Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review.

Transcranial magnetic stimulation (TMS) has been proposed as a potential treatment add-on for positive symptoms in schizophrenia. To summarize the current evidence for its efficacy, we reviewed clinical trials from the last 20 years that investigated TMS for positive symptoms. We performed a search on the PubMed database for clinical trials that used TMS for the treatment of positive symptoms published in peer-reviewed journals. We excluded reviews, case reports, and opinion papers. Of the 30 studies included, the majority (n = 25) investigated auditory verbal hallucinations. Twelve studies found evidence for a positive treatment effect of TMS on positive symptoms, while 18 did not find enough evidence to conclude that TMS is effective for positive symptoms. However, the small sample size of the majority of studies is a limiting factor for the reliability of previous findings. In conclusion, evidence for an effect of TMS on positive symptoms was mixed. Since most of the studies were performed in patients with auditory verbal hallucinations, further research of TMS for other positive symptoms including thought disorder and delusions is warranted.

Electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD): A modified study protocol.

OBJECTIVE: This study began as a single-blind randomized controlled trial (RCT) to investigate the efficacy and safety of electroconvulsive therapy (ECT) for severe treatment-refractory agitation in advanced dementia. The aims are to assess agitation reduction using the Cohen-Mansfield Agitation Inventory (CMAI), evaluate tolerability and safety outcomes, and explore the long-term stability of agitation reduction and global functioning. Due to challenges encountered during implementation, including recruitment obstacles and operational difficulties, the study design was modified to an open-label format and other protocol amendments were implemented. METHODS: Initially, the RCT randomized participants 1:1 to either ECT plus usual care or simulated ECT plus usual care (S-ECT) groups. As patients were enrolled, data were collected from both ECT and simulated ECT (S-ECT) patients. The study now continues in an open-label study design where all patients receive actual ECT, reducing the targeted sample size from 200 to 50 participants. RESULTS: Study is ongoing and open to enrollment. CONCLUSION: The transition of the ECT-AD study design from an RCT to open-label design exemplifies adaptive research methodologies in response to real-world challenges. Data from both the RCT and open-label phases of the study will provide a unique perspective on the role of ECT in managing severe treatment-refractory agitation in dementia, potentially influencing future clinical practices and research approaches.

Peripheral Blood Levels of Brain-Derived Neurotrophic Factor in Patients with First Episode Psychosis: A Systematic Review and Meta-Analysis.

Background: Peripheral blood level of brain-derived neurotrophic factor (BDNF) may be used as a diagnostic and/or prognostic marker for schizophrenia. Previous studies were inconsistent. A systematic review was conducted to examine whether BDNF level is different in patients with first episode psychosis (FEP) compared to health controls (HC) and whether it changes after treatment. Methods: Literature search was done in PubMed, Web of Science, and Google Scholar following standard procedures. Hedges' g was used as the measure of effect size (ES), which was pooled with random effects model. Publication bias and moderator effects were examined. Results: Search yielded 29 studies with a total sample size of 2912. First meta-analysis included 27 studies with FEP vs. HC comparison. Pooled ES was −0.63, p < 0.001, indicating that BDNF level was lower in FEP than in HC. Studies were heterogeneous, and moderator analysis showed that studies of younger patient, higher symptom severity, and more drug naïve had larger ES. Second meta-analysis examined change in BDNF levels before and after antipsychotic treatment in eight studies. A pooled ES of −0.003 (p = 0.96) showed no change in peripheral BDNF level after treatment. Conclusion: Peripheral BDNF level was decreased in FEP compared to HC, but it did not change after treatment.