摘要
目的 观察重复经颅磁刺激（rTMS）合并帕罗西汀治疗难治性强迫症患者的疗效和不良反应.方法 被试入组后根据随机数字表随机分配到联合治疗组（rTMS＋帕罗西汀）和药物治疗组（伪rTMS＋帕罗西汀）.帕罗西汀用量为20～60mg/d,起始剂量20mg/d,在2周内渐增至40～60mg/d.联合治疗组治疗时使用rTMS真刺激.刺激部位为右侧背外侧额叶,刺激频率为10HZ,刺激强度为100%运动阈值.药物治疗组治疗时使用rTMS伪刺激.观察疗效6周.采用Yale-Brown强迫症量表（Y-BOCS）、汉密尔顿焦虑量表评定疗效,以药物治疗中需处理的副作用症状量表（TESS）评估不良反应.结果 帕罗西汀＋rTMS组患者痊愈9（32.14%）例,显著进步10例（35.71%）,好转5例（17.86%）,无变化4例（14.29%）;帕罗西汀＋伪rTMS组痊愈4例（16.36%）,显著进步5例（21.82%）,好转10例（38.18%）,无效6例（23.64%）,2组差异有统计学显著性（Z=2.010,P=0.044）.意向分析结果表明,2组治疗均有效,Y-BOCS评分（F=56.258,P=0.000）;HAMA评分（F=41.675,P=0.000）.但联合治疗组效果优于药物治疗组,Y-BOCS评分（F=13.652,P=0.028）;HAMA评分（F=11.632,P=0.031）.结论 右侧额叶背外侧rTMS刺激联合帕罗西汀治疗难治性强迫症的疗效优于单纯帕罗西汀治疗.
Objective To study the efficacy of repetitive transcranial magneticstimulation（rTMS） of the right prefrontal cortex combined paroxetine for patients with obsessive-compulsive disorder （ OCD） under doubleblind , sham-controlled conditions. Methods Patients were randomly assigned to 2 sessions of real （ n = 32） or sham （ n = 31） rTMS and both group received Paroxetine treatment. rTMS treatments lasted 20 minutes,and the frequency was 10 Hz and the intensity was 100% of motor threshold for real rTMS. Psychopathology was assessed by HAMA.Y-BOCS before the treatment,immediately after the experimental treatment,and 1,2,4,6 weeks after the experimental treatment by an independent reviewer. Results In combined therapy group,9（32. 14% ） recovered, 10（35.71% ） remitted,5（ 17. 86% ） improved,4（ 14. 29% ） remained unresponsive. In contrast,there were 4（16.36%） recovery,5（21.82%） remission, 10（38.18% ） improvement,6（23.64% ） unresponse in drug therapy group. The outcome of ITT showed all the patients in the two groups significant improvement （the scores of YBOCS（ F=56.258, P=0.000） ;the scores of HAMA（ F=41.675, P=0.000） after the treatment,but the effectiveness in the combined therapy group was better than that in the drug therapy group （the scores of Y-BOCS, F= 13.652, P=0.028;the scores of HAMA, F= 11.632, P=0.031）. Conclusions Repetitive transcranial rTMS of the right prefrontal cortex combined paroxetine is more effective than paroxetine only in treatment of refractory OCD.
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2010年第7期604-606,共3页
Chinese Journal of Behavioral Medicine and Brain Science
关键词
强迫症
难治性
重复经颅磁刺激
帕罗西汀
Obsessive compulsive disorder
Refractory
Repetitive transcranial magnetic stimulation
Proxetine
