藥物反應不佳的精神分裂症患者電痙攣治療前後聽覺誘發波P300之比較

Changes of AEPs P300 in Treatment-resistant Schizophrenic Patients before and after Electroconvulsive Therapy

10.29478/TJP.200512.0005

余伍洋(Younger W-Y Yu)；楊志偉(Chih-Wei Yang)；陳明招(Ming-Chao Chen)；張鈺姍(Yu-San Chang)；陳泰瑞(Tai-Jui Chen)

精神分裂症 ； 電痙攣治療 ； 長程聽覺誘發波P300 ； 簡短精神症狀評量表 ； schizophrenia ； ECT ； auditory evoked potentials ； BPRS

台灣精神醫學

19卷4期（2005 / 12 / 01）

298 - 304

繁體中文

目的：研究顯示電痙攣治療(Electroconvulsive therapy，ECT)會改變大腦的神經傳導物質，因此可能影響長程聽覺誘發波P300，所以本研究的目的在於比較抗精神病藥物反應不佳的精神分裂症患者接受ECT前後的長程聽覺誘發波P300變化。方法：收集31位抗精神病藥物反應不佳的精神分裂症個案，在施行ECT治療前、療程後一星期內及一個月後施以長程聽覺誘發波P300的檢測。精神症狀的嚴重程度，分別在ECT治療前、療程後一星期內及一個月後以簡短精神症狀評量表(brief psychiatric rating scale，BPRS)評分。結果：ECT療程後的BPRS分數有顯著下降，而ECT療程後一星期的聽覺誘發波P300比ECT前P300振幅增大，但ECT療程後一個月的聽覺誘發波P300振幅與ECT前無顯著差異。結論：我們的研究結果顯示ECT對難治型精神分裂症有明顯治療效果，且療程後一星期的長程聽覺誘發波變化主要在於P300振幅的增大。

Objective: Previous studies have demonstrated that electroconvulsive therapy (ECT) may influence auditory evoked potentials (AEPs) P300 by modulating neurotransmitters in the brain. This study compared the changes of AEPs P300 in treatment-resistant schizophrenic patients before and after receiving 12 courses of ECT treatment. Methods: Thirty-one treatment-resistant schizophrenic patients received P300 and the Brief Psychiatric Rating Scale (BPRS) assessments before, one week after, and one month after the ECT course. Results: BPRS scores declined significantly after the ECT course and remained significantly reduced at one month after ECT. The amplitude of the AEPs P300 was increased at one week after the ECT course. However, there was no significant difference between the P300 at one month after the ECT course and baseline levels. Conclusions: This study has demonstrated that treatment-resistant schizophrenic patients show improvement in psychiatric symptoms and the AEPs P300 amplitude at one week after a course of ECT.

