经颅直流电刺激治疗精神分裂症幻听症状的有效性及安全性:一项系统综述研究（英文）

背景:经颅直流电刺激(transcranial direct current stimulation,tDCS)是一项非侵入的脑刺激技术。它被认为是一项安全而有前景的精神分裂症幻听症状的治疗方法。然而尚无系统综述对tDCS治疗幻听的效果进行评价。目标:探索tDCS对于有幻听精神分裂症患者的有效性及安全性。方法:我们从以下数据库搜索了相关的临床对照试验:Pub Med、EMBASE、the Cochrane Library、中国知网、维普、万方、中国生物医学文献和台湾电子期刊服务网等数据库,时间截止于2016年2月13日。根据预先定好的纳入/排除标准筛选研究文献。纳入文献的质量经过偏倚风险评估,主要结局的证据等级水平采用GRADE评定,应用Rev Man5.3进行数据分析。结果:总共检索到415篇文献。最终3篇文献纳入meta分析,合计样本量87。其中2篇的研究评价为"低偏倚风险",1个研究为"无法判断"。3个纳入研究均为小样本量、主要结局指标结果不一致,主要结局指标的证据等级被评为"低水平"。结论:已发表的文献样本量均小,而且主要结局指标的结果不一致。我们无法从这些研究中得出一致结论。关于tDCS对于精神分裂症患者幻听症状的疗效评价,我们需要进一步的大样本、高质量的临床随机对照试验来验证。     

重复经颅磁刺激治疗对精神分裂症患者阴性症状的疗效和安全性:系统综述

背景:阴性症状是精神分裂症治疗的难点之一,抗精神病药物对其疗效较差.重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)是一项新型脑皮质刺激技术,被认为是一项安全而有前景的精神障碍治疗方法,近年来临床研究及新的治疗模式增多,rTMS治疗阴性症状的疗效和安全性评价需要更新.目标:探索rTMS治疗对精神分裂症患者阴性症状的有效性及安全性.方法:我们从以下数据库搜索了相关的临床对照试验:PubMed、EMBASE、the Cochrane Library、EBSCO、Web of science、中国知网、维普、万方、中国生物医学文摘数据库、台湾学术文献数据库等数据库,检索时间截止于2017年1月2日.按照预先定好的纳入和排除标准筛选研究文献,提取数据后应用RevMan 5.3和Stata 14.0对数据进行统计分析.对纳入研究进行质量评价,采用Cochrane风险评估偏倚工具评估各种偏倚的风险性.结合GRADE(Grades of Recommendation,Assessment,Development,and Evaluation,GRADE)系统推荐分级方法为参照标准,进行主要结局指标证据水平的分级.结果:总共检索到3500篇文献,最终29篇文献纳入meta分析,合计样本量1440例.进行meta分析后发现,抗精神病药物治疗合并使用rTMS可改善患者的阴性症状(SMD=-0.40,95%CI=-0.62~-0.18).根据Cochrane风险评估偏倚工具对疗效的评估的偏倚进行评估,其中6篇研究评价为"高偏倚风险",其它为"无法判断".根据GRADE分级的评估、制定和评价标准,该疗效评估指标的证据质量是"中等".rTMS治疗的可接受性较好(RR=0.75,95%CI=0.49~1.15,基于28项研究的1492例样本),但接受rTMS治疗的患者出现轻微不良反应的比率更高(RR=2.20,95%CI=1.53~3.18,基于23项研究的1296例样本).结论:抗精神病药物治疗合并使用rTMS治疗可以一定程度改善精神分裂症患者的阴性症状,可接受性较好,不良反应较轻.但是本研究存在发表性偏倚,且研究的异质性较高,所以对结果进行解释时需要慎重.     

