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Tsapakis EM, Treiber M, Mitkani C, Drakaki Z, Cholevas A, Spanaki C, Fountoulakis KN. Pharmacological Treatments of Negative Symptoms in Schizophrenia-An Update. J Clin Med 2024; 13:5637. [PMID: 39337126 DOI: 10.3390/jcm13185637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little improvement in the burden of negative symptoms. This article reviews current pharmacological strategies for treating negative symptoms. Dopaminergic, glutamatergic, serotonergic, noradrenergic, cholinergic, anti-inflammatory compounds, hormones, and psychostimulants are explored. Finally, we review pharmacological global treatment guidelines for negative symptoms. In general, switching to a second-generation antipsychotic seems to be most often recommended for patients with schizophrenia on first-generation antipsychotics, and an add-on antidepressant is considered when depression is also present. However, the treatment of negative symptoms remains an unmet need. Future, larger clinical studies and meta-analyses are needed to establish effective pharmacological agents for the effective treatment of negative symptoms.
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Affiliation(s)
- Evangelia Maria Tsapakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Michael Treiber
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, 1090 Vienna, Austria
| | - Calypso Mitkani
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, 55134 Thessaloniki, Greece
| | - Zoe Drakaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Anastasios Cholevas
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Cleanthe Spanaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Neurology, University Hospital of Heraklion, Voutes, 71110 Crete, Greece
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Fang J, Cai R, Hu Y, Wang Y, Ling Y, Lv Y, Fang X, Zhang X, Zhou C. Aberrant brain functional connectivity mediates the effects of negative symptoms on cognitive function in schizophrenia: A structural equation model. J Psychiatr Res 2024; 177:109-117. [PMID: 39004002 DOI: 10.1016/j.jpsychires.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Schizophrenia is a severe psychiatric disorder, characterized by positive symptoms, negative symptoms, and cognitive deficits. Elucidating the mechanism of negative symptom and cognitive deficits could contribute to the treatment and prognosis of schizophrenia. We hypothesized that abnormal functional connectivity would be involved in the indirect effects of negative symptoms on cognitive function. METHODS A total of 150 schizophrenia male patients and 108 healthy controls matched for age, education and gender were enrolled in the study. The scores of Brief Negative Symptom Scale were divided into two factors: motivation and pleasure deficits (MAP) and diminished expression (EXP). Subsequently, a series of classic neurocognitive tests were used to evaluate cognitive functions. Resting-state fMRI data was collected from all participants. The Anatomical Automatic Labeling template was employed to establish regions of interest, thereby constructing the functional connectivity network across the entire brain. Eventually, scores of patients' negative symptoms scale, cognitive function, and strengths of abnormal functional connectivity were incorporated into a structural equation model to explore the interactions among variables. RESULTS MAP exhibited a distinctly and significantly negative impact on cognitive function. The functional connectivity between the left insula and left precuneus, along with that between the left precuneus and right angular gyrus, collectively served as intermediaries, contributing to the indirect effects of MAP and EXP on cognitive function. CONCLUSIONS Our findings demonstrated the moderating role of aberrant brain functional connectivity between negative symptoms and cognitive function, providing clues about the neural correlates of negative symptoms and cognitive deficits in schizophrenia.
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Affiliation(s)
- Jin Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Renliang Cai
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yunshan Hu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yiding Lv
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Salabat D, Pourebrahimi A, Mayeli M, Cattarinussi G. The Therapeutic Role of Intermittent Theta Burst Stimulation in Schizophrenia: A Systematic Review and Meta-analysis. J ECT 2024; 40:78-87. [PMID: 38277616 DOI: 10.1097/yct.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
ABSTRACT Schizophrenia affects approximately 1% of the population worldwide. Multifactorial reasons, ranging from drug resistance to adverse effects of medications, have necessitated exploring further therapeutic options. Intermittent theta burst stimulation (iTBS) is a novel high-frequency form of transcranial magnetic stimulation, a safe procedure with minor adverse effects with faster and longer-lasting poststimulation effects with a potential role in treating symptoms; however, the exact target brain regions and symptoms are still controversial. Therefore, we aimed to systematically investigate the current literature regarding the therapeutic utilities of iTBS using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Twelve studies were included among which 9 found iTBS effective to some degree. These studies targeted the dorsolateral prefrontal cortex and the midline cerebellum. We performed a random-effects meta-analysis on studies that compared the effects of iTBS on schizophrenia symptoms measured by the Positive and Negative Syndrome Scale (PANSS) to sham treatment. Our results showed no significant difference between iTBS and sham in PANSS positive and negative scores, but a trend-level difference in PANSS general scores ( k = 6, P = 0.07), and a significant difference in PANSS total scores ( k = 6, P = 0.03). Analysis of the studies targeting the dorsolateral prefrontal cortex showed improvement in PANSS negative scores ( k = 5, standardized mean difference = -0.83, P = 0.049), but not in PANSS positive scores. Moderators (intensity, pulse, quality, sessions) did not affect the results. However, considering the small number of studies included in this meta-analysis, future works are required to further explore the effects of these factors and also find optimum target regions for positive symptoms.
