舍曲林联合重复经颅磁低频刺激右侧腹内侧前额叶(VMPFC)治疗青少年抑郁症非自杀性自伤行为(NSSI)临床观察

A clinical study of low frequency rTMS stimulation in the right ventromedial prefrontal cortex(VMPFC) combined with Sertraline on the treatment of the adolescents with nonsuicidal self-injurious behaviors

目的探讨重复经颅磁刺激(r TMS)对青少年抑郁症中非自杀性自伤行为的疗效,优势及应用前景。方法选择36例伴有非自杀性自伤行为的青少年抑郁症患者,随机分为单一药物治疗组(n=18),rTMS联合药物治疗组(n=18),于治疗前、治疗后2周末进行汉密尔顿抑郁量表(HAMD)评定临床疗效、冲动量表(BIS-II)评定冲动情绪水平、自我伤害行为筛选量表评估其外显行为、TESS评定不良反应。结果 2周末,rTMS联合药物治疗组患者抑郁症治疗有效率为84.6%,单一药物组有效率为38.9%,两组差异有统计学意义(P<0.05)。2周末r TMS联合药物治疗组较单一药物治疗组,HAMD总分及各因子分(F=249.35、301.03、25.69、34.87、2.95、151.31、64.33、41.81)均有明显下降(P<0.05),BIS-II总分及各项因子分(注意因子、运动因子、缺乏计划因子)(t=3.841、3.410、2.863.3.372),自我伤害行为筛选量表总分及忧郁孤独因子分、自残自杀因子分、退缩与自我批评因子分也均有明显下降(t=3.341、3.293、2.817、2.234)(P均<0.05)。结论低频重复经颅磁刺激联合药物治疗不仅可以尽快改善抑郁症状,而且能降低自伤自杀行为的风险,不良反应少,安全性高。

Objective To investigate the effects,advantages and application prospects of low frequency rTMS in the right ventromedial prefrontal cortex(VMPFC)combined with Sertraline on the treatment of the adolescents with nonsuicidal self-injurious behaviors. Methods 36 patients were collected. They were randomly divided into medication group(18 cases)and medication combined with rTMS group(18 cases).The Clinical curative effects were assessed using HAMD(Hamilton Depression Scale)before treatment and 2 weeks after treatment while we used the Barratt Impulsiveness Scale,11 th Version(BIS-11)assessing the emotional lability and impulsiveness and the Selfinjurious Behavior Screening Scale evaluating the overt behaviors. Adverse reaction was assessed after treatment with TESS. Results The effective rate was 84.6% in the rTMS group while 38.9% in the medication group(P<0.05)at the end of 2 nd week. There were significant difference of the total scores of the HAMD and each factor(F=249.35,301.03,25.69,34.87,2.95,151.31,64.33,41.81)(P<0.05). The BIS-11 scores and each facor(including attentional impulsivity,motor impulsivity,nonplanning impulsivity)were fewer in the rTMS group than in the medication group(t=3.841,3.410,2.863,3.372)(P<0.05). There were also significant difference of the total scores of the Self-injurious Behavior Screening Scale and some factor scores(including the melancholy and solitary factor,the selfinjury suicide factor and the withdrawal and self-criticism factor)between the rTMS group and the medication group at 2 th of treatment(P<0.05). The rTMS group got the fewer scores. Conclusions The rTMS stimulation combined with sertraline take effect rapidly not only with the improvement of depression symptoms,but also reducing the risk of nonsuicidal self-injurious behaviors,and with minor adverse reactions and high security.