重复经颅磁刺激治疗对精神分裂症患者阴性症状的疗效和安全性:系统综述（英文）

背景:阴性症状是精神分裂症治疗的难点之一,抗精神病药物对其疗效较差。重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)是一项新型脑皮质刺激技术,被认为是一项安全而有前景的精神障碍治疗方法,近年来临床研究及新的治疗模式增多,r TMS治疗阴性症状的疗效和安全性评价需要更新。目标:探索r TMS治疗对精神分裂症患者阴性症状的有效性及安全性。方法:我们从以下数据库搜索了相关的临床对照试验:Pub Med、EMBASE、the Cochrane Library、EBSCO、Web of science、中国知网、维普、万方、中国生物医学文摘数据库、台湾学术文献数据库等数据库,检索时间截止于2017年1月2日。按照预先定好的纳入和排除标准筛选研究文献,提取数据后应用Rev Man 5.3和Stata 14.0对数据进行统计分析。对纳入研究进行质量评价,采用Cochrane风险评估偏倚工具评估各种偏倚的风险性。结合GRADE(Grades of Recommendation,Assessment,Development,and Evaluation,GRADE)系统推荐分级方法为参照标准,进行主要结局指标证据水平的分级。结果:总共检索到3500篇文献,最终29篇文献纳入meta分析,合计样本量1440例。进行meta分析后发现,抗精神病药物治疗合并使用r TMS可改善患者的阴性症状(SMD=-0.40,95%CI=-0.62~-0.18)。根据Cochrane风险评估偏倚工具对疗效的评估的偏倚进行评估,其中6篇研究评价为"高偏倚风险",其它为"无法判断"。根据GRADE分级的评估、制定和评价标准,该疗效评估指标的证据质量是"中等"。r TMS治疗的可接受性较好(RR=0.75,95%CI=0.49~1.15,基于28项研究的1492例样本),但接受r TMS治疗的患者出现轻微不良反应的比率更高(RR=2.20,95%CI=1.53~3.18,基于23项研究的1296例样本)。结论:抗精神病药物治疗合并使用r TMS治疗可以一定程度改善精神分裂症患者的阴性症状,可接受性较好,不良反应较轻。但是本研究存在发表性偏倚,且研究的异质性较高,所以对结果进行解释时需要慎重。     

重复经颅磁刺激治疗抑郁症疗效及安全性的Meta分析（英文）

背景:重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)是一种新型的物理治疗技术,已经被广泛用于抑郁症的研究。尽管大量的临床实验发现相对于伪刺激,rTMS对抑郁症状有改善作用,但是由于rTMS治疗的频率、参数、部位等不同,因此研究结论仍不一致。目的:本研究系统评价中英文研究中rTMS联合抗抑郁药物在随机、双盲、伪刺激对照试验中对郁抑症状治疗的安全性及有效性,探索其中与疗效和安全性的可能相关因素。方法:利用关键词"抑郁""经颅磁刺激"查询中文数据库:万方、维普、中国知网,英文电子数据库:Pubmed、Web of Science、Embase、PsycInfo、Cochrane Library共8个数据库截止到2017年1月5日收录的rTMS治疗抑郁症的临床随机对照研究(randomized controlled trials,RCTs),利用Cochrane风险偏倚评估工具评估纳入研究的文献质量,利用RevMan5.3软件,根据研究组别对纳入的研究治疗效果及安全性进行统计分析。结果:共检索到9798篇文献,最终29篇文献纳入本研究,总样本量1659例,其中研究组样本838例,对照组样本821例,进行Meta分析后发现rTMS联合抗抑郁药物可改善抑郁症患者的抑郁症状(SMD=-0.84,95%CI=-1.19~-0.48)。纳入的研究中均无重大不良事件报道,Meta分析两组间脱落率差异无统计学意义(RR=1.27,95%CI:0.75~2.12,Z=0.89,p=0.37)。GRADE对主要结局指标的证据质量评价为中等水平。结论:抗抑郁药物联合rTMS治疗抑郁症状相对于伪刺激有一定的治疗优势,副反应轻微,可接受性好,研究间差异较大,有待大样本临床研究探索影响疗效的相关因素。     

精神分裂症与外周血清BDNF水平关系的系统综述(英文)

