高频重复经颅磁刺激联合心理疗法对颅脑创伤住院患者创伤应激障碍症状、心理健康的影响
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摘要
目的:探讨高频重复经颅刺激(repetitive transcranial magnetic stimulation,rTMS)联合心理疗法对颅脑外伤住院患者创伤应激障碍症状及心理健康的影响。方法:选取我院70例颅脑外伤后发生创伤应激障碍(post traumatic stress disorder,PTSD)患者为研究对象,根据住院单双号随机分为常规组与联合组,患者均予以常规脑外科干预,并予以舍曲林等抗精神药治疗,常规组予以rTMS治疗,每7d为1个周期,共治疗2个周期,观察组在常规组治疗基础上联合心理疗法,干预2周。干预前后采用创伤后应激障碍症状检查表-平民版(PTSD,ChecklistCivilian Version,PCL-C)问卷调查评估其临床症状改善情况,心理弹性量表(connor-Davidson Resilience Scale,CD-RISC)及正负性情绪量表(Positive and Negative Affect Scale,PANAS)评估其心理状态。结果:干预后常规组反复重现体验、回避症状评分、警觉症状评分,均显著高于观察组(t=2.183,2.492,2.226;P<0.05);观察组坚韧、力量、乐观评分均显著高于常规组(t=4.273,2.689,5.839;P<0.05),但常规组坚韧、乐观评分与干预前比较无显著差异(P>0.05);观察组正性情绪评分显著高于常规组(t=4.331,P<0.05);负性情绪显著低于常规组(t=-2.988,P<0.05),但常规组正性情绪与干预前无显著差异(P>0.05)。结论:rTMS联合心理疗法可有效改善颅脑外伤后PTSD患者创伤应激反应,避免负性情绪,促进患者树立良好的心态。
Objective:To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS) combined with psychotherapy on symptoms of traumatic stress disorders and mental health of hospitalized patients with craniocerebral trauma.Methods:A total of 70 patients with post traumatic stress disorder(PTSD)after craniocerebral trauma were selected as the subjects,and they were randomly divided into the routine group and the observation group,All patients were given routine nursing in the department of cerebral surgery,and treated with antipsychotic drugs,The routine group were treated with rTMS while the observation group were treated with rTMS combined with psychotherapy,The relief of clinical symptoms and the mental status were evaluated with the PTSD Checklist-Civilian Version(PCL-C),the connor-Davidson Resilience Scale(CD-RISC)and Positive and Negative Affect Scale(PANAS)respectively,Adverse reactions were statistically analyzed.Results:After the intervention,scores of recurrent experience,avoidance and alertness in the routine group were significantly higher than those in the observation group(t=2.183,2.492,2.226;P<0.05),while scores of tenacity,strength and optimism in the observation group were significantly higher than those in the routine group(t=4.273,2.689,5.839,P<0.05),There was no significant change in scores of tenacity and optimism in the routine group before and after the intervention(P>0.05),The score of positive emotions of observation group was significantly higher than that of the routine group(t=4.331,P<0.05),while the score of negative emotions was significantly lower than that of the routine group(t=2.988,P<0.05),There was no significant change in the score of positive emotions of the routine group before and after intervention(P>0.05).Conclusion:RTMS combined with psychotherapy can effectively relieve post-traumatic stress response in patients with PTSD after craniocerebral trauma,avoid negative emotions and help patients establish a good mental state.
Objective:To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS) combined with psychotherapy on symptoms of traumatic stress disorders and mental health of hospitalized patients with craniocerebral trauma.Methods:A total of 70 patients with post traumatic stress disorder(PTSD)after craniocerebral trauma were selected as the subjects,and they were randomly divided into the routine group and the observation group,All patients were given routine nursing in the department of cerebral surgery,and treated with antipsychotic drugs,The routine group were treated with rTMS while the observation group were treated with rTMS combined with psychotherapy,The relief of clinical symptoms and the mental status were evaluated with the PTSD Checklist-Civilian Version(PCL-C),the connor-Davidson Resilience Scale(CD-RISC)and Positive and Negative Affect Scale(PANAS)respectively,Adverse reactions were statistically analyzed.Results:After the intervention,scores of recurrent experience,avoidance and alertness in the routine group were significantly higher than those in the observation group(t=2.183,2.492,2.226;P<0.05),while scores of tenacity,strength and optimism in the observation group were significantly higher than those in the routine group(t=4.273,2.689,5.839,P<0.05),There was no significant change in scores of tenacity and optimism in the routine group before and after the intervention(P>0.05),The score of positive emotions of observation group was significantly higher than that of the routine group(t=4.331,P<0.05),while the score of negative emotions was significantly lower than that of the routine group(t=2.988,P<0.05),There was no significant change in the score of positive emotions of the routine group before and after intervention(P>0.05).Conclusion:RTMS combined with psychotherapy can effectively relieve post-traumatic stress response in patients with PTSD after craniocerebral trauma,avoid negative emotions and help patients establish a good mental state.
