ABSTRACT

BACKGROUND: To investigate the effects of adjunct ketamine treatment on depressive symptoms and brain activity in chronic treatment-resistant schizophrenia (CTRS) patients with treatment-resistant depressive (TRD) symptoms.

METHODS: Calgary Depression Scale for Schizophrenia (CDSS), positive and negative syndrome scale (PANSS), and regional homogeneity (ReHo) results were compared before versus after ketamine treatment in 12 CTRS patients with TRD symptoms.

RESULTS: From 7 days to 14 days after the first ketamine administration, CDSS and PANSS total scores were reduced by 63.8% and 12.9%, respectively. By day 21, ReHo values had increased in the main components of the default mode network (DMN) and bilateral orbitofrontal cortex (OFC) after family-wise error correction. ReHo alterations did not correlate with TRD symptom changes. TRD symptoms relapsed by the 21-day time point, while increased ReHo was sustained. No adverse secondary effects (ASEs) necessitating medical intervention occurred.

CONCLUSIONS: Adjunct ketamine alleviation of TRD symptoms lasted only a week, whereas increased ReHo in DMN regions and the OFC in CTRS patients was maintained beyond 2 weeks, indicating that adjunct ketamine is not well-suited for CTRS patients with TRD symptoms and that effects on functional activity dissociate from effects on TRD symptoms. This small-sample pilot study provides clues for further research into therapy for TRD symptoms in CTRS patients.

摘要

背景：探讨氯胺酮辅助治疗对具有耐药性抑郁（TRD）症状的慢性耐药性精神分裂症（CTRS）患者的抑郁症状和脑活动的影响。

方法：比较了氯胺酮治疗前后12例具有TRD症状的CTRS患者的精神分裂症卡尔加里抑郁量表（CDSS），正负综合症量表（PANSS）和区域均一性（ReHo）结果。

结果：从第一次服用氯胺酮后的7天到14天，CDSS和PAN​​SS的总得分分别降低了63.8％和12.9％。到第21天，经过家庭错误校正后，默认模式网络（DMN）和双侧眶额皮层（OFC）的主要成分中的ReHo值已经增加。ReHo改变与TRD症状改变无关。TRD症状在21天时间点复发，而ReHo持续升高。没有发生需要进行医疗干预的不良副反应（ASE）。

结论：氯胺酮辅助缓解TRD症状仅持续了一周，而DMRS地区的ReHo升高和CTRS患者的OFC维持了超过2周，这表明氯胺酮不适用于患有TRD症状的CTRS患者，并且对功能活动与对TRD症状的影响无关。这项小样本的初步研究为进一步研究CTRS患者的TRD症状提供了线索。