背景 脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)在精神分裂症的发生和病程演变过程中所起的作用受到了越来越广泛的关注,但有关精神分裂症与外周血清 BDNF 水平关系的研究结果不尽一致。目的 综合国内外研究,系统评价精神分裂症患者外周血清BDNF水平的特点。方法 我们采用 Cochrane 系统综述方法和 RevMan 5.1 软件筛选研究并提取数据。通过国内外电子检索系统的检索并对获得文献的参考文献进行追溯评估,共检出268篇相关文献。其中25篇(20篇英文,5篇中文)被纳入分析,它们为 2011 年 12 月底以前公开发表的病例对照研究,研究对象为不伴有其他疾病的精神分裂症患者,采用酶联免疫吸附法检测BDNF的血清水平。系统综述的主要结局指标是病例组与对照组间合并的标准化均数差值(standardized mean difference, SMD)。由两位评价者根据 GRADE 系统的方法独立评估纳入研究的质量。采用RevMan 5.1 软件对研究的异质性、敏感性和可能的发表性偏倚进行检验。结果 累计 1663 例精神分裂症患者,1355 名对照纳入 Meta 分析。15 项被评估为低质量研究,10 项为极低质量研究。研究结果存在高度的异质性(I2=89%),但亚组分析结果表明,异质性与人种、样本量、年龄、性别、入组前是否服用抗精神病药物以及研究质量等因素不存在相关性。由于研究间异质性,采用随机效应模型计算合并SMD,结果为-0.74(95% CI, -0.99～-0.50; Z=5.99,p<0.001)。敏感性分析表明结果稳定性较好。无发表偏倚的证据。结论 尽管统计结果强有力地表明精神分裂症患者外周血 BDNF 水平低于对照人群,但由于现有研究的质量较低以及各研究之间的结果存在明显的异质性,精神分裂症患者外周血 BDNF 浓度低的证据应属较"弱"。今后需要开展高质量的前瞻性研究,对患者进行长期随访,并使用统一的入组标准和监测程序,如最终能证实这些初步结果,血清 BDNF 才有可能用作精神分裂症的生物学指标。     

精神分裂症神经系统软体征的系统综述

目的收集国内外2000年-2014年公开发表的关于精神分裂症神经系统软体征(neurological soft signs,NSS)的文献,综述精神分裂症NSS主要研究领域的最新研究成果,为今后研究精神分裂症NSS提供新的视角和相关理论依据。方法计算机检索Pub Med、Embase、中国知网以及万方数据库,检索精神分裂症神经系统软体征的相关文献。由2位评价员按纳入与排除标准筛选文献,评价纳入研究质量并提取原始资料后,综述精神分裂症神经系统软体征的主要研究成果。结果共检索到相关文献407篇,最终纳入25篇。结果显示精神分裂症NSS与精神分裂症阴性症状以及患者认知功能存在一定的相关性,NSS也渐渐显示出潜在的脑区皮层相关性,同时被认为是潜在的精神分裂症内表型之一。结论神经系统软体征对精神分裂症病理机制的确定具有一定的理论意义,同时对精神分裂症临床工作的完善具有指导作用;建议今后的研究对协变量做出更好的控制,拓展被试样本的年龄跨度,增加纵向研究和遗传学证据。     

