Research On The Treatment Of Negative Symptoms Of Schizophrenia By Stimulating The Left DLPFC With Different Frequencies Of RTMS

Objectives: This paper mainly observed the changes in negative symptoms in schizophrenic patients treated with different frequency rTMS and studied the sensitization effect of rTMS on antipsychotic drugs.Furthermore,the improvement of cognitive function after treatment and its relationship with serum Hcy level was further explored,and the possible adverse reactions of rTMS in the treatment of schizophrenia were observed so as to explore the best choice mode of rTMS in the treatment of negative symptoms of schizophrenia.Methods: In this study,the diagnosis was in accordance with the International Statistical Classification of Diseases and Related Health Problems 10 th Revision(ICD-10).Eighty-eight patients with ICD-10 mental and behavioural disorders were included in the study.Patients with a total score on the SANS≥35 were randomly divided into sham stimulation group,5Hz rTMS group,10 Hz rTMS group,and 20 Hz rTMS group.Each treatment contained 1200 pulse stimuli and 100%MT.The stimulation area was the DLPFC.The sham stimulation group used a sham stimulation coil but did not generate electromagnetic stimulation.The stimulus was given five times a week for eight weeks,and a total of 40 times were treated.Serum Homocysteine was measured before treatment,at the end of 4 weeks and eight weeks after treatment,and its effect was evaluated by SANS and MoCA.TESS was used to evaluate the adverse reactions at 4 and 8 weeks after treatment.Results: A total of eighty-eight schizophrenic patients with mainly negative symptoms were evaluated in this study,and seventy-five patients were finally treated and evaluated.There were no statistically significant differences in general demography,SANS total score,MoCA total score and blood Hcy value among the four groups before treatment(P>0.05),which had comparability.1.At the end of 4 weeks of treatment:(1)SANS total score: The score of the four groups decreased,but the pairwise comparison of the four groups showed that compared with the sham stimulation group,the difference in the decrease of the 5Hz group was not statistically significant(P>0.05).Compared with the sham stimulation group,the difference between the 10 Hz group and the 20 Hz group was statistically significant(P<0.05),but the difference between the 10 Hz group and the 20 Hz group was not statistically significant(P>0.05).(2)SANS subscale scores: SAF,SPT and SVB scores of the four groups were decreased,but SISL and SAD of the sham stimulation group were not decreased.By pairwise comparison of the four groups,SAF,SPT,SVB,SISL,and SAD were not statistically significant compared with the sham stimulation group(P>0.05).Compared with the sham stimulation group,the differences in SVB,SISL and SAD between the 10 Hz group and the 20 Hz group were statistically significant(P<0.05),while the differences between the 10 Hz group,20 Hz group and the sham stimulation group were not statistically significant.(3)MoCA total score: the score of the four groups decreased,but the pairwise comparison of the four groups showed that there was no significant difference between the 5Hz group,10 Hz group and 20 Hz group compared with the sham stimulation group(P>0.05).(4)MoCA subscale scores: the attention,delayed recall and orientation scores of the 5Hz group were decreased,and the differences were statistically significant(P<0.05);Scores of the attention,language and delayed recall in the 10 Hz group decreased,and the differences were statistically significant(P<0.05).The scores of visuospatial/executive,naming and delayed recall in the 20 Hz group decreased,and the differences were statistically significant(P<0.05).(5)Serum Hcy value: the values of the four groups were decreased,but the comparison of the four groups showed that compared with the sham stimulation group,the difference of the 5Hz group was not statistically significant(P>0.05).The difference between the 10 Hz group and the 20 Hz group was statistically significant(P<0.05).There was no significant difference between the 10 Hz group,20 Hz group and sham stimulation group(P>0.05).