The Effect Observation And Nursing Of Patients With First-episode Schizophrenia Treated By Repetitive Transcranial Magnetic Stimulation With Different Paradigms

Objectives:The aims of this study are to observe the effects of different paradigms of repetitive transcranial magnetic stimulation(rTMS)on the treatment of first-episode schizophrenic patients.The main aspects are cognitive function and psychotic symptoms.Providing a reference for psychiatric nursing staffs when they choose the treatment parameters of rTMS.To evaluate the security and draw up the specific nursing plan through comparing the incidences of adverse reactions in the two experimental groups and the control group.Providing a new way for the individual therapy and nursing of first-episode schizophrenia.Methods:In this study,90 patients with schizophrenia were enrolled from December 2015 to December 2016 in the Sixth People's Hospital of Hebei Province.They were randomly divided into three groups by a random number table.There were two experimental groups and one control group.The patients in two experimental groups respectively accepted 10 Hz paradigm stimulation and theta burst stimulation(TBS)for 10 days.All the subjects were exposed to 10 daily treatments at 100% of motor threshold over the left dorsolateral prefrontal cortex with a total stimuli of 1200 per day,while being maintained on their former antipsychotic treatment.TMT,SC,HVLT-R and BVMT-R of MATRICS Consensus Cognitive Battery were applied to evaluate the cognitive function,while Positive and Negative Symptom Scale(PANSS)was used to assess the psychotic symptoms.The TESS was used to evaluate the adverse reactions of patients in the whole experiment.Epilepsy is the most serious adverse reaction.The other common adverse reactions include headache,dizziness,palpitation and so on.The researchers developed reasonable nursing measures to take care the patients.Evaluating the safety of the rTMS with different paradigms through comparing the incidences of adverse reactions in three groups.Evaluating the effectiveness of nursing measures by observing whether the adverse reactions were improved.Results:1.There is no statistical difference between the demographics,the cognitive function scores and the PANSS scores in three groups before the experiment(P>0.05).2.After the intervention of r TMS,comparing the cognitive function and psychiatric symptoms by the statistical methods of the paired t test.The results showed that the difference of cognitive function scores was statistically significant except the HVLT-R(t=0.338,P=0.738)of the control group.Negative symptoms score of 10 Hz group(t=9.286,P=0.000)and TBS group(t=9.931,P=0.000)was statistically significant.The general psychopathology score of TBS group(t = 4.031,P = 0.000)was statistically significant.3.After the intervention of r TMS,comparing the cognitive function and psychiatric symptoms by the statistical methods of ANOVA.The results showed that the difference of cognitive function tests of all groups was statistically significant except the TMT test(F = 0.818,P = 0.445).Only the negative symptom score(F = 4.859,P = 0.010)was statistically significant.4.Three groups of subjects did not experience serious adverse events during the intervention.The total incidence of adverse reactions was 24.05%,the three groups were 23.07%,25.92% and 23.07%,the incidence of common adverse reactions was not statistically significant(P> 0.05).After going to take care measures,all patients with adverse reactions were alleviated.Conclusion:1.The effects of rTMS on the cognitive function and psychotic symptoms of first-episode schizophrenic patients vary according to the changes in stimulus parameters.The paradigm of TBS could improve part of the cognitive function.The paradigm of TBS and 10 Hz could improve the negative symptoms.2.The safety of the repetitive transcranial magnetic stimulation with different paradigms in treating the first-episode schizophrenic patients is high.Specific nursing measures are effective to ease the influence of adverse reactions on patients.