不同针灸方法治疗神经根型颈椎病效果的系统评价

目的：运用cochrane评价系统的方法评价当前国内针灸疗法对神经根型颈椎病的有效性与安全性。 资料来源：计算机检索CBM(1978-01/2008-10)、CNKI(1979-01/2008-10)、VIP(1989-01/2008-10)3个数据库,辅以手工检索。 资料选择：纳入针灸疗法治疗神经根型型颈椎病的随机对照试验并对其进行质量评价。文献来源为随机对照和半随机对照。采用随机方法-选择性偏倚评估、隐蔽分组-选择性偏倚评估、盲法-实施偏倚与测量偏倚、剔除、失访、退出损耗性偏倚评价。 结局评价指标：①腹针与常规针灸相比较其有效率。②电针加絮刺火罐与常规针灸相比较其有效率。③腹针与牵引相比较其有效率。④颈椎牵引、电针结合穴位注射与牵引结合推拿比较其有效率。⑤牵引、电针、推拿、TDP结合导引与牵引、理疗、TDP结合运动疗法相比较其有效率。⑥电针结合醋离子导入与单纯电针相比较有效率。⑦仰针灸结合龙氏手法与单纯针灸相比较其有效率。⑧不良反应。 结果：选择其中7篇(1 416例观察对象),采用随机分组的文章。所有研究均有选择性偏倚、实施测量性偏倚、损耗性偏倚的高度可能性,质量等级均为“C”级。且只有1个研究证明实验组的有效率优于对照组。研究1表明,无足够证据证明腹针治疗神经根型颈椎病的有效率优于常规针灸疗法。研究2表明,无足够证据证明电针加絮刺火罐治疗神经根型颈椎病的有效率优于常规针灸疗法。研究3表明,无足够证据证明腹针疗法治疗神经根型颈椎病有效率优于牵引疗法。研究4表明,颈椎牵引、电针结合穴位注射治疗神经根型颈椎病的有效率优于牵引结合推拿疗法。研究5表明,无足够证据证明牵引、电针、推拿、TDP结合导引治疗神经根型颈椎病的有效率优于牵引、理疗、TDP结合运动疗法。研究6表明,无足够证据证明电针结合醋离子导入治疗神经根型颈椎病的有效率优于单纯电针疗法。研究7表明,无足够证据证明针灸结合龙氏手法治疗神经根型颈椎病的优于单纯针灸疗法。7个研究均未出现不良反应而终止试验。 结论：所纳入的7个研究中,由于目前针灸疗法的不统一,质量不高,诊断标准、随访时间、结果测量标准不一致,因此需要开展大样本、多中心,方法学规范的高质量随机对照试验进一步验证。     

保守疗法治疗脊髓型颈椎病效果的系统评价

背景：脊髓型颈椎病保守疗法很多，每一种治疗方案目前尚未统一，有必要将各疗法的相关研究予以总结评价。 目的：运用Cochrane 评价系统的方法评价当前国内保守疗法对脊髓型颈椎病的有效性与安全性。 设计、时间及地点：随机对照试验（RCT）和半随机对照试验(CCT)，于2008-03/06在四川大学华西医院中国循证中心完成。 对象：来源于1978-01/2008-04 CCBM、CNKI、VIP3个数据库及辅以手工检索相关文献，选择其中4篇542例，年龄30~71岁，采用随机分组的文章。 方法：计算机检索CCBM、CNKI、VIP 数据库。电话访问标称随机对照试验作者证实是否真正RCT；纳入保守疗法治疗脊髓型颈椎病的随机对照试验并对其进行质量评价。由于纳入研究的干预手段不统一，未能进行合并分析。只能进行单个研究的MeTa分析。采用随机方法-选择性偏倚评估、隐蔽分组-选择性偏倚评估、盲法-实施偏倚与测量偏倚、剔除、失访、退出-损耗性偏倚评价。 主要观察指标：①针灸、电针、拔罐与氯唑沙宗、心痛定，胞二磷胆碱相比较其有效率。②针灸、推拿、中药与扶他林（双氯芬酸）相比较其有效率。③角度选择性牵引与0°牵引相比较其有效率。④中药与弥可保相比较其有效率。⑤不良反应。 结果：所有研究均有选择性偏倚、实施测量性偏倚、损耗性偏倚的高度可能性,质量等级均为“C”级。且只有1个研究证明实验组的有效率优于对照组。研究1表明，针灸、电针、拔罐治疗脊髓型颈椎病的显效率及有效率优于氯唑沙宗、心痛定，胞二磷胆碱。研究2表明，针灸、推拿、中药治疗脊髓型颈椎病的显效率及有效率优于扶他林（双氯芬酸）。研究3表明，角度选择性牵引治疗脊髓型颈椎病的显效率优于及好转率略于0°牵引，而无足够证据证明有效率优0°牵引。研究4表明，无足够证据证明中药治疗脊髓型颈椎病优于弥可保。4个研究均未出现不良反应而终止试验。 结论：所纳入的4个研究中，由于目前保守疗法的不统一，质量不高，诊断标准、随访时间、结果测量标准不一致，因此需要开展大样本、多中心，方法学规范的高质量随机对照试验进一步验证。     

