Journal Article Annotations
2025, 2nd Quarter

Neuromodulation

Annotations by Liliya Gershengoren, MD
July, 2025

An Update on the Use of Neuromodulation Strategies in the Treatment of Schizophrenia.

PUBLICATION #1 — Neuromodulation

An Update on the Use of Neuromodulation Strategies in the Treatment of Schizophrenia.

Nicholas H Neufeld, Daniel M Blumberger.

Abstract: Am J Psychiatry. 2025 Apr 1;182(4):332-340. doi: 10.1176/appi.ajp.20250068.

The field of neuromodulation has evolved tremendously and now includes a vast array of interventions utilizing different technologies that span electrical, magnetic, and ultrasound forms of stimulation. The evolution of interventions holds the promise of fewer adverse effects and a noninvasive approach, increasing the scale at which these interventions may be offered in hospital and community settings. While the majority of neuromodulation studies have focused on patients with mood disorders, predominantly depression, there is an unmet need for patients with schizophrenia, who are in dire need of novel therapeutic options. Advances in neuroimaging and approaches for examining individual variability and transdiagnostic symptoms may lead to more effective neuromodulation treatments in this patient population. This overview explores the modern landscape of invasive and noninvasive neuromodulation treatments for patients with schizophrenia. It begins with approaches that involve diffuse stimulation of the cortex and subcortex and then reviews more focal stimulation approaches at the cortical and subcortical levels. The authors also reflect on the relationship between our understanding of the neurobiology of schizophrenia and neuromodulation interventions.

Annotation

The finding:
This article reviews recent evidence on neuromodulation techniques in the treatment of schizophrenia, with a focus on electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). The authors highlight that ECT remains the most effective neuromodulation intervention, particularly for treatment-resistant schizophrenia and catatonia, while rTMS shows modest but growing support for addressing negative symptoms and auditory hallucinations. tDCS is noted to be safe and well tolerated, but evidence of efficacy remains limited and preliminary.

Strength and weaknesses:
A key strength of the article is its clear and concise summary of current literature, including recent randomized controlled trials and meta-analyses. The authors also appropriately contextualize the limitations of existing studies, such as small sample sizes and heterogeneous methodologies. However, the article lacks a detailed discussion of patient selection criteria, potential adverse effects in medically complex populations, and the logistical challenges of implementation in general hospital settings.

Relevance:
For consultation-liaison psychiatrists, this review is particularly relevant when working with medically hospitalized patients with schizophrenia who are exhibiting treatment resistance, catatonia, or severe agitation. Understanding the evolving role of neuromodulation can inform timely referrals and collaborative care, especially in settings where ECT or rTMS is being considered as a therapeutic option. Additionally, familiarity with the current evidence base helps guide family discussions, especially when standard pharmacologic treatments have failed.