非典型抗精神病药合并rTMS与合并MECT治疗首发精神分裂症的效果

Combination of atypical antipsychotics with rTMS or MECT in the treatment of first-episode schizophrenia

目的探讨二代非典型抗精神病药物合并重复经颅磁刺激(rTMS)与合并改良电休克(MECT)治疗首发精神分裂症的疗效,并观察安全性和不良反应。方法将70例首发精神分裂症患者随机分成对照组和研究组,各35例。研究组给予rTMS合并利培酮,对照组给予MECT合并利培酮。分别于治疗前、治疗后1、2及4周末应用精神症状阳性和阴性量表(PANSS)评定临床疗效,并在治疗后2周末采用不良反应症状量表(TESS)评价不良反应。结果治疗1、2、4周末,两组患者的阳性、阴性症状评分、PANSS总分均低于治疗前,且治疗2、4周末,研究组的阳性症状评分及PANSS总分均低于对照组(P<0.05)。经过4周治疗,对照组与研究组的治疗总有效率比较,差异无统计学意义(χ~2=2.147,P>0.05)。治疗后,研究组不良反应总发生率明显低于对照组(χ~2=6.108,P<0.05)。结论 rTMS或MECT联合利培酮治疗首发精神分裂症症状的疗效基本相当,但联合rTMS的不良反应较少、安全性较好。

Objective To eplore the effects of combination of second-yeneration atypical antipsychotics with repetitivetranscranial magnetic stimulation （rTMS） or modified electric convulsive therapy （MECT） in the treatment of first-episodeschizophrenia, and observe the safety and adverse reactions. Methods Seventy patients with first-episode schizophreniawere randomly divided into study group and control group, with 35 cases in each group. The study group received rTMSwith risperidone, and the control group received MECT with risperidone. The clinical efficacy was evaluated by the positiveand negative symptoms of psychiatric symptoms （PANSS） before treatment, at 1st, 2nd, and 4th weekend after treatment,and the adverse reactions were evaluated by treatment emergent symption scale （TESS） at 2nd weekend after treatment.Results At 1st, 2nd, and 4th weekend of treatment, the positive and negative symptom scores and total PANSS scores of thetwo groups were lower than those before treatment, and at 2nd, and 4th weekend, the positive scores and total PANSS scoresof the study group were lower than those of the control group （P〈0.05）. After 4 weeks of treatment, the total effective rate oftreatment between the control group and the study group was not statistically significant （x^2=2.147, P〉0.05）. After treatment,the total incidence of adverse reactions in the study group was significantly lower than that in the control group （x^2=6.108,P〈0.05）. Conclusion The risperidone combined with rTMS has same efficacy as which combined with MECT, but rTMSshows less adverse reactions and good security.