Efficacy of high-frequency repetitive transcranial magnetic stimulation on PANSS factors in schizophrenia with predominant negative symptoms – Results from an exploratory re-analysis
Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studie...
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Published in | Psychiatry research Vol. 263; pp. 22 - 29 |
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Abstract | Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the ‘rTMS for the Treatment of Negative Symptoms in Schizophrenia’ (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS.
•Active rTMS not superior to sham rTMS in improving negative symptoms if PANSS clusters are analyzed.•Analysis of PANSS factor models may be more precise in separating negative and general symptoms.•Improvements in positive symptoms are only intermittently and related to PANSS excitement factor. |
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AbstractList | Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS. Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the ‘rTMS for the Treatment of Negative Symptoms in Schizophrenia’ (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS. •Active rTMS not superior to sham rTMS in improving negative symptoms if PANSS clusters are analyzed.•Analysis of PANSS factor models may be more precise in separating negative and general symptoms.•Improvements in positive symptoms are only intermittently and related to PANSS excitement factor. |
Author | Frank, Elmar Wölwer, Wolfgang Eichhammer, Peter Kunze, Birgit Gaebel, Wolfgang Schneider-Axmann, Thomas Hasan, Alkomiet Falkai, Peter Wobrock, Thomas Winterer, Georg Honer, William G. Malchow, Berend Cordes, Joachim Ahmed, Raees Hansbauer, Maximilian Landgrebe, Michael Verde, Pablo E. Strube, Wolfgang Rietschel, Marcella Langguth, Berthold Hajak, Göran Ohmann, Christian |
Author_xml | – sequence: 1 givenname: Maximilian surname: Hansbauer fullname: Hansbauer, Maximilian email: Maximilian.Hansbauer@med.uni-muenchen.de organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany – sequence: 2 givenname: Thomas surname: Wobrock fullname: Wobrock, Thomas organization: Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany – sequence: 3 givenname: Birgit surname: Kunze fullname: Kunze, Birgit organization: Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany – sequence: 4 givenname: Berthold surname: Langguth fullname: Langguth, Berthold organization: Department of Psychiatry and Psychotherapy, University of Regensburg, Germany – sequence: 5 givenname: Michael surname: Landgrebe fullname: Landgrebe, Michael organization: Department of Psychiatry and Psychotherapy, University of Regensburg, Germany – sequence: 6 givenname: Peter surname: Eichhammer fullname: Eichhammer, Peter organization: Department of Psychiatry and Psychotherapy, University of Regensburg, Germany – sequence: 7 givenname: Elmar surname: Frank fullname: Frank, Elmar organization: Department of Psychiatry and Psychotherapy, University of Regensburg, Germany – sequence: 8 givenname: Joachim surname: Cordes fullname: Cordes, Joachim organization: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany – sequence: 9 givenname: Wolfgang surname: Wölwer fullname: Wölwer, Wolfgang organization: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany – sequence: 10 givenname: Georg surname: Winterer fullname: Winterer, Georg organization: Experimental & Clinical Research Center (ECRC), Charite – University Medicine Berlin, Germany – sequence: 11 givenname: Wolfgang surname: Gaebel fullname: Gaebel, Wolfgang organization: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany – sequence: 12 givenname: Göran surname: Hajak fullname: Hajak, Göran organization: Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany – sequence: 13 givenname: Christian surname: Ohmann fullname: Ohmann, Christian organization: European Clinical Research Network (ECRIN), Düsseldorf, Germany – sequence: 14 givenname: Pablo E. surname: Verde fullname: Verde, Pablo E. organization: Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany – sequence: 15 givenname: Marcella surname: Rietschel fullname: Rietschel, Marcella organization: Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany – sequence: 16 givenname: Raees surname: Ahmed fullname: Ahmed, Raees organization: Referat Klinische Studien Management, Universitätsmedizin Göttingen, Germany – sequence: 17 givenname: William G. surname: Honer fullname: Honer, William G. organization: Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada – sequence: 18 givenname: Berend surname: Malchow fullname: Malchow, Berend organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany – sequence: 19 givenname: Wolfgang surname: Strube fullname: Strube, Wolfgang organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany – sequence: 20 givenname: Thomas surname: Schneider-Axmann fullname: Schneider-Axmann, Thomas organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany – sequence: 21 givenname: Peter surname: Falkai fullname: Falkai, Peter organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany – sequence: 22 givenname: Alkomiet surname: Hasan fullname: Hasan, Alkomiet organization: Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany |
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Keywords | Schizophrenia Negative symptoms Randomized-controlled trial Repetitive transcranial magnetic stimulation PANSS |
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SubjectTerms | Adult Double-Blind Method Female Humans Intention Male Middle Aged Negative symptoms PANSS Pleasure - physiology Prefrontal Cortex - physiology Psychiatric Status Rating Scales Randomized-controlled trial Repetitive transcranial magnetic stimulation Schizophrenia Schizophrenia - diagnosis Schizophrenia - physiopathology Schizophrenia - therapy Schizophrenic Psychology Transcranial Magnetic Stimulation - methods Treatment Outcome |
Title | Efficacy of high-frequency repetitive transcranial magnetic stimulation on PANSS factors in schizophrenia with predominant negative symptoms – Results from an exploratory re-analysis |
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