重复经颅磁刺激对精神分裂症患者快感缺失和吸烟的影响

The effects of repeated transcranial magnetic stimulation on anhedonia and smoking in patients with schizophrenia

目的观察重复经颅磁刺激(rTMS)对精神分裂症患者快感缺失和吸烟的影响以及两者的改善是否存在一定相关性。方法选取2022年8月至2023年6月哈尔滨某精神专科医院住院的74例男性精神分裂症患者为研究对象,随机分为研究组及对照组,每组37例。两组在接受常规治疗的基础上,分别给予rTMS刺激和伪刺激,每天1次,每周5天,连续4周共20次治疗。采用中文版修订躯体快感缺失量表(RPAS-C)、尼古丁依赖量表(FTND)于治疗前、治疗4周结束时、治疗结束8周后进行评估,并记录近1周的日均吸烟量。结果重复测量方差分析显示:各变量组间效应、时间效应、交互效应显著,差异均有统计学意义(均P<0.01)。简单效应分析显示:研究组各变量随着时间效应显著(均P<0.01)差异均有统计学意义(均P<0.01)。研究组治疗4周结束时及治疗结束8周后吸烟量、RPAS-C评分、FTND评分均低于治疗前,差异均有统计学意义(均P<0.01)。研究组治疗4周结束时及治疗结束8周后吸烟量、RPAS-C评分、FTND评分均低于对照组,差异均有统计学意义(均P<0.01)。研究组治疗前后RPAS-C评分减分与吸烟量、FTND评分减分呈正相关(r=0.422,0.460,均P<0.01)。治疗期间两组在不良反应方面未见明显差异(P>0.05)。结论rTMS能有效改善精神分裂症的患者快感缺失、减少其尼古丁依赖水平及吸烟量,且其快感缺失的改善程度与吸烟量、尼古丁依赖水平降低程度存在一定相关性。

Objective To observe the effects of repetitive transcranial magnetic stimulation(rTMS)on anhedonia and smoking in patients with schizophrenia,and whether there is a certain correlation between the improvement of the both.Methods 74 male patients with schizophrenia,admitted to a Harbin psychiatric hospital specialist from August 2022 to June 2023,were selected as the research subjects.They were randomly divided into the study group and the control group,with 37 cases in each group.While receiving routine treatment,the two groups underwent rTMS stimulation and pseudostimulation once a day,five days a week,for a total of 20 treatments spanning 4 consecutive weeks.The Chinese Version of the Revised Physical Anhedonia Scale(RPAS-C)and the Fagerstrom Test for Nicotine Dependence(FTND)were used to evaluate before treatment,at the end of 4 weeks of treatment,and 8 weeks after treatment,and the daily average smoking volume of nearly 1 week was recorded.Results The repeated measurement analysis of variance showed that the effects,time effects,and interaction effects between each variable group were significant,and the differences were statistically significant(all P<0.01).Simple effect analysis showed that each variable in the study group had a significant effect over time(all P<0.01),and the differences were statistically significant(all P<0.01).The smoking volume,RPAS-C score,and FTND score of the study group at the end of 4 weeks of treatment and after 8 weeks of treatment were lower than before treatment,and the differences were statistically significant(all P<0.01).The smoking volume,RPAS-C score,and FTND score of the study group were lower than those of the control group at the end of 4 weeks of treatment and after 8 weeks of treatment,and the differences were statistically significant(all P<0.01).The reduction in RPAS-C score before and after treatment in the study group was negatively correlated with smoking volume and FTND score reduction(r=0.422,0.460,all P<0.01).During the treatment period,there was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion rTMS can effectively improve the anhedonia in with schizophrenia,reduce the level of nicotine dependence and the amount of smoking,and the improvement of the anhedonia is related to the reduction of the amount of smoking and the level of nicotine dependence.