引文
[1]邓明昱.创伤后应激障碍的临床研究新进展(DSM-5新标准)[J].中国健康心理学杂志,2016,24(5):641-650
[2]邱昌建,黄明金,黄国平,等.芦山地震受灾人群创伤后应激障碍的流行病学调查[J].中华精神科杂志,2015,48(4):215-219
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[5]Gilsanz P,Winning A,Koenen K C,et al.Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women[J].Psychological Medicine,2017,47(8):1-9
[6]Breslau N,Peterson E L,Poisson L M,et al.Estimating posttraumatic stress disorder in the community:Lifetime perspective and the impact of typical traumatic events[J].Psychological Medicine,2014,44(8):889-898
[7]董薇,蔡文鹏,张水淼,等.飞行事故后所在单位飞行员急性应激反应与心理控制源相关分析[J].第二军医大学学报,2016,37(9):1144-1147
[8]邢小莉,赵俊峰,赵国祥.神经及内分泌系统对社会支持缓冲应激的调节机制[J].心理科学进展,2016,24(4):517-524
[9]杜向东,殷铭,李哲,等.高频重复经颅磁刺激对慢性精神分裂症患者认知功能的影响[J].神经疾病与精神卫生,2016,16(4):414-417
[10]Dobie D J,Kivlahan D R,Maynard C,et al.Screening for posttraumatic stress disorder in female Veteran's Affairs patients:Validation of the PTSD checklist[J].General Hospital Psychiatry,2002,24(6):367-374
[11]倪倩钰,田俊.心理弹性量表信度和效度评价及应用[J].中国公共卫生,2013,29(10):1524-1527
[12]郑泓,李玲艳,李诗晨,等.中文版正性负性情绪量表在乳腺癌患者中的信度和效度[J].中国临床心理学杂志,2016,24(4):671-674+670
[13]高媛媛,金圭星,于鲁璐,等.早年创伤对女性PTSD患者记忆与执行功能的影响[J].神经疾病与精神卫生,2015,15(1):12-14
[14]范淑群,梁瑞媚.社会支持对儿童青少年癌症患者创伤后应激障碍后生活质量的影响[J].国际护理学杂志,2016,35(9):1249-1252
[15]裴茂炜.肾素-血管紧张素系统两轴及其平衡与急性胰腺炎关系的研究进展[J].中国急救医学,2017,37(6):564-567
[16]陈铭泰,黄若兰,富文俊,等.慢性应激动脉粥样硬化动物模型和应激与AS的发生研究进展[J].现代生物医学进展,2016,16(15):2995-3000
[17]宋美,王冉,王学义.应激所致远期认知功能损害的研究进展[J].神经疾病与精神卫生,2015,15(5):512-514
[18]周田田,陆晓姿,牛娟,等.广泛性焦虑障碍病人心理健康水平与血浆皮质醇关系[J].齐鲁医学杂志,2015,30(1):62-66
[19]陈蓓婧,李敏.糖皮质激素与创伤后应激障碍的研究进展[J].重庆医学,2015,44(4):534-536
[20]白莉,甘景梨,梁学军,等.重复经颅磁刺激对精神分裂症患者弥散张量成像及阴性症状的影响[J].中国健康心理学杂志,2015,23(5):649-653
[21]王艺,彭李,周贤丽,等.rTMS对创伤后康复期PTSD患者核心症状、正负性情绪和心理弹性的影响[J].第三军医大学学报,2015,37(15):1571-1575
[22]张峰,郑丽娜,王传峰.高频重复经颅磁刺激联合帕罗西汀对创伤后应激障碍神经内分泌及临床疗效的观察[J].精神医学杂志,2017,30(3):225-227
[2]邱昌建,黄明金,黄国平,等.芦山地震受灾人群创伤后应激障碍的流行病学调查[J].中华精神科杂志,2015,48(4):215-219
