Brain stimulation to help schizophrenia patients with emotions, behaviour being tested

A fast, non-invasive form of brain stimulation to reduce persistent negative symptoms such as social withdrawal and lack of motivation in patients with schizophrenia is being tested at the Institute of Mental Health (IMH).

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A few trials overseas on the use of intermittent theta burst stimulation, or iTBS, for this purpose have had patients showing significant improvement.

The IMH study will test an accelerated form of iTBS using a changing magnetic field to modify brain activity in a specific brain location over multiple sessions, for a total of five working days.

iTBS is a form of transcranial magnetic stimulation, or TMS, which is being used to treat depression in Singapore.

So far, 22 patients out of a target pool of 40 have been enrolled in the trial in Singapore's only psychiatric hospital, where schizophrenia is the most common disorder seen. The study could be completed by July 2025.

In 2023, about 27 per cent of IMH's patients had schizophrenia. That year, it saw 55,782 patients, of whom nearly 15,000 patients with schizophrenia had an inpatient admission or made outpatient visits.

Overall, it had 27,200 patients with a diagnosis of schizophrenia as at end-2023.

The principal investigator of the IMH study, Dr Tan Xiaowei, said its aim is to work out the best iTBS treatment procedure for schizophrenia patients here who suffer from persistent negative symptoms.

Individuals with negative symptoms may avoid social interaction, show very little facial expression and hardly speak. This makes it hard for them to take care of themselves, stay organised or hold down a job, said Associate Professor Jimmy Lee, a senior consultant in IMH's department of psychosis.

These negative symptoms are often misunderstood, and individuals are mistaken as lazy and not doing their chores or finding work, he added.

A recent study by Dr Li Yanhui, a second-year psychiatry resident at IMH, and Prof Lee showed that negative symptoms affect a patient's ability to live a fulfilling life.

Hence, the person is in need of treatment, though he may vigorously resist it.

COVERT MEDICATION