PANSS培训

·学术交流·重复经颅磁刺激对精神分裂症患者阴性症状和认知功能的疗效及安全性研究封阳，徐静文，管晓波，于士静，刘群摘要：　目的：探讨重复经颅磁刺激（ｒＴＭＳ）改善精神分裂症患者阴性症状及认知功能的疗效及安全性。

　方法：入组２０１８年１月至２０１９年６月上海市民政第三精神卫生中心就诊的９０例病程５年以下精神分裂症患者，给予利培酮药物维持治疗，后随机分为ｒＴＭＳ组（ｎ＝４７）和伪刺激组（ｎ＝４３），分别于治疗前、治疗４周末、治疗８周末对研究对象行阳性和阴性综合量表（ＰＡＮＳＳ）、神经心理状态评定量表（ＲＢＡＮＳ）测试，比较两组间各变量治疗前后的差异。

　结果：治疗４周后，ｒＴＭＳ组ＰＡＮＳＳ量表总分和阴性症状分均低于治疗前，且均低于伪刺激组，差异有统计学意义（Ｐ均＜０．０１）。

对分组主效应方差分析发现ｒＴＭＳ组和伪刺激组在ＰＡＮＳＳ量表阴性分、总分２项和ＲＢＡＮＳ量表即刻记忆、视空间结构、语言功能、注意力、延迟记忆及ＲＢＡＮＳ总分６项有统计学差异（Ｐ均＜０．０１）。

　结论：ｒＴＭＳ治疗对精神分裂症患者阴性症状及认知功能具有改善作用，且疗效有持续效应，安全性好。

关键词：　重复经颅磁刺激；　精神分裂症；　阴性症状；　认知功能中图分类号：　Ｒ７４９．３ 文献标识码：　Ａ 文章编号：　１００５ ３２２０（２０２３）０４ ０２８８ ０４Ｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙｏｆｒｅｐｅｔｉｔｉｖｅｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎｏｎｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓａｎｄｃｏｇｎｉｔｉｖｅｆｕｎｃｔｉｏｎｉｎｐａｔｉｅｎｔｓｗｉｔｈｓｃｈｉｚｏｐｈｒｅｎｉａ　ＦＥＮＧＹａｎｇ，ＸＵＪｉｎｇ ｗｅｎ，ＧＵＡＮＸｉａｏ ｂｏ，ＹＵＳｈｉ ｊｉｎｇ，ＬＩＵＱｕｎ．ＲｅｈａｂｉｌｉｔａｔｉｏｎＤｅｐａｒｔｍｅｎｔ，ＳｈａｎｇｈａｉＣｉｖｉｌＡｆｆａｉｒｓＴｈｉｒｄＭｅｎｔａｌＨｅａｌｔｈＣｅｎｔｅｒ，Ｓｈａｎｇｈａｉ２００４３５，ＣｈｉｎａＡｂｓｔｒａｃｔ：　Ｏｂｊｅｃｔｉｖｅ：Ｔｏｉｎｖｅｓｔｉｇａｔｅｔｈｅｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙｏｆｒｅｐｅａｔｅｄｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎ（ｒＴＭＳ）ｉｎｉｍｐｒｏｖｉｎｇｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓａｎｄｃｏｇｎｉｔｉｖｅｆｕｎｃｔｉｏｎｉｎｐａｔｉｅｎｔｓｗｉｔｈｓｃｈｉｚｏｐｈｒｅｎｉａ．　Ｍｅｔｈｏｄ：Ａｔｏｔａｌｏｆ９０ｐａｔｉｅｎｔｓｗｉｔｈｓｃｈｉｚｏｐｈｒｅｎｉａｗｉｔｈａｃｏｕｒｓｅｏｆｌｅｓｓｔｈａｎ５ｙｅａｒｓｉｎＳｈａｎｇｈａｉＣｉｖｉｌＡｆｆａｉｒｓＴｈｉｒｄＭｅｎｔａｌＨｅａｌｔｈＣｅｎｔｅｒｂｅｔｗｅｅｎＪａｎｕａｒｙ２０１８ａｎｄＪｕｎｅ２０１９ｗｅｒｅａｓｓｉｇｎｅｄｔｏｒｉｓｐｅｒｉｄｏｎｅｍａｉｎｔｅｎａｎｃｅｔｈｅｒａｐｙａｎｄｔｈｅｎｒａｎｄｏｍｌｙｄｉｖｉｄｅｄｉｎｔｏｒＴＭＳｇｒｏｕｐ（ｎ＝４７）ａｎｄｐｓｅｕｄｏ ｓｔｉｍｕｌｕｓｇｒｏｕｐ（ｎ＝４３）．ＰｏｓｉｔｉｖｅａｎｄＮｅｇａｔｉｖｅＳｙｍｐｔｏｍＳｃａｌｅ（ＰＡＮＳＳ）ａｎｄＲｅｐｅａｔａｂｌｅＢａｔｔｅｒｙｆｏｒｔｈｅＡｓｓｅｓｓｍｅｎｔｏｆＮｅｕｒｏｐｓｙｅｈｏｌｏｇｉｃａｌＳｔａｔｕｓ（ＲＢＡＮＳ）ｗｅｒｅｔｅｓｔｅｄｂｅｆｏｒｅｔｒｅａｔｍｅｎｔ，４ｗｅｅｋｓａｆｔｅｒｔｒｅａｔｍｅｎｔ，ａｎｄ８ｗｅｅｋｓａｆｔｅｒｔｒｅａｔｍｅｎｔ，ｒｅｓｐｅｃｔｉｖｅｌｙ．Ｔｈｅｄｉｆｆｅｒｅｎｃｅｓｏｆｖａｒｉａｂｌｅｓｂｅｆｏｒｅａｎｄａｆｔｅｒｔｒｅａｔｍｅｎｔｂｅｔｗｅｅｎｔｈｅｔｗｏｇｒｏｕｐｓｗｅｒｅｃｏｍｐａｒｅｄ．　Ｒｅｓｕｌｔｓ：Ａｆｔｅｒ４ｗｅｅｋｓｏｆｔｒｅａｔｍｅｎｔ，ｔｈｅｔｏ ｔａｌｓｃｏｒｅｏｆＰＡＮＳＳｓｃａｌｅａｎｄｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓｃｏｒｅｉｎｒＴＭＳｇｒｏｕｐｗｅｒｅｌｏｗｅｒｔｈａｎｂｅｆｏｒｅｔｒｅａｔｍｅｎｔ，ａｎｄｂｏｔｈｗｅｒｅｌｏｗｅｒｔｈａｎｔｈｏｓｅｉｎｐｓｅｕｄｏ ｓｔｉｍｕｌｕｓｇｒｏｕｐ，ｔｈｅｄｉｆｆｅｒｅｎｃｅｗａｓｓｔａｔｉｓｔｉｃａｌｌｙｓｉｇｎｉｆｉｃａｎｔ（ａｌｌＰ＜０．０１）．Ａｎａｌｙｓｉｓｏｆｖａｒｉａｎｃｅｏｎｔｈｅｍａｉｎｅｆｆｅｃｔｏｆｔｈｅｇｒｏｕｐｉｎｇ：ｔｈｅｒｅｗｅｒｅｓｔａｔｉｓｔｉｃａｌｄｉｆｆｅｒｅｎｃｅｓｂｅｔｗｅｅｎｔｈｅｒＴＭＳｇｒｏｕｐａｎｄｔｈｅｐｓｅｕｄｏ ｓｔｉｍｕｌｕｓｇｒｏｕｐｉｎｎｅｇａｔｉｖｅｓｃｏｒｅｓａｎｄ２ｔｏｔａｌｓｃｏｒｅｓｏｎＰＡＮＳＳａｎｄｏｎｉｍｍｅｄｉａｔｅｍｅｍｏｒｙ，ｖｉｓｕｏｓｐａ ｔｉａｌｓｔｒｕｃｔｕｒｅ，ｌａｎｇｕａｇｅｆｕｎｃｔｉｏｎ，ａｔｔｅｎｔｉｏｎ，ｄｅｌａｙｅｄｍｅｍｏｒｙａｎｄ６ｔｏｔａｌｓｃｏｒｅｓｏｎＲＢＡＮＳ（ａｌｌＰ＜０．０１）．　Ｃｏｎｃｌｕｓｉｏｎ：ｒＴＭＳｔｈｅｒａｐｙｃａｎｉｍｐｒｏｖｅｔｈｅｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓａｎｄｃｏｇｎｉｔｉｖｅｆｕｎｃｔｉｏｎｏｆｓｃｈｉｚｏｐｈｒｅｎｉａｐａｔｉｅｎｔｓ，ａｎｄｔｈｅｃｕｒａｔｉｖｅｅｆｆｅｃｔｈａｓａｌａｓｔｉｎｇｅｆｆｅｃｔａｎｄｇｏｏｄｓａｆｅｔｙ．Ｋｅｙｗｏｒｄｓ：　ｒｅｐｅｔｉｔｉｖｅｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎ；　ｓｃｈｉｚｏｐｈｒｅｎｉａ；　ｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓ；　ｃｏｇ ｎｉｔｉｖｅｆｕｎｃｔｉｏｎ精神分裂症（ｓｃｈｉｚｏｐｈｒｅｎｉａ）是一种病因未明且好发于青壮年的重性精神疾病。