1. Abraham KR,Kulhara P(1987).The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study.Br J Psychiatry,151,152-5.
2. Brandon S,Cowlcy P,McDonald C,Ncvillc P,Palmer R,Wellstood-Eason S(1984).Electroconvulsive therapy: results in depressive illness from the Leicestershire trial.Br Med J,288,22-5.
3. Bush G,Fink M,Petrides G,Dowling F,Francis A(1996).Catatonia. Ⅱ. Treatment with lorazepam and electroconvulsivc therapy.Acta Psychiatr Scand,93,137-43.
4. Chanpattana W,Kramer BA(2003).Acute and maintenance ECT with flupenthixol in refractory schizophrenia: sustained improvements in psychopathology, quality of life, and social outcomes.Schizophi Res,63,189-93.
5. Couvreur V,Ansseau M,Franck G(1989).Electroconvulsive therapy and its mechanism of action.Acta Psychiatr Belg,89,96-109.
6. Duman RS,Vaidya VA(1998).Molecular and cellular actions of chronic electroconvulsive seizures.J ECT,14,181-93.
7. Endler NS(1988).The Origins of Electroconvulsive Therapy (ECT).Convuls Thler,4,5-23.
8. Fink M(1990).How does convulsive therapy work.Neuropsychopharmacology,3,73-82.
9. Fink M(1984).Meduna and the origins of convulsive therapy.Am J Psychiatry,141,1034-41.
10. Ford JM,Mathalon DH,Marsh L(1999).P300 amplitude is related to clinical state in severely and moderately ill patients with schizophrenia.Biol Psychiatry,46,94-101.
11. Freeman CP,Basson JV,Crighton A(1978).Doubleblind controlled trail of electroconvulsive therapy (E.C.T.) and simulated E.C.T. in depressive illness.Lancet,1,738-40.
12. Friedel RO(1986).The combined use of neuroleptics and ECT in drug resistant schizophrenic patients.Psychopharmacol Bull,22,928-30.
13. Gangadhar BN,Ancy J,Janakiramaiah N,Umapathy C(1993).P300 amplitude in non-bipolar, melancholic depression.J Affect Disord,28,57-60.
14. Hirayasu Y,Asato N,Ohta H,Hokama H,Arakaki H,Ogura C(1998).Abnormalities of auditory event-related potentials in schizophrenia prior to treatment.Biol Psychiatry,43,244-53.
15. Janakiramaiah N,Channabasavanna SM,Murthy NS(1982).ECT/chlorpromazine combination versus chlorpromazine alone in acutely schizophrenic patients.Acta Psychiatr Scand,66,464-70.
16. Konig P,Glatter-Gotz U(1990).Combined electroconvulsive and neuroleptic therapy in schizophrenia refractory to neuroleptics.Schizophr Res,3,351-4.
17. Mann JJ,Kapur S(1994).Elucidation of biochemical basis of the antidepressant action of electroconvulsive therapy by human studies.Psychopharmacol Bull,30,445-53.
18. Overall JE,Gorham DR(1962).The brief psychiatric rating scale.Psychol Rep,10,799-812.
19. Pfefferbaum A,Ford JM,White PM,Roth WT(1989).P3 in schizophrenia is affected by stimulus modality, response requirements, medication status, and negative symptoms.Arch Gen Psychiatry,46,1035-44.
20. Tang WK,Ungvari GS(2002).Efficacy of electroconvulsive therapy combined with antipsychotic medication in treatment-resistant schizophrenia: a prospective, open trial.J ECT,18,90-4.
21. Vangu MD,Esser JD,Boyd IH,Berk M(2003).Effects of electroconvulsive therapy on regional cerebral blood flow measured by 99mtechnetium HMPAO SPECT.Prog Neuropsychopharmacol Biol Psychiatry,27,15-9.
22. West ED(1981).Electric convulsion therapy in depression: a double-blind controlled trial.Br Med J,282,355-7.
23. 余伍洋、楊寬弘、陳明招(1994)。聽覺誘發波在精神生理學之臨床意義。中華精醫，8，3-15。
24. 陳尚義、胡海國、張學岑、林信男(1994)。藥物難漢治型精神分裂症患者的電痙攣治療。臺灣精神醫學，8，91-5。
25. 陳泰瑞、陳明招、林清華、劉清輝、余伍洋(2001)。未曾治療過的精神分裂症患者長程聽學誘發波之變化。臺灣精醫，15，217-24。
26. 楊寬弘、周煌智、張和平、余伍洋(1996)。精神病患層級區分與病房類：增加病房轉換率的方法。臺灣精神醫學，10，259-67。
27. 謝明憲、李信謙、劉絮愷、胡海國(1998)。精神分裂症電痙攣治療效應之預測因子。臺灣精神醫學，12，218-27。

1. Yu, Chen-Hua,Kao, Chin-Yi,Huang, Yu-Mei,Hsu, Jer-Hwa(2011).Analyses of the Quality of Life among Patients with Schizophrenia.台灣精神醫學,25(3),158-166.