高频重复经颅磁刺激联合舍曲林对青少年抑郁症患者自伤行为的疗效

Effect of high-frequency repetitive transcranial magnetic stimulation combined with sertraline on self-injurious behavior in adolescents with depression

目的探讨重复经颅磁刺激(rTMS)联合舍曲林对青少年抑郁症(DD)患者自伤行为的疗效。方法选取皖西卫生职业学院附属医院精神科在2018年1月至2021年12月期间收治的152例伴有自伤行为的青少年抑郁症患者为研究对象,根据随机数字表法随机分为观察组(高频rTMS+舍曲林,n=76)和对照组(舍曲林,n=76)。观察组在左侧前额叶背外侧皮质区(DLPFC)给予高频rTMS(10Hz)治疗,在相同刺激部位给予对照组假刺激治疗。rTMS每周治疗5次,持续治疗4周。记录治疗前、后两组患者汉密尔顿抑郁量表-24(HAMD-24)评分、自伤行为种类及频率、不良反应等情况。结果组内比较,对照组和观察组治疗前后HAMD-24评分、自伤行为种类、自伤频率差异有统计学意义(P<0.05),均改善;组间比较,对照组和观察组治疗前后的HAMD-24评分、自伤行为种类、自伤频率差值差异均有统计学意义(P<0.05),观察组改善情况优于对照组。结论舍曲林联合高频rTMS可显著改善患者抑郁症状和自伤行为。

Objective To explore the efficacy,advantages and application of repetitive trans cranial magnetic stimulation(rTMS)com-bined with sertraline in the treatment of self-injury behavior in patients with adolescent depression(DD).Methods A total of 152 adolescent depression patients with self-injurious behavior were admitted to the Psychiatric Department of West Anhui Health Vocational College between January 2018 and December 2021 were recruited and randomly assigned to the observation group and the control groups each with 76 cases.All patients received sertraline treatments,and the observation group received high-frequency(10 Hz)rTMS in the left dorsolateral prefrontal cortex(DLPFC)area.The control group received sham stimulation at the same stimulation site,and both groups received rTMS treatment 5 times a week for 4 consecutive weeks.Two-group Hamilton Depression Rating Scale-24(HAMD-24),Comparison of antidepressant efficacy and side effects before treatment and 4 weeks after treatment.Self-injury behavior patterns and frequency in both groups were assessed by self-injury behavior questionnaire.Results The baseline data before treatment,including age,years of education,course of disease,and gender balance,were comparable between the two groups,and the difference was not statistically significant.Comparison within the group showed that:both groups had statistical significance in HAMD-24,types of self-injury behaviors,and frequency of self-injury before and after treatment(P<0.05);there were statistically significant differences in HAMD-24,types of self-injury behaviors,and frequency of self-injury in the control group before and after treatment.The comparison between the groups showed that the differences in HAMD-24,the types of self-injury behav-iors,and the frequency of self-injury in the control group and the observation group before and after treatment were statistically significant(P<0.05).The improvement of self-injury behavior types and self-injury frequency were better than those of the control group.Conclusions Compared with sertraline alone,high frequency rTMS combined with sertraline can quickly improve depressive symptoms and effectively re-duce self-injury behavior in adolescent depression patients,with small adverse reactions and good safety.