帕利哌酮治疗复发分裂症1年随访研究目的观察帕利哌酮对复发精神分裂症长期治疗的有效性、安全性及对社会功能的影响。

方法50例使用帕利哌酮治疗患者，剂量为6mg～12mg/d，疗程1年。

分别于入组时，治疗1月末、3月末、6月末、9月末、1年末用阳性和阴性症状量表（PANSS）评定疗效。

用不良反应症状量表（TESS）评价药物副反应。

用社会功能缺陷评定量表（SDSS）评定社会功能的影响程度。

治疗过程中定期检查血常规、血糖、心电图、肝功能。

结果随访治疗3月末～1年末PANSS、SDSS评分与治疗前比较差异均有非常显著性（P＜0.01），无论PANSS评分还是SDSS评分在帕利哌酮治疗过程中均呈下降趋势。

随访1年间发现有12例复发，占随访人数的24%。

TESS结果表明：早期的不良反应有头晕、嗜睡、口干相对较多，后期以体重增加为主，且症状程度较轻。

结论帕利哌酮对复发精神分裂症维持治疗有效且安全，长期服用能够恢复、保持患者良好的社会适应能力。

标签：帕利哌酮；精神分裂症；长期疗效；社会功能帕利哌酮是非典型抗精神病药利培酮的活性代谢产物9-羟利培酮，为苯并异噁唑的衍生物，主要通过阻断5-羟色胺2A（5-HT2A）受体和多巴胺D2（DA2）受体发挥抗精神病的作用。

临床研究提示帕利哌酮可以有效控制精神分裂症阳性症状、改善阴性和认知损害、提高患者的耐受性和依从性，起效较快，并能改善对其他非典型抗精神病药治疗无效患者的临床疗效，为精神分裂症患者的全面康复提供了一种新的治疗选择。

国内有关帕利哌酮对急性期及首发精神分裂症疗效的报道已较多[1，2]，发现具有较好效果，但帕利哌酮对复发精神分裂症效果如何尚无系统报道，为此我们对住院及门诊复发精神分裂症患者进行了1年的跟踪随访观察，评价帕利哌酮长期治疗复发精神分裂症的有效性、安全性及对社会功能影响，现将结果报道如下。

