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P.3.06 High-frequency repetitive transcranial magnetic stimulation and its influence on negative symptoms of schizophrenia
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Clinical neuropsychopharmacology
cadian pacemaker mechanisms, and posttranslational regulation. Annu. Rev. Genet. 34, 533–562. [2] Abe H, Honma S, Namihira M, et al., 2001, Clock gene expressions in the suprachiasmatic nucleus and other areas of the brain during rhythm splitting in CS mice. Brain Res. Mol. Brain Res. 87, 92−99. [3] Greene JD, Sommerville RB, Nystrom LE, et al., 2001, An fMRI investigation of emotional engagement in moral judgment. Science 293, 2105–2108.
P.3.06 High-frequency repetitive transcranial magnetic stimulation and its influence on negative symptoms of schizophrenia L. Ustohal, R. Prikryl, T. Kasparek, S. Skotakova, H. Kucerova, P. Navratilova, M. Cernik, E. Ceskova. Medical Faculty Masaryk University and Faculty Hospital Brno, Department of Psychiatry, Brno, Czech Republic Background: Negative symptoms rank among basic symptoms of schizophrenia. They are believed to be the most persistent, refractory and debilitating component of the disorder. Negative symptoms do not respond to therapy with antipsychotics of the first generation and the effect of antipsychotics of the second generation remains unclear. Repetitive transcranial magnetic stimulation (rTMS) represents a new opportunity for influencing these symptoms. A possible theoretical justification of this claim is that high-frequency stimulation has a neuronactivating effect. Another important fact is that dopamine can be released in the mesolimbic and mezostriatal brain systems by high-frequency stimulation of the frontal cortex (Strafella et al. 2001). Aim: The aim of this simple blind randomised study is to assess the ability of rTMS to influence negative symptoms of schizophrenia. Methodology: Twenty two patients, divided into two subgroups, were included to this study. The first subgroup was treated with effective rTMS, while the second one with ineffective “sham” rTMS. The inefficiacy of “sham” stimulation was achieved through coil position. The stimulation was applied to the left dorsolateral prefrontal cortex, using a Magstim Super Rapid stimulator equipped with a focal figure 8-shaped coil that allowed continuous air cooling to prevent overheating during the stimulation. The stimulation frequency was 10 Hz and the stimulation intensity was 110% of the motor threshold intensity. Each patient received 15 rTMS sessions and each daily session consisted of 15 trains of 10 seconds duration and 30 seconds intertrains intervals. It means 1500 stimuli per session. The psychopathology was rated by PANSS and
SANS before and after the stimulation by a rater, who was blinded to the kind of the stimulation. Results: The average age of the total group of patients was 37.7 years (SD = 9.9). The average score of total PANSS was 59.3 (SD = 11.8), negative PANSS 22.3 (SD = 5.1) and SANS 61.6 (SD = 13.1). There were no significant differences in any variable between patients in two subgroups. In active rTMS subgroup the mean score of total PANSS was 59.6 (SD = 7.9), negative PANSS 21.8 (SD = 3.2) and SANS 68.6 (SD = 11.8) before treatment. After active rTMS the mean scores of all applied scores dropped statistically significantly: total PANSS was 44.8 (SD = 5.6; p = 0.02; paired t-test), negative PANSS 14.6 (SD = 3.2; p = 0.01) and SANS 29.4 (SD = 11.2; p = 0.01). In “sham” rTMS subgroup the mean score of total PANSS was 64.0 (SD = 13.1), negative PANSS 21.8 (SD = 5.8) and SANS 59.6 (SD = 19.1) before “treatment”. After “sham” rTMS the mean scores of all applied scales did not change statistically significantly: total PANSS was 57.0 (SD = 10.3), negative PANSS 20.2 (SD = 5.8) and SANS 52.2 (SD = 21.2). All patients were longterm treated by antipsychotics of the second generation and the level of negative symptoms was constant. The augmentation by rTMS meant for patients decrease of the significance of negative symptoms of schizofrenia. Conclusion: This simple blind study confirmed the promising effect of high-frequency rTMS in patients suffering from negative symptoms of schizophrenia. Reference(s) [1] Strafella AP, Paus T, Barett J, et al., 2001, Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci 21, 157: 1−4. P.3.07 Is it possible to identify future patients in the months before the first psychotic episode? A population-based study A. Livny-Ezer1 , M. Weiser1 , A. Reichneberg2 , G. Lubin3 , M. Shmushkevich3 , G. Peretz3 , M. Chason3 , M. Davidson1 . 1 Chaim Sheba Medical Center, Department of Psychiatry, Tel Hashomer, Israel; 2 Unit of Psychiatry, Psychiatry, London, UK; 3 IDF Medical Corps, Department of Mental Health, Tel Hashomer, Israel Background: Early identification and treatment of impending psychosis might delay or attenuate the first psychotic episode, therefore it is of utmost relevance. Method: Using a historical prospective design on a population-based cohort followed for up to 7 years,
Clinical neuropsychopharmacology
cadian pacemaker mechanisms, and posttranslational regulation. Annu. Rev. Genet. 34, 533–562. [2] Abe H, Honma S, Namihira M, et al., 2001, Clock gene expressions in the suprachiasmatic nucleus and other areas of the brain during rhythm splitting in CS mice. Brain Res. Mol. Brain Res. 87, 92−99. [3] Greene JD, Sommerville RB, Nystrom LE, et al., 2001, An fMRI investigation of emotional engagement in moral judgment. Science 293, 2105–2108.
