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Maintenance Repetitive Transcranial Magnetic Stimulation (rTMS) Weakly Improved Treatment Effect in Patients with Treatment-Resistant Schizophrenia Who Responded to maintenance ECT and Adjunct Olanzapine Treatment – A Pilot Study

Dali Xu 1 , Gongying Li 2 , Yonghui Zhang 3 , Deguo Jiang 1 , Hongjun Tian 4 , Wenqiang Wang 5 , Xiaodong Lin 1 , Chunjun Zhuo 4 6 2 1 , Jinliang Zhang 6
1.

Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People’s Hospital, Wenzhou

2.

Department of Biological Psychiatry, School of Mental Health, Jining Medical University, Jining

3.

Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, Tianjin

4.

Department of Psychiatry, The Fourth Center Hospital of Tianjin, Tianjin

5.

Canada and China Joint Laboratory of Biological Psychiatry, Xiamen Xianye Hospital, Xiamen

6.

Department of Psychiatry, Wenzhou Kangning Hospital, Wenzhou, China

Psychiatry and Clinical Psychopharmacology 2020; 30: 254-263
DOI: 10.5455/PCP.20200229104954
Keywords : TRS, rTMS, gFCD, antipsychotics, PANSS, MCCB
Read: 1159 Downloads: 711 Published: 20 January 2021
Volume 30, Issue 3, August 2020
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Background: Maintenance treatment with electroconvulsive therapy (ECT) and adjunct antipsychotics can alleviate symptoms of treatment-resistant schizophrenia (TRS), although cognitive impairment is a side effect. Transcranial magnetic stimulation (TMS) has alleviated symptoms and improved cognitive impairment caused by maintenance ECT treatment. This study aimed to investigate long-term treatment effects of maintenance repetitive TMS combined with maintenance ECT and Olanzapine (MTEO) treatment strategy on TRS patients.

Methods: Eighty TRS patients underwent MTEO or sham-MTEO treatments for 112 weeks. Severity of illness and patient cognition were evaluated with Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB), respectively. Global functional connectivity density (gFCD) was used to assess alterations in brain activity.

Results: Compared to the sham-MTEO group, the MTEO group exhibited an increase in mean MCCB total score [140.8 ± 17.5 vs. 165.5 ± 10.2, respectively; P < 0.05]. Compared to baseline, reductions in PANSS scores were significant in both groups. Also compared to baseline, a marked increase in gFCD was only observed in the left prefontal lobe, parietal lobe, and insular lobe in the MTEO group (FWE correct, P < 0.01). The sham-MTEO group exhibited an increase in gFCD in the temporal lobe and anterior cingulated cortex at baseline. In the striatum, gFCD decreased in both groups.

Conclusions: This novel MTEO treatment for TRS patients improved cognitive ability based on PANSS and MCCB scores, and this improvement may be related to increased brain activity in the prefontal, parietal, and insular lobes. Thus, further study of this treatment approach is warranted.

To cite this article: Xu D, Li G, Zhang Y, Jiang D, Tian H, Wang W, Lin X, Zhuo C, Zhang J. Maintenance Repetitive Transcranial Magnetic Stimulation (rTMS) Weakly Improved Treatment Effect in Patients with Treatment-Resistant Schizophrenia Who Responded to maintenance ECT and Adjunct Olanzapine Treatment – A Pilot Study. Psychiatry and Clinical Psychopharmacology 2020;30(3):254-263

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