Johnstone Samantha, Sorkhou Maryam, Al-Saghir Nada, Lowe Darby J E, Steele Vaughn R, Pearlson Godfrey D, Castle David J, George Tony P
Addictions Division, Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
Olin Center for Neuropsychiatric Research, Institute of Living, Hartford, CT, United States.
Front Psychiatry. 2022 Feb 14;13:793938. doi: 10.3389/fpsyt.2022.793938. eCollection 2022.
Substance use disorders (SUDs) are a common yet poorly studied comorbidity in individuals with psychotic disorders. The co-occurrence of the two complicates recovery and interferes with pharmacological and behavioral treatment response and adherence. Recently, researchers have been exploring both invasive and non-invasive neuromodulation techniques as potential treatment methods for SUDs. We review the evidence that neuromodulation may reduce substance craving and consumption in individuals with schizophrenia.
A comprehensive literature search of PubMed, MEDLINE, and PsycINFO databases was conducted ( = 1,432). Of these, we identified seven studies examining the effects of repetitive transcranial magnetic stimulation (rTMS) and two studies using transcranial direct current stimulation (tDCS) on drug consumption and craving in schizophrenia or schizoaffective disorders.
Despite the limited number of studies in this area, the evidence suggests that rTMS to the dorsolateral prefrontal cortex (DLPFC) may reduce cannabis and tobacco use in patients with schizophrenia and schizoaffective disorder. Findings with tDCS, however, were inconclusive.
Our systematic review suggests that rTMS applied to DLPFC is a safe and promising therapeutic technique for the management of comorbid schizophrenia and SUDs, with the majority of the evidence in tobacco use disorder. However, there was substantial heterogeneity in study methods, underscoring the need to optimize stimulation parameters (e.g., frequency, duration, and target regions). Larger clinical trials are needed to establish the efficacy of rTMS in reducing drug consumption and craving in psychotic patients, ideally in comparison to existing pharmacological and behavioral interventions.
物质使用障碍（SUDs）在患有精神障碍的个体中是一种常见但研究较少的共病情况。这两种疾病的同时存在使康复变得复杂，并干扰药物和行为治疗的反应及依从性。最近，研究人员一直在探索侵入性和非侵入性神经调节技术作为SUDs的潜在治疗方法。我们综述了神经调节可能减少精神分裂症患者对物质的渴望和使用的证据。
对PubMed、MEDLINE和PsycINFO数据库进行了全面的文献检索（n = 1432）。其中，我们确定了七项研究重复经颅磁刺激（rTMS）效果的研究，以及两项使用经颅直流电刺激（tDCS）对精神分裂症或分裂情感性障碍患者药物使用和渴望影响的研究。
尽管该领域的研究数量有限，但证据表明，对背外侧前额叶皮质（DLPFC）进行rTMS可能会减少精神分裂症和分裂情感性障碍患者的大麻和烟草使用。然而，tDCS的研究结果尚无定论。
我们的系统综述表明，应用于DLPFC的rTMS是治疗精神分裂症和SUDs共病的一种安全且有前景的治疗技术，大部分证据集中在烟草使用障碍方面。然而，研究方法存在很大异质性，这突出了优化刺激参数（如频率、持续时间和目标区域）的必要性。需要进行更大规模的临床试验来确定rTMS在减少精神病患者药物使用和渴望方面的疗效，理想情况下与现有的药物和行为干预措施进行比较。