[3]王永堂,位景香,鲁秀敏.常见危重病患者人群并发创伤后应激障碍研究进展[J]现代预防医学,2016,43(21):3928-3931+3939
[4]Sri Warsini BNS M.Med,Petra Buettner MSc PhD.Post-traumatic stress disorder among survivors two years after the 2010Mount Merapi volcano eruption:A survey study[J].Nursing&Health Sciences,2015,17(2):173-180
[5]Gilsanz P,Winning A,Koenen K C,et al.Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women[J].Psychological Medicine,2017,47(8):1-9
[6]Breslau N,Peterson E L,Poisson L M,et al.Estimating posttraumatic stress disorder in the community:Lifetime perspective and the impact of typical traumatic events[J].Psychological Medicine,2014,44(8):889-898
[7]董薇,蔡文鹏,张水淼,等.飞行事故后所在单位飞行员急性应激反应与心理控制源相关分析[J].第二军医大学学报,2016,37(9):1144-1147
[8]邢小莉,赵俊峰,赵国祥.神经及内分泌系统对社会支持缓冲应激的调节机制[J].心理科学进展,2016,24(4):517-524
[9]杜向东,殷铭,李哲,等.高频重复经颅磁刺激对慢性精神分裂症患者认知功能的影响[J].神经疾病与精神卫生,2016,16(4):414-417
[10]Dobie D J,Kivlahan D R,Maynard C,et al.Screening for posttraumatic stress disorder in female Veteran's Affairs patients:Validation of the PTSD checklist[J].General Hospital Psychiatry,2002,24(6):367-374
[11]倪倩钰,田俊.心理弹性量表信度和效度评价及应用[J].中国公共卫生,2013,29(10):1524-1527
[12]郑泓,李玲艳,李诗晨,等.中文版正性负性情绪量表在乳腺癌患者中的信度和效度[J].中国临床心理学杂志,2016,24(4):671-674+670
[13]高媛媛,金圭星,于鲁璐,等.早年创伤对女性PTSD患者记忆与执行功能的影响[J].神经疾病与精神卫生,2015,15(1):12-14
[14]范淑群,梁瑞媚.社会支持对儿童青少年癌症患者创伤后应激障碍后生活质量的影响[J].国际护理学杂志,2016,35(9):1249-1252
[15]裴茂炜.肾素-血管紧张素系统两轴及其平衡与急性胰腺炎关系的研究进展[J].中国急救医学,2017,37(6):564-567
[16]陈铭泰,黄若兰,富文俊,等.慢性应激动脉粥样硬化动物模型和应激与AS的发生研究进展[J].现代生物医学进展,2016,16(15):2995-3000
[17]宋美,王冉,王学义.应激所致远期认知功能损害的研究进展[J].神经疾病与精神卫生,2015,15(5):512-514
[18]周田田,陆晓姿,牛娟,等.广泛性焦虑障碍病人心理健康水平与血浆皮质醇关系[J].齐鲁医学杂志,2015,30(1):62-66
[19]陈蓓婧,李敏.糖皮质激素与创伤后应激障碍的研究进展[J].重庆医学,2015,44(4):534-536
[20]白莉,甘景梨,梁学军,等.重复经颅磁刺激对精神分裂症患者弥散张量成像及阴性症状的影响[J].中国健康心理学杂志,2015,23(5):649-653
[21]王艺,彭李,周贤丽,等.rTMS对创伤后康复期PTSD患者核心症状、正负性情绪和心理弹性的影响[J].第三军医大学学报,2015,37(15):1571-1575
[22]张峰,郑丽娜,王传峰.高频重复经颅磁刺激联合帕罗西汀对创伤后应激障碍神经内分泌及临床疗效的观察[J].精神医学杂志,2017,30(3):225-227