Li Jing, Jiang Dan, Huang Xingyu, Wang Xiao, Xia Tingting, Zhang Wei
Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
Psychiatry Department, Jinxin Mental Hospital, Chengdu, China.
Psychiatry Clin Neurosci. 2025 Apr;79(4):147-157. doi: 10.1111/pcn.13779. Epub 2025 Jan 30.
This study aims to assess the therapeutic effects of intermittent theta burst stimulation (iTBS) targeting the bilateral dorsomedial prefrontal cortex (DMPFC) on negative symptoms in patients with schizophrenia, utilizing functional near-infrared spectroscopy for evaluation.
Thirty-five schizophrenia patients with negative symptoms and moderate to severe cognitive impairment were randomly assigned to a treatment group (n = 18) or a control group (n = 17). The treatment group received iTBS via bilateral DMPFC. Negative symptoms, cognitive function, emotional state, and social function were assessed using Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Montreal Cognitive Assessment (MoCA), Calgary Depression Scale for Schizophrenia (CDSS), and Social Dysfunction Screening Questionnaire (SDSS) scales at pretreatment, posttreatment, and follow-up at 4, 8, and 12 weeks. Brain activation in regions of interest (ROIs) was evaluated through verbal fluency tasks.
Prior to treatment there was no significant difference in the two groups. After 20 iTBS sessions, a significant difference was observed in SANS total score, its related subscales, PANSS total score, and PANSS-negative symptoms (all P < 0.05). The group-by-time interaction showed statistical significance, indicating improvements in negative symptoms and related dimensions over time, with therapeutic effects persisting for at least 8 weeks posttreatment. Prior to treatment, there were no significant differences in activation across all ROIs between the two groups. Posttreatment, the activation of right inferior frontal gyrus (t = 2.19, P = 0.036) and right frontal eye field (t = 2.14, P = 0.04) in the treatment group was significantly higher than in the control group.
iTBS stimulation of bilateral DMPFC demonstrates therapeutic effects in improving negative symptoms in schizophrenia patients, and this treatment approach has the potential to enhance activation within the prefrontal cortex.
本研究旨在利用功能近红外光谱技术评估针对双侧背内侧前额叶皮质（DMPFC）的间歇性θ波爆发刺激（iTBS）对精神分裂症患者阴性症状的治疗效果。
35例伴有阴性症状且有中度至重度认知障碍的精神分裂症患者被随机分为治疗组（n = 18）和对照组（n = 17）。治疗组接受经双侧DMPFC的iTBS治疗。在治疗前、治疗后以及4周、8周和12周随访时，使用阳性与阴性症状量表（PANSS）、阴性症状评估量表（SANS）、蒙特利尔认知评估量表（MoCA）、精神分裂症卡尔加里抑郁量表（CDSS）和社会功能缺陷筛选问卷（SDSS）对阴性症状、认知功能、情绪状态和社会功能进行评估。通过言语流畅性任务评估感兴趣区域（ROIs）的脑激活情况。
治疗前两组之间无显著差异。经过20次iTBS治疗后，SANS总分及其相关子量表、PANSS总分和PANSS阴性症状均有显著差异（均P < 0.05）。组间时间交互作用具有统计学意义，表明阴性症状及相关维度随时间有所改善，治疗效果在治疗后至少持续8周。治疗前，两组所有ROIs的激活情况无显著差异。治疗后，治疗组右侧额下回（t = 2.19，P = 0.036）和右侧额眼区（t = 2.14，P = 0.04）的激活明显高于对照组。
iTBS刺激双侧DMPFC对改善精神分裂症患者的阴性症状具有治疗效果，且这种治疗方法有可能增强前额叶皮质内的激活。
