSS scale scores dropped significantly in the end point of the treatment; The result of the WMS-RC score showed that the combination group＇s pic- ture,recognition,understanding and tenovo score were higher than the simple MECT treatment group. The result＇of the Wisconsin card sorting test （WCST） showed that the scores of the combination group＇s total number of errors, the number of continuous reac- tion and the number of continuous error were lower than simple MECT treatment group,the score of the the number of complete classification in combination group was higher than the simple MECT treatment group. Conclusion Both MECT combined rTMS treatment and the simple MECT treatment were effective in paranoid schizophrenia,and MECT combined rTMS treatment had less side effect on cognitive function in patients with paranoid schizophrenia.