MECT或rTMS分别联合氯氮平对难治性精神分裂症患者记忆和执行功能影响

Effects of modified electroconvulsive therapy(MECT)or repetitive transcranial magnetic stimulation(rTMS)combined with clozapine respectively on memory and executive function in patients with refractory schizophrenia

目的探讨无抽搐电休克疗法(MECT)或重复经颅磁刺激法(rTMS)分别联合氯氮平对难治性精神分裂症(RS)患者记忆和执行功能影响。方法选取2019年12月至2022年12月期间本院收治的98例RS患者,采用随机数字表法分为MECT组和rTMS组,每组各49例患者,MECT组给予氯氮平口服联合MECT治疗,rTMS组给予氯氮平口服联合rTMS治疗,均治疗8周。比较两组临床疗效和两组治疗前、治疗4周、治疗8周的阳性和阴性症状量表(PANSS)评分、韦氏记忆量表(WMS)评分、威斯康星卡片分类测验(WCST)评分,统计治疗期间不良反应情况。结果两组临床总有效率比较,差异无统计学意义(P>0.05)。与治疗前比较,两组治疗4周和治疗8周PANSS阳性症状、阴性症状评分、一般精神病理及总分均降低,且治疗8周后上述评分低于治疗4周后的评分(P<0.05);MECT组治疗4周后上述PANSS各项评分低于rTMS组(P<0.05)。与治疗前比较,rTMS组治疗4周和治疗8周、MECT组治疗8周的WMS评分均升高,且治疗8周后上述评分高于治疗4周后的评分(P<0.05);MECT组治疗4周WMS评分低于rTMS组(P<0.05)。与治疗前比较,两组治疗4周和治疗8周WCST正确应答数和完成分类数均升高,且治疗8周后上述评分高于治疗4周后的评分(P<0.05);与治疗前比较,rTMS组治疗4周和治疗8周、MECT组治疗8周的WCST错误应答数和持续应答数均降低,且治疗8周后上述评分低于治疗4周后的评分(P<0.05);MECT组治疗4周的WCST错误应答数和持续应答数高于rTMS组(P<0.05)。MECT组治疗期间不良反应发生率为36.73%,高于rTMS组的16.33%(P<0.05)。结论MECT或rTMS分别联合氯氮平对RS患者的治疗效果相当,前者短期内对症状的改善效果较好,后者短期内对记忆和执行功能影响更小,且不良反应较少。

Objective To investigate the effects of modified electroconvulsive therapy(MECT)or repetitive transcranial magnetic stimulation(rTMS)combined with clozapine on memory and executive function in patients with refractory schizophrenia(RS).Methods 98 patients with RS admitted to the hospital form December 2019 to December 2022 were selected and divided into MECT group and rTMS group by random number table method,with 49 cases in each group.The MECT group was given oral clozapine combined with MECT,and the rTMS group was given oral clozapine combined with rTMS,both treated for 8 weeks.The clinical efficacy of 2 groups and the scores of Positive and Negative Symptom Scale(PANSS),Wechsler Memory Scale(WMS)and Wisconsin Card Sorting Test(WCST)of 2 groups were compared before,4 weeks and 8 weeks of treatment,and the adverse effects during treatment period were analyzed.Results There was no statistically significant difference in the total clinical efficiency between 2 groups(P>0.05).Compared with before the treatment,the positive symptoms score,negative symptoms score,general psychopathology score and total scores of PANSS were decreased in 2 groups after 4 and 8 weeks of the treatment,and the above scores after 8 weeks of thetreatment were lower than those after 4 weeks of the treatment(P<0.05).All the above PANSS scores were lower in MECT group than those in rTMS group after 4 weeks of the treatment(P<0.05).Compared with before the treatment,WMS scores in rTMS group after 4 and 8 weeks and MECT group after 8 weeks were increased,and the above scores after 8 weeks of the treatment were higher than those after 4 weeks(P<0.05).After 4 weeks of the treatment,WMS scores in MECT group were lower than those in rTMS group(P<0.05).Compared with before thetreatment,the number of correct responses and completed classification of WCST in 4 and 8 weeks of the treatment were increased in both groups,and the number of correct responses and completed classification after 8 weeks of treatment were higher than those after 4 weeks(P<0.05).Compared with before the treatment,the number of WCST false response and sustained response were decreased in rTMS group at 4 and 8 weeks of the treatment and in MECT group at 8 weeks of the treatment,and the number of WCST false response and sustained response after 8 weeks of the treatment were lower than those after 4 weeks(P<0.05).The number of WCST false responses and sustained responses at 4 weeks in MECT group were higher than those in rTMS group(P<0.05).The incidence of adverse reactions in MECT group was 36.73%,which was higher than that in rTMS group(16.33%)(P<0.05).Conclusion MECT or rTMS combined with clozapine have the same effect in the treatment of RS patients,the former has a better effect on improving symptoms in the short term,while the latter has less effect on memory and executive function in the short term,and it has fewer adverse reactions.