1资料与方法1.1一般资料病例来自2012年1月～6月临沂市精神卫生中心住院及门诊患者。

POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS) RATING CRITERIAGENERAL RATING INSTRUCTIONSData gathered from this assessment procedure are applied to the PANSS ratings. Each of the 30 items is accompanied by a specific definition as well as detailed anchoring criteria for all seven rating points. These seven points represent increasing levels of psychopathology, as follows:1- absent2- minimal3- mild4- moderate5- moderate severe6- severe7- extremeIn assigning ratings, one first considers whether an item is at all present, as judging by its definition. If the item is absent, it is scored 1, whereas if it is present one must determine its severity by reference to the particular criteria from the anchoring points. The highest applicable rating point is always assigned, even if the patient meets criteria for lower points as well. In judging the level of severity, the rater must utilise a holistic perspective in deciding which anchoring point best characterises the patient’s functioning and rate accordingly, whether or not all elements of the description are observed.The rating points of 2 to 7 correspond to incremental levels of symptom severity:• A rating of 2 (minimal) denotes questionable or subtle or suspected pathology, or it also may allude to the extreme end of the normal range.• A rating of 3 (mild) is indicative of a symptom whose presence is clearly established but not pronounced and interferes little in day-to-day functioning.• A rating of 4 (moderate) characterises a symptom which, though representing a serious problem, either occurs only occasionally or intrudes on daily life only to a moderate extent.• A rating of 5 (moderate severe) indicates marked manifestations that distinctly impact on one’s functioning but are not all-consuming and usually can be contained at will.• A rating of 6 (severe) represents gross pathology that is present very frequently, proves highly disruptive to one’s life, and often calls for direct supervision.• A rating of 7 (extreme) refers to the most serious level of psychopathology, whereby the manifestations drastically interfere in most or all major life functions, typically necessitating close supervision and assistance in many areas.Each item is rated in consultation with the definitions and criteria provided in this manual. The ratings are rendered on the PANSS rating form overleaf by encircling the appropriate number following each dimension.P A N S S R A T I N G F O R Mabsent minimal mild moderate moderateseveresevere extremeP1 Delusions 1 2 3 4 5 6 7 P2 Conceptualdisorganisation 1 2 3 4 5 6 7 P3 Hallucinatorybehaviour 1 2 3 4 5 6 7 P4 Excitement 1 2 3 4 5 6 7 P5 Grandiosity 1 2 3 4 5 6 7 P6 Suspiciousness/persecution 1 2 3 4 5 6 7 P7 Hostility 1 2 3 4 5 6 7 N1 Bluntedaffect 1 2 3 4 5 6 7 N2 Emotionalwithdrawal 1 2 3 4 5 6 7 N3 Poorrapport 1 2 3 4 5 6 7N4 Passive/apathetic socialwithdrawal 1 2 3 4 5 6 7N5 Difficulty in abstract thinking 1 2 3 4 5 6 7N6 Lack of spontaneity &flow of conversation 1 2 3 4 5 6 7N7 Stereotypedthinking 1 2 3 4 5 6 7 G1 Somaticconcern 1 2 3 4 5 6 7 G2 Anxiety 1 2 3 4 5 6 7 G3 Guiltfeelings 1 2 3 4 5 6 7 G4 Tension 1 2 3 4 5 6 7 G5 Mannerisms&posturing 1 2 3 4 5 6 7 G6 Depression 1 2 3 4 5 6 7 G7 Motorretardation 1 2 3 4 5 6 7 G8 Uncooperativeness 1 2 3 4 5 6 7 G9 Unusual thought content 1 2 3 4 5 6 7 G10 Disorientation 1 2 3 4 5 6 7 G11 Poorattention 1 2 3 4 5 6 7 G12 Lack of judgement & insight 1 2 3 4 5 6 7 G13 Disturbance of volition 1 2 3 4 5 6 7 G14 Poor impulse control 1 2 3 4 5 6 7 G15 Preoccupation 1 2 3 4 5 6 7 G16 Activesocialavoidance 1 2 3 4 5 6 7SCORING INSTRUCTIONSOf the 30 items included in the PANSS, 7 constitute a Positive Scale, 7 a Negative Scale, and the remaining 16 a General Psychopathology Scale. The scores for these scales are arrived at by summation of ratings across component items. Therefore, the potential ranges are 7 to 49 for the Positive and Negative Scales, and 16 to 112 for the General Psychopathology Scale. In addition to these measures, a Composite Scale is scored by subtracting the negative score from the positive score. This yields a bipolar index that ranges from –42 to +42, which is essentially a difference score reflecting the degree of predominance of one syndrome in relation to the other.P OSITIVE S CALE (P)P1. D ELUSIONS- Beliefs which are unfounded, unrealistic and idiosyncratic.Basis for rating - Thought content expressed in the interview and its influence on social relations and behaviour.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Presence of one or two delusions which are vague, uncrystallised and nottenaciously held. Delusions do not interfere with thinking, social relations or behaviour.4 Moderate - Presence of either a kaleidoscopic array of poorly formed, unstable delusions or afew well-formed delusions that occasionally interfere with thinking, social relations or behaviour.5 Moderate Severe - Presence of numerous well-formed delusions that are tenaciously heldand occasionally interfere with thinking, social relations and behaviour.6 Severe - Presence of a stable set of delusions which are crystallised, possibly systematised,tenaciously held and clearly interfere with thinking, social relations and behaviour.7 Extreme - Presence of a stable set of delusions which are either highly systematised or verynumerous, and which dominate major facets of the patient’s life. This frequently results ininappropriate and irresponsible action, which may even jeopardise the safety of the patient or others.P2. C ONCEPTUAL D ISORGANISATION- Disorganised process of thinking characterised by disruption of goal-directed sequencing, e.g. circumstantiality, loose associations, tangentiality, gross illogicality or thought block.Basis for rating - Cognitive-verbal processes observed during the course of interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Thinking is circumstantial, tangential or paralogical. There is some difficulty in directingthoughts towards a goal, and some loosening of associations may be evidenced under pressure.4 Moderate - Able to focus thoughts when communications are brief and structured, but becomesloose or irrelevant when dealing with more complex communications or when under minimal pressure.5 Moderate Severe - Generally has difficulty in organising thoughts, as evidenced by frequentirrelevancies, disconnectedness or loosening of associations even when not under pressure.6 Severe - Thinking is seriously derailed and internally inconsistent, resulting in grossirrelevancies and disruption of thought processes, which occur almost constantly.7 Extreme - Thoughts are disrupted to the point where the patient is incoherent. There is markedloosening of associations, which result in total failure of communication, e.g. “word salad” or mutism.P3. H ALLUCINATORY B EHAVIOUR- Verbal report or behaviour indicating perceptions which are not generated by external stimuli. These may occur in the auditory, visual, olfactory or somatic realms.Basis for rating - Verbal report and physical manifestations during the course of interview as well as reports of behaviour by primary care workers or family.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - One or two clearly formed but infrequent hallucinations, or else a number of vagueabnormal perceptions which do not result in distortions of thinking or behaviour.4 Moderate - Hallucinations occur frequently but not continuously, and the patient’sthinking and behaviour are only affected to a minor extent.5 Moderate Severe - Hallucinations occur frequently, may involve more than one sensory modality,and tend to distort thinking and/or disrupt behaviour. Patient may have a delusional interpretation ofthese experiences and respond to them emotionally and, on occasion, verbally as well.6 Severe - Hallucinations are present almost continuously, causing major disruption ofthinking and behaviour. Patient treats these as real perceptions, and functioning is impededby frequent emotional and verbal responses to them.7 Extreme - Patient is almost totally preoccupied with hallucinations, which virtually dominatethinking and behaviour. Hallucinations are provided a rigid delusional interpretation andprovoke verbal and behavioural responses, including obedience to command hallucinations.P4. E XCITEMENT- Hyperactivity as reflected in accelerated motor behaviour, heightened responsivity to stimuli, hypervigilance or excessive mood lability.Basis for rating - Behavioural manifestations during the course of interview as wellas reports of behaviour by primary care workers or family.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Tends to be slightly agitated, hypervigilant or mildly overaroused throughout the interview, butwithout distinct episodes of excitement or marked mood lability. Speech may be slightly pressured.4 Moderate - Agitation or overarousal is clearly evident throughout the interview, affectingspeech and general mobility, or episodic outbursts occur sporadically.5 Moderate Severe - Significant hyperactivity or frequent outbursts of motor activity are observed,making it difficult for the patient to sit still for longer than several minutes at any given time.6 Severe - Marked excitement dominates the interview, delimits attention, and to someextent affects personal functions such as eating or sleeping.7 Extreme - marked excitement seriously interferes in eating and sleeping and makesinterpersonal interactions virtually impossible. Acceleration of speech and motor activitymay result in incoherence and exhaustion.P5. G RANDIOSITY- Exaggerated self-opinion and unrealistic convictions of superiority, including delusions of extraordinary abilities, wealth, knowledge, fame, power and moral righteousness.Basis for rating - Thought content expressed in the interview and its influence on behaviour.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Some expansiveness or boastfulness is evident, but without clear-cut grandiosedelusions.4 Moderate - Feels distinctly and unrealistically superior to others. Some poorly formeddelusions about special status or abilities may be present but are not acted upon.5 Moderate Severe - Clear-cut delusions concerning remarkable abilities, status or power areexpressed and influence attitude but not behaviour.6 Severe - Clear-cut delusions of remarkable superiority involving more than one parameter (wealth,knowledge, fame, etc) are expressed, notably influence interactions and may be acted upon.7 Extreme - Thinking, interactions and behaviour are dominated by multiple delusions of amazingability, wealth, knowledge, fame, power and/or moral stature, which may take on a bizarre quality.P6. S USPICIOUSNESS/P ERSECUTION - Unrealistic or exaggerated ideas of persecution, as reflected in guardedness, ad distrustful attitude, suspicious hypervigilance or frank delusions that others mean harm.Basis for rating – Thought content expressed in the interview and its influence on behaviour.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Presents a guarded or even openly distrustful attitude, but thoughts, interactions andbehaviour are minimally affected.4 Moderate - Distrustfulness is clearly evident and intrudes on the interview and/or behaviour, butthere is no evidence of persecutory delusions. Alternatively, there may be indication of loosely formedpersecutory delusions, but these do not seem to affect the patient’s attitude or interpersonal relations.5 Moderate Severe - Patient shows marked distrustfulness, leading to major disruption ofinterpersonal relations, or else there are clear-cut persecutory delusions that have limitedimpact on interpersonal relations and behaviour.6 Severe - Clear-cut pervasive delusions of persecution which may be systematised andsignificantly interfere in interpersonal relations.7 Extreme - A network of systematised persecutory delusions dominates the patient’sthinking, social relations and behaviour.P7. H OSTILITY- Verbal and nonverbal expressions of anger and resentment, including sarcasm, passive-aggressive behaviour, verbal abuse and assualtiveness.Basis for rating – Interpersonal behaviour observed during the interview and reports by primary care workers or family.