摘要
自我伤害行为，包括自杀行为和非自杀性自伤行为，在青少年抑郁症患者中较常见。为探索更适合青少年的安全有效的治疗方式，确定重复经颅磁刺激治疗对青少年抑郁症自我伤害行为意图的治疗是否有效，本文关注青少年自我伤害的神经生物学相关形成机制，及现有重复经颅磁刺激对伴有自我伤害行为或意图的抑郁症青少年的治疗进展，并收取有自我伤害行为意图的青少年抑郁症患者，设计治疗方案完成为期两周的治疗，分析和对照治疗效果，为有自我伤害行为及意图的青少年抑郁症患者的临床治疗提供参考。
一、低频重复经颅磁刺激治疗针对抑郁症青少年的非自杀性自伤行为意图的研究。目的：探讨低频重复经颅磁刺激(rTMS)作用于右背外侧前额叶(DLPFC)治疗青少年抑郁症患者的效果，以及是否能减轻患者的非自杀性自伤(NSSI)行为和意图。方法：在随机、单盲、真假对照试验中，55例平均年龄16.75岁(n=55,SD=2.51, range=13-21)的青少年抑郁症患者，在治疗前后采用汉密尔顿24项抑郁量表(HAMD24)、抑郁自评量表(SDS)和青少年非自杀性自伤行为和功能量表(ANSSIQ)进行评估。患者共分为四组：用药真刺激组、用药假刺激组、未用药真刺激组和未用药假刺激组。采用t检验统计资料，对HAMD24、SDS、ANSSIQ的前后总分及因子评分进行比较。结果：四组患者治疗前量表评分无显著差异(P>0.05)，经rTMS治疗2周后，无论用药和未用药，真刺激组在HAMD24、SDS以及ANSSIQ 量表上的减分率与假刺激组相比更加显著(P<0.05)。结论：低频rTMS刺激右侧DLPFC治疗能缓解青少年抑郁症
的临床症状，并且对青少年非NSSI行为和意图有一定的抑制作用。
机械式立体车库二、低频重复经颅磁刺激治疗针对抑郁症青少年自杀意念的研究。目的：通过实验探讨低频经颅磁刺激作用于右背外侧前额叶治疗对有自杀意念的青少年抑郁症群体的作用。方法：选取32名有自杀意念的青少年抑郁症患者（平均年龄17.00岁，SD=2.286,range=13-21）随机分为研究组和对照组，两组均给予常规药物治疗，同时分别给予为期两周的真假经颅磁刺激治疗，在治疗前后分别以汉密尔顿抑郁量表（HAMD24）、抑郁自评量表（SDS）、贝克自杀意念量表（BSI-CV）对治疗效果进行评分。结果：两组患者治疗前量表评分无显著差异(P>0.05)，治疗后两组评分均有不同程度降低，研究组与对照组相比减分率更显著(P<0.05)。结论：低频rTMS刺激右侧DLPFC治疗方法能够在两周的治疗中改善青少年抑郁症患者的症状，缩短药物起效时间，改善患者的认知障碍和绝望感等，降低患
者的自杀意念强度。
关键词：重复经颅磁刺激治疗，青少年抑郁症，自我伤害，自杀意念，非自杀性自伤行为意图
梨的成语
ABSTRACT
Self-harm behaviors are common in adolescents with depression,including suicidal behaviors and non-suicidal lf-injurious behaviors.In order to explore and prove a more safe and effective way of tr
eatment for adolescents,this paper focus on the neurobiologically-related formation mechanism of lf-harm in adolescents,and the current progress in the treatment of depresd adolescents with lf-harm behaviors or intentions by repetitive transcranial magnetic stimulation.Meanwhile,depresd adolescents with ideation of lf-harm were recruited,and a treatment plan was designed to complete the effect of treatment before and after two weeks.The treatment effect was analyzed and compared aiming to provide reference for the clinical treatment of adolescent depression patients with lf-harm behavior and intention.The main content of this paper is divided into two parts:
1.Rearch progress of repetitive transcranial magnetic stimulation(rTMS)in the treatment of lf-injury in depresd adolescents:Starting from the formation mechanism of lf-harm behaviors in adolescent,to analyze and understand the current neurobiological explanations of lf-harm behaviors and the mechanism of the treatment of depression and lf-harm behaviors of depression by repetitive transcranial magnetic stimulation.This part reviews the existing therapeutic rearch, discuss the missing and insufficient of the existing rearch,and looks forward to the possible rearch direction.
