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Lisoni J, Nibbio G, Baglioni A, Dini S, Manera B, Maccari A, Altieri L, Calzavara-Pinton I, Zucchetti A, Deste G, Barlati S, Vita A. Is It Possible to Combine Non-Invasive Brain Stimulation and Evidence-Based Psychosocial Interventions in Schizophrenia? A Critical Review. Brain Sci 2024; 14:1067. [PMID: 39595830 PMCID: PMC11591595 DOI: 10.3390/brainsci14111067] [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: 09/05/2024] [Revised: 10/24/2024] [Accepted: 10/26/2024] [Indexed: 11/28/2024] Open
Abstract
In schizophrenia, it was suggested that an integrated and multimodal approach, combining pharmacological and non-pharmacological interventions, could improve functional outcomes and clinical features in patients living with schizophrenia (PLWS). Among these alternatives, evidence-based psychosocial interventions (EBPIs) and Non-Invasive Brain Stimulation (NIBS) represent feasible treatment options targeting the clinical features that are unmet needs of PLWS (especially negative and cognitive symptoms). As no clear evidence is available on the combination of these non-pharmacological approaches, this review aimed to collect the available literature on the combination of EBPIs and NIBS in the treatment of PLWS. We demonstrated that the field of combining EBPIs and NIBS in schizophrenia is in its infancy, as only 11 studies were reviewed. In fact, only a few trials, with divergent results, combined these non-pharmacological modalities; while emerging evidence is available on the combination of cognitive remediation and rTMS/iTBS, inconclusive results were obtained. Conversely, albeit preliminary, more solid findings are available on the combination of HF-rTMS and family intervention. Moreover, despite the fact that cognitive activation could not be considered an EBPI, promising results are available in combination with tDCS to improve the working memory domain. To overcome these limitations, we considered several methodological issues to promote research in this field.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Antonio Baglioni
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Simona Dini
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Bianca Manera
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Alessandra Maccari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Luca Altieri
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Irene Calzavara-Pinton
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Andrea Zucchetti
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
- Department of Mental Health and Addiction Services, ASST Vallecamonica, 25040 Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (I.C.-P.); (A.Z.); (S.B.); (A.V.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (G.N.); (A.B.); (S.D.); (B.M.); (A.M.); (L.A.); (G.D.)
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Tikka SK, Godi SM, Siddiqui MA, Garg S. Evidence from Indian studies on safety and efficacy of therapeutic transcranial magnetic stimulation across neuropsychiatric disorders- A systematic review and meta-analysis. Indian J Psychiatry 2023; 65:18-35. [PMID: 36874512 PMCID: PMC9983459 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_572_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is potentially effective as an augmentation strategy in the treatment of many neuropsychiatric conditions. Several Indian studies have been conducted in this regard. We aimed to quantitatively synthesize evidence from Indian studies assessing efficacy and safety of rTMS across broad range of neuropsychiatric conditions. Fifty two studies- both randomized controlled and non-controlled studies were included for a series of random-effects meta-analyses. Pre-post intervention effects of rTMS efficacy were estimated in "active only" rTMS treatment arms/groups and "active vs sham" (sham-controlled) studies using pooled Standardized Mean Differences (SMDs). The outcomes were 'any depression', depression in unipolar/bipolar depressive disorder, depression in obsessive compulsive disorder (OCD), depression in schizophrenia, schizophrenia symptoms (positive, negative, total psychopathology, auditory hallucinations and cognitive deficits), obsessive compulsive symptoms of OCD, mania, craving/compulsion in substance use disorders (SUDs) and migraine (headache severity and frequency). Frequencies and odds ratios (OR) for adverse events were calculated. Methodological quality of included studies, publication bias and sensitivity assessment for each meta-analyses was conducted. Meta-analyses of "active only" studies suggested a significant effect of rTMS for all outcomes, with moderate to large effect sizes, at both end of treatment as well as at follow-up. However, except for migraine (headache severity and frequency) with large effect sizes at end of treatment only and craving in alcohol dependence where moderate effect size at follow-up only, rTMS was not found to be effective for any outcome in the series of "active vs sham" meta-analyses. Significant heterogeneity was seen. Serious adverse events were rare. Publication bias was common and the sham controlled positive results lost significance in sensitivity analysis. We conclude that rTMS is safe and shows positive results in 'only active' treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India. Conclusion rTMS is safe and shows positive results in "only active" treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India.
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Affiliation(s)
- Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sangha Mitra Godi
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - M Aleem Siddiqui
- Department of Psychiatry, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Wu Y, Yang Z, Cui S. Update Research Advances in the Application of Transcranial Magnetic Stimulation in the Treatment of Schizophrenia. SCANNING 2022; 2022:5415775. [PMID: 36160325 PMCID: PMC9484979 DOI: 10.1155/2022/5415775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Schizophrenia presents a chronic progressive course and requires long-term treatment. The current treatment of schizophrenia is mainly based on antipsychotic drugs, but drugs are ineffective for the negative symptoms and cognitive dysfunction of schizophrenia, and long-term medication may increase the burden on the endocrine and circulatory systems of patients. Repetitive transcranial magnetic stimulation is a noninvasive, painless, safe, efficacious, and economical physical therapy measure that has achieved good results in the treatment of schizophrenia. This paper reviews the progress of research on the clinical application of transcranial magnetic stimulation in the treatment of schizophrenia.
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Affiliation(s)
- Yanhai Wu
- The Third People's Hospital of Fuyang, Fuyang 236000, China
| | - Zucheng Yang
- Anhui Province Veterans Hospital, Bengbu 233000, China
| | - Shu Cui
- The Third People's Hospital of Fuyang, Fuyang 236000, China
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