Adjunctive intermittent theta-burst stimulation for first-episode schizophrenia: A randomized clinical trial

Area of Science:

• Neuroscience
• Psychiatry
• Biomarker Research

Background:

• Efficacy of intermittent theta-burst stimulation (iTBS) combined with pharmacotherapy and psychotherapy for first-episode schizophrenia is not well-established.
• This study investigates adjunctive iTBS with risperidone and cognitive behavioral therapy (CBT).

Purpose of the Study:

• To evaluate the efficacy of adjunctive iTBS in first-episode schizophrenia patients.
• To explore serum biomarkers associated with treatment response.

Main Methods:

• A 3-month randomized, assessor-blind trial involving 100 first-episode schizophrenia patients.
• Patients received either iTBS plus risperidone and CBT or risperidone and CBT alone.
• Primary outcome: change in PANSS total score; Secondary outcomes: cognitive function and serum biomarker levels (GDNF, cortisol, DHEA-S).

Main Results:

• The iTBS group demonstrated significantly greater PANSS score reduction at 4 weeks and 3 months compared to controls.
• Significant improvements in all cognitive domains were observed in the iTBS group.
• Post-treatment, the iTBS group showed higher GDNF and lower cortisol and DHEA-S levels, with a combined biomarker panel showing high discriminative performance (AUC=0.865).

Conclusions:

• Adjunctive iTBS to risperidone and CBT significantly enhances clinical symptom and cognitive function outcomes in first-episode schizophrenia.
• A composite biomarker panel including GDNF, cortisol, and DHEA-S shows promise for predicting treatment response.
• Further sham-controlled validation is recommended for the identified biomarker panel.