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Meta-Analysis
. 2022 Nov 18;48(6):1284-1294.
doi: 10.1093/schbul/sbac078.

Efficacy of Transcranial Direct Current Stimulation to Improve Insight in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Ondine Adam  1   2 , Martin Blay  1 , Andre R Brunoni  3   4 , Hsin-An Chang  5 , July S Gomes  6 , Daniel C Javitt  7   8   9 , Do-Un Jung  10 , Joshua T Kantrowitz  7   8   9 , Sanne Koops  11 , Jean-Pierre Lindenmayer  9   12   13 , Ulrich Palm  14   15 , Robert C Smith  9   12 , Iris E Sommer  11 , Leandro do Costa Lane Valiengo  3   4 , Thomas W Weickert  16   17   18 , Jérôme Brunelin  1   2 , Marine Mondino  1   2
Affiliations
Meta-Analysis

Efficacy of Transcranial Direct Current Stimulation to Improve Insight in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Ondine Adam et al. Schizophr Bull. .

Abstract

Background and hypothesis: Impaired insight into the illness and its consequences is associated with poor outcomes in schizophrenia. While transcranial direct current stimulation (tDCS) may represent a potentially effective treatment strategy to relieve various symptoms of schizophrenia, its impact on insight remains unclear. To investigate whether tDCS would modulate insight in patients with schizophrenia, we undertook a meta-analysis based on results from previous RCTs that investigated the clinical efficacy of tDCS. We hypothesize that repeated sessions of tDCS will be associated with insight improvement among patients.

Study design: PubMed and ScienceDirect databases were systematically searched to identify RCTs that delivered at least 10 tDCS sessions in patients with schizophrenia. The primary outcome was the change in insight score, assessed by the Positive and Negative Syndrome Scale (PANSS) item G12 following active tDCS sessions as opposed to sham stimulation. Effect sizes were calculated for all studies and pooled using a random-effects model. Meta-regression and subgroup analyses were conducted.

Study results: Thirteen studies (587 patients with schizophrenia) were included. A significant pooled effect size (g) of -0.46 (95% CI [-0.78; -0.14]) in favor of active tDCS was observed. Age and G12 score at baseline were identified as significant moderators, while change in total PANSS score was not significant.

Conclusions: Ten sessions of active tDCS with either frontotemporoparietal or bifrontal montage may improve insight into the illness in patients with schizophrenia. The effect of this treatment could contribute to the beneficial outcomes observed in patients following stimulation.

Keywords: neuromodulation; psychosis; tDCS.

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Figures

Fig. 1.
Fig. 1.
PRISMA 2020 flow diagram of included studies. Abbreviations: RCTs, randomized controlled trials; tDCS, transcranial direct current stimulation.
Fig. 2.
Fig. 2.
Forest plot showing comparison of insight, as measured by the G12 score, among patients with schizophrenia who received either active or sham tDCS. Abbreviations: ES, effect size; CI, confidence interval; RE, random effect.
See this image and copyright information in PMC

References

    1. Yen CF, Chen CS, Ko CH, Yen JY, Huang CF.. Changes in insight among patients with bipolar I disorder: a 2-year prospective study. Bipolar Disord. 2007;9:238–242. - PubMed
    1. Matsunaga H, Kiriike N, Matsui T, et al. Obsessive-compulsive disorder with poor insight. Compr Psychiatry. 2002;43(2):150–157. - PubMed
    1. Wilson RS, Sytsma J, Barnes LL, Boyle PA.. Anosognosia in dementia. Curr Neurol Neurosci Rep. 2016;16:77. - PubMed
    1. Erol A, Delibas H, Bora O, Mete L.. The impact of insight on social functioning in patients with schizophrenia. Int J Soc Psychiatry. 2015;61:379–385. - PubMed
    1. Li W, Zhang HH, Wang Y, et al. Poor insight in schizophrenia patients in China: a meta-analysis of observational studies. Psychiatr Q. 2020;91(4):1017–1031. - PubMed

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