Combining transcranial magnetic stimulation and cognitive- behavioral therapy in treatment resistant obsessive-compulsive disorder

Amaç: Obsesif kompulsif bozukluk (OKB) hastalarının azımsanamayacak bir kısm ı tedaviye yeterli yanıt vermezler. Yataklı tedavide uygulanan bilişsel davranışçı terapiler (BDT) kronik ve dirençli olgularda dahi bir yarar sağlayabilir. Yineleyen transkranyal manyetik uyarım tedavisi (TMU) ile de umut verici sonuçlar bildirilmiştir, ancak bu iki etkin tedavi yöntemini bir arada kullanan çalışma bulunmamaktadır. Yöntem: Tedaviye dirençli ve kronik OKB tanısı olan 18 olgu farmakoterapi, BDT ve TMU tedavisi kombinasyonu uygulanmak üzere yatırıldı. Olgular Yale-Brown Obses- yon ve Kompulsiyon Ölçeği (Y-BOCS) ve Hamilton Depresyon Dercelendirme Ölçeği-17 (HDRS-17) ile değerlendi- rildiler. TMU 20 seans, 25 Hz, 1000 vuru parametreleri ile sol dorsolateral prefrontal kortekse uygulandı. Bulgular: Tedavi öncesinde ortalama 30.72±6.12 olan Y-BOCS puanları tedavi bitiminde 12.55±7.44 puana inerek %59.14 gerilemiş bulundu. Tedavi öncesinde ortalama 18.38±3.94 olan HDRS-17 puanlarında ise tedavi bitiminde 7.94±5.70 puan ile %56.80 azalma saptandı. Uygulanan tedavi seanslarının ortalama sayıları TMU için 23.28±6.78 ve BDT için 17.17±5.04 olarak gerçekleşti. Tartışma: Tedaviye dirençli ve kronik OKB olgularında farmakoterapi, BDT ve TMU kombinasyonu ile yapılacak tedavi etkili bir seçenek olabilir.

Tedaviye dirençli obsesif kompulsif bozuklukta transkranyal manyetik uyarım ve bilişsel-davranışçı terapinin birlikte kullanımı

Objective: A non-negligible percentage of patients with obsessive-compulsive disorder (OCD) do not respond satis- factorily to treatments. Inpatient cognitive-behavioral therapy (CBT) has provided some relief in even refractory and chronic patients. Repetitive transcranial magnetic stimulation (rTMS) has also provided promising results. However, no studies have combined these two strategies. Methods: Eighteen patients with treatment resistant and chronic OCD who had been hospitalized in order to receive pharmacotherapy, inpatient CBT and rTMS were evaluated on the Yale-Brown Obsession and Compulsion Scale (Y-BOCS) and the Hamilton Depression Rating Scale-17 (HDRS- 17). rTMS was applied every day over the left dorsolateral prefrontal cortex for 5 days in a week with parameters of 25 Hz and 1000 pulses. Results: Y-BOCS scores decreased by 59.14%, from 30.72±6.12 at admission to 12.55±7.44 when discharged. HDRS-17 scores decreased by 56.80%; from 18.38±3.94 at admission to 7.94±5.70 at discharge. The mean numbers of rTMS and CBT sessions were 23.28±6.78 and 17.17±5.04 respectively. D iscussion: The combination of pharmacotherapy, CBT and rTMS may be effective in treatment resistant and chronic OCD in the short term.

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Anadolu Psikiyatri Dergisi-Cover
  • ISSN: 1302-6631
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 2000
  • Yayıncı: -
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