Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada.
Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
Schizophr Res. 2022 May;243:349-360. doi: 10.1016/j.schres.2021.06.009. Epub 2021 Jun 26.
Novel treatment modalities, such as non-invasive brain stimulation (NIBS), typically focus on patient groups that have failed multiple treatment interventions. Despite its promise, the clinical translation of NIBS in schizophrenia has been limited. One important obstacle to implementation is the inconsistent reporting of treatment resistance in the clinical trial literature contributing to heterogeneity in reported effects. In response, we develop a numerical approach to synthesize quality of assessment of Treatment-Resistant Schizophrenia (TRS) and apply this to studies investigating therapeutic response to NIBS in patients with schizophrenia. Literature search conducted through PubMed database identified 119 studies investigating Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation in treating resistant schizophrenia symptoms. A quality score out of 11 was assigned to each study based on adherence to the international consensus guidelines for TRS developed by the Treatment Response and Resistance in Psychosis (TRRIP) group. Results revealed an overall paucity of studies with thorough assessment and/or reporting of TRS phenomenon, as evidenced by a mean quality score of 3.38/11 (SD: 1.01) for trials and 5.16/11 (SD: 1.57) for case reports, though this improved minimally since the publication of consensus criteria. Most studies considered treatment-resistance as a single dimensional construct by reporting resistance of a single symptom, and failed to establish treatment adherence, resistance time course and functional impairment. We conclude that the current NIBS literature in schizophrenia do not reflect its true effects on treatment-resistance. There is an urgent need to improve assessment and reporting standards of clinical trials that target TRS.
新的治疗方式，如非侵入性脑刺激（NIBS），通常针对那些已经多次治疗干预失败的患者群体。尽管有很大的前景，但 NIBS 在精神分裂症中的临床应用一直受到限制。一个重要的实施障碍是临床试验文献中对治疗抵抗的报告不一致，导致报告的效果存在异质性。针对这一问题，我们开发了一种综合评估治疗抵抗性精神分裂症（TRS）的数值方法，并将其应用于研究非侵入性脑刺激治疗精神分裂症患者的治疗反应。通过 PubMed 数据库进行文献检索，确定了 119 项研究，这些研究调查了经颅磁刺激和经颅电刺激治疗抵抗性精神分裂症症状的效果。根据治疗反应和精神分裂症抵抗性（TRRIP）小组制定的国际共识指南，对每一项研究进行了 11 分制的质量评分。结果显示，尽管自共识标准发布以来，情况略有改善，但总体上缺乏对 TRS 现象进行全面评估和/或报告的研究，试验的平均质量评分为 3.38/11（SD：1.01），病例报告的平均质量评分为 5.16/11（SD：1.57）。大多数研究通过报告单一症状的抵抗来将治疗抵抗视为单一维度的构念，并且未能确定治疗依从性、抵抗时间过程和功能障碍。我们得出结论，目前精神分裂症的非侵入性脑刺激文献并不能反映其对治疗抵抗的真实效果。迫切需要改进针对治疗抵抗的临床试验的评估和报告标准。