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Indirect or restrained communication of anger, such as sarcasm, disrespect, hostileexpressions and occasional irritability.4 Moderate - Presents an overtly hostile attitude, showing frequent irritability and directexpression of anger or resentment.5 Moderate Severe - Patient is highly irritable and occasionally verbally abusive or threatening.6 Severe - Uncooperativeness and verbal abuse or threats notably influence the interview andseriously impact upon social relations. Patient may be violent and destructive but is notphysically assualtive towards others.7 Extreme - Marked anger results in extreme uncooperativeness, precluding otherinteractions, or in episode(s) of physical assault towards others.N EGATIVE S CALE (N)N1. B LUNTED A FFECT- Diminished emotional responsiveness as characterised by a reduction in facial expression, modulation of feelings and communicative gestures.Basis for rating - Observation of physical manifestations of affective tone and emotional responsiveness during the course of the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Changes in facial expression and communicative gestures seem to be stilted, forced,artificial or lacking in modulation.4 Moderate - Reduced range of facial expression and few expressive gestures result in a dullappearance5 Moderate Severe - Affect is generally ‘flat’ with only occasional changes in facialexpression and a paucity of communicative gestures.6 Severe - Marked flatness and deficiency of emotions exhibited most of the time. There maybe unmodulated extreme affective discharges, such as excitement, rage or inappropriateuncontrolled laughter.7 Extreme – Changes in facial expression and evidence of communicative gestures arevirtually absent. Patient seems constantly to show a barren or ‘wooden’ expression.N2. E MOTIONAL W ITHDRAWAL- Lack of interest in, involvement with, and affective commitment to life’s events.Basis for rating - Reports of functioning from primary care workers or family and observation of interpersonal behaviour during the course of the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Usually lack initiative and occasionally may show deficient interest in surrounding events.4 Moderate - Patient is generally distanced emotionally from the milieu and its challengesbut, with encouragement, can be engaged.5 Moderate Severe - Patient is clearly detached emotionally from persons and events in the milieu,resisting all efforts at engagement. Patient appears distant, docile and purposeless but can beinvolved in communication at least briefly and tends to personal needs, sometimes with assistance.6 Severe - Marked deficiency of interest and emotional commitment results in limited conversationwith others and frequent neglect of personal functions, for which the patient requires supervision.7 Extreme – Patient is almost totally withdrawn, uncommunicative and neglectful ofpersonal needs as a result of profound lack of interest and emotional commitment.N3. P OOR R APPORT- Lack of interpersonal empathy, openness in conversation and sense of closeness, interest or involvement with the interviewer. This is evidenced by interpersonal distancing and reduced verbal and nonverbal communication.Basis for rating - Interpersonal behaviour during the course of the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Conversation is characterised by a stilted, strained or artificial tone. It may lackemotional depth or tend to remain on an impersonal, intellectual plane.4 Moderate - Patient typically is aloof, with interpersonal distance quite evident. Patient mayanswer questions mechanically, act bored, or express disinterest.5 Moderate Severe - Disinvolvement is obvious and clearly impedes the productivity of theinterview. Patient may tend to avoid eye or face contact.6 Severe - Patient is highly indifferent, with marked interpersonal distance. Answers are perfunctory,and there is little nonverbal evidence of involvement. Eye and face contact are frequently avoided.7 Extreme - Patient is totally uninvolved with the interviewer. Patient appears to be completelyindifferent and consistently avoids verbal and nonverbal interactions during the interview.N4. P ASSIVE/A PATHETIC S OCIAL W ITHDRAWAL- Diminished interest and initiative in social interactions due to passivity, apathy, anergy or avolition. This leads to reduced interpersonal involvements and neglect of activities of daily living.Basis for rating – Reports on social behaviour from primary care workers or family.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Shows occasional interest in social activities but poor initiative. Usually engages withothers only when approached first by them.4 Moderate – Passively goes along with most social activities but in a disinterested ormechanical way. Tends to recede into the background.5 Moderate Severe - Passively participates in only a minority of activities and shows virtuallyno interest or initiative. Generally spends little time with others.6 Severe - Tends to be apathetic and isolated, participating very rarely in social activities andoccasionally neglecting personal needs. Has very few spontaneous social contacts.7 Extreme – Profoundly apathetic, socially isolated and personally neglectful.N5. D IFFICULTY IN A BSTRACT T HINKING- Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalisations and proceeding beyond concrete or egocentric thinking in problem-solving tasks.Basis for rating - Responses to questions on similarities and proverb interpretation, and use of concrete vs. abstract mode during the course of the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Tends to give literal or personalised interpretations to the more difficult proverbsand may have some problems with concepts that are fairly abstract or remotely related.4 Moderate - Often utilises a concrete mode. Has difficulty with most proverbs and somecategories. Tends to be distracted by functional aspects and salient features.5 Moderate Severe - Deals primarily in a concrete mode, exhibiting difficulty with mostproverbs and many categories.6 Severe - Unable to grasp the abstract meaning of any proverbs or figurative expressionsand can formulate classifications for only the most simple of similarities. Thinking is eithervacuous or locked into functional aspects, salient features and idiosyncratic interpretations.7 Extreme - Can use only concrete modes of thinking. Shows no comprehension of proverbs,common metaphors or similes, and simple categories. Even salient and functional attributesdo not serve as a basis for classification. This rating may apply to those who cannot interacteven minimally with the examiner due to marked cognitive impairment.N6. L ACK OF S PONTANEITY AND F LOW OF C ONVERSATION- Reduction in the normal flow of communication associated with apathy, avolition, defensiveness or cognitive deficit. This is manifested by diminished fluidity and productivity of the verbal interactional process.Basis for rating - Cognitive-verbal processes observed during the course of interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild – Conversation shows little initiative. Patient’s answers tend to be brief andunembellished, requiring direct and leading questions by the interviewer.4 Moderate – Conversation lacks free flow and appears uneven or halting. Leading questionsare frequently needed to elicit adequate responses and proceed with conversation.5 Moderate Severe - Patient shows a marked lack of spontaneity and openness, replying tothe interviewer’s questions with only one or two brief sentences.6 Severe - Patient’s responses are limited mainly to a few words or short phrases intended toavoid or curtail communication. (e.g. “I don’t know”, “I’m not at liberty to say”).Conversation is seriously impaired as a result and the interview is highly unproductive.7 Extreme - Verbal output is restricted to, at most, an occasional utterance, makingconversation not possible.N7. S TEREOTYPED T HINKING- Decreased fluidity, spontaneity and flexibility of thinking, as evidenced in rigid, repetitious or barren thought content.Basis for rating - Cognitive-verbal processes observed during the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Some rigidity shown in attitude or beliefs. Patient may refuse to consider alternativepositions or have difficulty in shifting from one idea to another.4 Moderate - Conversation revolves around a recurrent theme, resulting in difficulty inshifting to a new topic.5 Moderate Severe - Thinking is rigid and repetitious to the point that, despite theinterviewer’s efforts, conversation is limited to only two or three dominating topics.6 Severe – Uncontrolled repetition of demands, statements, ideas or questions which severelyimpairs conversation.7 Extreme - Thinking, behaviour and conversation are dominated by constant repetition offixed ideas or limited phrases, leading to gross rigidity, inappropriateness and restrictivenessof patient’s communication.G ENERAL P SYCHOPATHOLOGY S CALE (G)G1. S OMATIC C ONCERN- Physical complaints or beliefs about bodily illness or malfunctions. This may range from a vague sense of ill being to clear-cut delusions of catastrophic physical disease.Basis for rating - Thought content expressed in the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Distinctly concerned about health or bodily malfunction, but there is no delusionalconviction and overconcern can be allayed by reassurance.4 Moderate - Complains about poor health or bodily malfunction, but there is no delusionalconviction, and overconcern can be allayed by reassurance.5 Moderate Severe - Patient expresses numerous or frequent complaints about physicalillness or bodily malfunction, or else patient reveals one or two clear-cut delusionsinvolving these themes but is not preoccupied by them.6 Severe - Patient is preoccupied by one or a few clear-cut delusions about physical diseaseor organic malfunction, but affect is not fully immersed in these themes, and thoughts canbe diverted by the interviewer with some effort.7 Extreme – Numerous and frequently reported somatic delusions, or only a few somaticdelusions of a catastrophic nature, which totally dominate the patient’s affect or thinking.G2. A NXIETY-Subjective experience of nervousness, worry, apprehension or restlessness, ranging from excessive concern about the present or future to feelings of panic.Basis for rating - Verbal report during the course of interview and corresponding physical manifestations.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Expresses some worry, overconcern or subjective restlessness, but no somatic andbehavioural consequences are reported or evidenced.4 Moderate - Patient reports distinct symptoms of nervousness, which are reflected in mildphysical manifestations such as fine hand tremor and excessive perspiration.5 Moderate Severe - Patient reports serious problems of anxiety which have significantphysical and behavioural consequences, such as marked tension, poor concentration,palpitations or impaired sleep.6 Severe - Subjective state of almost constant fear associated with phobias, markedrestlessness or numerous somatic manifestations.7 Extreme - Patient’s life is seriously disrupted by anxiety, which is present almost constantlyand at times reaches panic proportion or is manifested in actual panic attacks.G3. G UILT F EELINGS - Sense of remorse or self-blame for real or imagined misdeeds in the past.Basis for rating - Verbal report of guilt feelings during the course of interview and the influence on attitudes and thoughts.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild – Questioning elicits a vague sense of guilt or self-blame for a minor incident, but thepatient clearly is not overly concerned.4 Moderate - Patient expresses distinct concern over his responsibility for a real incident inhis life but is not pre-occupied with it and attitude and behaviour are essentially unaffected.5 Moderate Severe - Patient expresses a strong sense of guilt associated with self-deprecation or the belief that he deserves punishment. The guilt feelings may have adelusional basis, may be volunteered spontaneously, may be a source of preoccupationand/or depressed mood, and cannot be allayed readily by the interviewer.6 Severe - Strong ideas of guilt take on a delusional quality and lead to an attitude of hopelessnessor worthlessness. The patient believes he should receive harsh sanctions as such punishment.7 Extreme - Patient’s life is dominated by unshakable delusions of guilt, for which he feelsdeserving of drastic punishment, such as life imprisonment, torture, or death. There may beassociated suicidal thoughts or attribution of others’ problems to one’s own past misdeeds.G4. T ENSION-Overt physical manifestations of fear, anxiety, and agitation, such as stiffness, tremor, profuse sweating and restlessness.Basis for rating - Verbal report attesting to anxiety and thereupon the severity of physical manifestations of tension observed during the interview.1 Absent - Definition does not apply2 Minimal - Questionable pathology; may be at the upper extreme of normal limits3 Mild - Posture and movements indicate slight apprehensiveness, such as minor rigidity,occasional restlessness, shifting of position, or fine rapid hand tremor.4 Moderate - A clearly nervous appearance emerges from various manifestations, such asfidgety behaviour, obvious hand tremor, excessive perspiration, or nervous mannerisms.5 Moderate Severe - Pronounced tension is evidenced by numerous manifestations, such as nervousshaking, profuse sweating and restlessness, but can conduct in the interview is not significantly affected.6 Severe - Pronounced tension to the point that interpersonal interactions are disrupted. The patient,for example, may be constantly fidgeting, unable to sit still for long, or show hyperventilation.7 Extreme - Marked tension is manifested by signs of panic or gross motor acceleration,such as rapid restless pacing and inability to remain seated for longer than a minute, whichmakes sustained conversation not possible.。

