| Popis: |
Introduction: Antipsychotics, although relatively effective on positive symptoms, have no consistent, reliable, and satisfactory effect on negative symptoms which may be more important for functional recovery of patients diagnosed with schizophrenia spectrum disorder (SSD). High frequency repetitive transcranial magnetic stimulation (rTMS) with H7-coil, targeting primarily the anterior cingulate cortex and medial prefrontal cortex may increase the cortical excitability and modulate the release of dopamine. Therefore, it is plausible hypothesis that it may have a beneficial effect on the negative psychotic symptoms. Objectives: To assess the efficacy of rTMS with H7-coil in twenty daily sessions augmentative to standard antipsychotic treatment of negative psychotic symptoms. Methods: A randomized sham-controlled, double- blind trial with concealed allocation and masked independent outcome assessment. Eligible were outpatients diagnosed with SSD, both genders, age 18-55 years, with higher negative and lower positive symptoms. The condition should had been stable and antipsychotic therapy unchanged for the minimum of three months. The primary outcome was The Scale for the Assessment of Negative Symptoms (SANS). Results: We randomized 25 patients in H7-coil, and 26 in sham-coil. Median (interquartile range) of age was 38 (27-48) years in H7 and 34 (24-44) years in sham arm. Two study groups were well balanced in large number of prognostic factors. Analysis was adjusted for age, gender, age at onset and duration of disorder, generation of antipsychotics, treatment with benzodiazepines and antidepressants, baseline scores of PANSS positive and negative symptoms subscales. SANS score was lowered in H7-coil group for -36 (95% CI -45 ; -28), and for -27 (95% CI -35 ; -19) in sham-coil group. Time x group interaction was significant (p = 0.035 ; η2 = 0.11 ; false discovery rate < 5%). We observed significant effects on blunting (p = 0.032) and alogia (p = 0.023), and no significant effects on avolition/apathy, anhedonia, and attention. Conclusions: It seems that rTMS with H7-coil as an adjunctive treatment might have beneficial effects on negative psychotic symptoms, but this effect is probably different in relation to different negative symptoms. |
