Dorsomedial prefrontal theta burst stimulation to treat anhedonia, avolition, and blunted affect in schizophrenia or depression-a randomized controlled trial
Dorsomedial prefrontal theta burst stimulation to treat anhedonia, avolition, and blunted affect in schizophrenia or depression-a randomized controlled trial
复制标题
DOI：
10.1016/j.jad.2021.04.053
复制
发表时间：
2021-05-18
影响因子：
6.6
通讯作者：
Persson, J.
中科院分区：
文献类型：
--
作者：
Boden, R.;Bengtsson, J.;Persson, J.
背景资料：间歇性theta爆发刺激（iTBS）的背内侧前额叶皮层（DMPFC）已显示出承诺在开放标签的试验depresson.Methods：在这个随机，双盲，假对照试验中，我们评估iTBS超过DMPFC的快感缺乏，无意志，钝感的精神分裂症或抑郁症患者。主动iTBS通过DMPFC输送，每次1200个脉冲，每天两次，持续10个工作日，目标强度，8个线圈成角。假手术条件包括线圈的磁屏蔽侧和同时的经皮神经电刺激。主要结果是阴性症状临床评估访谈（CAINS）的变化。结果：28例患者被随机分配到活性iTBS组，28例患者被随机分配到假手术组。CAINS评分从基线至末次治疗后第二天的平均（标准差）变化在活性iTBS组为-5.3（8.1），在假手术组为-2.1（7.1）。线性模型显示治疗无显著影响，占基线评分p= 0.088。每个诊断组的亚组分析显示，抑郁症患者的疗效显著，p= 0.038，但精神分裂症组的疗效不显著，p= 0.850。然而，抑郁症患者的总体抑郁症状没有显著变化。有三个严重的不良事件，所有在sham group.Limitations：可能太短的治疗过程和少数患者schizophrenia.Conclusion：在这第一transdiagnosis随机对照试验iTBS超过DMPFC的快感缺乏症，无意志力，钝感它可以得出结论，它一般是耐受性和安全的，但只有更有效的比假在抑郁症患者的亚组。
Background: Intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) has shown promise in open-label trials of depression.Methods: In this randomized, double-blind, sham controlled trial we evaluate iTBS over the DMPFC for anhedonia, avolition, and blunted affect in patients with schizophrenia or depression. Active iTBS was delivered over the DMPFC with 1200 pulses per session, twice daily over ten weekdays at target intensity with an angled figureof eight coil. Sham condition comprised the magnetically shielded side of the coil and simultaneous transcutaneous electrical nerve stimulation. Primary outcome was change on the Clinical Assessment Interview for Negative Symptoms (CAINS).Results: Twenty-eight patients were randomized to active iTBS and 28 to sham. Mean (standard deviation) change in CAINS score from baseline to the day after last treatment was -5.3 (8.1) in active iTBS and -2.1 (7.1) in sham. A linear model showed no significant effect of treatment, accounting for baseline scores p=.088. Sub analyses per diagnostic group showed a significant effect in patients with depression, p=.038, but not in the schizophrenia group, p=.850. However, overall depressive symptoms did not change significantly in patients with depression. There were three serious adverse events, all in the sham group.Limitations: Possibly too short treatment course and few patients with schizophrenia.Conclusion: In this first transdiagnostic randomized controlled trial of iTBS over DMPFC for anhedonia, avolition, and blunted affect it can be concluded that it was generally tolerable and safe but only more effective than sham in the subgroup of patients with depression.