P.3.06 High-frequency repetitive transcranial magnetic stimulation and its influence on negative symptoms of schizophrenia L. Ustohal, R. Prikryl, T. Kasparek, S. Skotakova, H. Kucerova, P. Navratilova, M. Cernik, E. Ceskova. Medical Faculty Masaryk University and Faculty Hospital Brno, Department of Psychiatry, Brno, Czech Republic Background: Negative symptoms rank among basic symptoms of schizophrenia. They are believed to be the most persistent, refractory and debilitating component of the disorder. Negative symptoms do not respond to therapy with antipsychotics of the first generation and the effect of antipsychotics of the second generation remains unclear. Repetitive transcranial magnetic stimulation (rTMS) represents a new opportunity for influencing these symptoms. A possible theoretical justification of this claim is that high-frequency stimulation has a neuronactivating effect. Another important fact is that dopamine can be released in the mesolimbic and mezostriatal brain systems by high-frequency stimulation of the frontal cortex (Strafella et al. 2001). Aim: The aim of this simple blind randomised study is to assess the ability of rTMS to influence negative symptoms of schizophrenia. Methodology: Twenty two patients, divided into two subgroups, were included to this study. The first subgroup was treated with effective rTMS, while the second one with ineffective “sham” rTMS. The inefficiacy of “sham” stimulation was achieved through coil position. The stimulation was applied to the left dorsolateral prefrontal cortex, using a Magstim Super Rapid stimulator equipped with a focal figure 8-shaped coil that allowed continuous air cooling to prevent overheating during the stimulation. The stimulation frequency was 10 Hz and the stimulation intensity was 110% of the motor threshold intensity. Each patient received 15 rTMS sessions and each daily session consisted of 15 trains of 10 seconds duration and 30 seconds intertrains intervals. It means 1500 stimuli per session. The psychopathology was rated by PANSS and
SANS before and after the stimulation by a rater, who was blinded to the kind of the stimulation. Results: The average age of the total group of patients was 37.7 years (SD = 9.9). The average score of total PANSS was 59.3 (SD = 11.8), negative PANSS 22.3 (SD = 5.1) and SANS 61.6 (SD = 13.1). There were no significant differences in any variable between patients in two subgroups. In active rTMS subgroup the mean score of total PANSS was 59.6 (SD = 7.9), negative PANSS 21.8 (SD = 3.2) and SANS 68.6 (SD = 11.8) before treatment. After active rTMS the mean scores of all applied scores dropped statistically significantly: total PANSS was 44.8 (SD = 5.6; p = 0.02; paired t-test), negative PANSS 14.6 (SD = 3.2; p = 0.01) and SANS 29.4 (SD = 11.2; p = 0.01). In “sham” rTMS subgroup the mean score of total PANSS was 64.0 (SD = 13.1), negative PANSS 21.8 (SD = 5.8) and SANS 59.6 (SD = 19.1) before “treatment”. After “sham” rTMS the mean scores of all applied scales did not change statistically significantly: total PANSS was 57.0 (SD = 10.3), negative PANSS 20.2 (SD = 5.8) and SANS 52.2 (SD = 21.2). All patients were longterm treated by antipsychotics of the second generation and the level of negative symptoms was constant. The augmentation by rTMS meant for patients decrease of the significance of negative symptoms of schizofrenia. Conclusion: This simple blind study confirmed the promising effect of high-frequency rTMS in patients suffering from negative symptoms of schizophrenia. Reference(s) [1] Strafella AP, Paus T, Barett J, et al., 2001, Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci 21, 157: 1−4. P.3.07 Is it possible to identify future patients in the months before the first psychotic episode? A population-based study A. Livny-Ezer1 , M. Weiser1 , A. Reichneberg2 , G. Lubin3 , M. Shmushkevich3 , G. Peretz3 , M. Chason3 , M. Davidson1 . 1 Chaim Sheba Medical Center, Department of Psychiatry, Tel Hashomer, Israel; 2 Unit of Psychiatry, Psychiatry, London, UK; 3 IDF Medical Corps, Department of Mental Health, Tel Hashomer, Israel Background: Early identification and treatment of impending psychosis might delay or attenuate the first psychotic episode, therefore it is of utmost relevance. Method: Using a historical prospective design on a population-based cohort followed for up to 7 years,