PANSS培训中心北京大学精神卫生研究所阳性与阴性症状量表Positive And Negative Syndrome Scale (PANSSPANSS)阴性和阳性症状的发展19世纪末Hughlings-Jackson首先提出19世纪末20世纪初Kraepelin和Bleuler提出：提出：阴性症状为早老性痴呆和精神分裂症的基本症状；阳性症状为附加症状20世纪50年代Schneider提出：提出：I级症状（主要为阳性症状）为精神分裂症特征性症状，并构成精神分裂症诊断标准的主要内容20世纪80年代Crow提出：I型精神分裂症－阳性症状为主II型精神分裂症－阴性症状为主精神分裂症症状量表简明精神病评定量表（BPRS）J. E. Overall，1962年 慢性精神患者标准化精神病评定量表M. Krawiccha，1977年 阴性症状评定量表（SANS）N. Andreason，1982年 阳性症状评定量表（SAPS）N. Andreason，1984年阳性和阴性症状量表（PANSS）Kay Fiszbein和Opler1987年推出评定精神分裂症的阳性和阴性症状PANSS的来源BPRS和PRS（精神病理评定量表）1996年引入我国用于临床研究及新药开发PANSS 的优点弥补了既往评定量表的不足（敏感性、准确性）较全面覆盖了精神分裂症的症状，尤其是阳性和阴性症状条目定义清楚有完整的、可操作的评分标准PANSS 的内容（一）阳性症状量表P1－妄想P2－概念紊乱P3－幻觉性行为P4－兴奋P5－夸大P6－猜疑/被害P7－敌对性阴性症状量表N1 －情感迟钝N2 －情绪退缩N3 －情感交流障碍N4 －被动/淡漠社交退缩N5 －抽象思维困难N6 －交谈缺乏自发性和流畅性N7 －刻板思维PANSS 的内容（二）一般精神病理学症状量表G1 -关注身体健康G9 -异常思维内容G2 -焦虑G10-定向障碍G3 -自罪感G11-注意障碍G4 -紧张G12-自知力缺乏G5 -装相和作态G13-意志障碍G6 -抑郁G14-冲动控制障碍G7 -动作迟缓G15-先占观念G8 -不合作G16-主动回避社交PANSS 评分依据2个项目仅依据知情人信息（N4和G16）12个项目需要结合会谈和知情人提供的确切信息16个项目需要在会谈中进行评估症状的评分依据y根据现场检查评分的项目16项：P2，N1，N3，N5，N6，N7，G1，G2，G3，G4，G9，G10，G11，G12，G13和G15y根据知情人提供资料评分的项目2项：N4，G16y依据检查和知情人资料评分的项目12项：P1，P3，P4，P5，P6，P7，N2，G5，G6，G7，G8，G14评分规则按1－7级评分1：无2：可能3：轻度4：中度5：明显6：重度7：极重遵循条目定义及《评分标准》评分时间跨度：最近1周症状评分的等级标准首先要根据项目的定义判断该症状是否存在如果没有，就评1如果存在，则参考具体的分级标准确定其严重度 如果同时符合一个以上分级的标准，原则是取高分，遵循就高不就低的原则在判断严重度水平时，评定者必须考虑患者的功能特点，不要求观察到所描述的全部要点。