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Sierra P, Cañada Y, Benavent P, Sabater A, Ribes J, Livianos L, Garcia-Blanco A. Opinion, Use and Knowledge About Transcranial Magnetic Stimulation in Spain: A National Survey of Mental Health Professionals. Psychiatr Q 2024; 95:271-285. [PMID: 38880831 DOI: 10.1007/s11126-024-10073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method of neuromodulation with heterogeneous usage between countries, which may be potentially influenced by healthcare professionals' opinions. This study aimed to assess the knowledge, acceptability, and attitudes of mental health professionals in Spain towards TMS. A cross-sectional multicentric study was conducted using an online survey, with 219 participants including psychiatrists, psychologists, and residents. Nearly 100% of participants correctly answered theoretical aspects related to the rationale and indications of TMS. Although only 55% considered TMS effective, 80% would refer patients if TMS were available at their workplace, and 74% would undergo TMS if experiencing depression. 85% believed neuromodulation training should be increased in residency, and 73% demanded TMS inclusion in public hospitals. Teaching staff and psychologists defined TMS as a last resort (p = 0.03 and 0.045). Both disagreed on its ease of use (p < 0.001) and patient referral (p = 0.01), considering an impact on the therapeutic bond (p = 0.029). Previous TMS training, clinical experience, or availability of TMS at the workplace, were associated with better knowledge, a higher perception of efficacy and utility in treating resistant patients (all p < 0.05). In conclusion, surveyed mental health professionals in Spain demonstrated good knowledge of the technique and positive opinions regarding its utility. Findings emphasized limited clinical experience of the sample, a call for training programs, and the demand for the inclusion of TMS in the portfolio of Spanish public hospitals.
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Affiliation(s)
- Pilar Sierra
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Yolanda Cañada
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain.
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain.
| | - Pilar Benavent
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Ana Sabater
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Josep Ribes
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- CIBERESP-17, Valencia, Spain
| | - Ana Garcia-Blanco
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Building D. 106th Av Fernando Abril Martorell, Valencia, 46026, Spain
- Mental Health Research Unit, La Fe Health Research Institute, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
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Wang M, Lu S, Hao L, Xia Y, Shi Z, Su L. Placebo effects of repetitive transcranial magnetic stimulation on negative symptoms and cognition in patients with schizophrenia spectrum disorders: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1377257. [PMID: 38863608 PMCID: PMC11165700 DOI: 10.3389/fpsyt.2024.1377257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
Background Negative symptoms and cognitive impairments are highly frequent in schizophrenia spectrum disorders (SSD), associated with adverse functional outcomes and quality of life. Repetitive transcranial magnetic stimulation (rTMS) has been considered a promising therapeutic option in SSD. However, placebo effects of rTMS on these symptoms remained unclear. Objective To investigate placebo effects of rTMS on alleviating negative symptoms and cognitive impairment in patients with SSD and to explore potential moderators. Methods We systematically searched five electronic databases up to 15 July 2023. Randomized, double-blind, sham-controlled trials investigating effects of rTMS on negative symptoms or cognition in patients with SSD were included. The pooled placebo effect sizes, represented by Hedges' g, were estimated using the random-effects model. Potential moderators were explored through subgroup analysis and meta-regression. Results Forty-four randomized controlled trials with 961 patients (mean age 37.53 years; 28.1% female) in the sham group were included. Significant low-to-moderate pooled placebo effect sizes were observed for negative symptoms (g=0.44, p<0.001), memory (g=0.31, p=0.010), executive function (g=0.35, p<0.001), working memory (g=0.26, p=0.004), and processing speed (g=0.36, p=0.004). Subgroup analysis indicated that placebo effects were affected by sham stimulation methods, rTMS targeting approaches, and stimulation frequency. Conclusions Placebo effects of rTMS on negative symptoms and cognition in patients with SSD are significant in a small-to-moderate magnitude, which might be mediated by rTMS parameters. Our findings will provide new insights for practitioners to further optimize and establish standardized rTMS protocols for future RCTs tackling cardinal symptoms in SSD. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023390138.
