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Accelerated Neuromodulation Therapy and Neurocomputational Biomarkers in Individuals at Clinical High Risk for Psychosis (TMS-CHR)

27. August 2026 aktualisiert von: David Benrimoh, Douglas Mental Health University Institute

The goal of this study is to learn whether an accelerated form of neuromodulation therapy is safe, feasible, and well tolerated in young people at clinical high risk for psychosis (CHR-P), and whether it is associated with changes in candidate biomarkers of treatment response.

Participants will be randomly assigned to receive either active accelerated intermittent theta burst stimulation (iTBS) or sham stimulation to the left dorsolateral prefrontal cortex, delivered over five consecutive days.

The study will look at whether this accelerated treatment approach is safe and feasible for people at clinical high risk for psychosis, whether depressive symptoms improve after treatment, and whether computerized behavioural tasks and passive digital monitoring (wearables, smartphone apps, and speech analysis) can detect treatment-related changes that may serve as biomarkers for future, larger trials.

Participants will complete clinical interviews and questionnaires, a cognitive battery, and computerized behavioral tasks; wear a Fitbit and use smartphone applications for at least two weeks before and throughout treatment; receive neuromodulation therapy or sham stimulation over five consecutive days; and attend follow-up visits at 1 week, 1 month, and 3 months after treatment.

Studienübersicht

Status

Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

There is currently no clinically validated treatment that reduces the risk of psychosis onset or mitigates the severity of a first psychotic episode in individuals at clinical high risk for psychosis (CHR-P). CHR-P is associated with attenuated psychotic symptoms, functional decline, and high rates of affective symptoms, including a comorbid mood disorder prevalence of 40% or higher. Repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (LDLPFC) is an established treatment for depression and is increasingly supported for negative symptoms in psychotic disorders, making it a promising low-burden candidate for early intervention in CHR-P.

This pilot study evaluates an accelerated intermittent theta burst stimulation (iTBS) protocol, delivered over five consecutive days, in individuals at CHR-P (SIPS-confirmed, aged 18-34). Forty participants will be randomized 1:1 to active accelerated iTBS or sham stimulation to the LDLPFC, using standard scalp-based (BEAM-F3) targeting rather than MRI-guided neuronavigation, reflecting the pilot nature and funding constraints of this early-phase study.

Given the variable incidence of and long latency to psychosis onset in the CHR-P population, this study also incorporates a battery of neurocomputational tasks (analyzed using Hierarchical Gaussian Filter modeling) and a multimodal digital phenotyping framework (wearables, smartphone-based passive sensing, facial/vocal affect analysis, and structured speech analysis) to assess candidate biomarkers of treatment response.

Primary outcomes are the safety, feasibility, and tolerability of the accelerated protocol in this population. Secondary outcomes include the sensitivity of neurocomputational biomarkers to treatment and change in depressive symptoms. Exploratory outcomes include treatment-related change across multiple domains of real-world functioning captured through digital phenotyping. This study is not designed to establish definitive treatment efficacy but to inform the design of future, adequately powered trials.

Studientyp

Interventionell

Einschreibung (Geschätzt)

40

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Studienorte

    • Quebec
      • Verdun, Quebec, Kanada, H4H1R3
        • Rekrutierung
        • McGill Lab for Computational Psychiatry and Translation
        • Kontakt:
        • Hauptermittler:
          • David Benrimoh

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Erwachsene

Akzeptiert gesunde Freiwillige

Nein

Beschreibung

Inclusion Criteria:

  • Meets clinical CHR-P criteria, confirmed by the Structured Interview for Psychosis-Risk Syndromes (SIPS)
  • Clinical team confirms sufficient stability to participate
  • Able to provide informed consent

Exclusion Criteria:

  • Pregnancy, lactation, or intrauterine device
  • History of electroconvulsive therapy (ECT) in the past 6 months
  • Substance use during the treatment week (cigarettes and cannabis excluded from this consideration)
  • Contraindications for TMS (e.g., metal implants in head/neck, seizure history, brain tumor/neurosurgery, severe cardiac disease)
  • Previous rTMS treatment
  • Documented history of significant intellectual disability

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Verdreifachen

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Active iTBS (BEAM-F3 Targeting)
Participants receive active accelerated iTBS over five consecutive days (up to 10 sessions/day, up to 50 sessions total) targeting the left dorsolateral prefrontal cortex (LDLPFC) using standard BEAM-F3 scalp-based coordinates.
Active iTBS is delivered using a MagVenture MagPro X100 stimulator with Cool-B65 A/P coil, targeting the LDLPFC at 110% of resting motor threshold (motor threshold determined via the PEST algorithm). Each session consists of 60 trains of 10 bursts of three pulses at 50 Hz, delivered every 200 ms, with an 8-second intertrain interval (1,800 pulses/session; up to 18,000 pulses/day; 90,000 pulses total over 5 days). The number of daily sessions is reviewed after every five participants and may be reduced from 10 to 8, or to 6, if needed; missed sessions are made up during the following week to preserve total pulse dose.
Schein-Komparator: Sham iTBS
Participants receive sham stimulation over five consecutive days, using the same device, coil, session structure, and schedule as the active arm, without delivering therapeutic cortical stimulation.
Sham iTBS is delivered using the same MagVenture Cool B65 A/P coil (device-integrated sham mode), with identical coil placement, session structure, and treatment schedule as the active arm.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Treatment Initiation Rate
Zeitfenster: Through end of treatment week (Day 5)
Proportion of consenting participants who begin the treatment protocol (receive at least one stimulation session).
Through end of treatment week (Day 5)
Treatment Acceptability Rate
Zeitfenster: Through study completion, an average of 18 months.
Proportion of approached, eligible individuals who consent to participate in the study.
Through study completion, an average of 18 months.
Treatment Adherence
Zeitfenster: Through end of treatment week (Day 5)
Number of treatment sessions completed per participant, out of the planned schedule (up to 10 sessions/day over 5 days).
Through end of treatment week (Day 5)
Treatment Completion Rate
Zeitfenster: Through end of treatment week (Day 5)
Proportion of participants who initiate treatment and complete the full course; expected completion rate of approximately 80%, based on prior work at the study site.
Through end of treatment week (Day 5)
Incidence of Adverse and Serious Adverse Events
Zeitfenster: Baseline through 3-month follow-up
Rate of treatment-related adverse events (e.g., scalp pain, headache, fatigue, symptom worsening) and serious adverse events (e.g., seizure, hospitalization, emergent suicidality), assessed via daily clinical ratings and structured interviews.
Baseline through 3-month follow-up
Qualitative Treatment Experience
Zeitfenster: End of treatment (Day 5)
Themes related to participant experience of tolerability and treatment burden, derived from a structured end-of-treatment qualitative interview and analyzed using inductive thematic analysis.
End of treatment (Day 5)