康复期精神分裂症患者实施基于复元理念的个案管理康复服务的护理效果观察牛丹丹;王稀琛;陈艳;朱磊【摘要】目的:观察康复期精神分裂症患者实施基于复元理念的个案管理康复服务的护理效果.方法:选取康复期精神分裂症患者68例作为研究对象,采用随机数字表法将其分成观察组和对照组各34例.对照组给予常规精神康复服务,观察组在对照组基础上给予基于复元理念的个案管理康复服务.采用阳性与阴性症状量表(PANSS)比较两组护理前后的精神症状严重程度,采用个人自我评价问卷(PEI)比较两组护理前后的自我评价,采用简易应对方式问卷(SCSQ)比较两组护理前后的应对方式.结果:护理后,观察组PANSS、PEI和SCSQ量表评分均明显优于对照组,差异有统计学意义(P<0.05).结论:在常规精神康复服务基础上,采用基于复元理念的个案管理康复服务有助于减轻康复期精神分裂症患者的精神症状、提高自我评价、改变应对方式,效果优于单纯常规精神康复服务.【期刊名称】《中国民康医学》【年(卷),期】2018(030)004【总页数】3页(P6-7,10)【关键词】复元理念;康复期精神分裂症;自我评价;应对方式【作者】牛丹丹;王稀琛;陈艳;朱磊【作者单位】上海市静安区精神卫生中心,上海 200436;上海市静安区精神卫生中心,上海 200436;上海市静安区精神卫生中心,上海 200436;上海市静安区精神卫生中心,上海 200436【正文语种】中文【中图分类】R749.3处于康复期的精神分裂症患者常常表现为自我评价较低，处理问题的方式较为消极，而消极的自我评价往往导致患者预后较差[1]，而精神分裂症患者的生活质量受自身不良应对方式的影响[2]。