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Affiliation(s)
- Mingqi Wang
- Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Shensen Lu
- Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Lu Hao
- Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Yifei Xia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenchun Shi
- Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China
| | - Lei Su
- Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China
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Xu M, Nikolin S, Moffa AM, Xu XM, Su Y, Li R, Chan HF, Loo CK, Martin DM. Prolonged intermittent theta burst stimulation targeting the left prefrontal cortex and cerebellum does not affect executive functions in healthy individuals. Sci Rep 2024; 14:11847. [PMID: 38782921 PMCID: PMC11116424 DOI: 10.1038/s41598-024-61404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for alleviating negative symptoms and cognitive dysfunction in schizophrenia commonly targets the left dorsolateral prefrontal cortex (LDLPFC). However, the therapeutic effectiveness of rTMS at this site remains inconclusive and increasingly, studies are focusing on cerebellar rTMS. Recently, prolonged intermittent theta-burst stimulation (iTBS) has emerged as a rapid-acting form of rTMS with promising clinical benefits. This study explored the cognitive and neurophysiological effects of prolonged iTBS administered to the LDLPFC and cerebellum in a healthy cohort. 50 healthy participants took part in a cross-over study and received prolonged (1800 pulses) iTBS targeting the LDLPFC, cerebellar vermis, and sham iTBS. Mixed effects repeated measures models examined cognitive and event-related potentials (ERPs) from 2-back (P300, N200) and Stroop (N200, N450) tasks after stimulation. Exploratory non-parametric cluster-based permutation tests compared ERPs between conditions. There were no significant differences between conditions for behavioural and ERP outcomes on the 2-back and Stroop tasks. Exploratory cluster-based permutation tests of ERPs did not identify any significant differences between conditions. We did not find evidence that a single session of prolonged iTBS administered to either the LDLPFC or cerebellum could cause any cognitive or ERP changes compared to sham in a healthy sample.
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Affiliation(s)
- Mei Xu
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Stevan Nikolin
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Adriano M Moffa
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
| | - Xiao Min Xu
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Yon Su
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Roger Li
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Ho Fung Chan
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
| | - Colleen K Loo
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia
- Black Dog Institute, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Donel M Martin
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, High St, Kensington, Sydney, NSW, 2052, Australia.
- Black Dog Institute, Sydney, Australia.
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Cole E, O'Sullivan SJ, Tik M, Williams NR. Accelerated Theta Burst Stimulation: Safety, Efficacy, and Future Advancements. Biol Psychiatry 2024; 95:523-535. [PMID: 38383091 PMCID: PMC10952126 DOI: 10.1016/j.biopsych.2023.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/23/2024]
Abstract
Theta burst stimulation (TBS) is a noninvasive brain stimulation technique that can be used to modulate neural networks underlying psychiatric and neurological disorders. TBS can be delivered intermittently or continuously. The conventional intermittent TBS protocol is approved by the U.S. Food and Drug Administration to treat otherwise treatment-resistant depression, but the 6-week duration limits the applicability of this therapy. Accelerated TBS protocols present an opportunity to deliver higher pulse doses in shorter periods of time, thus resulting in faster and potentially more clinically effective treatment. However, the acceleration of TBS delivery raises questions regarding the relative safety, efficacy, and durability compared with conventional TBS protocols. In this review paper, we present the data from accelerated TBS trials to date that support the safety and effectiveness of accelerated protocols while acknowledging the need for more durability data. We discuss the stimulation parameters that seem to be important for the efficacy of accelerated TBS protocols and possible avenues for further optimization.
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Affiliation(s)
- Eleanor Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Sean J O'Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California; Department of Psychiatry and Behavioral Sciences, Dell School of Medicine, Austin, Texas
| | - Martin Tik
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
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Vergallito A, Gramano B, La Monica K, Giuliani L, Palumbo D, Gesi C, Torriero S. Combining transcranial magnetic stimulation with training to improve social cognition impairment in schizophrenia: a pilot randomized controlled trial. Front Psychol 2024; 15:1308971. [PMID: 38445059 PMCID: PMC10912559 DOI: 10.3389/fpsyg.2024.1308971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Schizophrenia is a severe, chronic mental disorder that profoundly impacts patients' everyday lives. The illness's core features include positive and negative symptoms and cognitive impairments. In particular, deficits in the social cognition domain showed a tighter connection to patients' everyday functioning than the other symptoms. Social remediation interventions have been developed, providing heterogeneous results considering the possibility of generalizing the acquired improvements in patients' daily activities. In this pilot randomized controlled trial, we investigated the feasibility of combining fifteen daily cognitive and social training sessions with non-invasive brain stimulation to boost the effectiveness of the two interventions. We delivered intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Twenty-one patients were randomized into four groups, varying for the assigned stimulation condition (real vs. sham iTBS) and the type of cognitive intervention (training vs. no training). Clinical symptoms and social cognition tests were administered at five time points, i.e., before and after the treatment, and at three follow-ups at one, three, and six months after the treatments' end. Preliminary data show a trend in improving the competence in managing emotion in participants performing the training. Conversely, no differences were found in pre and post-treatment scores for emotion recognition, theory of mind, and attribution of intentions scores. The iTBS intervention did not induce additional effects on individuals' performance. The methodological approach's novelty and limitations of the present study are discussed.