褪黑素治疗精神分裂症患者迟发性运动障碍的meta分析

目的:此荟萃分析基于随机对照试验(RCTs)文献系统评估褪黑素对精神分裂症患者迟发性运动障碍的临床疗效和安全性.方法:两位独立评估者从以下数据库对相关的临床随机对照试验(RCT)文献进行检索(万方数据、中国知网(CNKI)、中国生物医学文摘数据库和PubMed、PsycINFO、Embase、Cochrane Library数据库),检索时间截止于2017年6月8日.以TD症状严重程度为主要结局指标,采用Rev Man 5.3版本进行统计分析,对RCTs的质量评估采用Cochrane风险评估偏倚和Jadad量表来评估各种偏倚的风险性.采用GRADE(Grades of Recommendation,Assessment,Development,and Evaluation)系统推荐分级方法对meta-分析结果的整体证据质量水平进行分级评价.结果:最终筛选确定4个RCTs(n=130).3个RCTs采用双盲法,1个RCT单盲,根据Cochrane风险评估偏倚和Jadad量表显示3个RCTs的疗效评估指标的证据质量被评定为"高质量".与对照组相比,根据不自主运动量表(AIMS)评定褪黑素可改善TD严重程度(4个RCTs,n=130,加权平均差值(WMD):-1.52(95%CI:-3.24,0.20),p=0.08;I2=0%),但尚没有达到显著差异.根据等级方法,改善TD症状的meta分析结果的整体证据质量被评为"低",而关于不良反应和认知损害方面则数据太少.结论:荟萃分析表明,褪黑素或可改善精神分裂症TD症状.但仍有待今后更高质量和更大样本的RCTs验证.     

重复经颅磁刺激治疗精神分裂症幻听研究进展

重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)是一种无创神经调控技术,具有治疗精神分裂症幻听的潜在价值。我们检索了PubMed、CNKI数据库,分析了低频rTMS、高频rTMS、持续模式化刺激(cTBS)三种刺激模式治疗精神分裂症幻听的临床疗效,发现低频rTMS对治疗精神分裂症有一定的临床疗效,高频rTMS和cTBS的疗效尚不明确。该领域的进一步深入研究对于幻听治疗有重要意义。     

Transcranial direct current stimulation for auditory verbal hallucinations:a systematic review of clinical trials

Transcranial direct current stimulation(tDCS) has been reportedly beneficial for different neurodegenerative disorders. tDCS has been reported as a potential adjunctive or alternative treatment for auditory verbal hallucination(AVH). This study aims to review the effects of tDCS on AVH in patients with schizophrenia through combining the evidence from randomized clinical trials(RCTs). The databases of PsycINFO(2000–2019), PubMed(2000–2019), EMBASE(2000–2019), CINAHL(2000–2019), Web of Science(2000–2019), and Scopus(2000–2019) were systematically searched. The clinical trials with RCT design were selected for final analysis. A total of nine RCTs were eligible and included in the review. Nine RCTs were included in the final analysis. Among them, six RCTs reported a significant reduction of AVH after repeated sessions of tDCS, whereas three RCTs did not show any advantage of active tDCS over sham tDCS. The current studies showed an overall decrease of approximately 28% of AVH after active tDCS and 10% after sham tDCS. The tDCS protocols targeting the sensorimotor frontal-parietal network showed greater treatment effects compared with the protocols targeting other regions. In this regard, cathodal tDCS over the left temporoparietal area showed inhibitory effects on AVHs. The most effective tDCS protocol on AVHs was twice-daily sessions(2 mA, 20-minute duration) over 5 consecutive days(10 sessions) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporal area. Some patient-specific and diseasespecific factors such as young age, nonsmoking status, and higher frequencies of AVHs seemed to be the predictors of treatment response. Taken together, the results of tDCS as an alternative treatment option for AVH show controversy among current literatures, since not all studies were positive. However, the studies targeting the same site of the brain showed that the tDCS could be a promising treatment option to reduce AVH. Further RCTs, with larger sample sizes, should be conducted to reach a conclusion on the efficacy of tDCS for AVH and to develop an effective therapeutic protocol for clinical setting.     

