Overcoming Psychomotor Slowing in Psychosis (OCoPS-P) (OCoPS-P)

Overcoming Psychomotor Slowing in Psychosis (OCoPS-P): a 3-week, Randomized, Double-blind, Placebo-controlled Trial of add-on Repetitive Transcranial Magnetic Stimulation for Psychomotor Slowing in Psychosis

Psychomotor slowing is a major problem in psychosis. Aberrant function of the cerebral motor system is linked to psychomotor slowing in patients, particularly resting state hyperactivity in premotor cortices. A previous clinical trial indicated that inhibitory stimulation of the premotor cortex would reduce psychomotor slowing. The current study is further exploring this effect in a randomized, placebo-controlled, double-blind design with three arms of transcranial magnetic stimulation and measures of brain imaging and physiology prior to and after the intervention.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Schizoaffective Disorder; Schizophrenia and Related Disorders; Brief Psychotic Disorder
• Intervention / Treatment: Device: 1 Hz rTMS; Device: iTBS; Drug: Placebo

Detailed Description

As psychomotor slowing is a major problem in schizophrenia, contributing to poor functional outcome, and as no current treatment is effectively targeting psychomotor slowing, this study seeks to test noninvasive brain stimulation to overcome psychomotor slowing. Previous studies documented an aberrant increase of neural activity within the supplementary motor area (SMA) in patients with schizophrenia who had psychomotor slowing. Furthermore, a pilot study in major depression and schizophrenia indicated that inhibitory 1 Hz repetitive transcranial magnetic stimulation (rTMS) would improve psychomotor slowing in 82% of the participants. While this is encouraging, further evidence is needed to 1) replicate the clinical effect of 1 Hz rTMS on the SMA in schizophrenia, 2) to test against sham stimulation, facilitatory stimulation and no intervention, and 3) to test the effects of rTMS on the neural circuitry. Therefore, OCoPS includes more patients, more treatment arms, and more outcome variables than the first pilot trial.

Here we will enroll 88 patients with schizophrenia spectrum disorders and severe psychomotor slowing according to a standard rating scale. Subjects will be randomized to four arms, three of which are double blinded.

three weeks of daily rTMS over the SMA will be delivered. The first group receives inhibitory 1 Hz rTMS, the second group receives facilitatory intermittent theta burst stimulation (iTBS), and the third group receives sham stimulation with a placebo-coil. The fourth group will have no rTMS during the first three weeks, but will repeat the baseline measures after three weeks and then enter a treatment with 1Hz rTMS for three weeks. Outcome measures include the Salpetriere Retardation Rating Scale, observer ratings of motor behavior as well as measures of functioning. After the interventions, follow-up visits are planned at week 6 and week 24.

Finally, at baseline and after the rTMS course, patients will undergo MRI scanning for structural and functional alterations of the cerebral motor system.

• Study Type: Interventional
• Enrollment (Actual): 103
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sebastian Walther, MD; Phone Number: +41316328979; Email: sebastian.walther@upd.unibe.ch
• Study Contact Backup: Name: Stéphanie Lefebvre, PhD; Email: stephanie.lefebvre@upd.unibe.ch

Study Locations

• Switzerland
  • Bern, Switzerland, 3000
    • University Hospital of Psychiatry

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Right-handed subjects
• Ability and willingness to participate in the study
• Ability to provide written informed consent
• Informed Consent as documented by signature
• Schizophrenia spectrum disorder according to diagnostic and statistical manual version 5 (DSM-5) criteria with current psychomotor slowing according to the Salpetriere Retardation Rating Scale (SRRS), score >= 15

Exclusion Criteria:

