پیش‌بینی کننده‌های بالینی پاسخ به درمان تحریک مکرر مغناطیسی فراجمجمه ای (rTMS) در بیماران مبتلا به اختلال افسردگی

نوع مقاله: مقاله پژوهشی

نویسنده

گروه آموزشی روانشناسی سلامت، دانشکده روانشناسی و علوم تربیتی، دانشگاه تهران

چکیده

تحریک مکرر مغناطیسی فراجمجمهای بر روی قشر پیش پیشانی رویکردی جدید در درمان بیماران مبتلا به افسردگی است. پاسخ به درمان rTMS در بیماران مبتلا به افسردگی متفاوت است. شناخت پیش بینی کننده های پاسخ به درمان، نقش مهمی در درمان بیماران مبتلا به افسردگی به وسیله rTMS دارد. هدف این مطالعه بررسی پیش بینی کنندههای جمعیت شناختی و بالینی پاسخ به درمان rTMS در بین بیماران مبتلا به افسردگی است. در یک مطالعه طبیعی گذشته نگر اطلاعات 092 نفر از بیماران مبتلا به اختلال افسردگی که در خرداد ماه 1141 الی دی ماه 1141 در مرکز علوم اعصاب بالینی آتیه جهت درمان افسردگی تحت تحریک مکرر مغناطیسی فراجمجمها ی قرار گرفتند، جمع آوری شد. از سه پروتکل رایج rTMS  تحریک با فرکانس بالا،
تحریک با فرکانس پایین و تحریک دوطرفه بر روی قشر پیش پیشانی پشتی جانبی برای درمان بیماران استفاده شده بود. همه بیماران 12 جلسه rTMS را سه روز در هفته به مدت یک ماه دریافت کرده بودند. پاسخ به درمان توسط مقیاس افسردگی ب BDI-II و کاهش 52 درصدی نمرات نسبت به خط پایه تعریف گردید. در تحلیل دادهها از روش رگرسیون لوجستیک استفاده شد. از 092 نفر، 112 نفر 9 درصد به درمان rTMS پاسخ دادند که از 42 نفر مبتلا به افسردگی تکقطبی 52 نفر 51 درصدو از 190 نفر مبتلا به افسردگی دوقطبی 62 نفر ) 90 درصد به درمان پاسخ دادند. در کل بیماران سن، بدبینی، احساس شکست، بیقراری، بیعلاقگی، بلاتصمیمی، تحریکپذیری و اشتغال ذهنی متغیرهای پیشبین پاسخ به درمان بودند. در بیماران تکقطبی بیعلاقگی، اشتغال ذهنی با نشانهها، فقدان انرژی و بیارزشی و در بیماران دوقطبی غمگینی، احساس شکست، خودانتقادی، بیقراری، بیعلاقگی، تغییر الگوی خواب و اشتغال ذهنی با نشانه های جسمی متغیرهای پیشبین پاسخ به درمان بودند. از پیشبینی کننده جمعیت شناختی سن و از پیشبینی کنندههای بالینی میتوان برای پیش بینی پاسخ به درمان rTMS استفاده کرد.

کلیدواژه‌ها


عنوان مقاله [English]

Clinical Predictors of Response to rTMS in Patients with Depressive Disorder

نویسنده [English]

  • reza rostami
Department of Health Psychology, faculty of psychology and Educational Science, University of Tehran
چکیده [English]

 
Repetitive Transcranial Magnetic Stimulation (rTMS) on prefrontal cortex is a new approach in patients diagnosed with depression. rTMS treatment response is different on different patients. Identifying response predictors plays a key role in treating patients with depression using rTMS. This research has aimed to study the demographic and clinical predictors of response to rTMS in patients with depression. This is a natural retrospective study on 248 patients with depression. The patients underwent rTMS treatment in Atieh Clinical Neurosciences Center, Tehran, Iran from May 2012 to December 2014 in order to treat their depression. Three common rTMS protocols were employed for the treatment: High-Frequency Stimulation, Low-Frequency Stimulation, and Bilateral Stimulation of the dorsolateral prefrontal cortex. All patients received rTMS three days a week for one month. Response to treatment was defined by the Beck Depression Inventory (BDI-II) and 50% reduction of scores compared to the baseline. Data were analyzed using logistic regression. Out of 248 patients, 110 (44%) responded to rTMS. Out of 98 patients with unipolar depression, 50 (51%) responded to rTMS. Similarly, out of 142 patients with bipolar depression, 60 (42%) responded to the treatment. Age, pessimism, sense of failure, agitation, loss of interest, indecisiveness, irritability, and somatic preoccupation were predictor variables of response to treatment in all patients. Among unipolar depressive patients, loss of interest, and somatic preoccupation, loss of energy and worthlessness were found to be the predictor variables, while sadness, feelings of failure, self-criticalness, irritability, loss of interest, change in sleep patterns, and somatic preoccupation were found to be the predictor variables of response to treatment in bipolar depressive patients. Age and clinical predictor variables can be used to predict the response to rTMS treatment.

کلیدواژه‌ها [English]

  • Personalized Medicine
  • Predictors
  • Repetitive Transcranial Magnetic Stimulation
  • Depression
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