Transcranial direct current stimulation of prefrontal cortex: An auditory event-related potential study in schizophrenia

Cognitive impairment is one of the most significant factors determining the long-term rehabilitation prospects of schizophrenia patients. Cognitive training has been shown to be beneficial; however, effect sizes of cognitive remediation remain relatively low. Anodal transcranial direct current stimulation (tDCS) increases cortical excitability along with larger N1 auditory event-related potentials (ERPs), thus providing a non-invasive physiological mechanism that is potentially capable of facilitating cognitive training of schizophrenia patients. The current study investigated the effects of left-prefrontal anodal tDCS on auditory discrimination performance and N1, Mismatch Negativity (MMN), and P3b ERPs, which have been linked to cognitive and global function deficits in schizophrenia. We compared 20 min of 2 mA tDCS versus sham stimulation in 14 schizophrenia patients by employing a randomised crossover design. Patients performed equally well in a go/no-go auditory discrimination task when compared to healthy subjects but presented with significantly smaller N1, MMN and P3b amplitudes, which did not change with tDCS. Auditory discrimination performance and reaction times also remained unaffected by tDCS. Our findings suggest that a single application of tDCS has no acute effects on ERPs and associated auditory information processing in schizophrenia patients.     

太极拳治疗精神分裂症：系统综述

背景：太极拳起源于中国,是一种适度的有氧运动,可促进身心的平衡和康复。这一运动已用作精神分裂症患者的辅助治疗。然而,还没有关于太极拳辅助治疗精神分裂症患者的meta分析或系统综述的报告。目的：用随机对照试验（RCT）的数据进行系统综述和meta分析来检验太极拳辅助治疗精神分裂症患者的疗效。
　　方法：两位评估者各自系统地检索中英文数据库中用太极拳治疗精神分裂症患者的RCT研究,并进行研究项目的选择、数据提取、质量评估和数据合并。采用Review Manager（版本5.3）进行统计分析。采用推荐分级的评估、制定与评价（Cochrane Grades of Recommendation, Assessment, Development, and Evaluaiton,GRADE）来评估证据的强度。
　　结果：在中国大陆和香港进行的6项RCTS研究中,共有483名参与者,其中干预组215例,对照组268例。试验平均持续16.0（6.2）周。我们发现在研究期间,干预组阴性症状改善情况与对照组相比有显著差异[5项试验,6个治疗组,n=451, SMD：-0.87(95%CI：-1.51,-0.24),p=0.007; I2=90%],其中2项研究用阳性和阴性症状量表（PANSS）中的阴性症状分量表评估,另外3项用阴性症状评定量表（SANS）评估。此外,研究期间研究组与对照组间阳性症状的改善没有显著性差异[4项试验,5个治疗组,n=391, SMD：-0.09(95%CI：-0.44,0.26),p=0.60; I2=65%],其中2项研究用PANSS阳性症状分量表评估,2项用阳性症状评定量表（SAPS）。所有纳入的RCT研究均未报告不良反应。根据GRADE评估,主要结局指标的证据强度“很低”。
　　结论：抗精神病药辅以太极拳治疗精神分裂症患者的疗效的数据尚不足,难于得出该疗效如何的明确结论。此外,纳入研究的随访时间相对较短,所有的研究评估结局指标时都没有使用盲法。需要有高质量的随机试验才能做出临床建议。     

Transcranial direct-current stimulation in ultra-treatment-resistant schizophrenia

Background

Transcranial direct-current stimulation (tDCS), a non-invasive neurostimulation treatment, has been reported in a number of sham-controlled studies to show significant improvements in treatment-resistant auditory hallucinations in schizophrenia patients, primarily in ambulatory and higher-functioning patients, but little is known of the effects of tDCS on hospitalized, low-functioning inpatients.

