Repetitive transcranial magnetic stimulation can improve negative symptoms and/or neurocognitive impairments in the first psychosis episode: A randomized controlled trial

Qiang Hu; Xiong Jiao; YanYan Wei; XiaoChen Tang; LiHua Xu; HuiRu Cui; YeGang Hu; YingYing Tang; ZiXuan Wang; Tao Chen; HaiChun Liu; ChunBo Li; CuiXia An; JiJun Wang; TianHong Zhang

doi:10.1016/j.pnpbp.2024.111017

Repetitive transcranial magnetic stimulation can improve negative symptoms and/or neurocognitive impairments in the first psychosis episode: A randomized controlled trial

Prog Neuropsychopharmacol Biol Psychiatry. 2024 Jul 13:133:111017. doi: 10.1016/j.pnpbp.2024.111017. Epub 2024 Apr 23.

Authors

Qiang Hu¹, Xiong Jiao², YanYan Wei², XiaoChen Tang², LiHua Xu², HuiRu Cui², YeGang Hu², YingYing Tang², ZiXuan Wang³, Tao Chen⁴, HaiChun Liu⁵, ChunBo Li², CuiXia An⁶, JiJun Wang⁷, TianHong Zhang⁸

Affiliations

¹ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China; Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, China.
² Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China.
³ Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China.
⁴ Big Data Research Lab, University of Waterloo, Ontario, Canada; Labor and Worklife Program, Harvard University, MA, United States.
⁵ Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, China.
⁶ Hebei Technical Innovation Center, Mental Health Assessment and Intervention, Shijiazhuang 050031, Hebei Province, China; Hebei Clinical Research Center of Mental Disorders, Institute of Mental Health, Shijiazhuang 050031, Hebei Province, China. Electronic address: [email protected].
⁷ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China; Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China. Electronic address: [email protected].
⁸ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China. Electronic address: [email protected].

PMID: 38657896
DOI: 10.1016/j.pnpbp.2024.111017

Abstract

Objective: Negative symptoms and neurocognitive impairments in psychosis correlate with their severity. Currently, there is no satisfactory treatment. We aimed to evaluate and compare the effects of repetitive transcranial magnetic stimulation(rTMS) on negative symptoms and neurocognitive impairments in patients in first-episode of psychosis(FEP) in a randomized controlled trial(RCT).

Method: This is a single-site RCT of 85 patients with FEP. Patients were randomized to receive a 4-week course of active(n = 45) or sham rTMS(n = 40). Factor analysis was applied to a cross-sectional dataset of 744 FEP patients who completed negative symptom evaluation and neurocognitive battery tests. Two independent dimensions were generated and used for the K-means cluster analysis to produce sub-clusters. rTMS of 1-Hz was delivered to the right orbitofrontal(OFC) cortex.

Results: Two distinct dimensional factors of neurocognitive functions(factor-1) and negative symptoms(factor-2), and three clusters with distinctive features were generated. Significant improvements in factor-1 and factor-2 were observed after 4-weeks of rTMS treatment in both the active and sham rTMS groups. The repeated-measures analysis of variance revealed a significant effect of time×group(F = 5.594, p = 0.021, η² = 0.073) on factor-2, but no effect of time×group on factor-1. Only improvements in negative symptoms were significantly different between the active and sham rTMS groups(p = 0.028). Patients in cluster-3 characterized by extensive negative symptoms, showed greater improvement in the active rTMS group than in the sham rTMS group.

Conclusions: The 1-Hz right OFC cortex rTMS is more effective in reducing negative symptoms than neurocognitive impairments. It is especially effective in patients with dominantly negative symptoms in FEP.

Keywords: Brain stimulation; Low-frequency; Orbitofrontal cortex; Schizophrenia; rTMS.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Cognitive Dysfunction / etiology
Cognitive Dysfunction / therapy
Cross-Sectional Studies
Female
Humans
Male
Neuropsychological Tests / statistics & numerical data
Prefrontal Cortex
Psychiatric Status Rating Scales
Psychotic Disorders* / complications
Psychotic Disorders* / therapy
Transcranial Magnetic Stimulation* / methods
Treatment Outcome
Young Adult