Neuromodulation Treatments for Schizophrenia

Abstract

Opinion Statement Schizophrenia is a psychiatric disorder that causes great suffering and debilitation worldwide. We have a multitude of medications that are effective for psychosis. However, these have not been successful in treating the negative and cognitive symptom domains of schizophrenia. These symptoms are responsible for the larger part of functional impairments that result from schizophrenia. In addition, there are many patients for whom no significant improvement is achieved even in the positive symptom domain. Hence, other treatment modalities have been explored to help these patients. Electroconvulsive therapy and transcranial magnetic stimulation are two of the most promising adjunct treatment methods for medication resistant schizophrenia. Electroconvulsive therapy is the gold standard treatment for catatonias whether associated with schizophrenia, mood disorders or other non-psychiatric disorders. Although not effective for negative symptoms, electroconvulsive therapy provides substantial augmentation to antipsychotic medications in improving positive symptoms and overall severity. Electroconvulsive therapy should be considered more often in patients with inadequate response to antipsychotic medications even when they do not have prominent affective symptoms. Transcranial magnetic stimulation has emerged as a promising useful therapeutic tool in targeting medication resistant auditory hallucinations and negative symptoms. Transcranial magnetic stimulation has proven to be very safe and well-tolerated by the patients in spite of its labor intensiveness. The incorporation of transcranial magnetic stimulation to routine clinical use awaits further studies to substantiate its efficacy and to optimize and customize treatment parameters to individual patients and their symptom patterns. Moreover, combining transcranial magnetic stimulation with electroconvulsive therapy to synergize their likely different mechanisms of action is another exciting possibility.

Electroconvulsive therapy for negative symptoms in schizophrenia: a literature review from 2000 to 2021

“…From the 35 included publications investigating the effect of ECT on schizophrenia, 16 were prospective interventional studies (Chanpattana & Chakrabhand, 2001a;Chanpattana & Kramer, 2003;Chanpattana & Sackeim, 2010;Ipekcioglu et al, 2018;Jia et al, 2019;Kho et al, 2004;Li et al, 2016;Masoudzadeh et al, 2007;Pawełczyk et al, 2014aPawełczyk et al, , 2014bPetrides et al, 2015;Tang & Ungvari, 2001Zhang et al, 2012), two naturalistic observation studies (Kim et al, 2018;Usta Saglam et al, (Bansod et al, 2018), one retrospective controlled study (Jia et al, 2019) and one retrospective chart review (Xiang et al, 2015). Six literature reviews (Chanpattana, 2007;Chanpattana & Andrade, 2006;Dokucu, 2015;Hasan et al, 2015b;Lehnhardt et al, 2012;Remington et al, 2016), two systematic reviews (Sinclair et al, 2019;Tharyan & Adams, 2005) and two meta-analyses (Ahmed et al, 2017;Zheng et al, 2016), giving an overview of some aspects of the effect of ECT on schizophrenia, were also included in this review.…”

“…The eight reviews and the two meta-analyses came to mixed conclusions about the effect of ECT on negative symptoms. Citing insufficient data, Hasan et al (2015b), Remington et al (2016), Ahmed et al (2017) and Dokucu (2015) did not draw final conclusions on the effect of ECT on negative symptoms. It was concluded by Tharyan and Adams (2005) that a small amount of literature shows a significant reduction of negative symptoms by ECT and a better effect of the combination of ECT and antipsychotics compared to monotherapy (Tharyan & Adams, 2005), according to Ahmed et al (2017) especially in combination with clozapine.…”

“…In the studies reviewed, only two of them focused explicitly on negative symptoms (Pawełczyk et al, 2014a(Pawełczyk et al, , 2014b). The included reviews (Chanpattana, 2007;Chanpattana & Andrade, 2006;Dokucu, 2015;Hasan et al, 2015b;Lehnhardt et al, 2012;Remington et al, 2016;Sinclair et al, 2019;Tharyan & Adams, 2005) provided an overview of ECT for schizophrenia, especially for the time period before 2000, which was helpful to see the development of studies on this topic. Nonetheless, our literature review focuses on ECT for negative symptoms and there is not much research published on the topic before the respective period of time.…”

“…More studies on this topic and related symptoms are urgently needed to reduce the uncertainty surrounding the efficacy of ECT on negative symptoms. Unfortunately, the included literature reviews of Dokucu (2015), Hasan et al (2015b), Lehnhardt et al (2012) and Remington et al (2016) do not provide detailed information on the treatment plans of their included studies, so that no comparison could be made with our review in this respect. Preliminary searches of databases used in this study for ECT and schizophrenia with manifestations of either positive, negative, depressive, manic, psychomotor, or cognitive symptoms reveals that some symptoms receive little research attention, especially in comparison to other co-occurring symptoms (see Fig.…”

Holistic Solutions to Schizophrenia Management in Geriatric Populations

“…Neuromodulatory treatments, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), pose safer and more effective alternatives to elderly patients with medicationresistant schizophrenia [67]. ECT induces seizures in the human brain using small electrical currents [68].…”