重复经颅磁刺激对老年精神分裂症患者精神症状及认知功能的影响

Effects of repetitive transcranial magnetic stimulation on mental symptoms and cognitive function in elderly patients with schizophrenia

目的 探讨重复经颅磁刺激(rTMS)对老年精神分裂症患者精神症状及认知功能的影响。方法 选取2019年6月~2020年12月杭州市第七人民医院精神科收治的120例老年精神分裂症患者,随机分为对照组和治疗组,每组各60例;对照组给予奥氮平联合利培酮片治疗,治疗组在此基础上增加rTMS治疗;比较两组治疗12周后的PANSS评分、RBANS总分、MOCA总分、总有效率及不良反应发生率等。结果 治疗后,治疗组的阳性症状(14.40±3.57)分、阴性症状(19.83±3.47)分、一般精神病理(19.70±3.94)分等低于对照组[(14.40±3.57)分、(25.30±3.69)分、(24.36±4.28)分],两组比较,差异有统计学意义(均P<0.05);治疗组的RBANS总分(153.76±17.35)分、MOCA总分(28.31±5.17)分均高于对照组的[(141.60±16.47)分、(24.46±4.48分)](均P<0.05);治疗组的总有效率为93.33%,高于对照组的75.00%,两组比较,差异有统计学意义(P<0.05);治疗组的不良反应发生率为38.33%,与对照组的46.67%比较,差异无统计学意义(P>0.05)。结论 药物联合rTMS治疗老年精神分裂症患者,可减轻患者的精神症状,改善心理状态和认知功能,提高治疗效果,具有较好的安全性。

Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS) on mental symptoms and cognitive function in elderly patients with schizophrenia. Methods One hundred and twenty elderly patients with schizophrenia admitted to and treated in the psychiatric department of our hospital from June 2019 to December 2020were randomly divided into the control group(n=60) and the treatment group(n=60). The control group was treated with olanzapine combined with risperidone tablets, while the treatment group was treated with rTMS on the basis of the treatment in the control group. The positive and negative syndrome scale(PANSS) score, total score of repeatable battery for the assessment of neuropsychological status(RBANS) scale, total score of montreal cognitive assessment(MOCA), total effective rate and incidence of adverse reactions were compared between the two groups after 12 weeks of treatment.Results After treatment, the scores of positive symptoms(14.40±3.57) points, negative symptoms(19.83±3.47) points and general psychopathology(19.70 ±3.94) points in the treatment group were lower than those in the control group[(14.40±3.57) points,(25.30±3.69) points, and(24.36±4.28) points, respectively], with statistically significant differences between two groups(all P<0.05). The total points of RBANS and MOCA in the treatment group was(153.76 ±17.35)points and(28.31±5.17)points,respectively,which were significantly higher than those in the control group [(141.60 ±16.47) points and(24.46±4.48) points], respectively(all P<0.05).The total effective rate of the treatment group was93.33%, which was higher than that of the control group(75.00%), with statistically significant difference between the two groups(P<0.05).The incidence of adverse reactions was 38.33% in the treatment group and 46.67% in the control group, with no statistical difference(P>0.05). Conclusion The combination of drugs and rTMS can reduce mental symptoms, improve the mental state and cognitive function of elderly patients with schizophrenia, as well as improve the therapeutic effect, with high safety.