(6)Correlation analysis of SANS total score,MoCA total score and serum Hcy value: Hcy value was positively correlated with SANS total score,and the correlation was statistically significant(r=0.821,P<0.01).There was a positive correlation between MoCA total score and the Hcy value,but the correlation was not statistically significant(r=0.175).There was a negative correlation between MoCA total score and the SANS total score,but the correlation was not statistically significant(r= 0.175).2.After eight weeks of treatment:(1)SANS total score: the total score of the four groups decreased.A pairwise comparison of the four groups showed that the difference between the 5Hz group,10 Hz group and 20 Hz group was statistically significant compared with the sham stimulation group(P<0.05).Compared with the5 Hz group,the difference between the 10 Hz group and the 20 Hz group was statistically significant(P<0.05),while the difference between the 10 Hz group and the20 Hz group was not significant(P>0.05).(2)SANS factor scores: SAF,SPT,SVB,SISL,SAD scores of the four groups were all decreased,SPT,SISL,SAD three comparison,the 5Hz group and sham stimulation group,and the difference was statistically significant(P<0.05).There were significant differences in SAF,SPT,SVB,SISL and SAD between the 10 Hz group,20 Hz group and sham stimulation group(P<0.05),but no significant differences between the 10 Hz group and 20 Hz group(P>0.05).(3)MoCA total score: The total score of the four groups decreased,but the pairwise comparison of the four groups showed that there was no significant difference in the 5Hz group compared with the sham stimulation group(P>0.05).Compared with the sham stimulation group,the difference between the 10 Hz group and the 20 Hz group was statistically significant(P<0.05).There was no significant difference between the 10 Hz group and the 20 Hz group(P>0.05).(4)MoCA subscale scores: scores of the delayed recall,attention and orientation in the 5Hz group were decreased,and the differences were statistically significant(P<0.05).The scores of visuospatial/executive and naming,attention and language,delayed recall and orientation were decreased in the 10 Hz group,and the differences were statistically significant(P<0.05).The scores of visuospatial/executive,attention,language and delayed recall were significantly lower in the 20 Hz group(P<0.05).(5)Serum Hcy value: the values of the four groups were decreased,and the differences between the5 Hz group,10 Hz group and 20 Hz group were statistically significant when compared with the sham stimulation group(P<0.05).Compared with the 5Hz group,the difference between the 10 Hz group and the 20 Hz group was statistically significant(P<0.05).There was no significant difference between the 10 Hz group and the 20 Hz group(P>0.05).(6)Correlation analysis of SANS total score,MoCA total score and serum Hcy value: Hcy value was positively correlated with SANS total score,and the correlation was statistically significant(r=0.831,P<0.01).There was a positive correlation between MoCA total score and the Hcy value,but the correlation was not statistically significant(r=-0.125).There was a negative correlation between MoCA total score and the SANS total score,and the correlation was statistically significant(r=-0.316,P<0.01).Conclusions:1.Compared with single drug treatment,combined rTMS has a better therapeutic effect on negative symptoms and cognitive impairment of schizophrenia.2.rTMS with different frequencies of 5Hz,10 Hz and 20 Hz have a good curative effect on the negative symptoms of schizophrenia patients.The total SANS score and each factor score of patients decreased,and the negative symptoms are improved.The onset time of 10 Hz and 20 Hz is faster than that of 5Hz.The most significant effect was observed at 10 Hz and 20 Hz for eight weeks.3.The improvement of different dimensions of negative symptoms by high-frequency rTMS with different frequencies is inconsistent;There was no improvement in the affective flattening and avolition-apathy at four weeks,but the five symptom dimensions were improved at eight weeks.Therefore,it will take longer to treat affective flattening and avolition-apathy.4.rTMS combined with antipsychotics can improve the cognitive dysfunction of schizophrenia patients,which is more prominent in improving delayed recall,but not obvious in visuospatial/executive,naming,attention,language,orientation,abstraction and other aspects.5.Combined treatment with rTMS can improve the negative symptoms and cognitive dysfunction of schizophrenia patients,while reducing the serum Hcy level,suggesting that the expression of Hcy may be involved in the treatment process of rTMS.6.The negative symptoms and cognitive functions of schizophrenia were improved after treatment,and there is a correlation between negative symptoms and cognitive function.