Wang Mingqi, Lu Shensen, Hao Lu, Xia Yifei, Shi Zhenchun, Su Lei
Department of Rehabilitation Medicine, Shandong Mental Health Center, Shandong University, Jinan, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Psychiatry. 2024 May 28;15:1377257. doi: 10.3389/fpsyt.2024.1377257. eCollection 2024.
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.
To investigate placebo effects of rTMS on alleviating negative symptoms and cognitive impairment in patients with SSD and to explore potential moderators.
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.
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, 0.001), memory (g=0.31, 0.010), executive function (g=0.35, 0.001), working memory (g=0.26, 0.004), and processing speed (g=0.36, 0.004). Subgroup analysis indicated that placebo effects were affected by sham stimulation methods, rTMS targeting approaches, and stimulation frequency.
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.
https://www.crd.york.ac.uk/prospero/, identifier CRD42023390138.
阴性症状和认知障碍在精神分裂症谱系障碍（SSD）中极为常见，与不良的功能结局和生活质量相关。重复经颅磁刺激（rTMS）被认为是SSD中有前景的治疗选择。然而，rTMS对这些症状的安慰剂效应仍不明确。
探讨rTMS对SSD患者阴性症状和认知障碍的安慰剂效应，并探索潜在的调节因素。
我们系统检索了截至2023年7月15日的五个电子数据库。纳入研究rTMS对SSD患者阴性症状或认知影响的随机、双盲、假刺激对照试验。使用随机效应模型估计以Hedges' g表示的合并安慰剂效应量。通过亚组分析和meta回归探索潜在的调节因素。
纳入了44项随机对照试验，假刺激组有961例患者（平均年龄37.53岁；28.1%为女性）。观察到阴性症状（g=0.44，P=0.001）、记忆（g=0.31，P=0.010）、执行功能（g=0.35，P=0.001）、工作记忆（g=0.26，P=0.004）和处理速度（g=0.36，P=0.004）有显著的低至中度合并安慰剂效应量。亚组分析表明，安慰剂效应受假刺激方法、rTMS靶向方法和刺激频率的影响。
rTMS对SSD患者阴性症状和认知的安慰剂效应在小到中等程度上是显著的，这可能由rTMS参数介导。我们的研究结果将为从业者提供新的见解，以便进一步优化并建立标准化的rTMS方案，用于未来针对SSD主要症状的随机对照试验。
