Intervention Of Intermittent Theta Burst Stimulation On Empathy Disorder In Schizophrenia

Objective:Empathy is a very important social cognitive ability,which is of great significance in interpersonal communication and social life.Previous studies have shown that the empathy ability of schizophrenia is lower than that of the normal population,which leads to the deterioration of the patients’social function and the low desire for active social interaction,which has extremely negative effects on the patient’s quality of life and social relations.Empathy is an important manifestation of emotional interaction and social function,so empathy injury brings great harm to patients with schizophrenia.Previous imaging results show that the left dorsol lateral prefrontal cortex（L-DLPFC）is closely related to the clinical symptoms and empathy deficits of patients with schizophrenia.In recent years,intermittent Theta explosive stimulation（Intermittent TBS,iTBS）,as a new rTMS（Repetitive transcranial magnetic stimulation,rTMS）mode,has gradually been applied to treat mental illness.iTBS has achieved certain results in intervening the clinical symptoms of schizophrenia.However,there is no report of using intermittent Theta burst stimulation to stimulate L-DLPFC to improve empathy disorder in patients with schizophrenia.This article aims to explore the effect of intermittent Theta burst stimulation on empathy disorders in patients with schizophrenia.Methods:A total of 57 schizophrenia and 33 healthy controls were recruited,including33 in the iTBS group,24 in the sham group,and 33 in the healthy controls.The experimental design was a randomized single-blind study.The entire experimental process is about 15 days,including two clinical symptoms and neuropsychological assessments（before and after treatment）and 14 days of iTBS treatment.Clinical symptom testing includes PANSS,SAPS,SANS;neuropsychological assessment includes MoCA,IRI-C,HAMA,and HAMD.Patients are treated with iTBS for 14consecutive days at approximately the same time each day.Before and after treatment,we used the Chinese version of the MET paradigm to assess the empathy ability of patients with schizophrenia.Combining the results of MET-C before and after treatment between patients with schizophrenia and healthy subjects,the intervention effect of iTBS was evaluated.Results:First of all,there was no significant difference between the iTBS and sham groups in gender,age,average years of education,average duration of disease and other baseline levels.After the intervention of iTBS,in terms of the Accuracy（Accuracy,ACC）,the results of analysis of variance showed that"time×group"had a significant interaction[F_（1,55）=19.122,P<0.001,η²_p=0.258].Compared with the sham group,the iTBS group produced a higher correct rate.We found that the ACC of MET-C in the iTBS group increased significantly over time（t=5.247,P<0.001,Cohen’s d=1.298）.In the sham stimulation group,the accuracy rate decreased over time,but did not reach a significant level（t=1.249,P=0.387,Cohen’s d=0.361）.In terms of response time,the RTs of the iTBS group and the sham stimulation group decreased after treatment,and no significant interaction effect was found[F_（1,55）=0.610,P=0.956,η²_p=0.011].In the average rating of emotional empathy,no significant interaction was found[F_（1,55）=0.102,P=0.751,η²_p=0.002].The results of the analysis of variance after taking education age as the covariance showed that the Accuracy difference between the iTBS group,the sham group and the normal control group was significant（F=23.10,P<0.001）.Further multiple comparisons showed that the patients’ACC before iTBS stimulation was significantly lower than HC（P=0.033）.However,after iTBS stimulation,ACC increased significantly（P=0.003）,but still did not reach the level of HC.In addition,correlation analysis showed that the amount of change in the correct rate of MET-C was significantly negatively correlated with the change rate of clinical symptoms（including PANSS total score,positive symptom score,negative symptom score and SANS score）.Conclusion:This study used intermittent Theta burst stimulation to physically intervene the empathy deficits of schizophrenia patients.The results show that the personalized intermittent Theta burst stimulation under precise positioning can significantly improve the empathy deficit of patients with schizophrenia,and at the same time alleviate the patients’mental symptoms.Future research can use it as a potential treatment,and iTBS is expected to be used in the clinical treatment of schizophrenia.