Effects of high-frequency repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy on patients with anxiety and depression comorbidities after stroke

doi:10.3877/cma.j.issn.2095-9133.2022.04.003

Abstract

Abstract:

Objective

To observe the effect of high-frequency repeated transcranial magnetic stimulation (rTMS) and cognitive behavioral treatment on patients with comorbid post-stroke anxiety (PSA) and post-stroke depression (PSD).

Methods

A total of 160 patients with anxiety and depression after stroke were divided into control group and observation group by random number table method. All patients in 2 groups were given routine treatment for stroke, antidepressant therapy and cognitive behavioral therapy. The control group was also given high-frequency repetitive transcranial magnetic stimulation sham stimulation, and the observation group was given high-frequency repetitive transcranial magnetic stimulation true stimulation. After 4 weeks, the improvement of depression symptoms, anxiety symptoms, sleep quality, and daily life ability in group 2 patients were observed.

Results

At baseline, there were no significant differences in the Hamilton depression scale (HAMD) score, Hamilton anxiety scale (HAMA) score, Pittsburgh sleep index number scale (PSQI) score, and modified Barthel index (MBI score) (P>0.05). After 4 weeks of treatment, HAMD score, HAMA score and PSQI score all decreased compared with the treatment before. The difference was statistically significant (P<0.05). The MBI score of the control group and the observation group was significantly improved compared with that before treatment, with statistical significance (P<0.05), while the score of the observation group was significantly improved compared with that of the control group, with statistical significance (P<0.05). The treatment effective rate of the observation group was 87.50%, which was higher than that of the control group (71.25%). There was a significant difference between the two groups (Uc=-3.45, P=0.001).

Conclusion

High frequency repetition and cognitive behavior therapy can effectively improve the anxiety and depression, but the quality of repeated TMS treatment and cognitive behavior treatment is more obvious, and cognitive behavior treatment may take longer time and is related to the patient’s own comprehension ability.

Key words: Stroke, Depression, Anxiety, High-frequency repetitive TMS

Yun Chen, Qiaoyang Zhang, Min Zhang, Yin Cao, Guanzhong Dong, Wenwei Yun, Haiyan Yang, Weiyuan Zhang. Effects of high-frequency repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy on patients with anxiety and depression comorbidities after stroke[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2022, 08(04): 205-210.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2022.04.003

