Schizophrenia and Related Disorders
Conditions
Keywords
Schizophrenia, repetitive transcranial magnetic stimulation
Brief summary
Around 40% of schizophrenia patients present depressive symptoms, which are associated with elevated suicide and violence risk and poor prognosis and quality of life. Recent meta-analysis showed the effect size of antidepressants for depressive symptoms of schizophrenia patients was as low as 0.25, so new therapeutic approach is warranted. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free brain stimulation therapy for treatment refractory depression. Currently, rTMS is classified as high-frequency stimulation (\>5Hz, usually 10Hz or 20Hz) and low-frequency inhibition (usually 1Hz). Intermittent theta burst stimulation (iTBS) is a new variant of rTMS, with stimulation frequency as high as 50Hz. Compared with high-frequency rTMS, iTBS has similar therapeutic effect and shorter stimulation duration. Up to now, studies exploring treatment effect of rTMS or iTBS for schizophrenia patients mainly focused on negative symptoms rather than depressive symptoms. Therefore, this study aims to explore treatment effect of rTMS or iTBS of depressive symptoms, negative symptoms, cognitive function and physiological indices for schizophrenia patients.
Interventions
DEVICERepetitive Transcranial Magnetic Stimulation
rTMS using Magstim TMS system is delivered at the left dorsolateral prefrontal cortex
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 20 years * Able to give informed consent * Diagnosed with schizophrenia or schizoaffective disorder according to DSM-5 * Has a score ≥ 7 on Calgary depression scale for schizophrenia * The principal psychotropic agents are not changed within one month of the first session of rTMS
Exclusion criteria
* DSM-5 defined substance use disorder (excluding tobacco) in the past 3 months * Have clinically relevant cognitive impairment (e.g., delirium, intellectual disability or MMSE \< 15) * With electronic and/or magnetic implants (e.g. pacemaker, implantable cardioverter defibrillator \[ICD\], cerebral shunts, cochlear implant, etc.) * With metallic or mechanic fragments (e.g., screws, plates, stents, clips, etc.) * Pregnant, or has a pregnancy plan within 3 months * With any known or history of neurological conditions including cerebral vascular accidents, epilepsy (or epileptiform waves detected by EEG prior to the first session of rTMS), brain tumor or space occupying lesion * Received rTMS or iTBS treatment within 3 months * Has a clinically significant abnormality on the screening examination that might affect safety, study participation, or confound interpretation of study results
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in Calgary Depression Scale for Schizophrenia | baseline (Day 1), Day 8, Day 15, Day 29, Day 57, Day 85 | A 9-item scale developed for detecting major depressive episode for schizophrenia patients. Total score ranges from 0 to 27. Lower score indicates less depressive symptoms. A cut-off of 7 points yields to sensitivity of 85% and specificity of 82%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in Positive and Negative syndrome scale | baseline (Day 1), Day 8, Day 15, Day 29, Day 57, Day 85 | A 30-item scale developed to evaluating positive, negative and general symptoms for schizophrenia patients. Total score ranges from 30 to 210. Lower score indicates fewer schizophrenic symptoms. |
| Change from Baseline in Negative symptoms assessment 16 | baseline (Day 1), Day 8, Day 15, Day 29, Day 57, Day 85 | A scale developed to evaluating negative symptoms for schizophrenia patients. Items are scored based on behaviors during the interview (items 1-4, 6, 7, 9, 11, 15, 16) or previous 7 days (items 5, 8, 10, 12-14) on a 6-point scale from 1 to 6. The NSA-16 domain scores are the sum of item scores in each domain i.e. communication (min score 4, max score 24), emotion/affect (min 3, max 18), social involvement (min 3, max 18), motivation (min 4, max 24), and retardation (min 2, max 12); with higher scores denoting more severe negative symptoms in schizophrenia. |
| Change from Baseline in Clinical global impression | baseline (Day 1), Day 8, Day 15, Day 29, Day 57, Day 85 | A scale for primary-care psychiatrist to evaluate global symptom severity of a patient in comparison with others with same diagnosis. Lower score indicates less severe illness. |
| Change from Baseline in Self-Reported Graphic version of the Personal and Social Performance Scale | baseline (Day 1), Day 8, Day 15, Day 29, Day 57, Day 85 | A 22-item self-rated scale for schizophrenia patients, which includes four domains, i.e., global function (6 items, total scores 6-18), personal and social performance (5 items, total scores 5-15), self-care (6 items, total scores 6-18) and disturbing behaviors (5 items, total scores 5-15). Lower score indicates less severe illness. |
Countries
Taiwan
Contacts
CONTACTChia-Hao Ma, MD
PRINCIPAL_INVESTIGATORChia-Hao Ma, MD
Department of Psychiatry, National Taiwan University Hospital Yunlin Branch
Outcome results
None listed