• Substance abuse or dependence other than nicotine
• Past or current medical or neurological condition associated with impaired or aberrant movement, such as brain tumors, stroke, M. Parkinson, M. Huntington, dystonia, or severe head trauma with subsequent loss of consciousness.
• Epilepsy or other convulsions
• History of any hearing problems or ringing in the ears
• Standard exclusion criteria for MRI scanning and TMS; e.g. metal implants, claustrophobia
• Patients only: any TMS treatment in the past 3 months
• Women who are pregnant or breast feeding,
• Intention to become pregnant during the course of the study,
• Female participants who are surgically sterilised / hysterectomised or post-menopausal for longer than 2 years are not considered as being of child bearing potential.
• Previous enrolment into the current study,
• Enrolment of the investigator, his/her family members, employees and other dependent persons
• Controls only: history of any psychiatric disorder or first-degree relatives with schizophrenia spectrum disorders.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: TRIPLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Inhibitory repetitive transcranial magnetic stimulation (rTMS); 1 Hz stimulation of 17 mins over the supplementary motor area (SMA), 1000 pulses at 110% resting motor threshold intensity total of 15 sessions in 3 weeks	Device: 1 Hz rTMS; 1 Hz stimulation at 110% of resting motor threshold over supplementary motor area
ACTIVE_COMPARATOR: Facilitatory intermittent theta burst stimulation (iTBS); Intermittent theta burst stimulation of 50 Hz over the supplementary motor area (SMA) with 600 pulses in 2 sec trains every 10 seconds for 190 seconds total. Two iTBS stimulations will be administered with 15 mins pause in between. total of 15 sessions in 3 weeks	Device: iTBS; 50 Hz theta burst stimulation at 80% of resting motor threshold over supplementary motor area
PLACEBO_COMPARATOR: Placebo; 1 Hz stimulation of 17 mins over the supplementary motor area (SMA) without any magnetic emission using a placebo-coil that looks identical and makes identical sounds as the real TMS coil total of 15 sessions in 3 weeks	Drug: Placebo; 1 Hz stimulation with the placebo TMS coil without any magnetic emission
NO_INTERVENTION: Waiting group; This group will receive no intervention for 3 weeks. Afterwards they will receive the inhibitory rTMS protocol as in the first arm

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of responders at week 3	Proportion of participants with >30% reduction from baseline in the Salpetriere Retardation Rating Scale (SRRS)	Week 3
Change in Salpetriere Retardation Rating Scale (SSRS) from baseline	Change in the Salpetriere Retardation Rating Scale (SRRS) from baseline; the total score of 15 items is used, ranging 0-60 with higher scores indicating worse outcome	Week 3, week 6, week 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in catatonia severity from baseline to week 3	Observer based rating of catatonia severity with the Bush Francis Catatonia Rating Scale (BFCRS), assessment blind to intervention, total score of the BFCRS is used ranging 0-69 , with higher scores indicating poorer outcome	Week 3, week 6, week 24
Change in negative symptoms from baseline	Change in the Brief Negative Symptom Scale (BNSS) from baseline, total score is used, ranging from 0-78 with higher values indicating poorer outcome, i.e. more negative symptom severity	Week 3, week 6, week 24
Change in psychosis severity from baseline	Change in the Positive And Negative Symptom Scale (PANSS) from baseline, PANSS total score assesses the severity of positive, negative and general symptoms, ranging from 30-210 with higher scores indicating increased symptom severity, i.e. poorer outcome	Week 3, week 6, week 24
Change in physical activity self report from baseline	Change in the International Physical Activity Questionnaire (IPAQ), the total score is used ranging from 0-70000 metabolic equivalent (MET)	Week 3, week 6, week 24
Change in objectively measured physical activity from baseline	Change in the activity levels using wrist actigraphy	Week 3, week 6, week 24
Change in dexterity from baseline	Change in the coin rotation task from baseline	Week 3, week 6, week 24
Change in cortical excitability of the motor cortex from baseline	Change in Short Interval Cortical Inhibition (SICI) from baseline	Week 3, week 6, week 24
Change in social and community functioning	Change in Social and Occupational Functional Assesment Scale (SOFAS) from baseline, the score ranges from 0-100 with higher scores indicating better functioning, i.e. better outcome	Week 3, week 6, week 24
Change in functional capacity	Change in the Score of the brief version of the University of California, San Diego, Performance-Based Skills Assessment (UPSA-brief) assessment from baseline, higher scores indicating better function, the total score is used ranging 0-100	Week 3, week 6, week 24
Change in functional connectivity	Change in the resting state functional connectivity within the cerebral motor system based on functional magnetic resonance imaging scans from baseline	Week 3
Change in resting state cerebral perfusion	Change in the resting state cerebral perfusion within the cerebral motor system based on functional magnetic resonance imaging scans from baseline	Week 3

Collaborators and Investigators

• Sponsor: University of Bern

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 25, 2019
• Primary Completion (ACTUAL): November 1, 2022
• Study Completion (ACTUAL): February 10, 2023

Study Registration Dates

• First Submitted: April 16, 2019
• First Submitted That Met QC Criteria: April 16, 2019
• First Posted (ACTUAL): April 19, 2019

Study Record Updates

• Last Update Posted (ESTIMATE): February 14, 2023
• Last Update Submitted That Met QC Criteria: February 13, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: psychosis; motor behavior; psychomotor slowing
• Additional Relevant MeSH Terms: Pathologic Processes; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia; Disease; Psychotic Disorders; Mental Disorders
• Other Study ID Numbers: 2018-02164

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No