ImportancePsychomotor slowing is a frequent symptom of psychosis, impairing gross and fine motor behavior. It is associated with poor outcomes and functioning, and no treatment is available.ObjectiveTo investigate whether 15 sessions of inhibitory repetitive transcranial magnetic stimulation (rTMS) may reduce psychomotor slowing.Design, Setting, and ParticipantsThis was a 4-arm, double-blind, randomized, sham-controlled trial at a university hospital in Switzerland. Enrollment took place from March 2019 to August 2022. Adults aged 18 to 60 years with schizophrenia spectrum disorders and severe psychomotor slowing were eligible. All patients continued existing medications, including antipsychotics and benzodiazepines. Those with substance misuse (other than nicotine), conditions associated with impaired or aberrant movement, convulsions, history of hearing problems, other conditions typically excluded from magnetic resonance imaging or TMS, any TMS treatment in the past 3 months, or those who were pregnant or breastfeeding were excluded. Of 615 patients screened for eligibility, 103 were randomized and 88 received at least 1 session of rTMS: 22 were assigned to 1-Hz rTMS, 22 to iTBS, 22 to sham, and 22 to the waiting group. Follow-up was conducted at 6 weeks and 24 weeks following the week 3 assessments including clinical, functional, and motor measures.InterventionsFifteen sessions of rTMS in 3 weeks over the supplementary motor area: 1-Hz rTMS, iTBS, sham, or no treatment (waiting). After 3 weeks, the waiting group received 15 sessions of 1-Hz rTMS over the supplementary motor area.Main Outcomes and MeasuresThe main outcome was the proportion of responders at week 3 in the Salpêtrière Retardation Rating Scale (SRRS) defined as a 30% or greater reduction from baseline (last-observation-carried-forward). The SRRS has 15 items and a maximum total score of 60.ResultsOf the 88 participants analyzed, 45 were men and 43 were women. The mean (SD) age was 36.3 (12.4) years and the mean (SD) SRRS score was 24.0 (5.9). A total of 69 participants completed the study. At week 3, response rates differed between groups: 15 of 22 (68%) in the 1-Hz rTMS group, 8 of 22 (36%) in the iTBS group, 7 of 22 (32%) in the sham group, and 4 of 22 (18%) in the waiting group (χ23 = 12.1; P = .007). The 1-Hz rTMS group had more responders than sham (odds ratio [OR], 0.13; 95% CI, 0.02-0.65; P = .03), iTBS (OR, 0.12; 95% CI, 0.02-0.61; P = .02), and waiting (OR, 0.04; 95% CI, 0.01-0.22; P = .003). In the waiting group, 10 of 16 participants (63%) responded after receiving 15 sessions of 1-Hz rTMS. No serious adverse events occurred.Conclusions and RelevanceIn this study, inhibitory add-on rTMS safely alleviated psychomotor slowing in psychosis compared with iTBS, sham, and no treatment. The treatment was also effective with delayed onset. Future studies need to explore the neural changes associated with supplementary motor area rTMS in psychosis.Trial RegistrationClinicalTrials.gov Identifier: NCT03921450

中文翻译：

---

精神病中的精神运动减慢和抑制性重复经颅磁刺激

重要性精神运动减慢是精神病的常见症状，会损害粗大和精细的运动行为。它与不良的结果和功能有关，并且没有可用的治疗方法。目的调查 15 次抑制性重复经颅磁刺激 (rTMS) 是否可以减少精神运动减慢。设计、设置和参与者这是一个 4 臂、双盲、在瑞士一家大学医院进行的随机、假对照试验。招募时间为 2019 年 3 月至 2022 年 8 月。年龄在 18 岁至 60 岁之间、患有精神分裂症谱系障碍和严重精神运动迟缓的成年人符合资格。所有患者继续使用现有药物，包括抗精神病药物和苯二氮卓类药物。滥用物质（尼古丁除外）、与运动受损或异常相关的病症、抽搐、听力问题史、通常排除在磁共振成像或 TMS 之外的其他病症、过去 3 个月内接受过任何 TMS 治疗的人士或怀孕人士或母乳喂养被排除在外。在筛选资格的 615 名患者中，103 名被随机分配，其中 88 名接受了至少 1 次 rTMS：22 名被分配到 1-Hz rTMS，22 名被分配到 iTBS，22 名被分配到假手术组，22 名被分配到等待组。在第 3 周评估后的 6 周和 24 周进行随访，包括临床、功能和运动测量。干预措施 3 周内对辅助运动区域进行 15 次 rTMS：1-Hz rTMS、iTBS、假治疗或不治疗（等待）。3 周后，等待组在辅助运动区接受 15 次 1-Hz rTMS。 主要结果和措施 主要结果是 Salpêtrière 发育迟缓评定量表 (SRRS) 中第 3 周有反应者的比例，定义为 30% 或较基线大幅减少（最后观察结转）。SRRS 有 15 个项目，最高总分为 60 分。 结果 在分析的 88 名参与者中，45 名男性和 43 名女性。平均 (SD) 年龄为 36.3 (12.4) 岁，平均 (SD) SRRS 评分为 24.0 (5.9)。共有 69 名参与者完成了这项研究。第 3 周时，各组的反应率有所不同：1-Hz rTMS 组 22 人中有 15 人（68%），iTBS 组 22 人中有 8 人（36%），假手术组 22 人中有 7 人（32%）， 22 人中有 4 人 (18%) 在等待组 (χ23= 12.1；磷=.007)。1-Hz rTMS 组比假手术组有更多的反应者（比值比 [OR]，0.13；95% CI，0.02-0.65；磷= .03), iTBS (OR, 0.12; 95% CI, 0.02-0.61;磷= .02），然后等待（OR，0.04；95% CI，0.01-0.22；磷=.003）。在等待组中，16 名参与者中有 10 名 (63%) 在接受 15 次 1-Hz rTMS 治疗后做出了反应。没有发生严重的不良事件。结论和相关性在这项研究中，与 iTBS、假手术和不治疗相比，抑制性附加 rTMS 可以安全地缓解精神病患者的精神运动减慢。该治疗也有效，但起效延迟。未来的研究需要探索精神病中与辅助运动区 rTMS 相关的神经变化。试验注册ClinicalTrials.gov 标识符：NCT03921450