Transcranial Magnetic Stimulation for Schizophrenia

People with schizophrenia typically experience auditory hallucinations or delusions during acute episodes. Although effective drug treatments are available, many have intractable symptoms that do not recover between acute episodes. One proposed alternative to drug treatments is transcranial magnetic stimulation (TMS). To date, many research trials to assess effectiveness of TMS for people with symptoms of schizophrenia have been conducted worldwide. However, there is a lack of consensus on whether TMS should be recommended to be adopted in routine clinical practice. We conducted a systematic review of the literature for all relevant randomized controlled trials (RCTs) comparing TMS with sham or standard treatment. Forty-one trials (1473 participants) survived eligibility criteria and had extractable data. We found significant differences in favor of temporoparietal TMS compared with sham TMS for global state (7 RCTs, n = 224, MD: -0.5, 95% CI: -0.76 to -0.23) and for positive symptoms measured on the Positive and Negative Syndrome Scale (5 RCTs, n = 127, MD: -6.09, 95% CI: -10.95 to -1.22). However, we also found that the quality of trial reporting was frequently suboptimal and the risks of bias were strong or unascertainable for many trial aspects; this led to many results being graded as very low-quality evidence. On that basis, we were unable to definitively support or refute the routine use of TMS in clinical practice. Future definitive trials of TMS with rigorous processes and high-quality reporting are needed.Key words: schizophrenia, transcranial magnetic stimulation, auditory hallucinations     

Sex differences in the risk of schizophrenia: evidence from meta-analysis

BACKGROUND: Sex differences in the risk of a particular disorder can yield important clues regarding its pathogenesis. The evidence for a sex difference in the risk of schizophrenia is inconclusive. The purpose of this study was to integrate results from the published literature and to provide a quantitative index of the male-female ratio for the incidence of schizophrenia. METHODS: The MEDLINE and PsychLIT databases were searched for English-language publications on "incidence and schizophrenia" that appeared during the period between January 1980 and September 2001. Population-based incidence studies using standard clinical diagnostic criteria were included if they reported sex-specific incidence rates. Sex-specific incidence figures were extracted directly from each study. Categorical analyses were conducted on a subset of studies that met specific methodological criteria (to minimize criterion bias, hospital bias, and age bias). Study categorization and data extraction were performed independently by 2 of us (A. A. and J.-P.S.). RESULTS: Log risk ratio meta-analysis was conducted using a random-effects model. The incidence risk ratios for men to develop schizophrenia relative to women were 1.42 (95% confidence interval [CI], 1.30-1.56) when all studies were included in the analysis (49 effect sizes), 1.31 (95% CI, 1.13-1.51) when studies that minimized selection biases were analyzed separately (23 effect sizes), and 1.39 (95% CI, 1.15-1.68) when only high-quality studies were included (11 effect sizes). The sex difference was significantly smaller in studies with sample years before 1980 than those with sample years after 1980. No significant sex differences were reported in studies from developing countries. A final analysis, limited to studies with an age cutoff of 64 years or older (16 effect sizes), yielded a mean risk ratio of 1.32 (95% CI, 1.13-1.55). CONCLUSION: This meta-analysis provides evidence for a sex difference in the risk of developing schizophrenia, as reported in the published literature from the last 2 decades.     

A Negative Pilot Study of Daily Bimodal Transcranial Direct Current Stimulation in Schizophrenia

BackgroundA small number of studies conducted to date have suggested that transcranial direct current stimulation (tDCS) applied to the temporoparietal cortex may reduce auditory hallucinations in patients with schizophrenia. Prefrontal brain stimulation with other methods, has also been shown to potentially improve the negative symptoms of this disorder.ObjectiveTo investigate the therapeutic potential of daily bimodal tDCS: anodal stimulation to the prefrontal cortex and cathodal stimulation to the temporoparietal junction in patients with persistent hallucinations and negative symptoms of schizophrenia.MethodsWe conducted two small randomized double-blind controlled trials comparing bimodal tDCS to sham stimulation. In one study, stimulation was provided unilaterally, in the second study it was provided bilaterally.ResultsNeither unilateral nor bilateral tDCS resulted in a substantial change in either hallucinations or negative symptoms. Stimulation was well tolerated without side-effects.ConclusionDaily tDCS does not appear to have substantial potential in the treatment of hallucinations or negative symptoms and further research should investigate higher doses of stimulation or more frequently applied treatment schedules.     