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2022/V08/I04/205

Figures/Tables 3

References 48

1	王少石，周新雨，朱春燕．卒中后抑郁临床实践的中国专家共识[J].中国卒中杂志，2016，11(8):685-693.
2	河南省卒中学会卒中后心理与情感障碍分会，河南省医师协会精神科分会，河南省心理卫生协会，等．脑卒中后抑郁临床诊疗指南[J].临床心身疾病杂志，2020，26(3):后插1-5,封3.
3	Schneider MA, Schneider MD.Recognizing poststroke depression[J].Nursing，2012，42(12):60-63.
4	王思博，王慧彬，曲慧玲，等．卒中后抑郁的影响因素及其对生活质量的影响[J].中国医科大学学报，2017，46(9):844-847.
5	Lee AC, Tang SW, Yu GK，et al.Incidence and predictors of depression after stroke(DAS)[J].Int J Psychiatry Clin Pract，2007，11(3):200-206.
6	Ayerbe L, Ayis SA, Crichton S，et al.Natural history，predictors and associated outcomes of anxiety up to 10 years after stroke：the South London Stroke Register[J].Age Ageing，2014，43(4):542-547.
7	李丽君，胡卫疆，高雅坤，等．抗抑郁药联合重复经颅磁刺激治疗卒中后抑郁的meta分析[J].中国心理卫生志，2017，31(4):274-277.
8	Donse L, Padberg F, Sack AT，et al.Simultaneous rTMS and psychotherapy in major depressive disorder：Clinical outcomes and predictors from a large naturalistic study[J].Brain Stimul，2018，11(2):337-345.
9	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组．中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018，51(9):666-682.
10	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组．中国脑出血诊治指南(2014)[J].中华神经科杂志，2015，48(6):435-444.
11	中华医学会精神科分会．CCMD-3中国精神障碍分类与诊断标准[M].三版．济南：山东科学技术出版社，2001：87.
12	汪向东，王希林，马弘．心理卫生评定量表手册增订版[M].北京：中国心理卫生出版社，1999：220-223.
13	汪向东，王希林，马弘．心理卫生评定量表手册增订版[M].北京：中国心理卫生出版社，1999：253-255.
14	汪向东，王希林，马弘．心理卫生评定量表手册增订版[M].北京：中国心理卫生出版社，1999：375-378.
15	张作记．行为医学量表手册[M].北京：中华医学电子音像出版社，2005：292-293.
16	朱梅芳，王春雪．以认知行为治疗综合管理卒中后抑郁伴失眠患者病例报道[J].中国卒中杂志，2018，13(5):504-507.
17	袁秀霞，童永胜，陈景旭，等．团体认知行为治疗对抑郁症患者社会功能的改善作用[J].中华行为医学与脑科学杂志，2017，26(4):327-330.
18	谭友果，刘波，何瑞妮，等．短程团体认知行为治疗个体认知行为治疗联合艾斯西酞普兰与单用艾斯西酞普兰治疗老年抑郁症120例临床疗效分析[J].山西医药杂志，2017，46(13):1530-1533.
19	范思海，孙学礼，郑重，等．重复经颅磁刺激治疗抑郁症的研究进展[J].华西医学，2008，23(1):172-173.
20	陈静，张红波，张长国，等．高频与低频重复经颅磁刺激治疗帕金森病抑郁的疗效观察[J].中华物理医学与康复杂志，2015，37(11):838-841.
21	杨柳，刘玉山，刘兰祥，等．不同频率重复经颅磁刺激治疗脑卒中后抑郁障碍的疗效观察[J].中国实用神经疾病杂志，2014(22):18-20.
22	恽晓平．康复疗法评定学[M].北京：华夏出版社，2005：432-434.
23	梅峰，孙树印，张作记，等.5-羟色胺系统与卒中后抑郁[J].中华行为医学与脑科学杂志，2015，24(4):360-363.
24	Göthe F, Enache D, Wahlund LO，et al.Cerebrovascular diseases and depression：epidemiology，mechanisms and treatment[J].Panminerva Med，2012，54(3):161-170.
25	Hackett ML, Köhler S, O'Brien JT，et al.Neuro-psychiatric outcomes of strock[J].Lancet Neural，2014，13(5):525-534.
26	Schöttke H, Giabbiconi CM.Post-stroke depression and post-stroke anxiety：prevalence and predictors[J].Int Psychogeriatr，2015，27(11):1805-1812.
27	Cumming TB, Blomstrand C, Skoog I，et al.The high prevalence of anxiety disorders after stroke[J].Am J Geriatr Psychiatry，2016，24(2):154-160.
28	Fure B, Wyller TB, Engedal K，et al.Emotional symptoms in acute ischemic stroke[J].Int J Geriatr Psychiatry，2006，21(4):382-387.
29	刘永珍，于逢春，尹静，等．脑卒中后抑郁状态对预后的影响：7年随访[J].中国神经精神疾病杂志，2010，36(5):292-295.
30	Loubinoux I, Kronenberg G, Endres M，et al.Post-stroke depression：mechanisms，translation and therapy[J].J Cell Mol Med，2012，16(9):1961-1969.
31	康岚，王希林，刘粹，等．卒中后抑郁患者心理社会影响因素的对照研究[J].中国神经精神疾病杂志，2014(6):357-361.
32	Brown C, Hasson H, Thyselius V，et al.Post-stroke depression and functional independence：a conundrum[J].Acta Neurol Scand，2012，126(1):45-51.
33	Kim JS.Post-stroke mood and emotional disturbances：pharmacological therapy based on mechanisms[J].J Stroke，2016，18(3):244-255.
34	Knapp P, Campbell Burton CA, Holmes J，et al.Interventions for treating anxiety after stroke[J].Cochrane Database Syst Rev，2017，5(5):CD008860.
35	Das J, GKR.Post stroke depression：The sequelae of cerebral stroke[J].Neurosci Biobehav Rev，2018(90):104-114.
36	Lefaucheur JP, André-Obadia N, Antal A，et al.Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation(rTMS)[J].Clin Neurophysiol，2014，125(11):2150-2206.
37	Kimbrell TA, Little JT, Dunn RT，et al.Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation(rTMS)as a function of baseline cerebral glucose metabolism[J].Biol Psychiatry，1999，46(12):1603-1613.
38	Nobler MS, Teneback CC, Nahas Z，et al.Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation[J].Depress Anxiety，2000，12(3):144-156.
39	Hovington CL, McGirr A, Lepage M，et al.Repetitive transcranial magnetic stimulation (rTMS) for treating major depression and schizophrenia：a systematic review of recent meta-analyses[J].Ann Med，2013，45(4):308-321.
40	Vedeniapin A, Cheng L, George MS.Feasibility of simultaneous cognitive behavioral therapy and left prefrontal rTMS for treatment resistant depression[J].Brain Stimul，2010，3(4):207-210.
41	Cuijpers P, Smit F, Bohlmeijer E，et al.Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression：meta-analytic study of publication bias[J].Br J Psychiatry，2010，196(3):173-178.
42	Kamenov K, Twomey C, Cabello M，et al.The efficacy of psychotherapy，pharmacotherapy and their combination on functioning and quality of life in depression：a meta-analysis[J].Psychol Med，2017，47(3):414-425.
43	Berlim MT, Van den Eynde F, Daskalakis ZJ.High-frequency repetitive transcranial magnetic stimulation accelerates and enhances the clinical response to antidepressants in major depression：a meta-analysis of randomized，double-blind, and sham-controlled trials[J].J Clin Psychiatry，2013，74(2):e122-e129.
44	黄平，杨盛洲，李华，等．重复经颅磁刺激联合认知行为治疗对产后抑郁的疗效分析[J].中华精神科杂志，2016，49(6):404-409.
45	Ridding MC, Rothwell JC.Is there a future for therapeutic use of transcranial magnetic stimulation？[J].Nat Rev Neurosci，2007，8(7):559-567.
46	Yoshimura S, Okamoto Y, Matsunaga M，et al.Cognitive behavioral therapy changes functional connectivity between medial prefrontal and anterior cingulate cortices[J].J Affect Disord，2017，208:610-614.
47	Clark L, Chamberlain SR, Sahakian BJ.Neurocognitive mechanisms in depression: implications for treatment[J].Annu Rev Neurosci，2009;32:57-74.
48	Cramer SC, Sur M, Dobkin BH，et al.Harnessing neuroplasticity for clinical applications[J].Brain，2011，134(Pt 6):1591-1609.