2.Effects of low frequency repetitive transcranial magnetic stimulation(rTMS) on lf-harm in adolesc
ents with depression:
Effect of low frequency repetitive Transcranial Magnetic Stimulation treatment on non-suicidal lf-injury behaviour and intention of depresd adolescents: Objectives:This study aimed to explore the efficacy of a two weeks cour of repetitive transcranial magnetic stimulation(rTMS)treatment on adolescent patients of depression disorder,to relive their depressive symptoms,and reduce non-suicidal lf-injury(NSSI)behaviours and intentions within the patients.Method:Within randomized single-blinded trails,55adolescent patients of depression disorder with a mean age of16.75years(n=55,SD=2.51,range=13-22)were assd using24-iterm Hamilton Depression Rating Scale(HAMD24),Self-rating depression scale(SDS)and
Adolescent Non-suicidal Self-injury Asssment Questionnaire(ANSSIQ)before and after treatment.The patients were divided into four group:Medicated true-Stimulation group,Medicated sham-stimulation group,None-medicated true-stimulation group and None-medicated sham-stimulation group.The statistic of t-tests were ud to compare pre/post scores of factors on HAMD24,SDS,ANSSIQ.Result:Before treatment, there was no significant difference in scale scores between the four groups(P>0.05). With or without medication,the score reduction effect of true-stimulation group on HAMD24,SDS and ANSSIQ scale was more significant than that of the shame-
stimulation group(P<0.05)after2weeks of rTMS treatment.Conclusion:low-frequency rTMS treatment can significantly relive the clinical symptoms of adolescents with depression,and also have a certain inhibitory effect on adolescent non-suicidal lf-injury behaviour and intention.
Effects of Low-frequency repetitive transcranial magnetic stimulation on suicidal ideation in adolescents with depression:Objectives:This study aimed to explore the efficacy of a two weeks cour of repetitive transcranial magnetic stimulation(rTMS) treatment on adolescent patients of depression disorder,to relive their depressive symptoms,and reduce the suicidal ideation within the patients.Method:Within randomized single-blinded trails,adolescent patients of depression disorder with a mean age of17.00years(n=32,SD=2.286,range=13-21)were assd using24-iterm Hamilton Depression Scale(HAMD24),Self-rating depression scale(SDS)and Beck scale for suicide ideation(BSI-CV)before and after treatment.The patients were randomly divided into two group:true-Stimulation group,sham-stimulation group.The statistic of t-tests were ud to compare pre/post scores of factors on HDRS,SDS, BSI-CV.Result:There was no significant difference in the scale score between the two groups before treatment(P>0.05).After treatment,the scores of both groups decread to different degrees,and the effect was more significant in the study group than in the control group(P<0.05).Conclusion:rTMS treatment can reduce symptoms in adolescents with depres
叶志祥sion over the cour of two weeks,shorten the time of medicine ont,and also reduced the intensity of suicidal ideation.
Key words:Low frequency rTMS,Self-harm,Adolescent NSSI,Suicidal ideation,
Adolescent depression
目录
目录
白英第一章绪论 (1)
1.1研究背景 (1)
1.2重复经颅磁刺激治疗青少年抑郁症自我伤害的研究进展 (2)
1.2.1青少年抑郁症自我伤害行为和观念的产生机制 (2)
1.2.2重复经颅磁刺激治疗青少年抑郁症 (7)
1.2.3重复经颅磁刺激治疗青少年抑郁症自我伤害的现状 (10)
1.2.4展望 (13)
1.3本文贡献与创新 (14)
第二章低频重复经颅磁对青少年抑郁症自我伤害意念的影响 (15)
2.1研究一：低频rTMS治疗对青少年抑郁症NSSI行为意图的影响 (15)
2.1.1研究目的 (15)
2.1.2对象与方法 (17)
mercury2.1.3结果 (19)
青少年安全教育
2.1.4讨论 (25)
2.1.5结论 (26)
2.1.6本研究不足 (26)勇敢的小兵
2.2研究二：低频rTMS治疗对青少年抑郁症自杀意念的影响 (26)
2.2.1研究目的 (26)
2.2.2对象与方法 (27)
2.2.3结果 (30)
2.2.4讨论 (33)
2.3本章小结 (35)
第三章结论 (36)
致谢 (37)
参考文献 (38)
附录 (50)
研究生在读期间取得的成果 (65)
种子发芽的图片
