Brief Psychotic Disorder, Schizoaffective Disorder, Schizophrenia, Schizophrenia and Related Disorders
Conditions
Keywords
motor behavior, psychomotor slowing, psychosis
Brief summary
Psychomotor slowing is a major problem in psychosis. Aberrant function of the cerebral motor system is linked to psychomotor slowing in patients, particularly resting state hyperactivity in premotor cortices. A previous clinical trial indicated that inhibitory stimulation of the premotor cortex would reduce psychomotor slowing. The current study is further exploring this effect in a randomized, placebo-controlled, double-blind design with three arms of transcranial magnetic stimulation and measures of brain imaging and physiology prior to and after the intervention.
Detailed description
As psychomotor slowing is a major problem in schizophrenia, contributing to poor functional outcome, and as no current treatment is effectively targeting psychomotor slowing, this study seeks to test noninvasive brain stimulation to overcome psychomotor slowing. Previous studies documented an aberrant increase of neural activity within the supplementary motor area (SMA) in patients with schizophrenia who had psychomotor slowing. Furthermore, a pilot study in major depression and schizophrenia indicated that inhibitory 1 Hz repetitive transcranial magnetic stimulation (rTMS) would improve psychomotor slowing in 82% of the participants. While this is encouraging, further evidence is needed to 1) replicate the clinical effect of 1 Hz rTMS on the SMA in schizophrenia, 2) to test against sham stimulation, facilitatory stimulation and no intervention, and 3) to test the effects of rTMS on the neural circuitry. Therefore, OCoPS includes more patients, more treatment arms, and more outcome variables than the first pilot trial. Here we will enroll 88 patients with schizophrenia spectrum disorders and severe psychomotor slowing according to a standard rating scale. Subjects will be randomized to four arms, three of which are double blinded. three weeks of daily rTMS over the SMA will be delivered. The first group receives inhibitory 1 Hz rTMS, the second group receives facilitatory intermittent theta burst stimulation (iTBS), and the third group receives sham stimulation with a placebo-coil. The fourth group will have no rTMS during the first three weeks, but will repeat the baseline measures after three weeks and then enter a treatment with 1Hz rTMS for three weeks. Outcome measures include the Salpetriere Retardation Rating Scale, observer ratings of motor behavior as well as measures of functioning. After the interventions, follow-up visits are planned at week 6 and week 24. Finally, at baseline and after the rTMS course, patients will undergo MRI scanning for structural and functional alterations of the cerebral motor system.
Interventions
DEVICE1 Hz rTMS
1 Hz stimulation at 110% of resting motor threshold over supplementary motor area
DEVICEiTBS
50 Hz theta burst stimulation at 80% of resting motor threshold over supplementary motor area
DRUGPlacebo
1 Hz stimulation with the placebo TMS coil without any magnetic emission
Sponsors
University of Bern
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Masking description
Participants will not know the stimulation protocol, neither will the outcome assessor or the mental health care provider know the protocol applied
Intervention model description
3 week intervention with 15 sessions of add-on rTMS in 4 parallel arms, randomized, double-blind, placebo-controlled
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Right-handed subjects * Ability and willingness to participate in the study * Ability to provide written informed consent * Informed Consent as documented by signature * Schizophrenia spectrum disorder according to diagnostic and statistical manual version 5 (DSM-5) criteria with current psychomotor slowing according to the Salpetriere Retardation Rating Scale (SRRS), score \>= 15
Exclusion criteria
* Substance abuse or dependence other than nicotine * Past or current medical or neurological condition associated with impaired or aberrant movement, such as brain tumors, stroke, M. Parkinson, M. Huntington, dystonia, or severe head trauma with subsequent loss of consciousness. * Epilepsy or other convulsions * History of any hearing problems or ringing in the ears * Standard
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of responders at week 3 | Week 3 | Proportion of participants with \>30% reduction from baseline in the Salpetriere Retardation Rating Scale (SRRS) |
| Change in Salpetriere Retardation Rating Scale (SSRS) from baseline | Week 3, week 6, week 24 | Change in the Salpetriere Retardation Rating Scale (SRRS) from baseline; the total score of 15 items is used, ranging 0-60 with higher scores indicating worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in psychosis severity from baseline | Week 3, week 6, week 24 | Change in the Positive And Negative Symptom Scale (PANSS) from baseline, PANSS total score assesses the severity of positive, negative and general symptoms, ranging from 30-210 with higher scores indicating increased symptom severity, i.e. poorer outcome |
| Change in physical activity self report from baseline | Week 3, week 6, week 24 | Change in the International Physical Activity Questionnaire (IPAQ), the total score is used ranging from 0-70000 metabolic equivalent (MET) |
| Change in objectively measured physical activity from baseline | Week 3, week 6, week 24 | Change in the activity levels using wrist actigraphy |
| Change in dexterity from baseline | Week 3, week 6, week 24 | Change in the coin rotation task from baseline |
| Change in catatonia severity from baseline to week 3 | Week 3, week 6, week 24 | Observer based rating of catatonia severity with the Bush Francis Catatonia Rating Scale (BFCRS), assessment blind to intervention, total score of the BFCRS is used ranging 0-69 , with higher scores indicating poorer outcome |
| Change in social and community functioning | Week 3, week 6, week 24 | Change in Social and Occupational Functional Assesment Scale (SOFAS) from baseline, the score ranges from 0-100 with higher scores indicating better functioning, i.e. better outcome |
| Change in functional capacity | Week 3, week 6, week 24 | Change in the Score of the brief version of the University of California, San Diego, Performance-Based Skills Assessment (UPSA-brief) assessment from baseline, higher scores indicating better function, the total score is used ranging 0-100 |
| Change in functional connectivity | Week 3 | Change in the resting state functional connectivity within the cerebral motor system based on functional magnetic resonance imaging scans from baseline |
| Change in resting state cerebral perfusion | Week 3 | Change in the resting state cerebral perfusion within the cerebral motor system based on functional magnetic resonance imaging scans from baseline |
| Change in cortical excitability of the motor cortex from baseline | Week 3, week 6, week 24 | Change in Short Interval Cortical Inhibition (SICI) from baseline |
| Change in negative symptoms from baseline | Week 3, week 6, week 24 | Change in the Brief Negative Symptom Scale (BNSS) from baseline, total score is used, ranging from 0-78 with higher values indicating poorer outcome, i.e. more negative symptom severity |
Countries
Switzerland
Outcome results
None listed