Effects of Neurostimulation on Poststroke Dysphagia: A Synthesis of Current Evidence From Randomized Controlled Trials

ObjectivesTo evaluate the effects of neurostimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and pharyngeal electrical stimulation (PES), for poststroke dysphagia based on evidence from randomized controlled trials (RCTs).Materials and MethodsElectronic databases were systematically searched between January 1985 and June 2020 and studies were included based on prespecified selection criteria. The quality of studies was evaluated and data were extracted and synthesized by two independent reviewers. The primary outcome measure was change in (any) relevant clinical swallowing-related characteristic. Subgroup analysis were conducted based on follow-up period and stimulation parameters.ResultsData from 852 stroke patients were collected from 26 RCTs studies. Active neurostimulation treatments demonstrated a significant and moderate effect size compared to control treatment (0.69 [95% CI = 0.50, 0.89]; p < 0.001). The effect size of rTMS was the largest (0.73 [95% CI = 0.49, 0.98]; p < 0.001), followed by PES (0.68 [95% CI = 0.22, 1.14]; p = 0.004) and tDCS (0.65 [95% CI = 0.25, 1.04]; p = 0.001). All treatments showed comparable effect sizes within the first two weeks. Between three weeks and two months, tDCS demonstrated the largest effects (1.02 [95% CI = 0.45, 1.59]; p < 0.001) among the three treatments. No significant treatment effects were reported beyond three months. The combined effect size was large when applied in acute (<14 days) stroke (0.8 [95% CI = 0.34, 1.26]; p < 0.001). For noninvasive brain stimulation (NIBS), bihemispheric stimulation demonstrated the strongest effect size (0.93 [95% CI = 0.53, 1.33]; p < 0.001). In contrast, unilateral rTMS using ipsilesional high-frequency stimulation had a combined effect size of 0.83 (95% CI = 0.14, 1.52; p = 0.02). For tDCS, a significant effect size was found only with anodal stimulation applied over the contralesional hemisphere (1.04 [95% CI = 0.54, 1.53]; p < 0.001).ConclusionsThe results show that neurostimulation can benefit patients with poststroke dysphagia. The treatment effects were the strongest in acute stroke patients and within the first two months of application. For NIBS, bihemispheric stimulation appeared to be most effective. The most beneficial hemisphere for unilateral stimulation differed between rTMS and tDCS. These findings provide a platform for future studies and clinical practice.     

Meta-analysis of the effects of transcranial direct current stimulation on inhibitory control

BackgroundInhibitory control refers to a central cognitive capacity involved in the interruption and correction of actions. Dysfunctions in these cognitive control processes have been identified as major maintaining mechanisms in a range of mental disorders such as ADHD, binge eating disorder, obesity, and addiction. Improving inhibitory control by transcranial direct current stimulation (tDCS) could ameliorate symptoms in a broad range of mental disorders.ObjectiveThe primary aim of this pre-registered meta-analysis was to investigate whether inhibitory control can be improved by tDCS in healthy and clinical samples. Additionally, several moderator variables were investigated.MethodsA comprehensive literature search was performed on PubMed/MEDLINE database, Web of Science, and Scopus. To achieve a homogenous sample, only studies that assessed inhibitory control in the go-/no-go (GNG) or stop-signal task (SST) were included, yielding a total of 75 effect sizes from 45 studies.ResultsResults of the meta-analysis indicate a small but significant overall effect of tDCS on inhibitory control (g = 0.21) which was moderated by target and return electrode placement as well as by the task. The small effect size was further reduced after correction for publication bias.ConclusionBased on the studies included, our meta-analytic approach substantiates previously observed differences between brain regions, i.e., involvement of the right inferior frontal gyrus (rIFG) vs. the right dorsolateral prefrontal cortex (rDLPFC) in inhibitory control. Results indicate a small moderating effect of tDCS on inhibitory control in single-session studies and highlight the relevance of technical and behavioral parameters.