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Affiliation(s)
| | - Bianca Gramano
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Kevin La Monica
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luigi Giuliani
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Palumbo
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
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Li J, Zhou W, Liang L, Li Y, Xu K, Li X, Huang Z, Jin Y. Noninvasive electrical stimulation as a neuroprotective strategy in retinal diseases: a systematic review of preclinical studies. J Transl Med 2024; 22:28. [PMID: 38184580 PMCID: PMC10770974 DOI: 10.1186/s12967-023-04766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/27/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Electrical activity has a crucial impact on the development and survival of neurons. Numerous recent studies have shown that noninvasive electrical stimulation (NES) has neuroprotective action in various retinal disorders. OBJECTIVE To systematically review the literature on in vivo studies and provide a comprehensive summary of the neuroprotective action and the mechanisms of NES on retinal disorders. METHODS Based on the PRISMA guideline, a systematic review was conducted in PubMed, Web of Science, Embase, Scopus and Cochrane Library to collect all relevant in vivo studies on "the role of NES on retinal diseases" published up until September 2023. Possible biases were identified with the adopted SYRCLE's tool. RESULTS Of the 791 initially gathered studies, 21 articles met inclusion/exclusion criteria for full-text review. The results revealed the neuroprotective effect of NES (involved whole-eye, transcorneal, transscleral, transpalpebral, transorbital electrical stimulation) on different retinal diseases, including retinitis pigmentosa, retinal degeneration, high-intraocular pressure injury, traumatic optic neuropathy, nonarteritic ischemic optic neuropathy. NES could effectively delay degeneration and apoptosis of retinal neurons, preserve retinal structure and visual function with high security, and its mechanism of action might be related to promoting the secretion of neurotrophins and growth factors, decreasing inflammation, inhibiting apoptosis. The quality scores of included studies ranged from 5 to 8 points (a total of 10 points), according to SYRCLE's risk of bias tool. CONCLUSION This systematic review indicated that NES exerts neuroprotective effects on retinal disease models mainly through its neurotrophic, anti-inflammatory, and anti-apoptotic capabilities. To assess the efficacy of NES in a therapeutic setting, however, well-designed clinical trials are required in the future.
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Affiliation(s)
- Jiaxian Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Wei Zhou
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Lina Liang
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China.
| | - Yamin Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Kai Xu
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Xiaoyu Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Ziyang Huang
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Yu Jin
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
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Poorganji M, Goeke K, Zomorrodi R, Voineskos D, Rajji TK, Daskalakis ZJ, Blumberger DM. The use of theta burst stimulation in patients with schizophrenia - A systematic review. Schizophr Res 2023; 261:245-255. [PMID: 37844414 DOI: 10.1016/j.schres.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Transcranial magnetic stimulation (TMS) can offer therapeutic benefits and provide value in neurophysiological research. One of the newer TMS paradigms is theta burst stimulation (TBS) which can be delivered in two patterns: continuous (cTBS - inducing LTD-like effects) and intermittent (iTBS - inducing LTP-like effects). This review paper aims to explore studies that have utilized TBS protocols over different areas of the cortex to study the neurophysiological functions and treatment of patients with schizophrenia. PubMed was searched using the following keywords "schizophrenia", "schizoaffective", or "psychosis", and "theta burst stimulation". Out of the 90 articles which were found, thirty met review inclusion criteria. The inclusion criteria included studying the reported effect (clinical, physiological, or both) of at least one session of TBS on human subjects, and abstracts (at minimum) must have been in English. The main target areas included prefrontal cortex (12 studies - 10 dorsolateral prefrontal cortex (DLPFC), 2 dorsomedial prefrontal cortex (DMPFC)) vermal cerebellum (5), and temporo-parietal cortex (8). Other target areas included inferior parietal lobe (2), and motor cortex (3). TBS neurophysiological effect was explored in 5 studies using functional magnetic resonance image (fMRI), magnetic resonance spectroscopy (MRS), electroencephalography (EEG), electromyography (EMG) and positron emission topography (PET) scan. Overall, TBS can offer great therapeutic potential as it is well-tolerated, feasible, and has few, if any, adverse effects. TBS may be targeted to treat specific symptomatology, as an augmenting intervention to pharmacotherapy, or even improving patient's insight into their diagnosis.
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Affiliation(s)
- Mohsen Poorganji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, USA
| | - Katharina Goeke
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada; Poul Hansen Family Centre for Depression, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, USA
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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