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SYSTEMATIC REVIEW article

Front. Psychiatry
Sec. Psychopathology
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1446849
This article is part of the Research Topic Brain Pathology and Rehabilitation Mechanisms of Neuromodulation in Psychiatric Disorders View all articles

The efficacy and safety of continuous theta burst stimulation for auditory hallucinations: a systematic review and meta-analysis of randomized controlled trials

Provisionally accepted
Shi-Yi Ye Shi-Yi Ye 1Chun-Nuan Chen Chun-Nuan Chen 2Bo Wei Bo Wei 3Jin-Qiong Zhan Jin-Qiong Zhan 3*Yi-Heng Li Yi-Heng Li 3*Chen Zhang Chen Zhang 4*Jing-Jing Huang Jing-Jing Huang 5*Yuan-Jian Yang Yuan-Jian Yang 3*
  • 1 Nanchang University, Nanchang, Jiangxi Province, China
  • 2 The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
  • 3 Affiliated Mental Hospital of Nanchang University, Nanchang, China
  • 4 Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai Municipality, China
  • 5 Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, Shanghai Municipality, China

The final, formatted version of the article will be published soon.

    Objective: Auditory hallucinations are the most frequently occurring psychotic symptom in schizophrenia. Continuous theta burst stimulation (cTBS) has been used as an adjuvant treatment for auditory hallucinations. This meta-analysis focused on randomized controlled clinical trials (RCTs) to assess the efficacy of adjuvant cTBS on auditory hallucinations in schizophrenia. Methods: We performed a comprehensive search of four international databases from their inception to January 14, 2024, to identify relevant RCTs that assessed the effects of adjuvant cTBS on auditory hallucinations. The key words included “auditory hallucinations”, “continuous theta burst stimulation” and “transcranial magnetic stimulation”. Inclusion criteria included patients with auditory hallucinations in schizophrenia or schizoaffective disorder. The Revised Cochrane risk-of-bias tool for randomized trials (RoB1) were used to evaluate the risk of bias and the Review Manager Software Version 5.4 was employed to pool the data. Results: A total of 4 RCTs involving 151 patients with auditory hallucinations were included in the analysis. The Cochrane risk of bias of these studies presented “low risk” in all items. Preliminary analysis showed no significant advantage of adjuvant cTBS over sham stimulation in reducing hallucinations [4 RCTs, n = 151; SMD: -0.45 (95%CI: -1.01, 0.12), P = 0.13; I2 = 61%]. Subgroup analysis revealed that patients treated with adjuvant cTBS for more than 10 stimulation sessions and total number of pulses more than 6000 [3 RCTs, n = 87; SMD: -4.43 (95%CI: -8.22, -0.63), P = 0.02; I2 = 47%] had a statistically significant improvement in hallucination symptoms. Moreover, the rates of adverse events and discontinuation did not show any significant difference between the cTBS and sham group. Conclusions: Although preliminary analysis did not revealed a significant advantage of adjuvant cTBS over sham stimulation, subgroup analysis showed that specific parameters of cTBS appear to be effective in the treatment of auditory hallucinations in schizophrenia. Further large-scale studies are needed to determine the standard protocol of cTBS for treating auditory hallucinations.

    Keywords: Continuous Theta Burst Stimulation (cTBS), auditory hallucinations, Treatment, Meta-analysis, non-invasive brain stimulation

    Received: 10 Jun 2024; Accepted: 30 Jul 2024.

    Copyright: © 2024 Ye, Chen, Wei, Zhan, Li, Zhang, Huang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Jin-Qiong Zhan, Affiliated Mental Hospital of Nanchang University, Nanchang, China
    Yi-Heng Li, Affiliated Mental Hospital of Nanchang University, Nanchang, China
    Chen Zhang, Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200013, Shanghai Municipality, China
    Jing-Jing Huang, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, Shanghai Municipality, China
    Yuan-Jian Yang, Affiliated Mental Hospital of Nanchang University, Nanchang, China

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