Navigated and individual α-peak-frequency-guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia.

BACKGROUND: Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia. METHODS: We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention. RESULTS: We included 44 patients. After treatment, we observed a significantly higher PANSS total score (p = 0.029), PANSS general psychopathology score (p = 0.027) and PANSS 5-factor model cognitive-disorganized factor score (p = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation (p = 0.048). LIMITATIONS: The limited number of study participants included only male patients. Depression was not formally evaluated. CONCLUSION: Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia. CLINICAL TRIAL REGISTRATION: NCT01941251; ClinicalTrials.gov.

Group psychoeducation for long-term offender patients with schizophrenia: an exploratory randomised controlled trial.

BACKGROUND: Psychoeducation is now commonly provided in forensic settings, but its effectiveness among long-term offender patients with schizophrenia has not yet been established in randomised controlled trials (RCTs). AIM: To test the effects of a brief group psychoeducation programme for offenders with schizophrenia (n = 39) resident in a high-security hospital (Niuvanniemi Hospital, Finland). METHOD: High-security hospital patients were randomised into either eight sessions of group psychoeducation or 'treatment as usual' (TAU). Outcome measures, made at baseline, immediately post-treatment, and 3 months after that, included knowledge about illness, insight, compliance, attitudes towards medication, psychiatric symptoms and ward behaviour, self-esteem, health-related quality of life and perceived stigma. RESULTS: Three months after completing treatment, or an equivalent time under TAU, patients in the intervention group showed a positive treatment effect in terms of knowledge about illness, self-esteem and insight into the illness. The only possible adverse effect was a slight increase in irritability, but this did not translate into behaviour of concern to staff. CONCLUSIONS: Our sample size was small, and the findings must be regarded as preliminary, but the positive treatment effect of psychoeducation, and the absence of alarming side effects, suggests a full scale trial would be worthwhile. Most encouraging was that even the most severely ill patients were able to join the groups.

Group psychoeducation for forensic and dangerous non-forensic long-term patients with schizophrenia. A pilot study

Background and Objectives: The effectiveness of patient psychoeducation has only rarely been studied among forensic populations. This paper examines the outcomes of an eight-time psycho educational group comprised of schizophrenic patients in a forensic hospital setting in Finland. Methods: The intervention group contained forensic or dangerous non-forensic long-term patients with schizophrenia. Treatment outcomes were compared between the intervention group (n = 7) and a matched treatment-as-usual control group (n = 8). The group provided information about schizophrenia and its treatment and cognitive-behavioural elements were used to enhance patients’ learning and coping. The results were obtained from a knowledge of schizophrenia, awareness of mental disorder, attitudes toward psychiatric treatment and medication, and depression. Results: The results of this pilot study suggest that even severely ill patients were able to gain improved knowledge about their illness, and psychoeducation also had positive impact on their awareness of the illness. The results showed no significant changes in attitudes toward psychiatric treatment or medication, or depressive symptoms. No significant changes in any measures were found in the control group. Conclusions: Despite our positive results further research with larger samples is needed to discover the effectiveness of patient education as a component of the comprehensive treatment of forensic patients with schizophrenia (AU)

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