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Change in Affective Conditioned Hallucinations Task Parameters
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Change in individual-level information-processing parameters (Hierarchical Gaussian Filter modeling) derived from an affective variant of the Conditioned Hallucinations task.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Social Appraisal Task Parameters
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Change in HGF-derived parameters of social inference and belief updating.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Beads Task Parameters
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Change in probabilistic reasoning bias related to delusion-proneness.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Prisoner's Dilemma Task Parameters
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Change in HGF-derived parameters of social inference.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Montgomery-Åsberg Depression Rating Scale (MADRS) Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Change in clinician-rated depressive symptom severity. Total scores range from 0 to 60, with higher scores indicating greater severity.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Quick Inventory of Depressive Symptomatology (QIDS) Score
Zeitfenster: Baseline, Daily from Day 1 to Day 5, and at 1 week, 1 month, and 3 months post-treatment
Change in self-reported depressive symptom severity on the Quick Inventory of Depressive Symptomatology, 16-item Self-Report (QIDS-SR16). Total scores range from 0 to 27, with higher scores indicating greater depressive symptom severity.
Baseline, Daily from Day 1 to Day 5, and at 1 week, 1 month, and 3 months post-treatment

Andere Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Change in Heart Rate During Task Performance
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Heart rate recorded via BIOPAC physiological monitoring during the computational task battery, measured in beats per minute (bpm).
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Galvanic Skin Response During Task Performance
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Galvanic skin response (electrodermal activity) recorded via BIOPAC physiological monitoring during the computational task battery, measured in microsiemens (µS).
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Sleep Consolidation
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Sleep consolidation (e.g., sleep efficiency, wake after sleep onset) recorded via Fitbit wearable device.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Daytime Activity Level
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Daytime activity level (e.g., step count) recorded via Fitbit wearable device.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Geolocation-Based Mobility
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Geolocation-based mobility patterns (e.g., time spent away from home, location variability) recorded via mindLAMP passive sensing.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Phone Usage Patterns
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Smartphone usage patterns (e.g., screen time, app engagement) recorded via mindLAMP passive sensing.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Facial Expressivity
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Facial expressivity recorded via the EMOCARE application using automated facial action unit analysis.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Vocal Prosody
Zeitfenster: Continuous, from 2-week baseline lead-in through 3-month follow-up
Vocal prosody (e.g., pitch variability, speech rate) recorded via the EMOCARE application.
Continuous, from 2-week baseline lead-in through 3-month follow-up
Change in Speech Coherence
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Linguistic coherence features (e.g., semantic coherence) extracted from structured speech samples (Quebec Speech Bank), associated with thought disorder.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Speech Prosody
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Prosodic features (e.g., pitch, pause duration) extracted from structured speech samples (Quebec Speech Bank), associated with negative symptoms.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Structured Interview for Psychosis-Risk Syndromes (SIPS) Positive Symptom Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Sum of the 5 SIPS positive symptom severity items (P1-P5), each rated 0-6. Total scores range from 0 to 30, with higher scores indicating greater positive symptom severity.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Scale for the Assessment of Negative Symptoms (SANS) Total Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Sum of the 4 global rating items across the Affective Flattening or Blunting, Alogia, Avolition-Apathy, and Anhedonia-Asociality subscales, each rated 0-5. Total scores range from 0 to 20, with higher scores indicating greater negative symptom severity.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Scale for the Assessment of Positive Symptoms (SAPS) Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Sum of the 4 global rating items across the Hallucinations, Delusions, Bizarre Behavior, and Positive Formal Thought Disorder subscales, each rated 0-5. Total scores range from 0 to 20, with higher scores indicating greater positive symptom severity.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Positive and Negative Syndrome Scale (PANSS) Total Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Total scores range from 30 to 210, with higher scores indicating greater overall symptom severity.
Baseline to 1 week, 1 month, and 3 months post-treatment
Change in Social and Occupational Functioning Assessment Scale (SOFAS) Score
Zeitfenster: Baseline to 1 week, 1 month, and 3 months post-treatment
Scores range from 0 to 100, with higher scores indicating better functioning.
Baseline to 1 week, 1 month, and 3 months post-treatment

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Ermittler

  • Hauptermittler: David Benrimoh, McGill University, Department of Psychiatry

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Geschätzt)

1. August 2026

Primärer Abschluss (Geschätzt)

1. August 2028

Studienabschluss (Geschätzt)

1. Dezember 2029

Studienanmeldedaten

Zuerst eingereicht

19. August 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

21. August 2026

Zuerst gepostet (Tatsächlich)

26. August 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

28. August 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

27. August 2026

Zuletzt verifiziert

1. August 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • 2026-1387

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Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

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