“复元”是指通过患者的主动参与，协助他们利用周围的资源，逐步获得自信和掌控自己生活的能力[3]。

本文观察康复期精神分裂症患者实施基于复元理念的个案管理康复服务的护理效果。

1 资料与方法1.1 一般资料选取2015年4月至2016年3月上海市静安区精神卫生中心的精神分裂症患者68例作为观察对象。

利培酮合并氯硝西泮口服与氟哌啶醇肌注后换利培酮口服治疗精神分裂症兴奋激越症状的随机对照研究陈正;诸索宇;闻晖;乔颖;吴彦;徐筠;李朝;彭代辉;黄继忠【摘要】目的比较利培酮口服液合并氯硝西泮片与氟哌啶醇肌注控制精神分裂症兴奋激越症状的疗效和安全性,以及在兴奋激越控制后以利培酮口服液替换氟哌啶醇肌注的疗效及安全性.方法纳入33例兴奋激越的精神分裂症患者:18例随机分入利培酮组,利培酮口服液(2～6ml/d)合并氯硝西泮(4～8 mg/d),第6天起氯硝西泮逐渐减量,共观察47 d;15例分入氟哌啶醇组,前5天氟哌啶醇肌注(10～20 mg/d),第6天起逐渐替换为利培酮口服液(2～6 ml/d),共观察47 d.以阳性与阴性综合征量表(PANSS)、Barnes静坐不能量表(BAS),类帕金森综合征量表(SAS)评定疗效和不良反应.结果第5天末利培酮组和氟哌啶醇组PANSS兴奋激越因子分的平均(标准差)减分值分别为6.9(3.8)分,8.2(4.7)分,t=0.85,P=0.403,PANSS总分平均减分值分别为41.1(13.5)分,47.7(14.2)分,t=1.31,P=0.199.第5天末利培酮组的SAS 评分低于氟哌啶醇肌注组[分别为0(0)分,2(9)分,Z=2.72,P=0.006].结论利培酮口服液合并氯硝西泮片剂可有效安全地治疗精神分裂症急性兴奋激越.用氟哌啶醇肌注控制兴奋激越后直接换利培酮口服液,也能保持疗效.【期刊名称】《上海精神医学》【年(卷),期】2010(022)006【总页数】4页(P354-357)【关键词】利培酮;氟哌啶醇;精神分裂症;激越【作者】陈正;诸索宇;闻晖;乔颖;吴彦;徐筠;李朝;彭代辉;黄继忠【作者单位】上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030;上海交通大学医学院附属精神卫生中心,200030【正文语种】中文兴奋激越和攻击行为是精神分裂症患者急性发作时常见的主要症状，这些症状不仅影响治疗依从性，而且对患者或他人造成危险。

·论著·重复经颅磁刺激辅助治疗精神分裂症幻听的疗效和安全性戴伯坚，杨凌凯，涂献珠，刘立滢，邓江南，金晓庄，朱晶晶，陈杰，王芳，林崇光，孔令光，陈兴时，马俊 摘要：　目的：探讨双背侧前额叶低频重复经颅磁刺激（ｒＴＭＳ）辅助治疗对精神分裂症患者幻听症状的疗效和安全性。

　方法：采用随机双盲法将１０９例有幻听症状的精神分裂症患者分为ｒＴＭＳ组（５５例）和对照组（５４例）；两组在维持原有抗精神病药种类及剂量的基础上，分别给予低频（１Ｈｚ）ｒＴＭＳ真刺激和伪刺激治疗，每天１次、每次２０ｍｉｎ、每周５次，疗程４周。

分别于治疗前后采用阳性和阴性症状量表（ＰＡＮＳＳ）评定临床症状，以治疗后幻听症状评分减分≥２为有效；治疗后采用治疗中出现的症状量表（ＴＥＳＳ）评估安全性。

　结果：治疗后ｒＴＭＳ组的ＰＡＮＳＳ总分、幻听症状分、阴性症状分、一般病理分显著低于对照组（Ｐ＜０．０５或Ｐ＜０．０１）；幻听症状的有效率（７２．７％）显著高于对照组（３５．１％）（Ｐ＜０．０５）；两组患者均无严重不良事件发生。

