Journal: Behavioral Sciences (2021)
Authors: Monem RG, Okusaga OO
Background:
Obesity is highly prevalent in patients with schizophrenia and, in association with metabolic syndrome, contributes to premature deaths of patients due to cardiovascular disease complications. Moreover, pharmacologic, and behavioral interventions have not stemmed the tide of obesity in schizophrenia. Therefore, novel effective interventions are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for inducing weight loss in obese non-psychiatric samples but this promising intervention has not been evaluated as a weight loss intervention in patients with schizophrenia.
Objective:
To review overlapping neurobiological mechanisms implicated in obesity and schizophrenia and evaluate the potential role of repetitive transcranial magnetic stimulation (rTMS), including deep TMS, as a weight loss intervention for patients with schizophrenia and comorbid obesity.
Methods:
In this narrative review, the authors describe three brain mechanisms (hypothalamic inflammation, dysregulated mesocorticolimbic reward system, and impaired prefrontal cortex function) implicated in the pathogenesis and pathophysiology of obesity and emphasize how the three mechanisms have also been implicated in the neurobiology of schizophrenia. They then argue that, based on the three overlapping brain mechanisms in obesity and schizophrenia, rTMS would be effective as a weight loss intervention in patients with schizophrenia and comorbid obesity. The review concludes by describing how deep TMS, relative to conventional TMS, could potentially result in larger effect size for weight loss.
Results:
The review identified three overlapping mechanisms in obesity and schizophrenia: hypothalamic inflammation, dysregulated reward circuitry, and impaired prefrontal cortex function. Based on evidence from non-psychiatric populations, the authors propose that rTMS, particularly deep TMS, may have potential as a weight loss intervention in patients with schizophrenia and obesity.
Conclusions:
While this review is mainly conceptual and based on an extrapolation of findings from non-schizophrenia samples, its aim is to stimulate research in the use of rTMS for weight loss in patients with schizophrenia.
