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Transcranial Magnetic Stimulation in the Treatment of Positive, Negative, and Cognitive Symptoms of Psychosis

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Abstract

Purpose of Review

The aim of this review is to examine the clinical efficacy of transcranial magnetic stimulation (TMS) as an interventional psychiatric treatment for psychotic disorders, with a focus on its impact on positive, negative, and cognitive symptoms. The paper explores the use of specific stimulation frequencies, brain target, and functional neuroimaging in facilitating more precise TMS treatment.

Recent Findings

Despite several limitations and inconsistent results across different studies, TMS shows promise as a noninvasive therapeutic approach to manage negative and cognitive symptoms of psychosis. The use of TMS for positive symptoms shows mixed evidence, with some indications that low-frequency repetitive TMS (rTMS) may have some benefits, though this is inconsistently demonstrated. Promisingly, high-frequency, excitatory TMS has been effective in treating negative symptoms, with some evidence of intermittent theta-burst stimulation (iTBS) being particularly beneficial. Further, TMS has shown to improve cognitive deficiencies from psychosis, as patients continue to exhibit a reduction in cognitive symptoms lasting beyond treatment period.

Summary

While TMS is emerging as a promising treatment for symptoms of psychosis, further research is needed to delineate the most optimal stimulation parameters, protocols, and brain targets to stimulate. Moreover, the incorporation of advanced neuroimaging techniques such as fMRI could allow for the development of personalized treatment protocols that account for the neuroanatomical and functional differences that exist among patients. Considering the noninvasive nature and potential efficacy of TMS, this emerging therapeutic approach may bring significant changes to existing treatment options for patients struggling with psychosis.

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Authors and Affiliations

  1. Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA

    Nicola Manfredi, Rebecca Zhang, Hayley Seltzberg & Megan Johnson

  2. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Jarrod Ehrie

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  1. Nicola Manfredi
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Contributions

The authors confirm contribution to the paper as follows: abstract: Rebecca Zhang; introduction: Hayley Seltzberg, Nicola Manfredi, and Rebecca Zhang; positive symptoms of psychosis: Nicola Manfredi; negative symptoms of psychosis: Rebecca Zhang; cognitive symptoms of psychosis: Rebecca Zhang and Megan Johnson; conclusion: Nicola Manfredi; Table: Nicola Manfredi; manuscript draft: Nicola Manfredi, Rebecca Zhang, and Jarrod Ehrie. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Jarrod Ehrie.

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Manfredi, N., Zhang, R., Seltzberg, H. et al. Transcranial Magnetic Stimulation in the Treatment of Positive, Negative, and Cognitive Symptoms of Psychosis. Curr Behav Neurosci Rep 10, 82–90 (2023). https://doi.org/10.1007/s40473-023-00262-7

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