　结论：双背侧前额叶低频ｒＴＭＳ辅助治疗对精神分裂患者病情缓解及对症幻听症状有一定效果，且安全。

关键词：　精神分裂症；　低频重复经颅磁刺激；　幻听中图分类号：　Ｒ７４９．３ 文献标识码：　Ａ 文章编号：　１００５ ３２２０（２０２２）０３ ０１７７ ０３Ｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙｏｆｒｅｐｅｔｉｔｉｖｅｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｉｎｓｃｈｉｚｏｐｈｒｅｎｉａ　ＤＡＩＢｏ ｊｉａｎ，ＹＡＮＧＬｉｎｇ ｋａｉ，ＴＵＸｉａｎ ｚｈｕ，ＬＩＵＬｉ ｙｉｎｇ，ＤＥＮＧＪｉａｎｇ ｎａｎ，ＪＩＮＸｉａｏ ｚｈｕａｎｇ，ＺＨＵＪｉｎｇ ｊｉｎｇ，ＣＨＥＮＪｉｅ，ＷＡＮＧＦａｎｇ，ＬＩＮＣｈｏｎｇ ｇｕａｎｇ，ＫＯＮＧＬｉｎｇ ｇｕａｎｇ，ＣＨＥＮＸｉｎｇ ｓｈｉ，ＭＡＪｕｎ．ＷｅｎｚｈｏｕＳｅｖｅｎｔｈＰｅｏｐｌｅ＇ｓＨｏｓｐｉｔａｌ，Ｗｅｎｚｈｏｕ３２５００５，ＣｈｉｎａＡｂｓｔｒａｃｔ：　Ｏｂｊｅｃｔｉｖｅ：Ｔｏｉｎｖｅｓｔｉｇａｔｅｔｈｅｅｆｆｉｃａｃｙａｎｄｓａｆｅｔｙｏｆｌｏｗｆｒｅｑｕｅｎｃｙｒｅｐｅｔｉｔｉｖｅｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎ（ｒＴＭＳ）ｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｉｎｐａｔｉｅｎｔｓｗｉｔｈｓｃｈｉｚｏｐｈｒｅｎｉａ．　Ｍｅｔｈｏｄ：１０９ｓｃｈｉｚｏｐｈｒｅｎｉｃｐａｔｉｅｎｔｓｗｉｔｈａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｗｅｒｅｒａｎｄｏｍｌｙｄｉｖｉｄｅｄｉｎｔｏｒＴＭＳｇｒｏｕｐ（ｎ＝５５）ａｎｄｃｏｎｔｒｏｌｇｒｏｕｐ（ｎ＝５４）ｂｙｒａｎｄｏｍｉｚｅｄａｎｄｄｏｕｂｌｅｂｌｉｎｄｗａｙ．Ｏｎｔｈｅｂａｓｉｓｏｆｍａｉｎｔａｉｎｉｎｇｔｈｅｏｒｉｇｉｎａｌｔｙｐｅａｎｄｄｏｓｅｏｆａｎｔｉｐｓｙｃｈｏｔｉｃｓ，ｔｈｅｔｗｏｇｒｏｕｐｓｗｅｒｅｔｒｅａｔｅｄｗｉｔｈｌｏｗ ｆｒｅｑｕｅｎｃｙ（１Ｈｚ）ｒＴＭＳｔｒｕｅｓｔｉｍｕｌａｔｉｏｎｏｒｆａｌｓｅｓｔｉｍｕｌａｔｉｏｎ，ｏｎｃｅａｄａｙ，２０ｍｉｎｕｔｅｓｅａｃｈｔｉｍｅ，５ｔｉｍｅｓａｗｅｅｋｆｏｒ４ｗｅｅｋｓ．ＴｈｅｃｌｉｎｉｃａｌｓｙｍｐｔｏｍｓｗｅｒｅａｓｓｅｓｓｅｄｂｙＰｏｓｉｔｉｖｅａｎｄＮｅｇａｔｉｖｅＳｙｍｐｔｏｍＳｃａｌｅ（ＰＡＮＳＳ）ｂｅｆｏｒｅａｎｄａｆｔｅｒｔｒｅａｔｍｅｎｔ，ａｎｄｔｈｅｒｅｄｕｃｔｉｏｎｏｆａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｙｍｐｔｏｍｓｃｏｒｅ≥２ａｆｔｅｒｔｒｅａｔｍｅｎｔｗａｓｅｆｆｅｃｔｉｖｅ．Ａｆｔｅｒｔｒｅａｔｍｅｎｔ，ｔｈｅｓａｆｅｔｙｗａｓｅｖａｌｕａｔｅｄｂｙＴｒｅａｔｍｅｎｔＥｍｅｒｇｅｎｔＳｙｍｐｔｏｍＳｃａｌｅ（ＴＥＳＳ）．　Ｒｅｓｕｌｔｓ：Ａｆｔｅｒｔｒｅａｔｍｅｎｔ，ｔｈｅｔｏｔａｌｓｃｏｒｅｏｆＰＡＮＳＳ，ｓｃｏｒｅｓｏｆａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｙｍｐｔｏｍｓ，ｎｅｇａｔｉｖｅｓｙｍｐｔｏｍｓａｎｄｇｅｎｅｒａｌｐａｔｈｏｌｏｇｙｉｎｔｈｅｒＴＭＳｇｒｏｕｐｗｅｒｅｓｉｇｎｉｆｉｃａｎｔｌｙｌｏｗｅｒｔｈａｎｔｈｏｓｅｉｎｔｈｅｃｏｎｔｒｏｌｇｒｏｕｐ（Ｐ＜０．０５ｏｒＰ＜０．０１）．Ｔｈｅｅｆｆｅｃｔｉｖｅｒａｔｅｏｆａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓｙｍｐｔｏｍｓ（７２．７％）ｗａｓｓｉｇｎｉｆｉｃａｎｔｌｙｈｉｇｈｅｒｔｈａｎｔｈａｔｉｎｔｈｅｃｏｎｔｒｏｌｇｒｏｕｐ（３５．１％）（Ｐ＜０．０５）．Ｔｈｅｒｅｗｅｒｅｎｏｓｅｒｉｏｕｓａｄｖｅｒｓｅｅｖｅｎｔｓｉｎｂｏｔｈｇｒｏｕｐｓ．　Ｃｏｎｃｌｕｓｉｏｎ：Ｔｈｅｌｏｗ ｆｒｅｑｕｅｎｃｙｒＴＭＳａｄｊｕｖａｎｔｔｈｅｒａｐｙｏｆｄｏｕｂｌｅｄｏｒｓａｌｐｒｅｆｒｏｎｔａｌｌｏｂｅｓｈａｓａｃｅｒｔａｉｎｅｆｆｅｃｔａｎｄｓａｆｅｔｙｏｎｔｈｅｒｅｍｉｓｓｉｏｎｏｆｓｃｈｉｚｏｐｈｒｅｎｉａａｎｄｓｙｍｐｔｏｍａｔｉｃａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓ．Ｋｅｙｗｏｒｄｓ：　ｓｃｈｉｚｏｐｈｒｅｎｉａ；　ｌｏｗｆｒｅｑｕｅｎｃｙｒｅｐｅｔｉｔｉｖｅｔｒａｎｓｃｒａｎｉａｌｍａｇｎｅｔｉｃｓｔｉｍｕｌａｔｉｏｎ；　ａｕｄｉｔｏｒｙｈａｌｌｕｃｉｎａｔｉｏｎｓ基金项目：温州市基础性科研项目（Ｙ２０１９０４８３）；南京市医学科技发展基金项目（ＹＫＫ２１２３６）作者单位：３２５００５　温州市第七人民医院精神科（戴伯坚，杨凌凯，涂献珠，刘立滢，邓江南，金晓庄，朱晶晶，陈杰，王芳，林崇光，孔令光）；上海交通大学附属精神卫生中心神经生理室（陈兴时）；南京浦口医院精神科（马俊）通信作者：马俊，Ｅ Ｍａｉｌ：ｊｓｓｈｍｊ０５２７＠１６３．ｃｏｍＤＯＩ：１０．３９６９／ｊ．ｉｓｓｎ．１００５ ３２２０．２０２２．０３．００３ 幻听是精神分裂症的核心症状之一，发生率可高达６０％～８０％，带给患者不同的体验并由此可产生相应的行为，而严重影响其安危及生活质量［１］。