组别	例数	年龄[岁，(±s)]	性别[例(%)]		文化程度[例(%)]			病程(d)	脑卒中类型[例(%)]
组别	例数	年龄[岁，(±s)]	男性	女性	小学及以下	初中至高中	大专及以上	病程(d)	脑梗死	脑出血
对照组	80	68.08±9.29	32(40.00)	48(60.00)	23(28.75)	48(60.00)	9(11.25)	35.89±8.03	62(77.50)	18(22.50)
观察组	80	69.23±8.17	43(53.80)	37(46.20)	19(23.75)	47(58.75)	14(17.50)	36.42±7.81	58(72.50)	22(27.50)
t/χ²值		－0.83	3.04		1.48			－0.53	0.53
P值		>0.05	>0.05		>0.05			>0.05	>0.05

组别	例数	年龄[岁，(±s)]	性别[例(%)]		文化程度[例(%)]			病程(d)	脑卒中类型[例(%)]
组别	例数	年龄[岁，(±s)]	男性	女性	小学及以下	初中至高中	大专及以上	病程(d)	脑梗死	脑出血
对照组	80	68.08±9.29	32(40.00)	48(60.00)	23(28.75)	48(60.00)	9(11.25)	35.89±8.03	62(77.50)	18(22.50)
观察组	80	69.23±8.17	43(53.80)	37(46.20)	19(23.75)	47(58.75)	14(17.50)	36.42±7.81	58(72.50)	22(27.50)
t/χ²值		－0.83	3.04		1.48			－0.53	0.53
P值		>0.05	>0.05		>0.05			>0.05	>0.05

组别		例数	HAMD评分	HAMA评分	PSQI评分	MBI评分
对照组
	治疗前	80	20.69±1.66	21.23±1.90	14.39±1.93	60.81±11.29
	治疗后	80	14.99±1.87^a	15.94±2.06^a	10.98±1.60^a	73.44±9.47^a
观察组
	治疗前	80	20.78±1.38	21.29±1.72	14.21±1.95	58.38±13.35
	治疗后	80	12.90±1.63^ab	13.90±2.00^ab	9.54±1.62^ab	78.88±10.34^ab
	t值		7.53	6.34	5.65	－3.47
	P值		<0.001	<0.001	<0.001	<0.05

组别		例数	HAMD评分	HAMA评分	PSQI评分	MBI评分
对照组
	治疗前	80	20.69±1.66	21.23±1.90	14.39±1.93	60.81±11.29
	治疗后	80	14.99±1.87^a	15.94±2.06^a	10.98±1.60^a	73.44±9.47^a
观察组
	治疗前	80	20.78±1.38	21.29±1.72	14.21±1.95	58.38±13.35
	治疗后	80	12.90±1.63^ab	13.90±2.00^ab	9.54±1.62^ab	78.88±10.34^ab
	t值		7.53	6.34	5.65	－3.47
	P值		<0.001	<0.001	<0.001	<0.05

组别	例数	痊愈	显效	有效	无效	总有效率
对照组	80	2(2.50)	30(37.50)	25(31.25)	23(28.75)	57(71.25)
观察组	80	7(8.75)	45(56.25)^a	18(22.50)	10(12.50)^a	70(87.50)^a
χ²值		1.88	5.65	1.56	6.45	6.45
P值		>0.05	<0.05	>0.05	<0.05	<0.05
Uc值				－3.45
P值				<0.05

Please choose a citation manager

Content to export