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

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.